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Pharmacology > Week 5 ~ Drugs Affecting CVS/Renal/Electrolytes > Flashcards

Week 5 ~ Drugs Affecting CVS/Renal/Electrolytes Flashcards

1
Q

2 Kinds of Positive Inotropic Drugs?

A
  1. Cardiac Glycosides: Digoxin
    ~ Obtained from Digitalis Plant Foxglove
  2. Phosphodiesterase Inhibitors: Milrinone
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2
Q

Cardiac Glycosides Mechanism of Action

A

~ Used for heart failure

~ Control ventricular response to arterial fibrillation and flutter

~ Increase myocardial contractility

~ Change electrical conduction properties of the heart

     - Decrease rate of electrical conduction
     - Prolong the refractory period, between SA node and AV node

~ Reduces heart rate and improves cardiac efficiency

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3
Q

Cardiac Glycosides Drug Effects

A
  1. Increases stroke volume
  2. Decrease venous blood pressure
  3. Increase in coronary circulation
  4. Promotion of diuretics due to improved blood circulation
  5. Positive Inotropic effect
  6. Negative chronotropic effect
  7. Negative dromotropic effect
  8. Palliative of exertion all and paroxysmal nocturnal dyspnea, cough,
    Cyanosis
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4
Q

What’s a Positive Inotropic Effect?

A

Increase in force of the heart

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5
Q

What’s a Negative Chronotropic Effect?

A

Reduced heart rate

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6
Q

What’s a Negative Dromotropic Effect?

A

Decreases the automaticity at SA node, decreases AV node conduction

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7
Q

Cardiac Glycosides Indications

A

Heart Failure

Supra ventricular Dysrhythmias
- Atrial Fibrillation and atrial flutter

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8
Q

Cardiac Glycosides Contraindications

A

Drug allergy

2nd or 3rd degree heart block

Ventricular tachycardia or fibrillation

Sub-aortic stenosis

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9
Q

Digoxin Adverse Effects

A

Very narrow Therapeutic window

Drug levels and electrolyte levels must be monitored

Low potassium levels increase its toxicity

Dysrthmias: Tachycardia or bradycardia

Headaches, fatigue, confusion, convulsions

Coloured vision (green, yellow, purple), halo

Anorexia, nausea, vomiting, diarrhea

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10
Q

Digoxin Toxicity Therapy

A

Hyperkalemia K> 5mmol/L can cause life threatening
Dysrhythmia

Digoxin immune Fab (antibodies) therapy

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11
Q

Phosphodiesterase Inhibitors Mechanism of Action

A

Work by inhibiting the enzyme phosphodiesterase

Results in a Positive Inotropic Response and Vasodilation

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12
Q

What’s the name of the only Phosphodiesterase Inhibitor in Canada?

A

Milrinone

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13
Q

Indications for Phosphodiesterase Inhibitors

A

Used for short term management of heart failure

Given when the patient hasn’t responded to treatment with digoxin, diuretics or vasodilators

Given as weekly 6 hour infusions

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14
Q

Phosphodiesterase Inhibitors Contraindications

A

Drug Allergy

Severe aortic or pulmonary valscular disease

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15
Q

Milrinone Adverse Effects

A

Dysthymia, mainly ventricular

Hypotension, angina, hypo kalmia, tremor, thrombocytopenia

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16
Q

Milrinone Drug Interactions

A

With Diuretics:

Hypovolemia
Reduced cardiac filling pressure

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17
Q

Digoxin Adverse Effects

A

Potentiates Inotropic Effects

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18
Q

What’s a Dysrhythmia?

A

Any deviation from the normal rhythm of the heart which can be seen on ECG

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19
Q

What are AntiDysrhythmic Drugs?

A

Drugs used for the treatment and prevention of disturbances in cardiac rhythm

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20
Q

3 Common Dysrhthmias

A
  1. Supra Ventricular Dysrhythmias
  2. Ventricular Dysrhythmias
  3. Conduction Blocks
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21
Q

Vaughan Williams Classification

A
  1. Class 1: Block Na Channels
    • class 1a
    • class 1b
    • class 1c
  2. Class 2: decrease spontaneous depolarization
  3. Class 3: prolong action potential duration
  4. Class 4: blocks Ca channels
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22
Q

What do Vaughan Williams Class 1 drugs do?

