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PC707 Pharmacology > Module 5 Cardiac > Flashcards

Module 5 Cardiac Flashcards

1
Q

What is the BP goal for >60 with no chronic kidney disease (CKD) or diabetes?

A

<150/90

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2
Q

BP goal for <60?

A

<140/90

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3
Q

BP goal for >18 with CKD or diabetes?

A

<140/90

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4
Q

Initial tx for HTN per JNC8?

A

Individualized; Can be ACE, ARB,CCB or diuretic

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5
Q

What is the preferred diuretic?

A

Chlorthalidone, which is in the thiazide class

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6
Q

What is the recommended initial tx in blacks?

A

Thiazide diuretic or CCB.

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7
Q

First step for treating hypertension is ______________ unless BP is _________.

A

Lifestyle modifications; 160/100

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8
Q

Diuretics - Actions

A

Action takes place on different parts of the renal tubule. Blocks active reabsorption of Na and Chloride.
Increases: Urinary Na excretion, which increases water excretion.
Decreases: extracellular fluid and/or plasma volume

Acute effect: decreases stroke volume and cardiac output; Chronic effect: Decreased TPR, peripheral vascular resistance with normal CO , by unknown mechanism

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9
Q

Thiazide Diuretics - Side Effects

A

hypokalemia, dehydration, hyperuricemia, impaired glucose tolerance

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10
Q

Thiazide Diruetics - Contraindications

A

gout, renal failure, hypersenstiviity to sulfonamides

*May worsen diabetes

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11
Q

Angiotensin Converting Enzyme (ACE) Inhibitors : Actions

A

Inhibit ACE, which is responsible for converting angiotensin I to angiotensin II; also inhibits the degradation of bradykinin (kinin II) and increases the synthesis of vasodilating prostaglandins. The result is vasodilation, decreased blood volume, and prevention or reversal of pathologic changes in the heart and blood vessels mediated by angiotensin II and aldosterone.

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12
Q

Angiotensin Converting Enzyme (ACE) Inhibitors : Side Effects

A

Nonproductive cough

Angioedema

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13
Q

Angiotensin Converting Enzyme (ACE) Inhibitors : Contraindications

A

Patients taking K+ sparing diuretics
Renal artery stenosis
Pregnancy- teratogenic effects

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14
Q

Angiotensin receptor blockers: Actions

A
  • ARBs block the actions of angiotensin II in blood vessels, the adrenals, and all other tissues.
  • ARBs are similar to ACE inhibitors in that they cause vasodilation, suppress aldosterone release, promote excretion of sodium and water, reduce blood pressure.
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15
Q

Angiotensin receptor blockers: Side Effects

A

BIrth defects, angioedema

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16
Q

Angiotensin receptor blockers: Contraindications

A

pregnancy

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17
Q

Calcium channel blockers: Actions

A

Inhibit the movement of calcium ions across the cell membrane. Results in decreased myocardial contractility (negative ionotropic force), slowed rate of ventricular contractions, coronary artery dilation, peripheral arterial dilation, and reduced peripheral resistance. They work by blocking the movement of calcium into the cell membranes of the cardiac and smooth muscle.

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18
Q

Calcium channel blockers: Side Effects

A

Can cause reflex tachycardia- (use beta blocker in combination to control this). Bradycardia
Causes peripheral edema, primarily in lower extremities
Are not to be used with patients who are in heart block.
Contribute to acid reflux as they inhibit contraction of LES.
Multiple drug-drug interactions
**• Because of their cardiosuppressant effects, verapamil and diltiazem can cause bradycardia, partial or complete AV block, and exacerbation of heart failure.
• Beta blockers intensify cardiosuppression caused by verapamil and diltiazem.

