Pharm 5 Cardio pt4 Flashcards
Combination/Vasodilating Selective a- and ß-Adrenergic Blockers (3 examples and their route of admin)
Oral only: Carvidilol, Nebivolol
IV/Oral: Labetolol
Side effects of a-blockers (3)
Postural hypotension, especially with first dose(s)
Tachycardia
Increased mortality
2 Centrally Acting Sympatholytics: a2-Adrenoceptor Agonists
Clonidine
Methyldopa
Central action of alpha-2 adrenoceptor agonists
Stimulation of 2 adrenoceptors in the brainstem reduces sympathetic tone, causing a centrally mediated vasodilatation and reduction in heart rate
Clonidine is useful in: (3)
Diagnosis of pheochromocytoma
Hypertensive patients IN WITHDRAWAL*
Also available in a once-weekly, trans-dermal
the only hyptertensive drug that is available in a patch-formulation.
For ppl who have difficulty remembering their medications.
Clonidine
5 classes (route of entry) of Common Nitrate Formulations (Vasodilators)
SL, TOP, TransDermal Patch, PO, IV
all Prototypical version is Nitro
Sublinguals are Absorbed within __ seconds
15-20 seconds
Nitro tablets are weakened by __ and __, so…
air & light, so it’s kept in a brown bottle.
Note about TOP Nitro
*Ointment is flammable. Nitro ointment on a patient’s chest must be wiped off before using AED b/c you’ll set them on fire.
If it’s dermal, don’t wipe it off with your hand – you’ll get a wicked headache, feel dizzy, and possibly pass out b/c it’s a vasodilator that makes you hypotensive.
Where is IV Nitro mainly used?
IV is used more often in ED and ICU
What is Nitro approved for? What causes this problem? How does it work?
FDA approved to alleviate chest pain - vasodilate coronary arteries to supply greater blood supply to the heart. The problem is ppl’s coronary arteries are hard (from calcium), and can’t be dilated.
? Peripheral arteries and arterials are dilated. This dec venous return, dec CO, reduces chest pain
Prototypical ORAL Nitrate
Example
Indication
Isosorbide
Indications: prophylaxis and treatment of angina; NOT for acute attacks
Prototypical S/L Nitrate
Example
Indication
Nitroglycerine
Indications: prophylaxis and treatment of angina including acute attacks
Prototypical Topical Nitrate
Example
Indication
Nitroglycerine
Indications: prophylaxis of angina; not indicated for acute attacks
Drugs On the Renin-angiotensin System (3)
ACE-I, ARBs, DRIs
Clinical Indications for ATII Antagonists (ARBs) (4)
Hypertension
DM in those intolerant of ACE-I
Heart failure
Decreases re-stenosis rate following angioplasty
Pimp question: Why do people have a cough from Ace Inhibitors?
B/c it’s a buildup of bradykinin that causes the cough.
ARBs and DRIs don’t build up bradykinin therefore no cough happens.
ACE Inhibitors
Mechanism of Action
Inhibition of angiotensin II formation
reducing vascular tone - vasodilating
and reduced aldosterone secretion (loss of negative feedback because of decreased angiontensin II - less Na-K secretion & slight increase in serum K+
5 labeled uses of ACE-I
Hypertension Heart failure Myocardial infarction Left ventricular dysfunction Diabetic nephropathy
4 off-label uses of ACE-I
Hypertensive crisis
Rheumatoid arthritis
Idiopathic edema
Raynaud’s syndrome
All ACE-I’s end in
-pril
Among the advantages of ACE-I (and ARBs) is their relative freedom from:
freedom from serious adverse metabolic, respiratory, or CNS side effects
do not affect serum lipid levels and reports of sexual dysfunction are almost non-existent
Abrupt withdrawal does not result in rebound hypertension
None of the ppl who get the ACE-I cough get it from ARB
potentially serious, but rare, problems of ACE-i (not the cough) (3)
Hyperkalemia, Hypotension, ARF
If a patient wants to take a med to lower their heart rate but go to the gym, what’s better?
Beta-blocker and go to the gym: you feel exhausted. B/c you can’t increase your heart rate now.
ARBs don’t block your heart rate so you can exercise normally.