A
  1. Membrane stabilizing drugs
  2. Fast sodium channel blockers
  3. Increase the action potential duration (APD)

~Divided into 3 different classes

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23
Q

Class 1a Drugs

A

Procainamide

Quinidine

Disopyramide

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24
Q

Class 1b Drugs

A

Phenytoin

Lidocaine

Mexiletine

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25
Q

Class 1c Drugs

A

Propafenone

Flecainide

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26
Q

Class 1 Drugs Mechanism of Action and Indications

A

Atrial/Ventricular fibrillation

Premature atrial/ventricular contractions

Ventricular Tachycardia

Wolff Parkinson White Syndrome

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27
Q

What is Wolff Parkinson White Syndrome?

A

A condition in which there is an extra electrical pathway of the heart. The condition can lead to tachycardia.

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28
Q

Class 2 Drugs Mechanism of Action and Indications

A

B-Blockers

Reduce or block sympathetic nerve system

Used as antianginal and anti hypertensive drugs

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29
Q

Class 2 B-Blocker drugs

A
  1. Acebutolol
  2. Esmolol
  3. Propranolol
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30
Q

Class 3 Drugs Mechanism of Action and Indications

A

Increase action potential duration

Used for Dysrhythmias that are difficult to treat

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31
Q

Class 3 drugs

A
  1. Amiodarone

2. Sotalol (Also exhibits class 2 properties)

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32
Q

Class 4 Drugs

A
  1. Verapamil

2. Diltiazem

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33
Q

Class 4 Drugs Mechanism of Action and Indications

A

~ Calcium Channel blockers

~ Inhibit slow channel (calcium dependant) pathways

~ Reduce AV node conduction

  • used for paroxysmal Supra Ventricular tachycardia, rate control for atrial fibrillation and flutter
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34
Q

What are Unclassified AntiDysrhythmic Drugs?

A

Have properties of several classes and are not placed into one particular class

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35
Q

What’s the name of an Unclassified AntiDysrhythmic drug?

A

Adenosine

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36
Q

What does Adenosine do?

A

Slows conduction through the AV node

Has a very short half life - less then 10 sec

Ad instead only as intravenous push

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37
Q

AntiDysrhythmic Drug Adverse Effects

A

ALL can cause Dysrhythmias!

Hypersensitivity reactions

Nausea, vomiting, diarrhea

Dizziness, blurred vision, headache

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38
Q

AntiDysrhythmic Drug Interactions

A

Commonly potentiates anticoagulant activity of warfarin (Coumadin)

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39
Q

What is Acute Coronary Syndrome?

A

Group of clinical symptoms compatible with acute myocardial Ischemia

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40
Q

What’s Angina?

A

When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart and the heart muscle “aches”

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41
Q

Drugs for Angina

A
  1. Nitrates and Nitrites
  2. B-blockers
  3. Calcium Channel Blockers
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42
Q

2 Nitrate/Nitrite Drugs

A
  1. Isosorbide Dinitrate

2. Nitroglycerin

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43
Q

Nitrate/Nitrite Mechanism of Action

A

Potent vasodilator, mainly affecting the venous vascular bed

Dose dependant effect atrial vasodilator effect

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44
Q

What’s the Prototypical Nitrate?

A

Nitroglycerin

Has large first pass effects with oral forms

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45
Q

Nitrate Indications

A
  1. Stable, unstable angina and vasospasm
  2. Rapid acting forms are used to treat acute anginal attacks
  3. Hypertensive emergencies
    * Long acting Nitrates are used to prevent anginal episodes in Hypertensive emergencies*
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46
Q

Nitrate/Nitrite Contraindications

A

Drug Allergy

Severe anemia

Closed Angle Glaucoma

Hypotension

Severe head injury

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47
Q

Nitrate/Nitrite Adverse Effects

A

Headaches

Tachycardia, postural hypotension

Tolerance

48
Q

What is Tolerance?