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19
Q

Calcium channel blockers: Contraindications

A

Heart block

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20
Q

Beta Blockers: Actions

A

Achieve their effects by competing for adrenergic receptor binding sites. Prevent epinephrine from activating the heart causing a decrease cardiac output by decreasing the rate, contractility, and conduction velocity of the heart. Peripheral vascular resistance is decreased; mechanism is unknown. May decrease sympathetic activity & ventricular remodeling- used in stable heart failure patients

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21
Q

Beta Blockers: Side Effects

A 
Bradycardia
Postural hypotension
Fatigue & dizziness
Worsens asthma: Blocking of beta receptors may cause bronchial constriction. Selective beta 1 blockers have less risk, as they mainly affect heart- metoprolol & atenolol. Noncardioselective are propranolol & nadolol
May worsen depression
Sexual dysfunction
Increase serum triglycerides
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22
Q

Beta Blockers: Contraindications

A

May mask effects of hypoglycemia & inhibit glycogenolysis, therefore not recommended for diabetes
Not recommended in heart block, COPD, asthma, bradycardia or severe heart failure
Avoid with PVD
Caution with exercise enthusiasts

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23
Q

Direct -acting vasodilators (relax vascular smooth muscle): Actions

A

Cause arteriolar smooth muscle relaxation. Reserved for severe or essential hypertension

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24
Q

Direct -acting vasodilators (relax vascular smooth muscle): Side Effects

A

Edema & tachycardia

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25
Q

Direct -acting vasodilators (relax vascular smooth muscle): Contraindications

A

CAD & rheumatic hd

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26
Q

Alpha Blockers: Actions

A

Work on alpha receptors & block primarily norepinephrine causing vasodilation.

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27
Q

Alpha Blockers: Side Effects

A 
Dizziness
Orthostatic hypotension
Palpitations
Bradycardia
Edema
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28
Q

Alpha Blockers: Contraindications

A

Cardiovascular disease

Concomitant use of selective phosphodiesterase type 5 (PDE5) inhibitors, ie. tadalafil(Cialis) & vardenafil (Levitra)

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29
Q

Utilize one antihypertensive drug for __________. If not at goal either ___________or ________________.
(per JNC8)

A

one month; increase dose; add a second agent.

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30
Q

What is DASH diet?

A

Heart healthy diet with sodium restriction.

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31
Q

Which lifestyle change has the largest effect on reducing BP?

A

Weight loss and next is DASH diet

32
Q

Natural products that elevate BP?

A

Ginseng, yohimbe, mahaung, and black licorice

33
Q

Which classes work on the sympathetic nervous system?

A

Anti-adrenergics: Alpha Blockers, Beta Blockers, and centrally acting drugs.
Calcium Channel Blockers

34
Q

Which class works on vascular tone?

A

Vasodilators

35
Q

Which classes work on vascular volume?

A

Diuretics, ACE, & ARB

36
Q

Goal of antihypertensive therapy?

A

Reduce cardiovascular and renal morbidity and mortality.

37
Q

Which diuretics produce the greatest diuresis?

A

High ceiling (LOOP diuretics) which work in the loop of henle

38
Q

Loop Diuretics: Side Effects

A 
Hypokalemia
Hyponatremia
Hypocalcemia
Hypomagnesemia
Orthostatic hypotension
Dehydration
Hearing loss (reversible)
39
Q

Loop Diuretics: contraindications

A

anuria, hypersensitivity to sufonylureas, hepatic coma, severe electrolyte depletion

40
Q

Which diuretic works when the GFR is low?

A

Loop

41
Q

Hypokalemia caused by diuretics is a special problem for patients taking _________________.

A

Digoxin; Hypokalemia and Hypomagnesium can cause cardiac arrhythmias

42
Q

Loop diuretics (high ceiling) can cause hypotension by decreasing ______________ and relaxing _________________.

A

blood volume; venous smooth muscle

43
Q

Thiazide diuretics work in the _____________.

A

distal convoluted tubule.

44
Q

Common thiazides

A

Hydrochlorthiazide, Chlorthalidone

45
Q

Thiazide diuretics may be beneficial for people with ________________. Why?

A

Osteopenia; decreased calcium excretion

46
Q

Do loop diuretics decrease or increase calcium?

A

decrease calcium reabsorption - bad for pt with osteopenia

47
Q

Common Loop diuretics

A

Furosemide (Lasix)

Bumetanide (Bumex)

48
Q

How do Potassium sparing diuretics work?

A

directly or indirectly block sodium-potassium “exchange” in the distal convoluted tubule.

