LECUTRE 3: cardiovascular meds Flashcards
1
Q
the goal for the medication is to reestablish the balance between myocardial O2 supply and demand … which disease is this for
A
ischemic heart disease
2
Q
Goals of pharmacological management:
• Address the underlying contribution to heart failure
• Maintain CO
• Regulate fluid and salt intake
• Decrease preload / afterload
• Increase cardiac contractility
• Reduce cardiac workload
• Decrease sympathetic stimulation
for what disease
A
HF
3
Q
which stages of heart disease is usually in hospital
A
stage b c d
4
Q
Goals of pharmacological management:
• Inhibit abnormal impulse formation and conduction by altering
membrane permeability to specific ions
• Classified based on the:
• Ionic gates they control:
• Na+
• K+
• Ca+
• Cl-
• Location:
• Myocardial pacemaker cells (SA, AV)
for which disease
A
arrthymias
5
Q
Goals of pharmacological management :
• Reduce fluid volume (diuretics)
• Limit sympathetic nervous system activity to:
• promote arterial and venous vasodilation
• reduce CO
• reduce the effects of the renin-angiotension-aldosterone system at the
kidney to:
• promote vasodilation
• reduce fluid volume
for which disease
A
HTN
6
Q
what is the suffix for beta blockers
A
“lol”
7
Q
beta blockers ____ beta receptor binding sites of ____ and ____
A
reduces
epinephrine
norepinephrine
8
Q
what are the 2 selective beta blockers
A
Beta 1 and 2
9
Q
when blocked , which selective beta blocker causes decrease HR ad myocardial contractility
A
Beta 1
10
Q
when blocked , which selective beta blocker causes bronchoconstriction and vasoconstriction
A
beta 2
11
Q
which beta receptor is locked on the heart ? lungs and peripheral mm?
A
beta 1
beta 2
12
Q
what does nonselective beta blockers do
A
block both types of beta receptors
13
Q
nonselective beta blockers are not indicated for individuals with
A
PVD or COPD
14
Q
beta blockers block which system
A
SNS
15
Q
beta blockers are clinically indicated for what
A
HTN
ischemic heart disease
HF
arrthymias
16
Q
can beta blockers mask symptoms of hypoglycemia ?
A
yes
17
Q
in some older people selctive beta blocker may promote what
A
hyperglycemia
18
Q
someone with orthostatic Hypotensoin has a drop of systolic by ___ and HR by ____
A
20
30
19
Q
beta blockers causes exaggerated cardiac responses like what
A
bradycardia
orthostatic hypotension
heart block
excess negative iontropic effect
20
Q
what are calcium channels blockers clinically indicated for
A
ischemic heart diease
arrhythmias
BP control
reduction of re infarction in patient with non Q wave infarcts
21
Q
what type of iontropic effect do calcium channel blockers have
A
negative
22
Q
when the heart infarcts what releases
A
calcium
23
Q
someone who is taking calcium chanel blockers may have negative iontropic effects which. may lead to PT using ___ during exercise as HR responses to exercise may be blunted
A
RPE
24
Q
what suffix does calcium channel blockers have
A
pine
25
calcium channel blockers decrease arterial BP via
smooth mm relaxation
vasodilatation (decreases cardiac after load)
26
myocardial ischemia causes an influx on calcium which ____ HR and ______ ______
increase
myocardial contractility
27
calcium channel blockers reduce O2 demand which ____ HR and ____ contractions
slows
strengthen
28
what are nitrates clinically indicated for
HTN
ischemic heart disease ( angina)
heart failure
29
how does nitrates effect the HR
slows it down
30
nitrates reduce blood back to the heart by doing what
dilating veins (reduces preload)
31
since nitrates reduce blood to the heart by dilating veins which reduces preload , this causes the heart to contract with ___ force
less
32
how does nitrates effect BP
lowers it
33
if someone has a lower BP then there is ___ resistance in the heart to push blood from the chambers leading to a reduce ____
less
afterload
34
what is chest pain related to ischemia of the myocardium
angina
35
what is caaused by an imbalance in myocardial oxygen supply and demand
angina
36
someone with angina has a lack of oxygen which then stimulates ___ receptors within the heart
pain
37
nitrates tend to have what within the name of the drug
“nitr”
38
what are some side effects of nitrate
hypotension
dizziness
