Quiz 3 Study Guide: Cardiovascular Therapeutics Flashcards
By what 2 mechanisms is angina treated?
- Vasodilation (Increase flow)
- Nitrates and Nitrites
- Decrease O2 consumption
- B Blockers; Ca++ channel blockers
How do Nitrates/Nitrites work to treat angina?
Metabolize Nitric oxide to increase cGMP therefore relaxing smooth muscle and dilating cardiac vessels
What are some examples of Nitrates/Nitrites?
Nitroglycerine
Amyl nitrate
Characteristics of Nitroglycerine…
-Sublingual Administration
-Volatile (Sealed Glass bottle)
Long-lasting patches (8hrs)
Characteristics of Amyl-Nitrate
- Crushed ampule and fumes inhaled
- Short acting
Side effects of Nitrates/Nitrites
Orthostatic hypertension Tachycardia (reflex to dilation) Throbbing headache (Vasodilation)
Tolerance develops rapidly
How do Ca++ Channel Blockers work to treat angina?
Blocks contraction of smooth and cardiac muscle to reduce O2 demand.
What are Ca++ Channel Blockers used for?
Prophylaxis of angina (4-8 hour duration)
“take in the morning to prevent angina during the day”
What are examples of Ca++ Channel Blockers?
Verapamil
Nifedipine
Diltiazem
*also used as hypertensives
What Toxic side effects can be present with Ca++ Channel Blockers?
- Cardiac depression and bradycardia (Heart Failure)
- Flushing and dizziness.
How do B Blockers (B1) work to treat angina?
Decreases Blood output by decreasing the HR, causing BP and contractility to decrease.
- Not a vasodilator
- Prophylactic use
What are some examples of B blockers used to treat angina?
Propanolol (Nonselective - Pulmonary problems)
atemolol (B1 selective - less lung problems)
What Toxic side effects can be present with B Blockers?
- Asthma
- acute heart failure
What are non-drug lipid and cholesterol-lowering treatments?
Dietary
- 15-20% daily intake of fat calories
- avoid red meats
-Exercise
What do Statins do?
They are competitive inhibitors of HMG-COA Reductase.
*they reduce the synthesis of cholesterol (LDL) and reduce coronary events.
What are some examples of Statins?
Lovastatin (Mevacor)
Atorvastin (Lipitor)
Simvastatin (Zocor)
What are side effects of Statin Toxicity?
Liver Damage
Weakness in skeletal muscles.
What do Fibrates do?
Increases lipolysis in liver and muscles
*reduces VLDL, modest effect on LDL, and moderate increase in HDL. Reduces Triglycerides.
What is an example of a fibrate?
Fenobrate (Tricor)
*side effect is GI symptoms
What does Niacin (nicotinic acid) do?
Decreases triglyceride and LDL
*Tolerance develops
What is a side effect of Niacin?
Fairly pronounced Mild Flushing.
What do Bile acid-binding agents do?
Reduces reabsorption of bile acids and metabolite.
Toxicity: Constipation and Bloating
What is and example of a Bile acid-binding agent?
Cholesteramine
What do inhibitors of intestinal sterol absorption do?
Inhibits intestinal absorption of cholesterol and reduces LDL.
What is an example of and inhibitor of intestinal sterol absorption drugs?
Ezetimibe
What is the objective of treatment for patients with heart failure?
Reduce symptoms and slow progression
What are the 6 types of drugs that treat heart failure?
Positive Ionotropic Drugs B1 adrenoceptor agonists Diuretics ACE Inhibitors Vasodilators B adrenoceptor blockers
*Na+ restriction as dietary non-drug treatment
What do Positive Ionotropic drugs do?
Increases intracellular Ca++ and Cardiac contractility therefore increasing blood ejection.
What are examples of Positive Ionotropic Drugs?
Digitalis (foxglove)
Milrinone -this is really a Bipyridine drug
What are side effects of Positive Ionotropic Drugs?
Premature depolarization (arrhythmias)
Ectopic beats
Affects all excitable tissues
What is an example of a B1-adenoceptor agonist?
Dobutamine
*can cause arrythmias
What do diuretics do?
- Reduce salt and H2O retention and edema
- Reduce venous pressure and ventricular preload
What is an example of a diuretic?
Furosemide
What do ACE inhibitors do?
Reduce peripheral resistance by reducing salt and water
What is an example of an ACE inhibitor?
Captopril
What does a Vasodilator do?
Relax smooth muscle
What is an example of a Vasodilator?
Hydralazine
What does a B adrenoceptor blocker do?
Reduce heart rate and block the Sympathetic Nervous System
What is and example of a B adrenoceptor blocker?
metoprolol
What are characteristics of Cardiac Arrhythmias?
- 80% with history of Myocardial Infarct
- Requires treatment if there is significant reduction in cardiac output
- Treatments themselves can cause arrhythmias
What types of drugs treat Cardiac Arrhythmias?
Na+ channel blockers
B adrenergic blockers
Prolong refractory
Ca++ channel blockers
What do Na+ channel blockers do to treat cardiac arrhythmias?
Slows action potential conduction
Effective for most A or V arrhythmias.
*can precipitate new arrhythmias.
What is an example of a Na+ channel blockers used to treat cardiac arrhythmias?
Procainamide
Quinidine
Lidocaine
(Class 1)
Which drug is the 1st choice for ventricular arrhythmias.
Lidocaine
*low toxicity
What are Prolong refractory drugs used for when treating cardiac arrhythmias?
A fib. or V. arrhythmias
What is an example of a Prolong Refractory Drug?
Amiodarone
Class III
What is and example of a B blocker used for arrhythmias?
propanolol
Class II
What do Ca++ channel blockers do to treat cardiac arrhythmias?
Prolong refractory time
Peripheral Vasodilation
What is an example of a Ca++ blocker used to treat arrhythmias?
Verapamil
Diltiazem
(Class IV)
