Module 5 Flashcards
HTN
Hypertension = High Blood Pressure
most forms of HTN are idiopathic or “essential” - meaning the cause is not identifiable.
less than 10% caused by renal endocrine, or other abn such as morbid obesity or sleep apnea.
CAD
Coronary artery disease = coronary heart disease (CHD)
is a narrowing of the small blood vessels that supply blood and oxygen to the heart
CHF risk factors:
Congestive heart failure - causes of CHF include alcohol, pregnancy, viral…but most common cause of CHF is high blood pressure in conjuction with clogging and hardening (atherosclerosis) of the arteries (often occurs post MI)
Myocardial infarction MI
Heart attack - Permanent loss of heart muscle cause by CAD. MI is irreversible (meaning it causes scarring of the myocardium)
*leading cause of death in the US for male and female
ANGINA
ANGINA PECTORIS - heart pain caused by CAD
Angina is heart pain that is reversible - it is due to lack of oxygen to the heart muscle.
HF
Heart Failure - is a condition in which the heart fails to pump adequate a mounts of blood. HF often occurs months or years after a heart attack.
Risk factors - CHF is high blood pressure in conjuction with clogging and hardening (atherosclerosis) of the arteries (often occurs post MI)
HF prognosis
is very poor, worse than most cancers. with FH pressure builds up within the heart and fluids accumulate in body tissues
One of a patient with HF and the other of a highly conditioned athlete during competition. Which of the two have the most heart exposure to the transmitter Norepinephrine? Grandma with HF or Michael Jordan?
The answer is Grandma with HF. HF pt will be exposed to more NE “24/7” than the heart of a trained competing athlete during the period of athletic performance. High NE loads improve the hearts performance in the short term, but they are toxic if exposure is 24/7.
* The body tries to “help” the pump (heart) by releasing more NE, but it eventually remodels and destroys the heart
arrhythmia
better said as dysrhythmia - is used to describe an abn heart rate or rhythm.
ECG
is the best way to diagnose the nature of the rhythm, but not the underlying disease.
ABN of heart rhythm
- fast heart rates (tachycardia)
- slow heart rates (bradycardia)
- many weird conduction patterns and most bizarre configuration is no rhythm ast all
Dietary “Cholesterol” from
red meat, egg yolk and dairy products.
Dietary “triglyceride” from
oils, margarine, and sugar
* excess sugar is converted into triglycerides for storage
Lipid disorders
Fats are essential to good health; but eating too must fat, and of the wrong type, or having a disorder of lipids, can lead to atherosclerosis and other diseases.
Risk factors for Hyperlipidemia
are mostly genetics, poor diet both.
Initial drug therapy in treating hypertension involves prescribing an ACE-inhibitor, a calcium channel blocker, or?
A. a loop diuretic B. a cardiac glycoside C. a thiazide diuretic D. an antiarrhythmic drug E. vitamins A and D ans: C
Hypertension drugs
ACE-inhibitor/ARB, CCBs, vasodilators and diuretics.
ACE = Angiotensin Converting Inhibitor
Hypertension ladder - non drug therapy
The standard approach to treatment is a “stepped-care” or increasing complexity, starting with:
- salt reduction
- weight loss
- exercise
- smoking cessation
Diuretics
or “water pills”, through various mechanisms, promote excretion of Na+ and water by the kidneys
HCTZ
Hydrochlorothiazide is the prototype Thiazide diuretic, often used in combination with a potassium sparing diuretic.
furosemide (Lasix)
drug work for Loop Diuretics (not used for HTN)
inhibits reabsorption of Na+/H2O in the ascending loop of Henle.
Potassium Supplements
K+ as a drug is given to pt who are taking loop diuretics to avoid complications of hypokalemia.
- Oral usually given
- IV K+ usually given only in urgent situations or in the ICU
- Banana - good source of K+
Thiazides and Loop diuretics cause
loss of K+ (which we don’t have much) as well as Na+ (which we have a lot).
***loss too much of K+ can cause serious side efffects: Muscle weakness, dysrhythmias, and nerve conduction problems.
Potassium Sparing Diuretics drug
are used to help maintain blood K+ levels - drug like triamterence (Dyrenium)
The first-line drugs (combo) for treatment of uncomplicated “essential” HTN
Thiazides diuretic + K+ sparing
{HCTZ + triamterene (Dyrenium)}
Diuretic drug used to treat CHF
Loop diuretics like Lasix are used to treat CHF but not HTN.
