Pharmachology - CV Flashcards
What is a Cardiac arrhythmia?
Change in automaticity, conductivity or both. Heart Without rhythm
What is Dysrhythmia?
Abnormal rhythm of the heart
What are Arrhythmias and Dysrhythmia brought on by?
Hypoxia
Ischemia
K levels - high or low
What are the 4 types of arrhythmias or Dysrhythmia ?
Sinus (bradycardia, tachycardia)
Atrial (fibrillation, flutter)
Nodal or junctional (AV node)
Ventricular (often life threatening: PVC, V tachycardia, V fibrillation)
Classifications of antiarrhythmic Meds:
Class I
Class I - Na channel blockers
Lidocaine (Xylocaine)
Classifications of antiarrhythmic Meds:
Class II
Class II Beta Adrenergic Blockers
Propranolol (Inderal)
Classifications of antiarrhythmic Meds:
Class III
Class III Potassium Channel blockers
Amiodarone (cordarone)
Classifications of antiarrhythmic Meds:
Class IV calcium
Channel blockers
Verapamil (calan)
Characteristics of Class I Anti arrhythmics:
Na channel blockers
Lidocaine (Xylocaine)
Blocks the movement of Na into cardiac cells
Slows conduction
Tx rapid ventricular arrhythmias.
Cardiac use only.
Must say on label “IV use for ventricular arrhythmias.
Metabolizes by liver and excreted by kidneys
Lidocaine common ADE
Hypotension, bradycardia, “lidocaine crazies”
Serious lidocaine ADE
Cardiac arrest and seizures
Lidocaine contraindications (1st classification) Na channels blockers
Dig toxicity, heart failure/block and allergy to med
Characteristics of Class II Anti arrhythmics:
Beta Adrenergic blockers
Propranolol (Inderal)
Blocks the SNS and slows down ventricular conduction.
Neg chronotropic, inotropic. Used to treat rapid ventricular Arrhythmias, HTN and Angina
Common ADE: bradycardia, hypotension, lethargy
Serious ADE: bronchoconstricion
Characteristics of Class III Anti arrhythmics:
K channel blockers
Amiodarone (Cordarone)
Slow repolarization and prolongs the refractory period.
Use to treat life threatening arrhythmias ONLY. By ACLS this is the 1st line of defense recommended
Common ADE: tremors, n/v, hypotension
Serious ADE: pulmonary toxicity, exacerbation of arrhythmia, hepatotoxicity.
Characteristics of Class IV Anti arrhythmics:
Calcium channel blockers
Verapamil (Calan)
Slows depolarization and decrease ventricular rate
Also used to treat HTN and angina
Common ADE: constipation, dizziness, orthostatic hypotension, edema.
Serious: hypotension, dradycardia.
Non-pharmacological treatment of arrhythmias?
Treat underlying disorder. Valsalva or carotid artery massage. Defibrillate. Pacemakers, AICDs. Ablation
What happens in Angina ?
Increase myocardial O2 demand. (Exercise, stress, anxiety, smoking and cold weather
What happens in Angina II?
Decrease O2 supply to myocardium (atherosclerosis, arteriosclerosis, diabetes)
Types of Angina
Most common “classics or stable angina”. Goes away when the patient rests. Patients can tell you intensity, triggers and is very predictable.
Antianginal medications
1- nitrates
2- beta blockers
3- calcium channel blockers
All work by decreasing myocardial O2 demand and/or increasing blood supply to the myocardium
Organic nitrates - Nitroglycerine (nitrostat)
Dilate veins
Dilates coronary arteries
Dilate arterioles
Preload
Think of terms of volume
Afterload
Pressure
Nitrates ADE
Common: headache, orthostatic hypotension
Serious: severe hypotension
Contraindications: hypotension, phosphodiesterase inhibitors (Viagra)
Heart pumps
5-6 L/min
Antianginal medication: Nitrates patch
Careful with hairy chest. Need skin contact. Dispose of it carefully. Cleanse the area where the patch was daily. As nurses wear gloves to avoid headaches
Antianginal medication. Beta blockers
Propranolol (Inderal). Decrease heart rate, neg chronotropic/neg inotropic.
