New Cardiac Flashcards
Beta Blocker (-lol)
1st Generation
- non-selective
- Block B1and B2
Propranolol
Beta Blocker (-lol)
2nd Generation
- Cardioselective
- Block B1
Metoprolol
Beta Blocker (-lol)
3rd Generation
- Mixed Receptor Blockers
- Used in Hypertension, but not first-line drugs
- Block B1, B2, and a1
Carvedilol
Are the secondary drug used for hypertension
Adverse effects:
• Fluid retention
• Hypotension, bradycardia, heart attack
Beta Blocker
Block ____ receptors and *reduce sympathetic effect
- decrease HR and contractility
- decrease renin
Prevents Remodeling
Prevents arrhythmia’s
TX:
ANGINA
DYSRHYTHMIAS:
- Protect against tachydysrhythmias – slows ventricular rate
Adverse effects:
- *Resp wheezing
- *Insomnia/bizarre dreams/hallucinations
*abrupt withdrawal can worsen angina
Beta Blocker
-lol!
Propranolol, Metoprolol,
(Carvedilol (mixed))
Primary Drug for Beta Blockers
MOA:
- Prevents excessive sympathetic stimulation to prevent heart muscle failure
- Keeps heart responsive
- Turn off structural remodeling
- Increased survival in HF patients
Carvedilol (B1, B2, and a1)
*Calcium Channel Blockers - Block L -type calcium channels on *vascular smooth muscle only
• PREVENT angina
HYPERTENSION:
• Most commonly used in HTN
Effective in African American Populations
*More common with fewer adverse effects
-dipine
Nifedipine,
Amlodipine
Calcium Channel Blockers
- Vascular + cardiac effects
- Class IV antiarrhythmic - PREVENT angina
- *Lessen how quick/hard the heart beats
- *Cardiac SE - cardiac depression, conduction
Diltiazem
Verapamil
Diltia Vera
Anti_______ drugs decrease cardiac and O2 demand
Antianginal
ACEs
MOA:
- Inhibit ACE
- DECREASE angiotensin II
- Block degradation of kinin
Decreases Pulmonary Hypertension
Adverse Effect
- First dose hypertension
- YES Bradykinin (promotes inflammation)
- Intractable cough and angioedema (main-face swelling)
Pregnancy D Category
Enalapril
Catopril
-pril
ARBs
MOA:
- BLOCK angiotensin II receptors
Less Angiotensin II:
- *replacement for ACEI if they can’t be tolerated
- *NO bradykinin/irretractable cough
- *Increases survival in HF patients
Adverse Effect
- Extensive hypotension initially
- Hyperkalemia
(-sartan)
Losartan
Valsartan
Loop Diuretics
MOA:
- Block Na+/K+/Cl- in *Loop of Henle (decreases Na+ reabsorption)
- Causes Large reduction in plasma volume
Use: Mainly Edema and *HF (Tx symptoms caused by edema)
Adverse Effects:
- hypokalemia
- *Ototoxicity
Furosemide (lasix)
MOA:
- Blocks Na+/Cl- in *Distal Convoluted tubule
- Less sodium reabsorption (reduces total body sodium)
Use: Edema in HF
- primarily HTN
- May cause arrhythmias
Effective in AA population
Hydrochlorothiazide
Potassium Sparing Diuretic:
HF first choice diuretic
MOA:
- Blocks aldosterone receptors (↑K+, ↓ Na+) (cortical collecting duct)
Use: small diuresis with other drugs, HF to reduce remodeling
Adverse Effects:
- Hyperkalemia
- Hormone Effects (gynecomastia, menstrual irregularities, and hirsutism)
- Not for pregnancy
Spironolactone
Osmotic Diuretic – NOT used for HF
Route: IV
MOA:
- Draws water into nephron with osmotic force (holds water in nephron)
Use:
- For patients with renal failure
- Reduces Intracranial Pressure/Edema (ICP)
Adverse Effects:
- HA
- nausea
- vomiting
- Fluid loss and electrolyte imbalances
Laxative - stool in 3-12 hours
Mannitol
Cardiac Glycosides
MOA:
- *Inhibits Na+/K+ ATPase in heart
- *cardiotonic drug (heart contraction)