reflex tachycardia (if BP drop fast then heart beats faster)
flushing of skin
39
if nitrates are taken before exercises it is important to measure ___ before and after meds are taken
vitals
40
nitrates can be administered via
enteral or parental routes
oral
sublingual
percutaneous spray
41
if a patient decribes their chest pain as an “elephant sitting on my chest” , chest pressure or tightness , or vice like , gripping or burning then we can suspect they have what
angina
42
if your patient is complaining of chest pain that radiates to the shoulder , in between the scalps , arm , throat or jaw or anywhere above the umbilicus what can we suspect
ischemic pain patterns
43
if ST segments downwardly shifts then what does that indicate
ischemia or infarction
44
what type of angina does a patient have if they have no pain at rest , pain last for several minutes , relived by rest or taking nitrates, and patient can reliably predict activities that will provoke discomfort
stable
45
what types of angina is it if a patient has an onset that is unpredictable or accelerating in frequency , severity or intensity , may occur at rest , pain last longer then 15 minutes
unstable
46
what types of angina is it if the patient has pain at rest and often in the morning , there is ST elevation on ECG
prinzmetals (variant)
47
what are some medications taken for angina
nitrates
beta blockers
calcium channel blockers
48
for someone with angina what do beta blockers do for the heart rate
decreases it , which then decreases the workload on the heart (decreases O2 demand)
49
for someone with angina , calcium channel blocked main coronary artery ___ and limits
vasodilation (increased o2 supply)
vasospasm
50
when the heart fails it releases ___ which can cause the mm spams in the heart
CA
51
if someone has angina and is taking nitrates that will causes ___ which ____ blood flow to myocardium and ___ venous return to the heart
vasodilation
increases
decreases
52
where is referred pain region for the lung and diaphragm
left shoulder and neck
53
where is the referred pain for the liver and gallbladder
right shoulder and neck and right upper ab area
54
what is an estimate of myocardial workload
rate pressure produce
55
if someone RPP is over ____ then we are not gonna exercise them
10000
56
which medication is clinically indicated for Blood clots formation in the coronary artery at the time of plaque rupture
thrombolytic agents
57
what is the suffix for thrombolytic agents
-are
58
Patients with clinical evidence of thrombus formation should be treated immediately via thrombolytics within ___ minutes
30
59
overall goal for a patient with clinical evidence of thrombus formation is to keep total ischemic time to less than ___ minutes from time of symptoms to repercussion
120
60
what is clinically indicated for Primary and secondary preventive measure to prevent thrombus formation
anti platelet agents
61
anti platelet agents ___ platelet adherence at site of injury
decreases
62
what are clinically indicated for prevention. of blood clots , prevent an emboli and inhibit the production of the hormonal thrombin
anticoagulants
63
what are the 3 commonly used anticoagulants
pradaxa, xarelto, eliquis
64
what are diuretics clinally used for
hypertension and HF
65
diuretics ____ circulating blood volume (preload)
decreases
66
diuretics ____ circulating ventricular length-tension relationship which improves cardiac _____
decreases
contractility
67
diuretics promotes ___ and ___ ____ and ____ reabsorption of water and Na+ at the kidneys
diuresis and electrolyte balance and decreases
68
what suffix does diuretics tend to have
ide
69
lasix is the most potent whatt
diuretic
70
loop diuretics has a site of action where
loop of henle
71
there is caution with aerobic exercise for people taking diuretics due to
hypotension (due to fluid loss) and arrthymias (due to K+ loss)
72
what are sodium glucose transporter inhibitors used for
lower blood sugar for type 2 diabetics
73
how much does sodium glucose transporter inhibitors reduce blood pressure by
SBP: 3-5 mmHg
74
how much weight loss does sodium glucose transporter inhibitors promote
4-6 lbs
75
T/F: sodium glycogen transporter inhibitors do not reduce cardiovascular deaths