Decrease BP –> decrease myocardial workload and oxygen demand
Po Long term management of angina. Also tx HTN, arrhythmias
Common: hypotension, bradycardia, lethargy
Serious: bronchoconstricion, heart block
Antianginal med: calcium channel blockers
Verapamil (Calan)
Slows the movement of extra cellular calcium in the cell –> coronary & peripheral heart dilation –> decrease Afterload –> increase blood supply to the heart and reduce workload of the heart.
Tx - use to treat Angina when NTG or BB don’t work.
Diuretic medication
Diuresis: excretion of fluid, esp water
Categories of diuretics
Thiazides (hydrochlorothiazide) Loop - Furosemide (Lasix) Potassium sparing or Aldosterone antagonist -spironolactone (Aldactone) Osmotic - Mannitol (Osmitrol)
Diuretics: Thiazides (hydrochlorothiazide)
Not the choice if we need a patient to get rid of fluid immediately. Not for immediate diuresis.
Diuretics: Loop - Furosemide (Lasix)
Renal diuresis. They give a rapid immediate response if given PO 30- 45 min IV result in 5 min.
Diuretics: K+ Sparing
Don’t loose K
Uses: HTN, liver disease
Not used in renal disease
Do not use K supplements
Diuretics: Osmotics. Mannitol
Uses: intracranial pressure (ICP), glaucoma, oliguria/anuria
Short term IV use only
Diuretics intervention
Watch the potassium K
Normal is 3.5 - 5.2
Meaning of weight for patients on Diuretics
1 Lt weights 1kg (2.2 lbs)
HTN risks
MI
CFH (congestive heart failure)
CVA and hemorrhage
Renal disease
What is primary HTN
90-95% of people. Not one cause. It is a variety of issues
What is secondary HTN
Hypertension that is secondary to something else. Example: renal issues, central nerves sys issues, renal arteries, use of Meds like long term steroids, Meds retaining water and sodium. To cure you must find the cause
Arteriosclerosis
Thickening of the vessels. They are not as flexible anymore
What are the target organs affected by HTN
Heart (MI heart attack)
Brain (CVA stroke)
Kidneys (renal failure)
Eyes (retinopathy)
HTN treatment
Stepped : use several different meds to attack the problem and minimized side effects Lifestyle modification Diuretics Combination therapy Add a third medication Maximize drug doses
HTN treatment
ACE Inhibitors
Prevents Angiotensin I from becoming II
Captopril (Capoten)
Decrease afterload
Decrease preload
Thus decrease the workload of the heart
ACE Inhibitors effects?
Well tolerated but common side effect:
Dry cough
Serious ADE: angioedema
Black Box: avoid 2nd and 3rd trimester of pregnancy
Note: great to tx DM as it preserves kidney function
HTN treatment:
Angiotensin II receptor blockers
Losartan (Cozaar)
ARB
Blocks the Angiotensin II
Txs HTN and HF (CHF)
Common ADE: Upper respiratory infection, dizziness, orthostatic, hypotension.
Serious ADE: angioedema
HTN treatment:
Calcium channel blockers
Verapamil (calan)
Slows the movement of extra cellular Ca into the cell.
Decrease afterload
Good for patients with migraine and asthma (who cannot take beta blockers)
Common ADE: constipation, dizziness edema
Serious ADE: profound hypotension and bradycardia
HTN treatment
2nd line Anti-hypertensive drugs
Beta blockers
Propranolol (Inderal)
First choice for pt’s with history of MI, stable HF, angina
Treatment for Hypertensive Crisis?
HTN BP > 210/120 Sodium nitroprusside (Nitropress) Decrease BP slowly and systematically Med must be mixed in IV fluids b/c can cause excessive hypotension Cyanide toxicity - almond breath
Causes for Heart Failure?
