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Module 5: Mali: Cardio > CV1-Pharm > Flashcards

CV1-Pharm Flashcards

1
Q

what is the pathophysiology of ischemic heart disease?

A

imbalance between cardiac oxygen needs and supply

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2
Q

what are the two branches of ischemic heart disease?

A
  • chronic stable angina

- acute coronary syndrome

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3
Q

what are the three types of acute coronary syndrome?

A
  • unstable angina
  • non ST segment elevation MI
  • ST segment elevation MI
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4
Q

what are are the reasons someone can have angina which is a type of ischemic heart disease?

A
  1. athrosclerosis
  2. atheroscleorosis and vasospasm
  3. vasospasm alone
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5
Q

what are the characteristics of stable angina? what is an example of this?

A

CHRONIC

stable pattern with known inducers

Ex: stable athrosclerosis >70% narrowing

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6
Q

what are the characteristics of unstable angina which is a type of ischemic heart disease? what is the example?

A

increase in frequency, severity, duration

Ex: plaque rupture with platelet and fibrin thrombus

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7
Q

what is acute coronary syndrome caused by? and what type of ischemic heart disease is this?

what are four things that can increase the chances of this?

A

UNSTABLE ANGINA, STEMI, NSTEMI

  1. athroschlerosis plaque rupture with subsequent thrombrus +/- increased oxygen demand
  2. tobaccing smoking, coccaine, hyperventilation, cold temps
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8
Q

what is the acute drug class that can be used to treat chronic stable angina?

what drug falls under this?

A

nitrates

  1. isosorbide dinitrate
  2. nitroglycerin
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9
Q

what are the long term therapy drug classes that are used to treat chronic stable angina? (5)

A
  1. nitroglyerin: isosorbide dinitrate
  2. beta blockers
  3. calcium channel blockers
  4. sodium channel inhibitor
  5. ASA/clopidigrel
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10
Q

what are the two adjunct therapies that are used to treat chronic stable angina? (2)

A

ACE inhibitors/ARBs

HMG-CoA reductase inhibitors (statins)

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11
Q

what are the two drug classes that are included as vasodilators?

A
  1. nitrates

2. calcium channel blockers

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12
Q

what are the two drugs under nitrates drug class?

A
  1. isosorbide dinitrate

2. nitroglycerin

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13
Q

what are the two subcategories and four total drugs that are under the calcium channel blocker drug class?

A

Dihyrdropyridine (DCCBs)

 - amlodipine
 - nefedipine

Nondihydropyridine (NDCCBs)

- diltiazem
- verapamil
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14
Q

what is the drug class that is a sympatholytic?

A

beta blockers

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15
Q

what are the two non selective beta blocker drugs?

A
  1. propanolol (B1 +B2)

2. carvedilol (B1 + B2 + a1)

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16
Q

what are the two selective beta blocker drugs?

A
  1. metoprolol

2. atenolol

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17
Q

what is a miscellaneous drug that is used for chronic angina?

A

ranolazine

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18
Q

what is heart failure?

A

a clinical syndrome arising from numerous etiologies (HTN, CAD, Cardiomyopathy)

inability of the heart to pump enough blood to meet the metabolic demands of the body

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19
Q

what are the four goals of the therapy for heart failure treatment?

A
  1. improve cardiac function
  2. reduce the clinical symptoms
  3. reduce hospitalizations
  4. reduce the risk of death
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20
Q

what are 7 symptoms of clinical heart failure?

A
  1. fatigue/weakness/exercise intolerance
  2. polyuria
  3. nocturia
  4. JVD
  5. dyspnea, orthopnea, PND
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21
Q

what are the three loop direutics?

A
  • furosemide
  • torsemide
  • ethycrinic acid
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22
Q

what are the two anti-aldosterone agents?

A
  1. spironolactone

2. eplenerone

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23
Q

what are the 3 ACE-I drugs?

A

captopril
lisinopril
fosinopril

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24
Q

what are the three vasodilating classes?

A

nitrates
calcium channel blockers
hydralazine (direct acting vasodilator)

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25
Q

what is the inotropic cardiac glycoside agent?

A

digoxin

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26
Q

what is a miscellaneous recombinant BNP drug?

A

nisiritide

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27
Q

what is the direct renin inhibitor drug?

A

aliskiren

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28
Q

what is a miscellaneous drug that is totally random that you wanna know?

A

invabradine

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29
Q

what is your fast friend for heart failure?

A

diuretics

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30
Q

what do diuretics do?

A

improve fluid overload rapidly

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31
Q

what must you watch for when giving a patient diuretics?

A

electrolyte imbalance

general dehydration

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32
Q

for congestive heart failure, it is good to start direutics while other therapies are being started?

A

ABSOLUTELY

get some of that fluid off!!