Non-selective Beta-blockers
bind to and inactivate both the Beta 1 and B2 rc
* propranolol (Inderal) is the prototype
Cardioselective Beta-blockers
block mainly B1 rc in the heart, sparing the B2 rc in the bronchi (less tendency to trigger asthma
ACE Inhibitors
- Renin coverts the plasma protein angiotensinogen (produced in the liver) into angiotension I
- ACE converts angiotensin I to to angiotension II
- Angiotension II - stimulate the adrenal cortex to secrete aldosterone, which increase salt and water resorption and indirectly increases BP.
RAAS
Renin-angiotension-aldosterone system - is stimulates by a decrease in blood volume and /or blood pressure - as in cases of dyhydration or hemorrhage. Low BP stimulates juxtaglomerular cells in the kidney to secrete the enzyme renin
ACE - I drug
Captopril (Capoten) and enalapril (Vasotec)
most frequently used antihypertensive because of their low side effect.
ARB
Angiotensin II rc blockers - these drugs work very much like the ACE inhibitor I so often write ACEI/ARB
CCB
Calcium Chanel Blokers relax the smooth muscle of the blood vessels causing them to dilate, low BP and increase the blood flow.
Combo drugs for HTN
Capozide (captopril, ACEI + diuretic, HCTZ)
ACE-I/ARB, Beta blockers and CCBs can all be combined with a mild diuretic like HCTZ.
drugs used to relieve chest pain or angina pectoris
drugs used to relieve chest pain by dilating coronary vessels, or lowering the O2 demands - include nitroglycerine, beta-blockers and CCBs
Drugs class for CAD - Angina or MI
- Nitroglycerin (Nitrostat- sub lingual) tablets, (nitroglycerin paste- topical cream) and Transderm-Nitro patch and long acting capsules, and I.V. infusions.
- Nitrates - cause vasodilation throughout the circulatory system, enabling more blood and O2 to be available to the heart muscle.
- isosorbide dinitrate (Isordil) is a longer acting oral NTG preparation
- Isosorbide dinitrate / hydralazine (BiDil) is the first race based prescription drug in the US…approved for blacks in 2005
- Beta blockers - lower the heart rate which dramatically decreases the heart muscle’s need for O2 - propranolol (Inderal) used in 1970
- Calcium Channel Blockers - decrease blood pressure decrease heart rate, and increase coronary blood flow- improve myocardial O2 supply over O2 demand
Drugs for CAD - Angina or MI
- Nitroglycerin (Nitrostat)
- Nitrates
- Isosorbide dinitrate (Isordill)
- Isosorbide dinitrate / hydralazine (BiDil) - only approved for use in heart failure
- Propranolol (Inderal) - Beta blockers (can worsen some forms of depression, so they must be used with caution in people who are prone to this problem.
- Verapamil (calan) - CCB treating angina, hypertension certain dysrhythmias and migraine headaches
during an M.I
. TAKE 2 (325 mg) of aspirin tablets, chewed and swallowed - hopefully blood flow is quickly restored.
Aspirin
Anticoagulants are used to inhibit clot formation, and thrombolytics to “bust” the clot in a clogged coronary artery.
Post M.I drugs
captopril, Capoten and enalapril, Vasotec - when given within 24 hrs of and MI can increase survival rate
Post MI pts are often put on low-dose aspirin theyrapy, possibly combined with Beta blokers like atenolol(Tenormin) and metoprolol (Lopressor)
Digitalis
is the original drug for treating CHF, but because of its propensity for toxicity, and failure to show improved survival for those taking the drug, it has been relegated to back-up therapy - “carvedilol”
carvedilol
treating CHF. use for those NOT responding to a loop diuretic and ACE inhibitor, and a blocker.
Drugs for dysrhythmias
- Atropine - increases the heart rate
- Inderal (propranolol) - Beta blockers have negative chronotropic effects that slow the heart rate and stabilize “twitchy” areas of the myocardium that give rise to abn rhythms
- Verapamil (calan) - CCBs also slow the heart rate and suppress aberrant activity
- Digoxin’s negative chronotropy slows the heart rate
Statins
are currently the most widely used lipid lowering drugs because they have a good side effect profile.
* atorvastatin (Lipitor)
* simvastatin (Zocor)
these Statin drugs use to reverse the effects of plaque depositions. they block the production of cholesterol with lowers the LDL while increasing HDL.
Niaspan
is a recently added time released prescription preparation of niacin (vitamin B3) that raises HDL while lowering LDL and triglycerides.
Niaspan is used to lower the risk of heart attack
Name 6 diseases that Beta blockers are used to treat
- HTN but not drug of choice
- Tachycardia
- Angina
- CHF - only carvedilol
- Migraine headaches
- Anxiety disorders like test anxiety, and specifically PTSD (with imprinting of traumatic memories)
positive inotrope
any drug that increases the “force (strength)” of the heartbeat. A negative inotrope does the opposite.
positive chronotrope
any drug that increases the “rate” of the heartbeat