A

Occurs in patients taking long acting formulations or taking them continuously

49
Q

How to prevent Nitrate Tolerance…

A

Transdermal forms

Remove patch at bedtime for 8hours and apply a new patch in the morning

50
Q

Nitrate/Nitrite Drug Interactions

A

Addictive hypotensive effects when taken with:

  - alcohol
  - B-blockers
  - Calcium Channel Blockers
  - Phenothiazines
  - Sildenafil
51
Q

B-Blocker Drugs

A

Atenolol

Metoprolol

Propranolol

Nadolol

52
Q

What is CardioProtective?

A

After MI, high level of circulating Catecholamines can be blocked by B-Blockers

53
Q

3 Calcium Channel Blocker Drugs

A
  1. Benzodiazepines
    • Diltiazem Hydrochloride
  2. Dihydropyridines
    • Nifedipine
    • Amlodipine Besylate
    • Nimodipine
    • Felodipine
  3. Phenylalkylamines
    • Verapamil Hydrochloride
54
Q

Calcium Channel Blockers Mechanism of Action

A

Cause coronary artery vasodilation

Cause peripheral arterial vasodilation, decreasing systemic vascular resistance

Reduce the workload of the heart, decrease myocardial oxygen demand

55
Q

Calcium Channel Blockers Indications

A

Angina, hypertension and supraventricular tachycardia (first line)

Treat coronary artery spasms (Prinzmetal’s Angina)

Short term management of atrial fibrillation and flutter

56
Q

Calcium Channel Blockers Adverse Effects

A

Hypotension

Tachycardia

Bradycardia

Constipation

Nausea

Dyspnea

57
Q

Calcium Channel Blockers Drug Interactions

A

~ Diltiazem interferes with metabolism and elimination of cyclosporine

~ Grapefruit juice can reduce the metabolism of Calcium Channel Blockers

58
Q

Antihypertensive Drug Ethnocultural Considerations

A

B-Blockers and Angiotension-converting enzyme (ACE) inhibitors are more effective in White patients over Black patients

Calcium Channel Blockers (CCBs) and diuretics are more effect in Black patients then White patients

59
Q

What’s the Canadian Hypertension Education Program?

A

Endorses:

  1. Home blood pressure monitoring
  2. Annual Bp assessment for pre hypertension
  3. Ongoing routine assessment

LifeStyle Modifications:

  1. Regular exercise
  2. Stress reduction
  3. Moderation in alcohol
  4. Healthy diet and reduction in sodium

Treat to Target:

  1. Less then 140/90 mm Hg
  2. Less then 130/80 mm Hg in those with diabetes/chronic kid disease
60
Q

What are Positive Inotropic Drugs?

A

Drugs that increase the force of myocardial contraction.

These drugs are used to treat heart muscle failure

61
Q

6 Antihypertensive Drugs

A
  1. Adrenergic Drugs
  2. Angiotensin - converting enzyme inhibitor
  3. Diuretics
  4. Vasodilators
  5. Angiotensin 2 receptor blockers (ARBs)
  6. Calcium Channel Blockers
62
Q

4 ACE Inhibitors

A
  1. Benazepril Hydrochloride
  2. Captopril (Can be used in liver dysfunction)
    • short half life
  3. Enalapril
    • oral/Parenteral forms
  4. Lisinopril and Quinapril
    • newer drug, long half life, once a day dosing
63
Q

ACE Inhibitor Mechanism of Action

A

Block the angiotensin converting enzyme thus preventing the formation of angiotensin 2

Prevent the breakdown of Bradykinin
- result in vasodilation, decreased systemic vascular

64
Q

ACE Inhibitor Indications:

A

Hypertension

Heart Failure

Drugs of choice for diabetic patients

65
Q

ACE Inhibitor Contraindications

A

Drug Allergy

Lactating women and children

Bilateral rental artery stenosis or hyperkalemia

66
Q

ACE Inhibitor Adverse Effects

A

Fatigue

Headache

Impaired Taste

Dry Cough

Dizziness

Mood Changes

67
Q

ACE Inhibitor Drug Interactions

A

Lithium can result in lithium toxicity

No steroidal anti-inflammatory drugs can reduce the effect

Potassium supplements and potassium sparing diuretics may result in hyperkalemia

68
Q

Angiotensin 2 Receptor Blockers Mechanism of Action

A

Newer class, well tolerated and doesn’t cause a dry cough!

