Pharm 5 Cardio pt5

Question 1

How do ACE-I & ARBs lower bp?

Answer 1

reduction in systemic vascular resistance with either no effect or a minimal increase in cardiac output
BP reduction is not accomplished by changes in heart rate

Question 2

How do ACE-I act on the kidneys?

Answer 2

ACE-I act on the renal vasculature to reduce arteriolar resistance, improved renal hemodynamics and improve diabetic nephropathy

Question 3

Prototypical ACE-Inhibitor
Example
Indication

Answer 3

Lycinapril

Indications: hypertension

Question 4

CI of ACE-I

Answer 4

ACE-I angioedema
Pregnancy: Cat D
Precaution renal impairment

Question 5

Why precaution ACE I if it protects your kidneys?

Answer 5

It’s be helpful unless the kidney disease or CHF is too advanced.

Question 6

ACE-I have interactions with _, can result in _

Answer 6

diuretics; hyperkalemia can occur with potassium-sparring diuretics or supplements; may increase lithium levels

Question 7

Prototypical Angiotensin Receptor Blocker (ARB)
Example
Indication

Answer 7

Olmesartan

Indications: hypertension

Question 8

ARBs end in:

Answer 8

“-sartan”

Question 9

If Olmesartan 20 mg isn’t holding their bp, you can do what?

Answer 9

Add Hydrochlorothiazide

Question 10

DRI
Example (only drug in its class)
Good & Bad thing about it

Answer 10

Aliskirin
If on this drug for a few weeks and you miss doses, blood pressure does not go back up. It takes up to 2 weeks for bp to go back up.

Question 11

Cardiac Glycosides
Example
Mechanism

Answer 11

Digitalis
Inhibits the Na-K-ATP-ase pump, causing an increase in intracellular sodium
This makes an Inotropic effect on cardiac cells through enhancement of excitation-contraction coupling triggered by membrane depolarization

Question 12

Effects of Cardiac Glycosides (Digitalis) (6)

Answer 12

Inc force of myocardial contraction
Dec SA node by stimulating vagal activity
Prolong conduction to AV node due to this vagal activity
Inc refractory period of AV node
Inc peripheral vascular resistance
Dec heart rate through vegal mechanisms

Question 13

IV Cardiac Glycoside
Example
3 different types & each’s effects

Answer 13

Dobutamine
Low dose (below 8) - Inc myocardial contractility and CO, AV dilation
High dose (above 10) - tachycardia, arrhythmia, splanchnic, and renal vasoconstriction. Associated with symptomatic benefit.
continuous home pump infusion (for patients with CHF to improve their quality of life)

Question 14

4 sites of action of drug that Treat CHF.
What’s the mechanism for each?
What drug classes fall into each?

Answer 14

Venous system - Reduce preload. Venous dilators: Nitrates, ACE-inhibitors, Alpha-blockers
Arterial system - Reduce afterload. Arterial dilators: ACE-inhibitors, Hydralazine, Ca++ antagonists, Alpha-blockers
Kidney - Reduce blood volume. Diuretics
Left Ventricle - Inotropics: Digoxin; Myocardial protectants including B-blockers

Question 15

Scenario to understand Cardiac Glycosides

Answer 15

Think of the AV Node as the neck of the funnel

Digitalis “narrows” the neck of the funnel

Question 16

__ is the first drug found to slow conduction through the AV Node. Aka narrowing the neck of the funnel.

Answer 16

Digitalis

Question 17

Digitalis slows down heart rate but __.

Due to this what is more effective?

Answer 17

Takes 18 hours to do so.
A shot of Verapamil takes a couple minutes to do it (more effective time-wise, doesn’t poison the heart, no drug-drug interactions)

Question 18

Digitali comes in what forms? (3) (both are PO). Which is better absorbed?

Answer 18

tablets are 60-80% absorbed
elixir is 70-85% absorbed
Lanoxi-caps (solution filled capsules) are 90-100% absorbed

Question 19

Digitalis Distribution (won’t be writing this drug)

Answer 19

Highest concentrations are found in the myocardium, skeletal muscle, liver, brain and kidneys
It is not widely distributed in fatty tissues
Digoxin crosses the blood-brain barrier and the placenta

Question 20

Digitalis Metabolism. How can it be especially dangerous?

How many days until steady state or elimination?

Answer 20

57-75% of digoxin is excreted by the kidneys unchanged
In patients with impaired renal function, significant accumulation may occur
This is especially dangerous because of the 36-hour half-life
6 days are required to reach steady-state or elimination

Question 21

Digoxin vs Dialysis. Is it removed? Why?

Answer 21

Digoxin is not removed by dialysis because it is distributed in tissue and not blood

Question 22

Adverse effects of Digitalis (that the boards will ask about)

Answer 22

yellow/green haloes/visual disturbances

Question 23

How to assess a patient who sees haloes/visual disturbances

Answer 23

If it’s drug-related: Digitalis

If it’s the illness: Glaucoma

Question 24

*BQ: Digitalis overdose presents itself with what EKG dysrhytmia? What causes it?

Answer 24

You can see any arrhythmia caused by digitalis. Tachy brady arrhythmia is most common. A patient who is tachycardic goes into bradycardia, then goes back and forth over a nonspecific period of time.
Due to the poisoning of the Na-K ATPase pump.

Question 25

*BQ: : Digitalis overdose presents itself with what EKG dysrhythmia?
What is it due to?

Answer 25

You can see any arrhythmia caused by digitalis. Tachy brady arrhythmia is most common. A patient who is tachycardic goes into bradycardia, then goes back and forth over a nonspecific period of time. Due to the poisoning of the Na-K ATPase pump.