Week 1 Flashcards
Ch. 22: Atrial Fibrillation
A common cardiac dysrhythmia involving atrial contractions that are so rapid that they prevent full depolarization of myocardial fibres between heart beats
Ch. 22: Automaticity
A property of specialized excitable tissue that allows self-activation through the spontaneous development of an action potential, as in the pacemaker cells of the heart
Ch. 22: Cardiac Glycosides
Glycosides (carbohydrates that yield a sugar and a non sugar upon hydrolysis) that are derived from the plant species Digitalis Purpurea and are used in the treatment of heart disease
Ch. 22: Chronotropic Drugs
Drugs that influence the rate of the heartbeat
Ch. 22: Dromotropic Drugs
Drugs that influence the conduction of electrical impulses
Ch. 22: Ejection Fraction
The proportion of blood that is ejected during each ventricular contraction compared with the total ventricular filling volume
Ch. 22: Heart Failure
An abnormal condition in which cardiac pumping is impaired as the result of myocardial infarction, ischemic heart disease, or cardiomyopathy
Ch. 22: Inotropic Drugs
Drugs that affect the force or energy of muscular contractions, particularly contraction of the heart muscle
Ch. 22: Left Ventricular End-Distolic Volume (LVEDV)
The total amount of blood in the ventricle before it contracts, or the preload
Ch. 22: Phosphodiesterase Inhibitors
A group of inotropic drugs that work by inhibiting the enzyme phosphodiesterase
Ch. 22: Refractory Period
The period during which a pulse generator (e.g., the sinoatrial node of the heart) is unresponsive to an input signal of specified amplitude and it is impossible for the myocardium to respond
Ch. 22: Therapeutic Window
The range of drug levels in the blood that is considered beneficial as opposed to toxic or ineffective
Ch. 22: What percentage of the general population does heart failure affect?
Heart failure affects 1% to 2% of the general population, or approximately 450,000 Canadians
Ch. 22: Signs and Symptoms of Left Ventricle Heart Failure
Producing pulmonary edema and symptoms of dyspnea or cough
Ch. 22: Signs and Symptoms of Right Ventricle Heart Failure
Producing symptoms such as pedal edema, jugular venous distention, ascites, and liver congestion
Ch. 22: What is the normal ejection fraction?
Approximately 65% (0.65) of the total volume in the ventricle
Ch. 22: What does increased hydrostatic pressure from the left ventricle lead to?
Pulmonary congestion
Ch. 22: What does increased hydrostatic pressure from the right ventricle lead to?
Systemic venous congestion and peripheral edema
Ch. 22: What are the two types of physical defects producing heart failure?
- A heart defect (myocardial deficiency such as myocardial infarction or valve insufficiency), which leads to inadequate cardiac contractility and ventricular filling
- A defect outside the heart (e.g., systemic defects such as coronary artery disease, pulmonary hypertension, or diabetes), which results in an overload on an otherwise normal heart
Ch. 22: What are the common causes of Inadequate Contractility?
Cardiomyopathy
Coronary artery disease
Infection
Myocardial infarction
Ch. 22: What are the common causes of Inadequate Filling?
Atrial fibrillation
Infection
Ischemia
Tamponade
Ch. 22: What are the common causes of Pressure Overload?
Hypertension
Outflow Obstruction
Ch. 22: What are the common causes of Volume Overload?
Anemia
Congenital abnormalities
Hypervolemia
Thyroid disease
Ch. 22: What is the most frequently prescribed cardiac glycoside?
Digoxin is the most fequenly prescribed cardiac glycoside and the only one currently available in Canada
Ch. 22: Data recently released on the use of cardiac glycosides
Digoxin therapy as a first line treatment of heart failure did not improve mortality rates. Angiotensin-converting enzyme (ACE) inhibitors and diuretics were recommended as the key drugs to offer therapeutic benefit
Ch. 22: What are the primary beneficial effects of a cardiac glycoside?