F ( they do reduce cardiovascular deaths)
76
• Invokana (canagliflozin):
• Farxiga (dapagliflozin):
• Jardiance (empagliflozin)
are examples of what
sodium glucose transporter inhibitors
77
what are some side effects of sodium glucose transporter inhibitors
hypoglycemia
hypotension
UTIs
diabetic ketoacidosis
78
Drugs affecting the RAAS system is clinically indicated for
hypertension and HF
79
drugs affecting the RAAS system can be considered as
vasodilators and antihypertensives
80
what are the 3 drugs affecting the RAAS
ACE inhibitors
angiotensin receptor blockers (arb)
aldosterone antagonists
81
what prevents the conversion of angiotensin 1 to angiotensin 2
ace inhibitors
82
What does Angiotension 2 stimulate
aldosterone
83
does angiotensin 2 causes vasoconstriction or vasodilitation
vasoconstriction
84
angiotension 2 causes renal water and sodium ___
retention
85
what suffix does ACE inhibitors have
RIL
86
what limits the effects of angiotension 2 at the vasoreceptors of the arterial beds
angiotensin receptor blockers (ARBs)
87
what can be used as an alternative ACE inhibitors for patients who are intolerant to them
angiotensin receptor blockers
88
what is the suffix for angiotensin receptors blockers
sartan
89
what drug is a combination of ARB and Neprolysin inhibitors
entresto
90
what is entresto used for
pateint with HF
91
if potassium is to high what can that lead to
arrthymias
92
neprolysin inhibitor causes Na ___ and K ___-
excretion and retention
93
Angioedema is a side effect of what
ace inhibitors and ARBs
94
what is angioedema
tongue swelling for no reason
95
spironolactone is an example of what
aldosterone antagonist
96
aldosterone antagonists causes ____ renal fluid and ___ retention
decreased and NA
97
aldosterone antagonists causes ___ renal excretion of na+
increased
98
side effects of aldosterone antagonists
hyperkalemia
orthostatic hypotension
99
what is the effects of aldosterone antagonists on BP
decreases it
100
positive iontropes is clinically indicated for what
HF
101
what is the purpose of positive iniotropes
increase strength of contraction
102
what type of cardiomyopathy is positive ionotropes : cardiac glycosides used for
dilated
103
waht does positive inotropes : cardiac glycosides do to HR
slows it down
104
positive inotropes: cardiac glycosides is indicated for what
atrial fib
105
what are the 2 main drugs for positive inotropes : cardiac glycosides
digitalis
digoxin
106
which has a shorter half life and less toxic , digitalis or digoxin
digoxin
107
someone who is taking positive inotropes: cardiac glycosides , why may toxicity occur?
interaction with other drugs
decreased renal function
altered GI absorption
108
what are the signs and symbols of digitalis toxicity in the GI
Anorexia
• Nausea
• Vomiting
• Diarrhea
109
what are the signs and symbols of digitalis toxicity in the cardiovascular
Palpitations
Arrhythmias
Syncope
110
what are the sings and symptoms of digitalis toxicity on neuro
Malaise
• Fatigue
• Vertigo
• Insominia
• Depression
• Colored vision
• Facial pain
111
what are the signs and symptoms of digitalis toxicity on neuro
high digoxin / low K+
altered BUN /creathinine
112
if a patient is taking digoxin due to atrial fibrillation then patient may have am ____ HR
irregular
113
if a patient is taking digoxin due to a fib and has a resting HR > ____ then they may need to be reassessed by physician
110
114
digoxin controls a fib due to increased ___ interval
PR
115
how long should resting pulses be taken whenever a pateint has a irregular heart rhythm
one full min
116
cardiac glycosides should not be used for patient with __ or ___ degree AV block
2nd or 3rd
117
which positive inotropes is indicated for the parenteral use of acutely compromised heart failure patient
sympathomimetics
118
sympathomimetics mimic the actions of what system
SNS
119
sympathomimetics are used for a ___ periodd of time to minimize the possibility of sympathetic receptor
desensitization
short
120
selective Beta 1 receptors for sympathomimetics stimulate influx of ___ into the myocardium to increase contractility
Ca+
121
selective beta 1 r3ecptors of sympathomimetics increase __ and __ node firing and conduction