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33
Q

when is furosemide most commonly used? (this is lasix)

A

both inpatient and out patient settings

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34
Q

are the oral and IV dosing of torsemide equivalent?

A

yes they are!! they are the same

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35
Q

what is the chemistry of ethacrynic acid?

A

non-sulfa chemistry

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36
Q

what is the MOA of diuretics?

A

block the reabsorption of Na, K, and Cl ions glomular filtrate

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37
Q

why are diuretics effective in heart failure?

A

decrease preload, increase renal blood flow, and promote sodium excretion

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38
Q

what are 3 potential side effects of loop diuretics?

A
  1. electrolyte imbalance
  2. orthostatic hypertension
  3. dehydration
39
Q

which diuretic carries the highest risk of kypokalemia and dehydration?

A

furosemide!!!!

40
Q

what are most diuretics made of?

what do you need to watch patients closely for?

A

most are sulfa based so patients might be hesitant if they have a sulfa allergy, there is NO evidence of this however

YOU DO NEED TO WATCH CLOSELY FOR DECREASED PROFUSION…since you are decreasing the volume of fluid

41
Q

what do you need to watch closely when a patient is taking diuretics because of the decreased volume of fluid?

A

watch for decreased profusion

42
Q

what are 3 things you want to monitor when a patient is taking a diuretic?

A
  1. electrolyte levels
  2. BUN/creatine
  3. MONITOR DAILY BODY WEIGHT AS MEASURE OF EFFECTIVENESS OF TX
43
Q

when do MOST reactive electrolyte imbalance and renal functions changes changes STABALIZE in a pt taking a diuretic?

A

MOST within 2-3 weeks….but you gotta keep monitoring them at follow up visists

44
Q

what are the three classes of beta blockers?

A
  1. nonselective B1 and B2 beta blockers
  2. selective B1 blocker
  3. nonselective B1, B2, alpha1 blocker
45
Q

what is the nonselective B1 and B2 beta blocker?

A

propranolol

46
Q

what are the 3 SELECTIVE B1 beta blockers?

A
  1. metropolol tartrate
  2. metroprolol succinate (XL)
  3. atenolol
47
Q

what is the non selective B1, B2, Alpha1 blocker?

A

carvedilol

48
Q

what are the three things that antagonists of B-adrenergic receptors do? AKA beta blockers

A
  1. decrease HR
  2. decrease stroke volume
  3. decrease TPR via decreasing renin and angiotension II
49
Q

how do beta blockers decrease TPR?

A

by decreasing renin and angiotensin II

50
Q

what is the current thought of why beta blockers are used in heart failure?

A

poorly understood mechanism but WELL DOCUMENTED IT DOES HAVE AN EFFECT!!

possible from blockade of excessive sympathetic influences (aka it stops the heart from becoming overly stimulated)

51
Q

what do you want to monitor on the patient when taking a beta blocker?

A

THEIR HR!!!

52
Q

what are the 4 contraindications to beta blockers in HF?

A
  1. bradycardia
  2. heart block
  3. uncompensated HF
  4. severe depression
53
Q

what additional substance does carvedilol have that increases the changes that hypotension could occur?

A

it blocks NOREPINEPHRINE so has additive effect in lowering BP

theoretically this decreases the negative side effects seen with the beta blocker class

54
Q

carvedilol reduces….

do you start at a high or low dose? what do you need to monitor for?

A

BP and periphrieal vascular resistance

start at very low does 3.125 mg BID initital….monitor for weight gain!!

55
Q

what might a patient note about their symptoms when taking carvedilol?

A

symptoms may increase for 4-10 days before any improvement is noted

56
Q

what are four side effects of carvedilol?

A

dizziness, drowsiness, diarrhea, fatigue

57
Q

What population of people should ALWAYS be put on a ACE inhibitor?? why??

A

ALL PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION

it improves symptoms and survival in patients with HF

58
Q

what is the site of action for ACE inhibitors?

A

kidneys in the renin-angiotension system

59
Q

what is the MOA of ACE inhibitors?

what are 3 things that it lowers?

A

inhibits the conversion of antiotensin I to angiotensin II

lowers:

  1. arteriolar resistance
  2. increases venous capacity
  3. cardiac output and volume
60
Q

Explain the 5 functions of a ACE inhibitor in HF?

A
  1. reduced the afterload
  2. reduces preload
  3. decreases sympathetic activation
  4. improves O2 supply
  5. prevents angiotensin from triggering cardiac remodeling
61
Q

how do you reduce afterload?

A

enhance stroke volume and EF

62
Q

how often should you increase the dose of ACE inhibitors?

A

every two weeks?

63
Q

what are the target dosing for the two ACE inhibitor?

captopril
linsinopril

A

captopril- 50 mg TID
linsinopril-40 mg daily

start these drugs low and gradually increase them every two weeks to the target levels

64
Q

what do you want to monitor for TWO labs in patients taking ACE inhibitors?

