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Block 2 SD3 > Dr. Kacker Block 2 Pharm > Flashcards

Dr. Kacker Block 2 Pharm Flashcards

1
Q

What do you prescribe for heart dilation and why?

A

Nitrates, to bring the heart back to normal

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2
Q

What drugs do you give for lung symptoms in a patient with heart dilatation?

A

Furosemide

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3
Q

What tx do you give if the patient is an extremist?

A

Ventilatory support and intubation

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4
Q

What drug do you give to relieve symptoms for heart dilatation?

A

Loop diuretics

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5
Q

What are the drug classes given for Dilated Cardiomyopathy HF?

A

Human B-type naturetic peptide
ARBS, ACEi, Beta blockers, Aldosterone antagonist (reduce remolding)

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6
Q

What drugs are given to decrease mortality of CHF?

A

ACEi/ARBs, Beta Blockers and Spironolactone,
Digoxin decreases symptoms but does not lower mortality

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7
Q

What drug is given in cases of dilated cardiomyopathy secondary to myocarditis?

A

Corticosteroids

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8
Q

What drug do you give if there is an emergency lowering of BP?

A

Esmolol

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9
Q

What increases after given a positive inotropy?

A

Contractility, EF, SV and CO

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9
Q

What increases after given a positive inotropy?

A

Contractility, EF, SV and CO

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10
Q

What effects does Ace Inhibitors (prils) have on CHF (dilated cardiomyopathy)?

A

Decrease afterload and preload, Decrease aldosterone, Renal protective, Reduce remodeling, control BP and proteinuria, cardio protective, anti-proliferative, anti-hypertensive

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11
Q

What two drugs will both manage Hyperkalemia?

A

ACEi (prils) and Diuretics

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12
Q

What is the patient selection with ACEi (prils) ?

A

Pt’s with Left Ventricular dysfunction and CHF systolic dysfunction All 4 classes

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13
Q

What are the main adverse effects with ACEi (prils)?

A

Cough, hypotension, hyperkalemia, and renal dysfunction. Also, swelling of the lips, tongue, edema and mushy lips

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14
Q

What are the contraindications of ACEi (prils)?

A

Renal artery stenosis (due to the reabsorption of proteins and potassium), pregnancy and previous angioedema from kinin (bradykinin). Previous history of an allergic reaction avoids using ACEi

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15
Q

What effect do ACEi (prils) have on Bradykinin and Angiotensin 2?

A

ACEi (prils) will increase bradykinin and decrease Angiotensin 2.

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16
Q

What effect does ARBs (sartans) have on Bradykinin and Angiotensin 2?

A

No effect on Bradykinin and increase Angiotensin 2

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16
Q

What effect does ARBs (sartans) have on Bradykinin and Angiotensin 2?

A

No effect on Bradykinin and increase Angiotensin 2

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17
Q

When ACEi are given, what would increase?

A

Bradykinin, Angiotensin 1, Renin, Potassium and increase of Vasoconstriction

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18
Q

When given an ARBs (sartan) what would increase?

A

Renin, Angiotensin 1 and 2

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19
Q

What is the best beta blocker to use for HF and why?

A

Carvedilol, more beneficial. Has 3 properties, beta blocker, alpha blocker, antioxidant. Works faster because the other beta blockers will decrease renin release.

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20
Q

Why use a beta blocker in patient with CHF systolic dysfunction?

A

great reduction in mortality rates by reducing remodeling and less progression, improve quality of life and antiarrhythmic

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21
Q

What role does beta blockers have on patients with CHF?

A

Anti-hypertensive, Anti Angina, Anti arrythmia, REDUCE AFTERLOAD, cardioprotective

22
Q

What role does beta blockers have on patients with CHF?

A

Anti-hypertensive, Anti Angina, Anti arrythmia, REDUCE AFTERLOAD, cardioprotective

23
Q

What are Spironolactone and Eplerenone?

A

Aldosterone Antagonist

24
Q

What are Spironolactone and Eplerenone?

A

Aldosterone Antagonist

25
Q

What are Spironolactone and Eplerenone?

A

Aldosterone Antagonist

25
Q

What are Spironolactone and Eplerenone?

A

Aldosterone Antagonist

26
Q

Why use Spironolactone?

A

Will help in patients with a EF less than 40%.
In females, it will help with acne and hirsutism

27
Q

Why use Eplerenone?

A

It is more superior than spiralnectone
In Males, there is no gynecomastia and erectile dysfunction

28
Q

Why use Digoxin?

A

It is a cardiac glycoside, will improve contractility and CO, INCREASE CALCIUM by inhibiting the Na+/K+ ATPAse

29
Q

What drug will also increase calcium?

A

Dobutamine, beta 1 agonist

30
Q

What are the side effects of Dixogin?

A

GI and vision issues, yellow and greenish hues called chromotopsia, cardiac vagal arrest (for overdose) in the long run, automaticity, delayed after depolarization of premature contractility called bigamy, ventricular fib for the long run

31
Q

What symptoms does Diuretics have on the lungs?

A

Decrease preload and improve ventricular efficiency by reducing circulating volume. Reduction of peripheral edema and pulmonary congestion

32
Q

What are the Adverse Effects with Diuretics?

A

Hypokalemia and hypomagnesemia

33
Q

What drug should not be given with Diuretics?

A

antibiotic aminoglycosides because of the auto toxicity

34
Q

What drug class are Amiodarone and Dofetilide?

A

Antiarrhythmics

35
Q

What effects does Vasodilators cause?

A

Reduce afterload and preload

36
Q

What is the MOA for Vasodilators?

A

Nitric Oxide release to activate guanylate cyclase to cGMP to cause vasodilator

37
Q

What is the clinical use of Vasodilators?

A

Treatment of pulmonary edema secondary to CHF
Heart failure in Afro-Americans patients
Patients intolerant of ACEI or ARA. As soon as you decrease afterload you will increase CO

38
Q

What are Isosorbide dinitrate and hydralazine?

A

Isosorbide dinitrate is a Venodilator
Hydralazine is an Arterial dilator

39
Q

What are the Adverse Effects of Nitrates?

A

They cause Methemoglobinemia

40
Q

What are the clinical uses of Human B type Natriuretic Peptide?

A

acutely decompensated heart failure by their vasodilatory and diuretic effects.

41
Q

What is Milrinone?

A

PDE inhibitor  cAMP increase  increase Ca++ inotropic and vasodilation Only given for acute.

42
Q

Why should you NEVER use Milrinone for chronic management of CHF?

A

strong severe reflex tachycardia and arrythmia

43
Q

What are the clinical uses for Milrinone?

A

Reserved for patients who need hemodynamic-directed treatment during ACUTE DECOMPENSATION,
For those who are refractory to maximal standard therapy,
As palliation for end-stage heart failure, or as a bridge to transplantation for appropriate candidates.

44
Q

In what patients should you restrict giving Anti coagulants/ Anti platelets (Heparin and Enoxaparin) to?

A

In atrial fibrillation
With artificial valves
With known mural thrombus

45
Q

What patients should have the left ventricular device or for cardiomyopathy surgery?

A

Patients with disease refractory to medical therapy.

46
Q

How do you treat patient with Hypertrophic Cardiomyopathy?

A

Beta blockers, verapamil (CCB) and diuretics

47
Q

What are the Adverse Effects with Hypertrophic CardiomyopathyMedication?

A

non sustained ventricular tachycardia, abnormal blood pressure

48
Q

What is the treatment for (HOCM) Hypertrophic Cardiomyopathy?

A

Metoprolol

49
Q

What is the treatment for Aortic Regurgitation?

A

hydralazine and nifedipine to reduce afterload, surgery

50
Q

What is the treatment for Mitral Stenosis?

A

Percutaneous mitral balloon valvotomy. Beta Blockers and CCB, diuretics

51
Q

What is the treatment for patients with Rheumatic Fever?

A

Penicillin G benzathine (im), Penicillin V(oral)
Statin- can significantly slows progression

52
Q

What is the treatment with Atrial Fibrillation?

A

beta-blocker or calcium channel blocker therapy.Metoprolol (Lopressor, Toprol XL), Diltiazem

Anticoagulation is indicated: Heparin, Warfarin (Coumadin)
3 weeks prior cardioversion

53
Q

What is the treatment for Mitral Regurgitation?

A

Surgery, the physician should consider cardioversion in refractory or unstable patients.

54
Q

What is the treatment of Mitral Regurgitation?

A

Nitrate, nitroprusside (vasodilator). The goal is to reduce afterload
treatment of pulmonary edema should include oxygen, diuretics(furosemide), nitrates, nitroprusside and early intubation if respiratory failure results.
Treatment of myocardial infarction : Thrombolytics.
Rapid atrial fibrillation secondary to chronic mitral regurgitation should be controlled with digoxin or diltiazem.

Block 2 SD3 (5 decks)

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