49
Q

Risk with K sparing diuretics? (Spironolactone, Triamterene)

A

Hyperkalemia

50
Q

K sparing diuretics should not be used with…

A

K supplements, and cautiously with ACEs, ARBs, and direct renin inhibitors

51
Q

Where are beta 1 receptors?

A

Predominate in cardiac tissue (cardioselective)

52
Q

Where are beta 2 receptors?

A

Bronchial and vascular smooth muscles, as well as liver.

53
Q

Should beta blockers be given after an MI?

A

Beta blockers should be given for 2 to 3 years after a heart attack. The two most effective beta-blockers that improve CV outcomes are carvedilol and metoprolol ER.

54
Q

Which beta blocker should be avoided?

A

Atenolol

55
Q

Differentiate between selective and nonselective beta blockers.

A

Although both receptors affect blood pressure, those which are cardioselective (Beta 1 receptors) have reduced risk of bronchoconstriction and gluconeogenesis in the liver. (Example: B 1 selective: Metoprolol (Lopressor), atenolol Nonselective:, Timolol (Betim), Propranolol (Inderal).

56
Q

Alpha and Beta Blockers are _________________.

A

Peripheral adrenergic receptor blockers

57
Q

Centrally acting adrenergic receptor drugs: Action

A

block neurotransmitters that activate the sympathetic nervous system. These drugs affect the vasomotor center in the brain by limiting the sympathetic outflow to the heart and blood vessels. They are typcially used in combination with other antihypertensives.
Example: methyldopa (Aldomet®) & clonidine (Catapress).

58
Q

Can beta blockers be stopped suddenly?

A

No, they must be tapered.

59
Q

What drug is a B2 agonist?

A

Terbutaline - mimics the sympathetic nervous system; promotion of norepinephrine release, blockade of norepi uptake, and inhibition of norepi breakdown.

60
Q

What does activation of alpha 1 receptors cause?

A

Vasoconstriction & mydriasis; (peripheral alpha 2 activation of minimal significance, but activation in CNS has useful effects)

61
Q

What are alpha 1 agonists used for? Adverse effects?

A

Hemostasis, nasal decongestion, and elevation of BP. Hypertension and local necrosis.

62
Q

Activation of beta 1 (cardiac) receptors increases ___________, ____________, & ___________.

A

heart rate, for of cardiac contraction, conduction through the AV node.

63
Q

Beta 1 agonists are used to treat (3): The adverse effects are (3):

A

heart failure, AV block, and cardiac arrest; tachycardia, dysrhythmias, and angina.

64
Q

Beta 2 agonists are used to treat _________ & ___________. The adverse effects are:

A

asthma & PTL; hyperglycemia & tremor

65
Q

Benefits of alpha blockers:

A

The alpha blockers have the benefit of lowering LDL cholesterol and elevating HDL. The alpha blockers may also improve insulin sensitivity. These drugs also relax the smooth muscles surrounding the prostate which relieves constriction of the urethra which facilitates urination.

66
Q

ACEIs slow the progression of _____________ & _________________.

A

renal disease and heart failure.

67
Q

ACE inhibitors are used to treat:

A

hypertension, heart failure, myocardial infarction (MI), and nephropathy, both diabetic and nondiabetic. In addition, they are used to prevent MI, stroke, and death (from cardiovascular causes) in patients at high risk for a cardiovascular event.

68
Q

What can reduce the effectiveness of ACEIs?

A

NSAIDs

69
Q

What does calcium do in the heart?

A

• In the heart, calcium entry increases heart rate, atrioventricular (AV) conduction, and myocardial contractility, and hence calcium channel blockade has the opposite effects.

70
Q

Central alpha 2 receptor agonists should be used in conjunction with a _____________

A

diuretic

71
Q

Difference between DHP CCB and other CCB?

A

DHP drugs do not affect the cardiac conduction system, and thus are not used for cardiac arrhythmias. (Procardia, Norvasc)

72
Q

-olol

A

beta blocker

73
Q

-sartan

A

ARB

74
Q

-pine

A

CCB

75
Q

-pril

A

ACEI

76
Q

-azosin

A

Alpha 1 blocker

PC707 Pharmacology (5 decks)

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