Allow angiotensin 1 to be converted to angiotensin 2 but block the receptors that receive angiotensin 2

Block vasoconstriction and release of aldosterone

69
Q

2 Angiotension 2 Receptor Blocker Drugs

A
  1. Losartan Potassium

2. Valsartan

70
Q

Angiotension 2 Receptor Blocker Indications

A

Used primarily in patients who can’t tolerate ACE inhibitors

Diuretics

Hypertension

Adjunctive drugs from the treatment of heart failure

71
Q

Angiotension 2 Receptor Blocker Contraindications

A

Drug Allergy

Pregnancy

Lactation

72
Q

Angiotension 2 Receptor Blocker Adverse Effects

A

Upper respiratory infections

Headache

Dizziness

Inability to sleep

Diarrhea

Dyspnea

Heartburn

Nasal Congestion

Back pain

Fatigue

73
Q

Angiotension 2 Receptor Blocker Drug Interactions

A

Cimetidine

Phenobarbital

Rifampin

74
Q

Calcium Channel Blockers Mechanism of Action

A

Cause smooth muscle relaxation by blocking the binding of calcium to its receptors and preventing muscle contraction

This causes decreased peripheral smooth muscle tone and decreased systemic vascular resistance

Decreased blood pressure results

75
Q

Calcium Channel Blocker Indications

A

Angina

Hypertension

Dysrhthmias

Migraines

Raynaud’s Disease

76
Q

Diuretics ~ Thiazide Mechanism of Action

A

Most commonly used and first line Anti-Hypertensives in the CHEP guidelines

Decrease the plasma and extra cellular fluid volumes

Decreased pre-load

Decreased total peripheral resistance

Decreased workload of the heart and decreased blood pressure

77
Q

3 Types of Vasodilators

A
  1. Hydralazine Hydrochloride
  2. Minoxidil
  3. Sodium Niitroprusside
78
Q

Vasodilator Mechanism of Action

A

Directly relax arteriolar and venous smooth muscle

Result in decreased systemic vascular response, decreased after load and peripheral vasodilation

79
Q

Vasodilator Indications

A

Hypertension

Sodium Nitroprusside is reserved for the management of hypertensive emergencies

80
Q

Vasodilator Contraindications

A
  1. Drug Allergy
  2. Hypotension
  3. Cerebral Edema
  4. Head injury
  5. Acute myocardial infarction (MI)
  6. Coronary Artery Disease
81
Q

Vasodilator Hydralazine Adverse Effects

A 
Dizziness
Headache
Anxiety
Tachycardia
Nausea/Vomiting
Dyspnea
Edema
Anemia
Diarrhea
Nasal Congestion
82
Q

Vasodilator Sodium Nitroprusside Adverse Effects

A

Bradycardia

Hypotension

83
Q

How much of the human body is water (TBW)?

A

60%

84
Q

3 main compartments that TBW is distributed?

A
  1. Intracellular Fluid (ICF)
  2. Interstitial Fluid (ISF)
  3. Plasma Volume (PV)
85
Q

What is Crystalloids?

A

IV fluids that supply water and Na to maintain osmotic gradient between extravascular and intravascular compartments

86
Q

Types of Crystalloids?

A
  1. Normal Saline (0.9% Sodium Chloride)
  2. Hypertonic Saline (3% Sodium Chloride)
  3. Lactated Ringer’s
  4. D5W
  5. Plasma-Lyte
87
Q

Crystalloids Indications

A 
Dehydration
Acute Liver Failure
Acute Nephrosis
Burns
Adult Respiratory Distress Syndrome
Shock
Kidney Dialysis
Reduction of the risk of deep vein thrombosis
Hypotroteinemia
88
Q

Crystalloids Contraindications

A

Drug Allergy

Hypervolemia

Severe electrolyte disturbance

Drug interactions are rare!

