Lecture 4 Flashcards
1
Q
Diuretics
A
- increase the formation and excretion of urine
- decreases the volume of fluid in the vascular system
- act directly on the kidney to decrease plasma fluid volume
- direct effect on blood pressure
- inexpensive and work in a large portion of patients
2
Q
Side effects of Diurectics
A
- Fluid depletion and electrolyte imbalance
- excessive fatigue and weakness
3
Q
3 classifications of diuretics
A
- Thiazide
- Loop
- Potassium- sparing
4
Q
Sympatholytic drugs - Beta blockers
A
- Decrease heart rate and myocardial contraction force
- Slow down the heart and reduces cardiac output
- Maintain appropriate supply and demand of oxygen * Agina
- *olol endings
- Often complement other antihypertensives
5
Q
Side effects of Beta Blockers
A
- non-selective beta-blockers may produce bronchoconstriction in asthma or similar conditions, excessive heart rate/contractility reduction, may impair glucose/lipid metabolism
6
Q
Sympatholytic drugs - Alpha blockers
A
- Decrease in vascular resistance
- improve blood lipid profiles
- *osin endings
7
Q
Side effects of Alpha Blockers
A
- Hypotension
- Dizziness
- Reflex tachycardia
8
Q
Sympatholytic drugs: Presynaptic adrenergic inhibitors
A
- inhibit the release of norepinephrine from presynaptic terminals of peripheral adrenergic neurons
- decreases sympathetic - mediated excitation of the heart and peripheral vasculature
- not as well tolerated as other medications
9
Q
Side effects of Presynaptic adrenergic inhibitors
A
- bradycardia
- arrhythmias
- drowsiness
- depression
- GI disturbances
10
Q
Sympatholytic drugs: Centrally acting agents
A
- inhibit sympathetic discharge from the brainstem
- decrease in cardiovascular stimulation and blood pressure
- limit sympathetic activity at the source rather than the periphery
11
Q
Side effects of Centrally acting agents
A
- dry mouth
- dizziness
- sedation
12
Q
Sympatholytic drugs: Ganglionic blockers
A
- Block synaptic transmission at autonomic ganglia
- Decreases systemic sympathetic activity
- used in emergency situations, not as well tolerated
13
Q
Side effects of Ganglionic blockers
A
- GI disturbances
- Urinary retention
- visual disturbances
- orthostatic hypotension
14
Q
Vasodilators
A
- vasodilate the peripheral vasculature, decreasing peripheral vascular resistance
- inhibitory effect on vascular smooth muscle cells
- Emergency situations
- Nitric oxide, hydralazine
15
Q
Side effects of Vasodilators
A
- hypotension / orthostatic hypotension
- dizziness
- reflex tachycardia
- weakness
- nausea
- fluid retention
- headache
16
Q
Drugs that inhibit renin-angiotensin system
A
- regulate vascular tone as well as sodium, and water balance in the body
- inhibition of ACE inhibitors
- Lower incidence of cardiovascular side effects, lower vascular hypertrophy, lower morbidity and mortality associated with congestive heart failure
- Pril endings
17
Q
Side effects of drugs that inhibit renin-angiotensin system
A
- skin rash
- dry cough
- GI discomfort
- dizziness
- reflex tachycardia
- hypotension
18
Q
Calcium channel blockers
A
- Selectively block calcium entry into vascular smooth muscle
- Calcium partly activates contractile element in smooth muscle
- Increasing coronary blood flow/oxygen supply to the heart
- Maintain appropriate supply and demand of oxygen
- Increased risk of heart attack, especially with shorter-acting formulas
- *ipine endings
19
Q
Side effects of Calcium channel blockers
A
- excessive vasodilation
- swelling in feet or ankles
- hypotension
- heart rate abnormalities
- dizziness
- headache
- nausea
20
Q
Nonpharmacological treatment of hypertension
A
- Dietary modifications: Sodium restriction, increased fruits, vegetables, and low fat
- Decreased alcohol and tobacco use
- Decreased body weight
- Regular exercise
- Stress managment
21
Q
Angina pectoris
A
- chest pain during ischemic heart disease
- intense compression and tightness that can radiate to jaw or left arm
- often preceded by increased physical exertion but can be spontaneous / at rest
- supply of oxygen is insufficient to meet demands of the heart
22
Q
3 primary drug groups for Angina pectoris
A
- organic nitrates: increase exercise tolerance
- beta blockers: decreased cardiac response to exercise
