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Pharmacology > Exam #3 > Flashcards

Exam #3 Flashcards

1
Q

What blood does the left and right side of the heart receive?

A
  • Right: receives deoxygenated blood
  • Left: receives oxygenated blood
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2
Q

What is Starlings Law?

A

the more the muscle is stretched (heart), the stronger it will react until it is stretched to the point at which it will not react at all

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3
Q

What happens during systole and diastole?

A

Systole: contraction
Diastole: relaxation

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4
Q

What is the SA node?

A

Pacemake of the heart
generates an electrical signal that starts the heartbeat

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5
Q

What is the AV node?

A

delays until atria are empty of blood

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6
Q

What are the phases of an action potential?

A

Phase 0: rapid depolarization
Phase 1: brief repolarization
Phase 2: plateu
Phase 3: repolarization
Phase 4: resting state

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7
Q

What does the Autonomic nervous system do?

A

influences:
- heart rate
- rhythm
- strength on contraction

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8
Q

What does the Sympathetic nervous system do?

A

causes:
- heart beat faster
- speeds conduction through AV node
- Causes harder contraction

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9
Q

ECG Waveform?

A

P Wave: electrical depolarization of the atria
QRS Complex: represents the depolarization of the hearts ventricles
T Wave: repolarization of the hearts ventricles

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10
Q

What are the different Arrhythmias?

A

Arrhythmia: disturbance in electrical activity
Sinus Arrhythmias
Supraventricular Arrhythmias: Atrial fibrillation
– A Fib= blood clot
Atrioventricular block
Ventricular Arrhythmias

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11
Q

What is the path blood travels through the heart?

A
  • dexygenated blood enters through superior and inferior vena cava
  • right atrium
  • tricuspid valve
  • right ventricle
  • pulmonary valve
  • Pulmonary artery
  • Spits right and left pulmonary artery
  • lungs
  • returns through pulmonary veins
  • left atrium
  • mitral valve
  • left ventricle
  • aorta
  • body
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12
Q

What are the Forces Impacting Oxygen Consumption?

A

Heart Rate: faster heart rate = more oxygen needed
Preload: filling and stretching (diastole) increase blood return to the heart = causes heart to work harder ex. CHF
After Load: pressure to pump against (systole) more resistance= heart must contract harder ex. Hypertension

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13
Q

What are Natriuretic Peptides?

A

hormones that help regulate blood pressure and blood volume

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14
Q

How does the Renin-Angiotensin-Aldosterone-System work?

A

Process body uses to filter Kidneys
- blood pressure drops causing a release of renin into the blood stream
- renin splits angiotensinogen into angiotension 1
- ACE splits angiotension 1 into angiotension 2
- Angiotension 2 constricts small arteries and triggers the release of aldosterone and vasopressin

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15
Q

What are characteristics of left sided Heart Failure?

A

Pulmonary Edema
- respiratory issues
- fluid in lungs

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16
Q

What are characteristics of Right sided Heart Failure?

A

Peripheral Abdominal + Liver Edema
- edema
- swelling

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17
Q

How does the flow of blood move?

A

High to low pressure due to gravity
- Area of high pressure is always Left Ventricle
- Area of lowest pressure is always Right Atrium

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18
Q

How do you find stroke volume?

A

Systole - Diastole = stroke volume

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19
Q

What is Hypertension?

A

Elevated B/P for a sustained period of time

Cause:
- organ damage
- increased risk of stroke, HD, kidney damage (main organ affected)

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20
Q

What is Hypotension?

A

B/P is too low

Cause:
- Heart Attack

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21
Q

What are the Step Wise Management of Hypertension?

A

-Step 1: Lifestyle modifications
-Step 2: Drug therapy added
-Step 3: Change in drug dose or class or addition of another drug
-Step 4: Second or third agent of diuretic is added

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22
Q

ACE Inhibitor
Pril

A

captopril
- constricts blood vessels; lowering B/P
CAPTOPRIL
Cough
Angioedema
Pregnancy
Taste changes
Other (rash, fatigue)
Proteinuria
Renal insufficiency
Increased potassium
Low B/P

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23
Q

Angiotensin II receptor blocker (ARBS)
Sartan

A

losartan
- blocks angiotensin II -> blood vessels constrict -> lowering B/P
LOSARTAN
Low B/P
Other (fatigue, headache)
Swelliing
Allergic reaction
Raised potassium
Teratogenic
Acute kidney injury
Nasal congestion

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24
Q

Renin Inhibitor

A

Aliskiren
- stops cascade that leads to blood vessels tightening -> relaxing effect on circulatory system
do not take with potassium

