Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced pharmacology > HF, CAD, Angina Antiarrythmics > Flashcards

HF, CAD, Angina Antiarrythmics Flashcards

1
Q

Angina pectoris and goal of frug therapy

A

Sudden pain beneath the sternum, when oxygen supply to the heart is insufficient to meet oxygen demand

Goals:

  1. Prevent MI and death
  2. Prevent myocardial ischemia and angina pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Three families of antianginal agents

A

Organic nitrates
Beta blockers
CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Oxygen demand is based on these three things

A

Heart rate , MI contractility , intramyocardial wall tension ( preload/ afterload)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Oxygen supply needs 2 things

A

Myocardial blood flow

Myocardial perfusion only in diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chronic stable angina

A

Tx: increase oxygen supply and demand

By :
Organic nitrates, BB, CCB
Education: always avoid risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Variant Angina

A

Coronary artery spasm
Want to reduce incidence and severity

TX: increase cardiac oxygen supply

With : CCB, nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Organic nitrate: Nitroglycerin

Isosrbide mononitrate and isosorbide dinitrate

A

Vasodilator vascular smooth muscle and decreases o2 demand

Adverse : HA, orthostatic hypotension, reflex tachycardia

Contraindications: Viagra, Cialis

Tolerance : drug holidays

Wean and taper

Uses: rapid onset used for acute prophlyaxis and ongoing angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Beta blocker

A

Decrease cardiac oxygen demand

Propanolol and metoprolol

Adverse: bradycardia, asthmatic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Calcium channel blockers

A

Block calcium channels in vascular smooth muscle

Reduces after-load and cardiac demand

Used for stable and variant angina

Adverse: hypotension, HF, AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ranolazine ( ranexa)

A

Antianginal agent and anti-ischemic

Adverse: tornadoes due to QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prevention of MI

A

For pt with chronic stable angina:

  • anti-platelet drugs:
    • ASA 81
    • Plavix 75
  • cholesterol drug
  • ACE for people with CAD and DM

If nitro not working

  • add beta blocker
  • add CCB
  • refer to cards
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Systolic HF signs

A

Left sided HF
Right sided HF
Heptoslpenomegly ( palpate spleen and liver)

JVD, peripheral edema
Impaired EF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diastolic HF

A

HF with preserved LV ejection fraction

Pulmonary congestion
JVD, peripheral edema

Increased left atria pressure leas to a fib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Heart failure definition

A

Progressive, fatal
Characterized by left ventricular dysfunction, right sided engorgement, reduced cardiac output , insufficient tissue perfusion , signs of fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment goals for HF

A

To relieve symptoms , reduce morbidity and mortality , improve QOL, decrease preload and afterload

Improve contractility and decrease HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Drugs for HR ( overview)

A

Diuretics , RAAS inhibitors, beta blockers, digoxin, dopamine, hydralazine

17
Q

Thiazide diuretics

A

Produce mild to moderate diureses with early state HF

Decreases preload / after load
Decreases pulmonary and peripheral edema

Precaution : ineffective in pt with low GFR

Adverse: hypokalemia

18
Q

High ceiling loop diuretics

A

Drug of choice in pts with moderate to severe HF

Lasix, bumex, demaex

Adverse: hypokalemia, dig toxicity , ototoxicity, hyperglycemia

19
Q

Potassium sparing diuretics

A

Aldosterone blocker and diuretic that works on distal tubule

Used to counteract K loss

Use cautiously in pt prescribed ACE inhibitors and ARB’s = hyperkalemia

20
Q

Drugs that inhibit the RAAS

A

ACE, ARBS, beta blocker , hypertensive drugs, aldosterone inhibitors

21
Q

ACE inhibitor

A

Angiotensin - converting enzyme

  • dilation of venous and arteriolar

Adverse: hyperkalemia, cough, angioedema

Do not give in pregnant women

Give ARB if cough is not tolerable

22
Q

ARB’s

A

ARB’s improve LV ejection fraction, reduce HF symptoms, increase excerise tolerance, decrease hospitalizations, enhance QOL

ARBS do not increase levels of Kinins like ACE do

Drugs that end in SARTAN

Drugs approved form HF :

Atacand, Diovan, Cozaar

23
Q

Aldosterone antagonist

A

Spironolactone

Added it in standard HF therapy in patients with moderately severe symptoms

24
Q

Beta blockers

A

Protects from excessive sympathetic stimulation
Slows progression of HF
Improves LF function

Protect against dysrhythmias

Adverse: fluid retention, fatigue, bradycardia

Meds: Corey, Toprol XR, Zebeta

25
Q

Cardiac Glycoside : Digoxin

A

Does not prolong life and no longer 1 st line

Only improves cardiac output

Adverse : cardiac dysrhythmias , hypokalemia

Caution in elderly

Takes 6 days for the drug level to reach plateau

Under 2 ng/ml = therapeutic

26
Q

Digoxin toxicity

A

Long half and narrow therapuetuc window makes it high risk for toxicity

Signs: yellow/green halo , confusion bradycardia,

27
Q

Management of heart failure :

Stage A,

A

A = reducing risk factors

28
Q

Management for HF : stage B

A

B = goal to prevent symptomatic HR add ACE or ARB

29
Q

Management for HF stage C

A
  1. Relieve pulmonary and peripheral congestive symptoms
  2. Improve function capacity and QOL
  3. Slow cardiac remodeling and progression of LV dysfunction
  4. Prolong life

Use drugs
Avoid : CCB, NSAIDS, ASA, antidysrhytmic drugs

30
Q

Management of HF stage D

A

Marked symtoms of HF
Repeated hospitalization

Best solution : heart transplant

Management : control fluid retention,

Don’t use beta blacker = high risk of worsening HF

31
Q

Antidysrhythmic Drug overall thoughts

A

All have potential for serious adverse effects

Virtual all drug that treat dysrhythmias can also cause dysrhythmias

Most uses in primary care have other indication

Consult cardiology on these drugs

32
Q

Geriatrics and antiarythmics

A

With age comes decrease conduction fibers which predisposes them to benign arrhythmias

Treatment brings more ADR

Amiodarone and dig have decreased clearance and increased half life

Monitor CrCL and hepatic FX

33
Q

Pediatrics in antiarytmics

A

Congenital heart defects put those patients at higher risk to develop arrhythmias , HF, and heart valve infection

No long term studies effectiveness of any of the drugs

34
Q

Pregnant and lactation for AA

A

Drugs are excreted in breast mike

Dronedarone - CAT X

Most cat C

35
Q

Key points to anticoagulants

A

Anticoagulants affect various stages in the clotting cascade whereas anti-platelet affects components in platelet aggregation

Monitoring parameters on heparin and warfarin

Advanced pharmacology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions