Section 4: Drugs That Affect The Cardiovascular System

Question 1

Pharmacological Terms to Describe Actions of Cardiovascular Drugs:

______ drugs affect heart rate. If this particular drug accelerates the heart, it is said to have a positive ______ effect. A drug that decreases the heart rate, is said to have a negative ______ effect.

Answer 1

Chronotropic (Pg. 312 Box 13-23)

Question 2

Pharmacological Terms to Describe Actions of Cardiovascular Drugs:

______ drugs affect conduction velocity through the conducting tissues of the heart. If the drug accelerates the conduction, it has a positive ______ effect. Drugs with negative ______ effects delay conduction.

Answer 2

Dromotropic (Pg. 312 Box 13-23)

Question 3

Pharmacological Terms to Describe Actions of Cardiovascular Drugs:

______ drugs strengthen or increase the force of cardiac contraction (a positive ______ effect). A drug that weakens or decreases the force of cardiac contraction has a negative ______ effect.

Answer 3

Inotropic (Pg. 312 Box 13-23)

Question 4

What is a serious dysrhythmia that is generated by antidysrhythmic agents. The sequential use of two or more antidysrhythmic drugs compounds these effects. As a rule, it is best not to use more than one agent to manage dysrhythmias.

Answer 4

Proarrhythmias (Pg. 312 NOTE)

Question 5

Because of the narrow therapeutic index of Cardiac Glycosides, describe some signs and symptoms that patients may develop at one time or another.

Answer 5

Most common side effect: anorexia; nausea or vomiting, visual disturbances, and dysrhythmias.

High index of suspicion: report experiencing flu like symptoms.

(Pg. 312)

Question 6

What is considered to be a key Cardiac Glycoside that is used to treat heart failure and to manage certain tachycardias?

Answer 6

Digoxin (Lanoxin) (Pg. 312)

Question 7

What kind of drug is used to treat and prevent disorders of cardiac rhythm?

These drugs may have a direct action on cardiac cell membrane (vasopressin) or by indirect action that affects the cells (propranolol), or both.

Answer 7

Antidysrhythmics (Pg. 313)

Question 8

Factors that may cause cardiac rhythm disturbances:

Answer 8

Ischemia, hypoxia, acidosis or alkalosis, electrolyte abnormalities, excessive catecholamine exposure, autonomic influences, drug toxicity, or scarred and diseased tissue. (Pg. 313)

Question 9

True or False:

All antidysrhythmic drugs have some ability to suppress automaticity

Answer 9

True (Pg. 313)

Question 10

Antidysrhythmic drugs are classified into categories based on their fundamental mode of action on cardiac muscle. Name the classes and what they achieve.

Answer 10

Class I: Sodium channel blockers that work to slow conduction (subclass Ia, Ib, Ic)
Class II: Beta-blocking agents that reduce adrenergic stimulation of the heart (metoprolol)
Class III: Potassium channel blockade, increasing contractility. Do NOT suppress automaticity. (amiodarone)
Class IV: Calcium channel blockers, block the inflow of calcium depressing myocardial and smooth muscle contraction, decreases automaticity. (verapamil, diltiazem) 

(Pg. 313)

Question 11

What type of drug is used to accomplish the following:

Maintain blood pressure
Maintain or improve blood flow
Reduce workload of the heart
Have no undesirable side effects
Permit long-term administration without intolerance

Answer 11

Antihypertensives (Pg. 313)

Question 12

What is the drug of choice in managing hypertension, and how does this type of drug work on the body?

Answer 12

Diuretics. They cause a loss of excess salt and water from the body by the kidneys. The decrease in plasma and extracellular fluid volume decreases preload and stroke volume (Pg. 313)

Question 13

Thiazides work well to lower blood pressure. Thiazides may be given with other drugs to help prevent the retention of sodium and water. What is a common example of a thiazide diuretic?

Answer 13

Hydrochlorothiazide (HCTZ) (Pg. 313)

Question 14

What type of antihypertensive drug inhibits sodium and chloride reabsorption in the loop of henle?Because of the excessive loss of potassium, hypokalemia and profound dehydration can be a result of their use.

Answer 14

Loop diuretics (strong, short acting agents) (furosemide) (Pg. 314)

These drugs are prescribed to patients who have renal insufficiency and to patients who cannot take other diuretics

Question 15

Beta-blocking agents and adrenergic-inhibiting agents are what type of antihypertensive?

Answer 15

Sympathetic Blocking Agent (Pg. 314)

Question 16

Describe how beta-blocking agents work and what they are used to treat?

Answer 16

Treat: cardiovascular disorders, suspected MI, high-risk unstable angina, and hypertension.

Work by decreasing cardiac output and inhibiting renin secretion from the kidneys resulting in lowering blood pressure (Pg. 314)

Beta1-blocking: Atenolol, metoprolol
Beta1-and beta2- blocking: Labetalol, propranolol

Question 17

How do Adrenergic-inhibiting agents work?

How are they classified?

Answer 17

Work by modifying the actions of the sympathetic nervous system, thus reducing blood pressure.

centrally acting adrenergic inhibitors
Or
peripheral adrenergic inhibitors

(Pg. 314)

Question 18

Which type of drug acts directly on the smooth muscle walls of the arterioles, veins, or both? Lowering peripheral resistance thus lowering the blood pressure.

Answer 18

Vasodilator Drugs (Pg. 314)

Question 19

True or False:

Vasodilators stimulates the parasympathetic nervous system, resulting in having to provide medications that inhibit the sympathetic response?

Answer 19

False!

Vasodilators stimulate the sympathetic nervous system and also activates the baroreceptor reflexes. In turn this leads to an increase in heart rate, cardiac output, and renin release. Medications that inhibit the sympathetic response usually are given with vasodilators.

(Pg. 314)

Question 20

True or False:

Renin-angiotensin-aldosterone system plays a key role in maintaining blood pressure, sodium and fluid balance.

Answer 20

True (Pg. 314) - refer to chapter 11

Question 21

How do Angiotensin-Converting Enzyme (ACE) Inhibitor drugs work?

What are some examples?

Answer 21

By inhibiting conversion of the precursor angiotensin I to the active molecule angiotensin II (a process triggered by ACE), the renin-angiotensin-aldosterone system is suppressed and blood pressure is then lowered.

lisinopril, captopril, enalapril, benazepril

(Pg. 314-315)

Question 22

What type of antihypertensive agent reduces peripheral vascular resistance by inhibiting the contractility of vascular smooth muscle?

Examples: verapamil, amlodipine, felodipine, diltiazem

Answer 22

Calcium Channel Blockers (Pg. 315)

Question 23

Along with ACE inhibitors (“prils”), what is a newer class of antihypertensive agent that blocks the renin-angiotensin-aldosterone system more completely?

Answer 23

Angiotensin II Receptor Antagonist (Pg. 315)