89
Q

Crystalloids Adverse Effects

A

Edema, especially peripheral and pulmonary

May dilute plasma proteins

May have sort lived effects

90
Q

What are Colloids?

A

Increase Colloid Oncotic Pressure

Protein substance that move fluid from interstitial compartment to plasma compartment

91
Q

3 Types of Colloids

A
  1. Albumin + Na + Cl
  2. Dextran + Na + Cl
  3. Hetastarch + Na + Cl
92
Q

Colloid Indications

A

Superior to Crystalloids in plasma volume expansive but more expensive

93
Q

Colloid Contraindications

A

Drug Allergy

Severe electrolyte disturbance

Usually safe adverse effects

94
Q

What are Blood Products?

A

Blood products pull fluid from extravascular space into intravascular space

RBC products carry oxygen

Blood products increase the body’s supply of various products such as clotting factors and hemoglobin

95
Q

3 Types of Blood Products and their Indications

A
  1. Cryoprecipitate and Plasma Protein Fractions
    • Manage acute bleeding
  2. Fresh Frozen Plasma
    • Increase clotting factor levels
  3. Packed red cells and Whole Blood
    • Loss of blood
96
Q

Blood Products Adverse Effects

A

Anaphylaxis

Incompatibility with recipients immune system

Transmission of pathogens such as hep, Hiv

97
Q

Types of Electrolytes

A

Potassium

Sodium Cations

Chloride Cations

Calcium

Magnesium

Phosphorus

98
Q

What is Hypokalemia?

A

Serum Potassium levels less than 3.5 mmol/L

99
Q

Causes of Hypokalemia?

A

Digoxin Therapy

Corticosteroids

Loop Diuretics

Vomiting/Diarrhea

Ketoacidosis

100
Q

Potassium Contraindications

A

Drug allergy

Severe Kidney Disease

Acute Dehydration

Severe hemolytic disease

101
Q

Potassium Adverse Effects

A

Diarrhea

Nausea/Vomiting

GI bleeding

Ulcerations

102
Q

Potassium Drug Interactions

A

ACE inhibitors

With diuretics and amphotericin B

103
Q

Sodium Adverse Effects

A

Nausea/Vomiting

Cramps

Can cause phlebitis with IV route administration

104
Q

What is a normal Sodium concentration?

A

135 - 145 mmol/L

105
Q

What is Hyponatremia?

A

When sodium serum levels are below 135 mmol/L

Same causes as Hypokalemia

106
Q

What is Sodium responsible for?

A

~ Control of fluid and electrolyte balance

~ Participate in Acid-Base balance

107
Q

How is Sodium administered?

A

Available as intravenous normal saline or lactated Ringer’s solution

108
Q

3 Types of Fluids given in hospital?

A
  1. Crystalloids
  2. Colloids
  3. Blood Products
109
Q

3 Types of Hydralazine?

A
  1. Adrenergics
  2. Antihypertensive
  3. Monoamine oxidase inhibitors
110
Q

Type of Minoxidil?

A

Antihypertensives/ Thiazides

111
Q

Monoamine oxidase inhibitor mechanism and result?

A

M –> Altered Biotransformation

R –> Increased Hypotensive Effect

112
Q

Antihypertensives/Thiazides Mechanism and Result?

A

M –> Additive Effects

R –> Increased hypotensive effect

113
Q

Antihypertensives Mechanism and Result?

A

M –> Additive Effects

R –> Increased Hypotensive effect

114
Q

Adrenergics Mechanism and Result?

A

M –>Antagonism

R –> Decreased Hypotensive effect

115
Q

What’s the only drug that has a Decreased Hypotensive Effect?

A

Hydralazine –> Adrenergics

Pharmacology (6 decks)

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