MI
HTN
Anything that decrease the pumping ability or increase the workload of the heart and drops the CO
Drug therapy for heart failure
ACE Beta blockers Diuretics (decreasing preload) Inotropic: Digoxin Antianginal meds Vasodilators
What happens in blood coagulation?
Thrombus - blood clot
Embolus - piece of blood clot breaks off and travels to the heart, brain and lungs.
Drugs affecting blood coagulation
Anticoagulants: best in preventing venous thrombus
Drugs affecting blood coagulation
Anti platelet drugs are best in preventing arterial thrombus
Drugs affecting blood coagulation
Thrombolytics: lyse (break off) thrombus
Anticoagulants IV or subq?
Prototype: Heparin
Use to treat deep vein thrombosis, pulmonary emboli
ADE: bleeding
Serious: more bleeding, drop in platelets
Pt need labs for PTT: Norm 25-35 sec
Therapeutic PTT : 1 1/2 to 2 times normal 38 to 70 sec
Metabolize in liver and excreted in the kidneys
What is an antidote for heparin?
Protamine sulfate
Anticoagulant oral use?
Warfarin (Coumadin) PT - 12-13 seconds Therapeutic 18 seconds ADE: bleeding Serious: bleeding from anywhere (bloody nose, vomiting blood, coughing blood, in the urine/stool, bruising). Antidote: vitamin K
Antiplatelet drugs?
Prevent arterial thrombus. Interferes with platelet adhesion
ASA- aspirin (one a day and usually 81mg)
NSAID- bind with platelet only as long as the NSAID is in the system (about 4 hours)
Clopidogrel (Plavix)
ADE: bleeding
Thrombolytic drugs?
Alteplase (Activase)
Dissolve or lyse the clot
Treatment acute thromboembolic events: MI, PE, femoral thrombus
Goal: re establish blood flow and prevent tissue damage
“Limit time”
Drugs for hyperlipidemia
This meds are gonna lower lipids level in the blood which reduces mortality and morbidity.
Blood lipids? What do we talk about?
Cholesterol 60 (healthy one - preventitive) LDL N:
Drugs for hyperlipidemia
Lovastatin (Mevacor)
Common ADE: v/d, constipation
Pt teaching: continue w lifestyle changes. Take at bed time
Drugs for hyperlipidemia
Lovastatin (Mevacor)
Serious ADE:
Rhadomyolysis, Hepatotoxicity
Current recommendations for AHA for all patients with CVD
Statin ACE inhibitor Beta blocker ASA daily Nitro sl prn
What is the physiology of the CV system?
It is composed of: heart, blood vessels and blood.
Function: transport supplies to the cell and remove waste products.
Efficiency of CV system: ability to pump, patency of blood vessels, quality of blood and quantity of blood.
What is the conduction of the heart?
SA : 60-100 bpm
AV : 40-60 bpm
Ventricles: 20-40 bpm
ANS
What is the composition of blood?
55% plasma
45% solid particles
RBC (erythrocytes) - hct male 42% - 50% female 40% - 48%. Hgb male 13-18 and female 12-16
WBC (leukocytes) 5,000 to 10,000
Thrombocytes (platelets) 100,000 to 400,000
What do inotropics do?
They increase the force of myocardial contraction
Prototype: digoxin (lanoxin)
Uses of inotropic Digoxin?
Tx of heart failure Tx of atrial arrhythmias Tx sinus tachycardia Common ADE: n/v, anorexia, blurred vision, diplopia, halos, bradycardia, tachycardia Serious: ventricular fibrillation
What is digoxin toxicity?
N/v, confusion, blurred vision, bradycardia
Treatment: stop digoxin.
KCL, anti-arrhythmic, atropine for bradycardia and digibind
Who is at high risk for dig toxicity?
Hypokalemia (low K) Renal or liver failure Large loading dose Large maintenance dose Infants and aged Hypothyroidism Hypoxia