SA and AV
122
dobutrex and levophed are examples of what
selective B1 sympathomimetics
123
non selective beta 1 and beta 2 sympathomimetics increase ______ (B1) and ____ afterload due to ______ (b2)
contractility
reduce afterload
due to vasodilation
124
Adrenalin Chloride and Isuprel are examples of what
non selective B1 and B2 sympathomimetics
125
what is used when heart failure is present with systemic hypotension
dopamine (iontropin)
126
dopamine stimulates ___ myocardial , D-1. and alpha vascular receptors to increase
B1
127
what is indicated for patients with a combination of severe CHF
phosphodiesterase inhibitors
128
phosphodiesterase inhibitors are used to ____ the myocardial contraction
strengthen
129
Phosphodiesterase Inhibitors are typically used for pateint who did not respond to what other meds
Sympathomimetics
• Cardiac glycosides
130
inocor acts as a ____ inotropes and ____ which promotes preload /afterload balancing
positive and vasodilators
131
vasodilators are clinically indicated for what
hypertension
heart failure
ischemic heart disease
132
vasodilators are effective for ____ hypertension
systolic
133
what are examples of vasodilators
Ca+ channel blockers
ACE inhibitors
Nitrates
134
if there is vasodilators to arterial system then there is a ___ cardiac afterload
reduced
135
venodilators ___ cardiac preload and is effective for ___ hypertension
reduce
diastolic
136
vasodilators : alpha adernegric antagonists is used to mange ___ and not HF
hypertension
137
mini press and hytrin are examples of what
α1 adrenergic antagonists
138
what are side affects of α1 adrenergic antagonists
reflex tachycardia
139
nipride affects vascular bed of what
both systems (arterial and venous)
140
how is nipride given anf what is the onset of action
parenterally (IV) and rapid onset
141
basically nipride reduces ___ and ____
afterload and preload
142
morphine is a vasodilators that ____ pre load via venodilation
decreases
143
what reduces anxiety and effort associated with severe heart failure
morphine
144
T/F: can vasodilators causes compensatory sympathetic activation like tachycardia , vasoconstriction
true
145
what medication work to regulate BP
anti hypertensives
146
what drug classes are often used to control hypertension
SNS blockers
Ca+ blockers
ACE inhibitors
vasodilators
diuretics
147
what are the class 1 and class 2 anti arrhythmias membrane stabilizers
class 1: xylocaine
class 2: beta blockers
148
what class of anti arrhythmias are clinally indicated for Ventricular and supraventricular tachycardia and Atrial fib
class 1 : xylocaine
149
class 1 ( xylocaine) anti arrthymics reduced influx of ___ into the cell
Na+ which causes the heart to not contract well
150
what class of anti arrhythmics are clinally indicated for Ventricular and supraventricular arrhythmia post MI and exercise
class 2 beta blockers
151
Class 2 (beta blockers) of anti arrhythmics blocks ____ excitation fo the heart to control heart rhythm
sympathetic
152
what are class 3 and 4 for anti arrthymics
class 3” cordarone
class 4: calcium channel blockers
153
class 3 (cordarone) anti arrhythmics are clinically indicated for what
Ventricular and supraventricular tachycardia
154
in patients with hemodynamic instability ____ amiodarone is the antiarrythmic medication most often used
IV
155
one important side effect of membrane stabilizers is that it can cause
exacerbation of arrhythmias
156
class IV: Ca+ blockers help prolong the ___ period
refractory
157
digitalis is a cardiac glycosides that enhances the ______ tone in the healthy heart
parasympathetic
158
what is the net effect of digitalis (cardiac glycoside) as an anti arrhythmics
slows the heart and depresses AV node conduction
159
which anti arrhythmic drugs is clinally indicated for bradydysrhythmias
atropine
160
adenosine is an anti arrhythmic drug that is given ___ and slows conduction in the re entry pathway thru the ___ node
intavenously
AV
161
adenosine is an anti arrhythmic drug that is indicated for what
supraventricular tachycardia
162
Patients who receive hydroxychloroquine or azithromycin
in combination with antiarrhythmic drugs are at risk of
prolonged ____ interval and torsades de pointes.
QT