The primary beneficial effect f a cardiac glycoside is thought to be an increase in myocardial contractility. This occurs secondary to the inhibition of the sodium-potassium ATPase pump
Ch. 22: Digoxin…
Digoxin also auguments (cholinergic or parasympathetic) vagal tone, resulting in increased diastolic filling between heartbeats secondary to reduced heart rate. This further enhances cardiac efficiency and output
Ch. 22: What are the dramatic inotropic, chronotropic, dromotropic, and other heart effects that digoxin produces?
- A positive inotropic effect, resulting in an increase in the force and velocity of myocardial contraction without a corresponding increase in oxygen consumption
- A negative chronotropic effect, producing a reduced heart rate
- A negative dromotropic effect that decreases automaticity at the SA node, decreases AV nodal conduction, reduces conductivity at the bundle of His, and prolongs the atrial and ventricular refractory periods
- An increase in store volume
- A reduction in heart size during diastole
- A decrease in venous blood pressure and vein engorgement
- An increase in coronary circulation
- Promotion of dieresis as the result of improved blood circulation
- Palliation of exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis
Ch. 22: What is the primary use of Cardiac Glycosides?
Cardiac glycosides are used primarily in the treatment of heart failure and supra ventricular dysrhythmias
Cardiac glycosides are also effective in the treatment of supraventricular dysrhythmias such as atrial fibrillation and atrial flutter because of their negative chronotropic and negative dromotropic actions
Ch. 22: What are the contraindications to the use of cardiac glycosides?
Known drug allergy, may include second- or third- degree heart block, atrial fibrillation, ventricular tachycardia or fibrillation, heart failure resulting from diastolic dysfunction, and subaortic stenosis
Ch. 22: What are the common adverse effects of cardiac glycosides?
Any type of dysrhythmia including bradycardia or tachycardia. Headache, fatigue, malaise, confusion, convulsions. Coloured vision, halo vision, or flickering lights. Anorexia, N/V/D
Ch. 22: What are some of the possible interactions of cardiac glycosides?
Bran, taken in large amounts, may decrease the absorption or oral digitalis drugs.
Hawthorne (herbal supplement) can reduce the effectiveness of cardiac glycosides.
The consumption of excessive amounts of potassium-rich foods can decrease its therapeutic effect whereas the consumption of excessive amounts of liquorice can increase digoxin toxicity as the result of the hypokalemia produced. St. John’s wort (Hypericum perforatum) may interfere with intestinal digoxin absorption, resulting in low serum concentrations of digoxin
Ch. 22: What are Phosphodiestrerase Inhibitors?
Phosphodiesterase Inhibitors are a group of inotropic drugs that work by inhibiting an enzyme called phosphodiesterase. The inhibition of this enzyme results in two beneficial effects in an individual with heart failure: a positive inotropic response and vasodilation.
Ch. 22: What is the sole phosphodiesterase inhibitor available in Canada?
Milrinone
Ch. 22: How does Milrinone work?
Milrinone works by selectively inhibiting phosphodiesterase type III, which results in more calcium for the heart to use in muscle contraction. The increased calcium in heart muscle contraction. The increase calcium in heart muscle is also taken back up into its storage sites in the sacroplasmic reticulum at a much faster rate than normal. As a result, the heart muscle relaxes and is more compliant.
Ch. 22: What are the indications of Milrinone?
Milrinone is primarily used as an indicator for the short-term management of heart failure.
Traditionally, a PDI is administered to patients who can be closely monitored and who have not responded adequately to digoxin, diuretics, or vasodilators.
Many hospitals that treat large numbers of patients with heart failure now treat those experiencing end-stage heart failure with weekly 6-hour infusions of milrinone. This has been shown to increase patients’ quality of life and decrease the number of re-admissions to the hospital for exacerbations of heart failure
Ch. 22: What are the contraindications of PDIs?
Known drug allergy, and may include the presence of severe aortic or pulmonary valvular disease and heart failure resulting from diastolic dysfunction
Ch. 22: What are the adverse effects seen with milrinone therapy?
Primary adverse effects are ventricular dysrhythmia, occurring in approximately 12% of patients treated with this drug, hypotension (3.1%), headache (2.4%), angina, pectoris, and chest pain (1.4%), hypokalemia (0.7%), tremor (0.5%), and thrombocytopenia (0.5%)
Ch. 22: What is the toxicity and management of overdose for milrinone?
No specific antidote exists for an overdose f milrinone
Ch. 22: What are some of the interactions seen with PDIs (milrinone)?
Concurrent administration of diuretics may cause significant hypovolemia and reduced cardiac filling pressure. Also, additive inotropic effects may be seen with coadministration of digoxin. Furosemide must not be injected into IV lines of milrinone because it will precipitate immediately
Ch. 23: Action potential
Electrical activity consisting of a self-propagating series of polarizations and depolarizations that travel across the cell membrane of a nerve fibre during the transmission of a nerve impulse and across the cell membrane of a muscle cell during contraction or other activity of the cell
Ch. 23: Action potential duration (APD)
For a cell membrane, the interval beginning with baseline (resting) membrane potential followed by depolarization and ending with depolarization to baseline membrane potential
Ch. 23: Arrhythmia
Literally “no rhythm,” meaning absence of a heartbeat rhythm. More commonly used in clinical practice to refer to any variation from the normal rhythm of the heartbeat
Ch. 23: Cardia Arrhythmia Suppression Trial (CAST)
The name of the major research study conducted by the National Heart, Lung, and Blood Institute to investigate the possibility of eliminating sudden cardiac death in patients with asymptomatic, non-life threatening ectopy that has arisen after a myocardial infarction
Ch. 23: Depolarization
The movement of positive and negative ions on either side of a cell membrane across the membrane in a direction that tends to bring the net charge to zero
Ch. 23: Dysrhythmia
Any disturbance or abnormality in the rhythm of the heartbeat
Ch. 23: Effective refractory period (ERP)
The period after the firing of an impulse during which a cell may respond to a stimulus but the response will not be passed along or continued as another impulse
Ch. 23: Internodal pathways (Bachmann’s bundle)
Special pathways in the atria that carry electrical impulses spontaneously generated by the sinoatrial node. These impulses cause the heart to beat
Ch. 23: Relative Refractory Period (RRP)
The time after generation of an action potential during which a nerve fibre will show a (reduced) response only to a strong stimulus
Ch. 23: Resting membrane potential (RMP)
The transmembrane voltage that exists when cell membranes of heart muscle (or other muscle or nerve cells) are at rest
Ch. 23: Sodium-potassium adenosine triphosphatase (ATPase) pump
A mechanism for transporting sodium and potassium ions across the cell membrane against an opposing concentration gradient
Ch. 23: Sudden cardiac death
Unexpected, fatal cardiac arrest
Ch. 23: Threshold potential (TP)
The critical state of electrical tension required for spontaneous depolarization of a cell membrane
Ch. 23: Vaughan Williams Classification
The system most commonly used to classify antidysrhythmic drugs
Ch. 23: How many major classes of drugs does the Vaughan Williams classification identify?
4
Ch. 23: What are the four major classes of antidysrhythmic drugs?
Class I antidysrhythmics are considered membrane-stabilizing drugs, but they are further divided into Ia, Ib, and Ic drugs.
Class II drugs are B-blockers that depress phase 4 depolarization.
Class III drugs primarily prolong depolarization during phase 3.
Class IV drugs depress phase 4 depolarization during phases 1 and 2
Ch. 23: What is the gradual trend with the use of class Ia drugs?
There is a gradual current trend away from the use of class Ia drugs
Ch. 23: Which class Ic drug was removed?
The formerly available class Ic drug ecainide was removed from the market after research indicated that its risk of inducing fatal cardiac dysrhythmias overshadowed its dysrhythmia suppression effects. For similar reasons, the other two class Ic drugs, flecainide and propafenone, are generally used only in patients intolerant of other drugs