Increase:
- Cardiac output»_space; Urine production»_space; reduce edema
Decrease:
- Sympathetic tone & renin release
Competes with K+
Adverse:
Cardiac - Arrhythmias and bradycardia
- *Blurred vision, Visual Disturbances = yellowish/greenish tinge
Digoxin
Direct Vasodilators (Drug combo)
MOA:
- __________ Dinitrate decreases preload (dilating veins)
- ___________ decreases afterload (dilating arteries)
Use with: Severe Heart Failure
More effective in: African Americans
Adverse Effects:
- Orthostatic hypotension
- reflex tachycardia
- *___________: lupus erythematosus
Isosorbide Dinitrate
+
Hydralazine
= “BiDil”
Hydralazine
Selective a1 blocker:
MOA:
- Blocks a1 *vascular receptors that usually cause vasoconstriction
Adverse Effects:
- *First Dose Phenomenon:
1. Orthostatic hypotension
2. Dizziness
3. Fainting - Reflex Tachycardia
- Fatigue
Terazosin
Direct Vasodilators
MOA:
- Causes direct vasodilation
- Large drop in blood pressure from Nitric oxide or decrease Ca+
NOT for monotherapy (tachycardia, Na+ & H20 retention, etc).
*Drug used in Hypertensive emergencies: _______________
Hydralazine
nitroprusside
Anti-Hypertensive drugs treat ____ blood pressure
They ________ cardiac output and vascular constriction
High
decrease
________ choices that increase high blood pressure
- High sodium intake
- obesity
- lack of exercise
- cigarettes
Consequences:
- _______ pectoris
- Kidney disease
- heart failure
- __________ infarction
- stroke
- ______pathy (vision loss)
Lifestyle
Angina
Myocardial
retinopathy
Nitrates
- Nitrate»_space; nitric oxide
- increase formation of cGMP
- cGMP dephosphorylates»_space; vasodilation
(treat chest pain or lack of blood flow)
Adverse effects:
- *Facial Flushing
- Severe Heart Attack
- *Orthostatic hypotension
- Reflex Tachycardia
Notes:
Sublingual»_space; RAPID to treat acute angina attacks
PO (oral)»_space; Slower acting»_space; tx: angina (higher dose needed for 1st pass effect)
_ should not be taken with erectile dysfunction drugs _
Nitroglycerin
Vasoo Nitroo
New Drug
Decreases entry of sodium into heart»_space; decreases calcium overload»_space; decreases contractions = *prevents cardiac overload
Adverse effects:
- Arrhythmias = Prolonged QT (fast chaotic heartbeat)
- n/v/c
- dizzy
- HA
Ranoliazine
_____-ANGIOTENSIN SYSTEM BLOCKERS
• Turns off the ____ system and **lowers BP
• Blocks renin»_space; angiotensin»_space; angiotensin I»_space; angiotensin II
– Angiotensin II: Vasoconstrictor and _________ aldosterone causing sodium retention
Types
– ACE inhibiotrs
– ARB
RENIN
increases
_______ DRUGS:
• Thiazide diuretics
• Renin-angiotensin system blockers
– Angiotensin converting enzyme(ACE) inhibitors
– Angiotensin receptor blockers (ARB)
• Calcium channel blockers (CCB)
PRIMARY
_________ Drugs:
• Adrenergic receptor blockers
– β-blockers (BB);
– α1-blockers
• Sympathetic nerve blockers
– CNS α2 -adrenergic receptor agonists
- Direct vasodilators
- Others
Secondary
Alpha 2 blockers - CNS
Stimulates A2 in brain»_space; Reduces SNS input to the cardiovascular system
= vasodilation
= decrease HR & BP
_________ - crosses BBB
___________ - used in pregnancy
Adverse effects
- Sedation
- Dry Mouth
- Withdrawal Sydrome
Need to taper the dose slowly
Clonidine
Methyldopa
IV vasodilator
Adverse effect:
Profound hypoTN
Sodium nitroprusside
IV vasodilator
Adverse effect:
Symptomatic hypoTN
Nesiritide
Phosphdiesterase
Adverse effect:
Thrombocytopenia
Milrinone
