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NURS 804: Pharmacology > Unit 5: Cardiovascular Drugs > Flashcards

Unit 5: Cardiovascular Drugs Flashcards

1
Q

The PARASYMPATHETIC portion of the autonomic nervous system is primarily

ADRENERGIC or CHOLINERGIC?

A

CHOLINERGIC

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2
Q

The SYMPATHETIC portion of the autonomic nervous system is primarily

ADRENERGIC or CHOLINERGIC?

A

ADRENERGIC

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3
Q

When alpha-1 adrenergic receptors are stimulated, what results? (Think: cardiovascular)

A

VASOCONSTRICTION

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4
Q

When alpha-2 adrenergic receptors are stimulated, what results?

A

Affect postsynaptic nerve terminals (nerve itself) —> affects neurotransmitter release —> STIMULATES CNS

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5
Q

When beta-1 adrenergic receptors are stimulated, what is the primary result?

A

Cardiac stimulation: INCREASED HEART RATE

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6
Q

When beta-2 adrenergic receptors are stimulated, what is the primary result?

A

DILATION/RELAXATION of SMOOTH MUSCLE:

—decreased BP
—bronchodilation
—glycogenolysis —> increase in serum glucose

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7
Q

What do SNS Agonists do?

A

— Stimulate BETA-1: increase contractility, increase heart rate
— Stimulate BETA-2: vasodilation
— Stimulate ALPHA-1: vasoconstriction

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8
Q

Name 4 SNS AGONISTS used in the ACUTE setting:

A
  1. Dopamine
  2. Dobutamine
  3. Epinephrine
  4. Norepinephrine
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9
Q

What is DOPAMINE, and what does it do?

A

— SNS Agonist to DOPAMINE receptors
— effects are DOSE-DEPENDENT
— LOW DOSE: renal and coronary vasodilation, stimulates BETA-1 in the heart which increases heart rate and cardiac output
— HIGH DOSE: more ALPHA stimulation —> VASOCONSTRICTION

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10
Q

What is DOBUTAMINE, and what does it do?

A

— adrenergic AGONIST
— stimulates BETA-2
— stimulates BETA-1 to increase contractility
— TX: cardiogenic shock and severe heart failure

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11
Q

What is EPINEPHRINE, and what does it do?

A
    • SNS agonist with preference for BETA-1

- - increases contractility and heart rate

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12
Q

What is NOREPINEPHRINE, and what does it do?

A
    • SNS agonist with preference for ALPHA receptors

- - increases vasoconstriction and blood pressure

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13
Q

RISKS of SNS agonists

A
    • stimulation of adrenergic system can PRECIPITATE ARRHYTHMIAS d/t tachycardia
    • tachycardia can lead to DECREASED CARDIAC OUTPUT
    • ISCHEMIA AND TISSUE DAMAGE due to vasoconstriction:
    • – coronary arteries –> ischemia
    • – splanchnic circulation –> ischemia
    • – peripheral vessels –> decreased circulation to hands and feet –> tissue damage
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14
Q

Define splanchnic circulation

A

gut circulation

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15
Q

Name drugs with SNS agonist effects (but are not SNS agonists)

A

milrinone

vasopressin

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16
Q

What is MILRINONE, and what does it do?

A

phosphodiesterase inhibitor
increases contractility
vasodilation
good for beta blocker overdoses

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17
Q

What is VASOPRESSIN, and what does it do?

A

vasopressor
contracts smooth muscles
no effect on heart rate or contractility because it does not work on the CNS
improvement in BP due to vasoconstriction

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18
Q

What is DIGOXIN, and what does it do?

A

inhibits Na/K pump –> improves contractility to slow heart rate
USED in heart failure to improve symptoms; but DOES NOT improve mortality

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19
Q

ADVERSE EFFECTS of DIGOXIN

A

brady arrhythmias, especially if K+ is too low

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20
Q

ANTIDOTE to DIGOXIN

A

DIGIBIND

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21
Q

When is DIGIBIND used?

A

For life-threatening dysrhythmias/overdose due to/of digoxin

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22
Q

What is MIDODRINE, and what is it used for?

A

oral pressor
metabolized in body; active metabolite is an ALPHA-1 agonist
TX: orthostatic hypotension

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23
Q

What is FLUDROCORTISONE, and what is it used for?

A

synthetic corticosteroid
increases blood volume due to increased sodium and water retention
TX: orthostatic hypotension

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24
Q

What do ALPHA-1 BLOCKERS do to the CV SYSTEM?

A

vasodilation via peripheral arterioles

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25
Name 4 ALPHA-1 BLOCKERS
1. terazosin 2. prazosin 3. doxazosin 4. tamsulosin
26
What is key to remember about the ALPHA-1 BLOCKERS?
1st dose precipitous hypotension --> use low 1st dose
27
How do the ALPHA-2 AGONISTS work?
vasodilation ALPHA-2 stimulates CNS --> inhibits NE release --> inhibits vasoconstriction --> VASODILATION
28
Name 2 ALPHA-2 AGONISTS
1. clonidine | 2. methyldopa
29
What is clonidine used for?
1. hypertension | 2. relaxation
30
METHYLDOPA is rarely used; what do we use it for, and what is unique about it?
hypertension one of the rare BP meds that are okay to use in pregnancy
31
What beta blocker is good for heart failure as it also has an alpha-blocking effect?
carvedilol
32
Name 7 beta blockers
1. metoprolol 2. labetalol 3. atenolol 4. bisoprolol 5. esmolol 6. carvedilol 7. nebivolol
33
What beta blocker is nonselective, but selective at very low doses?
nebivolol
34
What beta blocker is good for aortic dissection because it cuts down on the shear force?
labetalol
35
What beta blockers also have alpha blocking effects?
labetalol | carvedilol
36
What to watch for with beta blockers?
BRONCOCONSTRICTION due to blocking of beta-2, especially in asthmatics (BETA-2 agonism causes broncodilation) BRADYCARDIA HYPOTENSION
37
Why do we often prefer selective beta blockers?
less likely to block beta-2 and cause issues for asthmatics
38
What can happen with abrupt withdrawal of beta blockers?
hypertension | tachycardia
39
When can rebound hypertension or tachycardia (from beta blocker withdrawal) cause ANGINA or MI?
in a patient with CAD
40
What can happen with beta blockers and cholesterol?
elevated LDL; low HDL (difficult to manage cholesterol when on a beta blocker)
41
What kinds of drugs have effects similar to beta blockers?
vasodilators and calcium channel blockers
42
Name 4 vasodilators
nitroprusside (IV) nitroglycerin (IV, SL, PO, patch) hydralazine (IV, PO) minoxidil (PO)
43
What to watch for with nitroprusside?
cyanide toxicity
44
What vasodilator is okay for use in pregnancy?
hydralazine
45
What side effect do we watch for with minoxidil use?
HYPERTRICHOSIS (abnormal amount of hair growth)
46
Name the 2 categories of calcium channel blockers
1. dihydropyridines | 2. nondihydropyridines
47
What to watch for with calcium channel blockers?
bradyarrhythmias | hypotension
48
Why is calcium important in the cardiac system?
Need it for muscle contraction
49
How do the calcium channel blockers work?
prevent calcium from entering cells --> decrease vascular smooth muscle contraction DECREASE CARDIAC CONTRACTILITY DECREASE CARDIAC CONDUCTION RATE
50
What drug category is helpful for large vessel stiffness in older adults?
calcium channel blockers
51
Name 4 dihydropyridine calcium channel blockers
1. amlodipine 2. nifedipine 3. nimodipine 4. nicardipine
52
name a phenylalkylamine nondihydropyridine calcium channel blocker
verapamil
53
name a benzothiazepine nondihydropyridine calcium channel blocker
Diltiazem
54
What adverse effect should we monitor for with amlodipine use?
peripheral edema (patients d/n like it)
55
What is RENIN?
renin is released when kidneys believe blood volume is low
56
What does renin do?
stimulates release of ANGIOTENSIN 1 from the liver
57
What is the difference between ANGIOTENSIN 1 and ANGIOTENSIN 2?
ANGIOTENSIN 1 is inactive ACE converts ANGIOTENSIN 1 to ANGIOTENSIN 2 ANGIOTENSIN 2 is a potent vasoconstrictor
58
What does ANGIOTENSIN 2 do?
a potent vasoconstrictor which increases blood pressure stimulates pituitary to release ADH stimulates adrenals to release ALDOSTERONE
59
What does Aldosterone do?
Aldosterone stimulates reabsorption of sodium and water to increase blood volume and excretion of potassium
60
Name 6 ACE Inhibitors
1. lisinopril 2. enalapril 3. captopril (shortest acting) 4. quinapril 5. fosinopril 6. benazepril
61
What to watch for with ACE inhibitors
renal failure hyperkalemia creatinine tends to bump up, but not by a ton cough (troublesome, but not usually dangerous) ANGIOEDEMA
62
What causes ANGIOEDEMA with ACE Inhibitors?
decreased breakdown of bradykinin (probably also causes cough)
63
What do ACE Inhibitors tend to end with?
"-PRIL"
64
What do ARBs tend to end with?
-SARTAN"
65
What is an ARB? What does it do?
Angiotensin II Receptor Blocker | after angiotensin II is produced, it blocks receptor sites
66
Name 5 ARBs
1. losartan 2. candesartan 3. valsartan 4. olmesartan 5. telmesartin
67
ARBs tend to have less hyperkalemia; why?
they do not affect aldosterone
68
Why do we not tend to use direct renin inhibitors?
they are new brand name expensive not any more effective than ACE-Is or ARBs
69
What are aldosterone receptor antagonists also known as?
potassium sparing diuretics
70
Name 2 potassium sparing diuretics
1. spironolactone | 2. eplerenone
71
Eplerenone is newer and more expensive. What is the advantage of eplerenone over spironolactone?
no gynecomastia
72
What to watch for with potassium sparing diuretics like spironolactone?
hyperkalemia | gynecomastia
73
What to watch for with diuretics?
``` hypokalemia electrolyte imbalance dysrhythmias fluid imbalance renal failure due to removing too much fluid ```
74
Name 2 diuretics that work on the proximal convoluted tubule. What are these diuretics called?
1. mannitol 2. acetazolamide "OSMOTIC DIURETICS"
75
Name 2 diuretics that work on the ascending limb of the Loop of Henle. What are these diuretics called?
1. furosemide 2. bumetanide "LOOP DIURETICS"
76
Name 2 diuretics that work on the distal convoluted tubule. What are these diuretics called?
1. hydrochlorothiazide 2. metolazone "THIAZIDE DIURETICS"
77
Name 2 diuretics that work just past the distal convoluted tubule. What are these diuretics called?
1. spironolactone 2. triamterene "POTASSIUM SPARING DIURETICS"
78
What to watch for with thiazide diuretics like HCTZ?
AGRANULOCYTOSIS - -extreme leukopenia - -fever - -ulcerations of mucous membranes
79
For whom are thiazide diuretics contraindicated?
people with a sulfa allergy
80
Which diuretic is very potent when given in combination with Loop diuretics? How is it given?
Metolazone | give 15-30 minutes prior to loop diuretic dose
81
Why are thiazide diuretics weaker?
the decrease reabsorption of water, sodium, bicarbonate, and chloride; BUT most sodium has already been reabsorbed by this point
82
What to beware of with Loop diuretics?
agranulocytosis | SJS
83
What is AGRANULOCYTOSIS?
- -extreme leukopenia - -fever - -ulcerations of mucous membranes
84
For whom are loop diuretics contraindicated?
people with sulfa allergies | pregnant women
85
How do osmotic diuretics work?
produce rapid diuresis by increasing the solute load (osmotic pressure) of glomerular filtrate --> inhibits reabsorption of water increased osmotic pressure causes water to be pulled from extravascular sites
86
What to remember for Bronchospastic Airway Disease?
avoid beta blockers with active symptoms also taking long-acting beta agonists if necessary, choose a cardioselective agent
87
What to remember for pregnant patients?
avoid ACE-I/ARB in 3rd trimester (teratogenic) | ok for HTN: methyldopa, hydralazine
88
What to remember for PVD?
beta blockers can worsen symptoms of claudication
89
What to remember for renal insufficiency?
avoid potassium-sparing diuretics and aldosterone antagonists (as these patients probably already have difficulty clearing potassium)
90
What to remember with gout?
diuretics can aggravate/initiate a gout flare
91
What to remember in patients who have experienced angioedema?
avoid ACE-I and ARB
92
What classes of drugs are used to treat heart failure?
1. ACE-I or ARB (if intolerant, use hydralazine plus nitrate) 2. Beta Blockers 3. aldosterone antagonist 4. digoxin 5. diuretic (only if needed to maintain fluid balance)
93
For heart failure treatment, what beta blockers to use?
FIRST CHOICE: carvedilol (added vasodilation effect); use the highest dose pt will tolerate (not great for rate control) NEXT CHOICE: metoprolol succinate 200mg (1st choice if rate control also needed
94
According to JNC8 guidelines, what are the targets for blood pressure management?
60+ <150/90 | <60 <140/90
95
If a patient has CKD, to manage hypertension, what drug class should be chosen first?
ACE-I or ARB
96
In the black population, what are the preferred drug classes for managing hypertension?
thiazide diuretic or CCB
97
What drug classes are used to manage CAD/Angina?
nitrates beta blockers CCBs (dihydropyridines)
98
What are the long-acting nitrates?
isosorbide-dinitrate | isosorbide-mononitrate

NURS 804: Pharmacology (42 decks)

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