- calcium channel blockers
23
Q
Organic nitrates
A
- decreasing myocardial demand
- general vasodilation throughout the body
- Administered sublingually, spray under the tongue or transdermal patch
24
Q
Side effects of Organic nitrates
A
- orthostatic hypotension
- dizziness
- headache
- nausea
25
Other info on drugs for Angina
- Supply and demand issue
- Anticoagulants to prevent artery occlusion / clot formation
- *Medications do not treat the underlying heart disease
- Surgical techniques to improve coronary blood flow
26
Congestive heart failure
- chronic condition of the heart unable to pump enough blood to the peripheral tissues and become progressively worse
- Symptoms: peripheral edema, decreased tolerance for PA, shortness of breath, dyspnea
- High prevalence of people with the disease
- Poor prognosis
27
Agents that increase myocardial contraction force
- positive inotropic agents: digoxin/digitalis
- Improves cardiac pumping ability
- Improves cardiac output at rest and during exercise
- Blood can pump more effectively
- Secondary to beta blockers, ace inhibitors
- Side effects: Toxicity (GI distress, drowsiness, fatigue, confusion, visual disturbances and abnormal cardiac function)
28
Agents that decrease cardiac workload
- ACE inhibitors
- Beta Blockers
- Diuretics
- Vasodilators
29
Signs of congestive heart failure
- increased cough, difficulty breathing/dyspnea, abnormal breathing sounds, frothy sputum
30
Signs of digitalis toxicity
- dizziness, confusion, nausea, arrhythmias
31
Coagulation disorders
- Blood coagulation (hemostasis) is necessary to prevent excessive hemorrhage from damaged blood vessels
- Thrombogenesis: abnormal formation of blood clots
- Thrombus formation can lead to vessel occlusion and tissue infarction
- can create an embolism and infarction
32
Hyperlipidemia
- chronic and excessive increase in plasma lipids
- cholesterol and other lipids progressively deposited into the arterial wall creating plague lesions (atherosclerosis)
- progressively occlude the artery
- can rupture
- related heart disease
- affected by diet, exercise, lifestyle choices, genetic, and other metabolic conditions
33
Drugs used for overactive clotting
- Anticoagulant
- Antiplatelet
- Fibrinolytic
34
Anticoagulant
- control function and synthesis of certain clotting factors
- used primarily to prevent clot formation in the venous system
- Heparin: IV administration
- Warfarin (Coumadin): Oral administration
- Long term Warfarin need periodic monitoring
35
Side effects of Anticoagulant
- increased risk of hemorrhage
- decrease platelets
- GI distress
- sudden increases in joint pain could indicate hemorrhage
36
Antiplatelet
- prevent excessive clotting through increased platelet activity
- primarily to prevent clot formation
- Aspirin, Plavix
37
Side effects of Antiplatele
- increased risk of hemorrhage
- decrease platelets
- GI distress
- sudden increases in joint pain could indicate hemorrhage
38
Fibrinolytics
- Facilitate breakdown and dissolution of clots that have already formed
- Important in treating acute heart attack (IV administration)
- T- PA
- Careful with elderly patients, severe/untreated hypertension, history of hemorrhagic stroke
39
Side effects of Fibrinolytics
- increased risk of hemorrhage
- decrease platelets
- GI distress
- Excessive bleeding
40
Drugs used for clotting deficiencies
- Hemophilia: hereditary disease in which an individual is unable to synthesize adequate amounts of a specific clotting factor
- Small injuries can produce severe or fatal hemorrhage
- Joint problems
- Vitamin K, Manufactured clotting factors, antifibrinolytics ( after surgery, trauma, cancer treatments, etc)
41
Statins- Hyperlipidemia
- Increases the breakdown of "bad" cholesterol
- support a modest increase of "good" cholesterol
- can lead to vasodilating, anti-inflammatory, and antioxidant effects
- improves morbidity and mortality in people with high cholesterol
- Decrease risk of major cardiac event
- side effects: GI distress, myopathy (muscular pain, inflammation, weakness)
42
Fibric acids: Hyperlipidemia
- Primarily decrease triglyceride levels
- increase good cholesterol and lower bad ones
- good for treating a combination of lipid abnormalities
side effects: GI distress