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25
Calcium Channel Blockers
**amlodipine, nifedipine, verapamil** - slows heart rate by blocking calcium channels in the heart **no grapefruit** **SHRED** **S**lower heart rate **H**ypotension + headache **R**eflex tachycardia **E**dema **D**izziness
26
Vasodilators
**hydralazine, nitroglycerin** - open up blood vessels to improve circulation **emergency drug not for matinence**
27
Diuretics
**Hydrochlorothiazide** - less fluid = less pressure to pump -> lower B/P - increases flow of urine **HyperGLUC** **G** hyperGlycemia **L** hyperLipidemia **U** hyperUricemia **C** hyperCalcemia
28
postassium sparing diuretics
**Spironolactone** Avoid food high in potassium: - avocados - dried fruit - prunes - sunflower seeds - grapefruit - tomatoes - broccoli - lima beans - cantaloupe - spinach
29
Beta-blockers **olol**
**atenolol** - blocks adrenaline (epinephrine) -> heart beats slower and w less force **Bad Fish** **B**radycardria/ bronchospasms **A**v block/ arryhthmias **D**izziness/ depression **F**atigue **I**mpotence **S**igns of hypoglycemia masked **H**ypotension
30
nonselective Alpha and Beta Blockers
**Carvedilol** - dampens activity of CNS --low heart rate, B/P, activity
31
Alpha 1-blockers **osin**
**doxazosin, prazosin** - decreases vascular tone and vasodilation -> fall in B/P
32
Alpha 2-blockers
**clonidine, guanfacine** - opens up blood vessels to improve circulation
33
Heart Failure occurs when?
the heart cant pump enough blood to the body
34
What are the four stages of heart disease?
**Stage A**: high risk for heart failure but no structural heart disease symptoms **Stage B**: structural heart disease but no signs or symptoms **Stage C**: structural heart disease with prior or current symptoms **Stage D**: Refractory heart failure requiring specialized interventions
35
What are the classifications of heart failure?
**Class 1**: no limitations of physical activity **Class 2**: slight limitation of physical activity **Class 3**: marked limitation of physical activity **Class 4**: unable to perform any physical activity w/o symptoms at rest
36
What are the Signs and Symptoms of Heart Failure?
- **SOB; especially at night** - **Chest pain** - **Fatigue** - **Swelling in ankles, legs, abdomen** - **Weight Gain**; due to accumulation of fluid - **Coughing up white, pink, foamy mucus**
37
Cardiac Glycosides
**digoxin** - increased force of myocardial contraction increasing cardiac output **Lots of Contraindications**
38
Phosphodiesterase Inhibitors
**Milrinone** - increases calcium level in the cell -> stronger contraction and prolonging effects of sympathetic stimulation **IV use ONLY**
39
Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blockers
**ivabradine** - blocks HCNs -> slows the sinus node in repolarizing phase of the action potential
40
Unmodifiable factors of Atherosclerotic Cardiovascular Disease
- age - sex - gender - genetic disposition
41
Modifiable factors of Atherosclerotic Cardiovascular Disease
- smoking - sedentary lifestyle - unhealthy diet - high stress - obesity - diabetes
42
What are Very-low-density Lipoproteins? **VLDL**
**"bad cholesterol"** high levels= - clogged arteries and heart disease
43
What are Intermediate-density Lipoproteins? **IDL**
**"remnant" of VLDL** - taken up by liver or processed into LDL
44
What are Low-density Lipoproteins? **LDL**
**"bad cholesterol"** - carries cholesterol throughout the body causing plaque build up
45
What are High-density Lipoproteins? **HDL**
**"good cholesterol"** high levels= - low risk for heart disease and stroke carries cholesterol to liver to get removed
46
What is Hyperlipidemia?
high levels of lipids in the blood caused by: - poor diet - genetic predisposition - can be treated w diet modification
47
HMC-CoA Reductase Inhibitors **Statin**
**Atorvastatin** - decreases LDL ad slightly increases HDL *may have protective CV effects on blood vessels *Rhabdomyolysis
48
Cholesterol Absorption Inhibitor
**Ezetimibe** - decreases absorption of dietary cholesterol * can cause hepatitis but its rare
49
Fibrates
**Gemfibrozil** - increases plasma HDL levels by stimulation their synthesis
50
Vitamin B3
**Niacin** - reduces LDL and triglyceride levels and increases HDL levels
51
Omega 3 Fatty Acid
- reduce the risk of CVD, death from CVD, sudden cardiac death, and blood clots
52
What is needed to maintain electrical activity in the heart?
sodium and potassium
53
What are the Phases of Action Potential?
- **Phase 0**: Na+ channel opens up quickly -> rapid positive increase Na+ ions -> rise in membrane potential - **Phase 1**: some K+ channels open -> small initial repolarization as Na+ channels close - **Phase 2**: Ca+ channels open -> Ca+ ions flow into cell -> balancing outward K+ -> depolarized state - **Phase 3**: most Ca+ channels close -> K+ channels stay open -> outward movement of K+ returns to resting potential - **Phase 4**: membrane potential is stable at a negative value w sodium potassium pump maintaining the ion balance
54
What is seen w high or low potassium?
Arrhythmias
55
What is seen with high or low sodium?
seizures
56
what is Automaticity?
the cells of the heart will make itself work even without he brain
57
What are factors of Arrhythmias?
- Electrolyte disturbances - Decreased oxygen delivery to cells= heart attack - Structural damage that changes conduction pathway = blockages - Acidosis or waste product accumulation = kidney issue pts. - Drugs that alter the action potential or cardiac conduction = drug induced
58
Class I Antiarrhythmics
*used locally - Class 1a: procainamide - Class 1b: lidocaine - Class 1c: Flecainide
59
Class I Antiarrhythmics
**procainamide, lidocaine, flecainide** - stops electrical signal needed for nerve impulse transmission *interacts w warfarin and foods that alkaline w urine (citrus, vegetables, grapefruit)
60
Class II Antiarrhythmics (Beta Blockers)
**Propranolol** - blocks beta-receptor sites in the heart and kidneys *slows everything down *theophylline and caffeine decreases exercise tolerance
61
Class III Antiarrhythmics
**Amiodarone** - blocks potassium channels * prolongs phase 3 of action potential
62
Class IV Antiarrhythmics (calcium channel blockers)
**Diltiazem, nifedipine**
63
What is Angina?
- chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen rich blood *narrowed or blocked arteries
64
What is Stable, Unstable, Prinzmetal angina?
- **Stable**: no damage to heart muscle - **Unstable**: episodes of ischemia even at rest - **Prinzmetal angina**: appears to be caused by spasm of the blood vessels not just by vessels narrowing
65
Antianginal Medications
**nitroglycerin** - smooth muscle relaxation and depress muscle tone - relax and dialate veins, arteries and capillaries - seems to be related to drop in blood pressure *given in multiple doses due to it leaving the system so quickly
66
What is homeostasis?
protective measures to prevent excess blood loss
67
What are the 3 Coagulation Pathways?
- Intrinsic pathway - Extrinsic pathway - Common clotting pathway
68
What are the Blood Coagulation Disorders?
- Thromboembolic Disorders (sickle cell): formation of thrombi resulting in decreased blood flow - Hemorrhagic Disorders: excessive bleeding (less common than thromboembolic disorders)
69
Antiplatelet Agents
**Clopidogrel, Ticagrelor** - doesn't allow blood to stick together
70
Anticoagulants
**Enoxaparin, Heparin, Warfarin** - makes blood more thin *heparin is safer than warfarin for pregnancy - HIT= Heparin Induced Thrombocytopenia
71
What should you monitor for Anticoagulant Monitoring?
**Warfarin** - Prothrombin Time: PT= 11-13.5 seconds - International Normalized Ration: INR= 2.0-3.0 *reversal agent Vitamin K **Heparin** - Activated partial Thromboplastin Time: aPTT= 60-80 seconds *reversal agent protamin sulfate
72
Thrombolytic Agents
**Alteplase** - activates natural anticlotting system
73
What makes up plasma?
- mostly water - proteins that are essential for immune response and clotting
74
What are the Formed Elements of Blood?
- Leukocytes (WBCs) - Erythrocytes (RBCs) - Platelets
75
What are the Steps of Erythropoiesis (process of producing RBCs in the bone marrow)
- Hematopoietic stem cell matures into erythroblast - Erythroblast become a reticulocyte, an immature RBC - Reticulocyte loses its organelles and develops into a mature RBC
76
What is required to produce RBCs?
- Adequate iron - Minute amounts of vitamin B12 and Folic Acid - Essential amino acids and carbohydrates
77
What are the Different types of Anemia?
**Iron deficiency anemia** - Negative iron balance **Megaloblastic anemia** - Folic acid/ vitamin B12 anemia - Perricious anemia **Hemolytic anemia** - sickle cell disease - Thalassemia
78
Erythropoiesis-stimulating agents
**Epoetin alfa** - stimulates production of RBC in bone marrow
79
Agents for Iron Deficiency
**Ferrous sulfate, Iron sucrose** - Elevates serum iron concentration
80
Agents for Megaloblastic Anemia
**Folic Acid Anemia** folic acid, Vitamin B12 - essential for cell growth and division

Pharmacology (7 decks)

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