A

potassium and creatinine, within 1-2 weeks after starting treatment and continue to monitor but less frequently

weekly-> monthly->yearly

65
Q

what are three things that make using ACE inhibitors contraindicated?

A
  1. renal artery stenosis
  2. hypersensitvitiy
  3. pregnancy!!
66
Q

the angiotensin 2 receptor blocker LOSARTAN acts on what site?

A

smooth muscle cells of the blood vessels cause dilation

67
Q

what is the MOA of LOSARTAN (angiotensin receptor blocker)?

A

Selectively and competitively blocks AT1 and AT2 receptors

68
Q

who do you use angiotensin receptor blocker LOSARTAN in?

A

patients who can’t tolerate ACE inhibitors because they basically have the same efficacy!!!

BUT DON’T USE THEM TOGETHER!!! DUH.

69
Q

what are the adverse effects of angiotensin 2 receptor blocker LOSARTAN ? (3)

A

muscle cramps
increased K+
impotence

70
Q

what four populations of people do you not want to sue angiotensin 2 receptor blocker LOSARTAN in?

A

pregnant
severe renal disease
liver disease
pts with elevated k

71
Q

of the calcium channel blockers, which ones do you WANT to use in CF patients? which ones do you NOT use?

A

USE: DIHYDROPYRIDINES (DCCBS) aka AMLODIPINE, these have little to no effect on cardiac contractability

DO NOT USE…..nondihydropyridines (NCCBS) because they have cardiac impact which is negative!!!

72
Q

which calcium channel blockers do you want to use in a patient with CF?

A

DCCBS…..

they “D” stands for “duh”, use this ;)

73
Q

what is the site of action for dihydropridines aka amlodipine?

A

vascular smooth muscle

74
Q

what is the MOA of dihydropridines aka amlodipine?

A

blocks Ca channel and prevents contraction resulting in vascular relaxation and decreased TPR, vasodilation of coronary arteries

75
Q

what are the severe portenital side effects seen with calcium channel blockers??

(includes diltiazem, verpampil, amlodipine)

A
  1. INCREASED MORTALITY IN POST MI PT
  2. INCREASED DOSES INCREASE RISK OF ACUTE MI

**these assume that the med is given in a high dose, but must be cautious of this and selective in regards to using this in HF patients

76
Q

what population of people are hydralazine reccomended for who are not optimized using other therapy?

A

african american people

can use as adjunct therapy or replacement therapy nonblack populations if tolerant to ACE, ARB, and diuretic

77
Q

what effect can hydralizine cause?

A

a reflex sympathetic (stimulating) of the heart….so actually can cause it to get worked up and work harder

78
Q

what is a interesting autoimmune disorder that can be caused by using hydralazine?

A

SLE!!!!!

so you need to check the ANA of the patient before using it!!!

79
Q

what is the DOC for treatment of hypertension in an EMERGENCY of a pregnant woman usually due to preeclampsia or preexisting HTN?

A

hydralazine!!!

80
Q

what is the drug class for digoxin?

A

positive inotropic agents: cardiac glycosides

81
Q

what signs would you see on a EKG with someone who is taking glycosides like digoxin? (5)

A
  1. prolonged P-R interval
  2. inverted T wave
  3. S-T segment depression
  4. shortened Q-T interval
  5. PVCs
82
Q

what levels do you want to maintain Digoxin between?

A

.5 and .8 ng/mL

83
Q

what should the initial dose of digoxin be?

A

.125-.25

84
Q

what are four negative side effects of digoxin?

A
  1. visual disturbances
  2. AV block
  3. EKG changes
  4. toxic psychosis
85
Q

what plants can you find glycosides in? (4)

A

milkweed
lilly of the valley
foxglove
oleander

natural plant analogs of glycosides have been used for over 300 years!

86
Q

what is the drug class for dobutamine?

A

positive inotropic agents: B-agonists

87
Q

what does dobutamine play a role in?

A

in HF patients who are awaiting a heart transplant because it can improve their quality of life

88
Q

what is the drug class for milrinone?

A

phosphodiesterase inhibitor

89
Q

what is the MOA of milirinone?

A

increase cAMP in heart and vascular muscle positive inotrope and vasodilator

90
Q

what is the drug class for tekturna?

A

aliskiren

91
Q

what is the MOA of tekturna?

A

inhibits reninin, therefor lowering BP

DONT USE IN PTS WITH RENAL DISEASE OR DIABETES!!!!

92
Q

who is ivabradine indicated for?

A

HF patients with EF 70

93
Q

what is the MOA of ivabradine?

A

selective and specific inhibition of If within SA node & prolonging diastolic depolarization and reducing HR

Module 5: Mali: Cardio (4 decks)

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