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NURS 365 - Pharmacology in Nursing > Week 9 + 10: Cardiovascular > Flashcards

Week 9 + 10: Cardiovascular Flashcards

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1
Q

Cardiovascular Prototype Drugs

A
  1. atorvastatin (Lipitor)
  2. methyldopa (Aldomet)
  3. prazosin (Minipress)
  4. atenolol (Tenormin)
  5. hydralazine (Apresoline)
  6. verapamil (Calan, Isoptin)
  7. lisinopril (Prinivil)
  8. losartan (Cozaar)
  9. nitroglycerin
  10. hydrochlorothiazide (Hydrodiuril)
  11. furosemide (Lasix)
  12. spironolactone
  13. mannitol
  14. digoxin (Lanoxin)
  15. Potassium
  16. Quinidine
  17. lidocaine (Xylocaine)
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2
Q

Respiratory drugs focused mainly on what receptors

A

Beta 2

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3
Q

Statin

A

Cardiovascular Drug Class

“Anti-Lipid” / Lower Cholesterol / Antilipemic Drugs

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4
Q

All Cholesterol/Anti Lipid Drugs end in…

A

-statin

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5
Q

How do statins affect lipid levels

A

Increases HDL (modestly - a little)

Decreases LDL, Total Cholesterol, VLDL, and Triglycerides (Main impact)

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6
Q

Atherosclorosis

A

Buildup of fatty plaque on the arterial walls

Narrows vessels but also makes the vessel more stiff - then the vessel cannot expand and constrict which is bad

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7
Q

The first thing to be done to lower elevated lipid levels is…

A

modify diet and exercise

Ex: Less meat, cheese, saturated fats, trans fats

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8
Q

What can be done after dietary/lifestyle changes for lipid levels

A

Drug therapy

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9
Q

A major cause of atherosclerosis is…

A

excess plasma levels of lipoproteins

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10
Q

What are the 2 ways we can modify/decrease lipoprotein

A
  1. Modify Diet and Exercise

2. Drug therapy if dietary changes do not work

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11
Q

VLDL

A

lipoprotein

produced in the liver, delivers triglycerides to adipose tissue and muscle

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12
Q

LDL

A

cholesterol

a by product of VLDL metabolism

delivers cholesterol to the liver and tissues

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13
Q

HDL

A

cholesterol

removes cholesterol from tissues

has a “good” protective effect

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14
Q

Nonpharmacologic Ways to Alter Plasma Lipoproteins

A

Diet modification (decrease LDL and triglyceride)

Weight loss - can be just a little

Exercise - even if you are not losing weight or change diet (Doesnt need to be strenuous just some movement)

Smoking (increases LDL and decreases HDL)

DM, Hypothyroidism, excessive ETOH ingestion increases risk

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15
Q

Alcohol ingestion can be toxic to ___ muscle as well

A

Heart

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16
Q

Most cases of high cholesterol/lipids will need to undergo

A

drug therapy for it - hard to change their ways

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17
Q

We want to lower ___ cholesterol without decreasing ___ cholesterol

A

LDL; HDL

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18
Q

Ideal LDL and HDL levels

A

LDL - Below 100

HDL - 40-60

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19
Q

What is important to know about how antilipemics work

A

They only ACT PROPHYLACTICALLY - they do not remove existing plaque, just prevents more from occurring

Once plaque is there it will stay there

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20
Q

What are the 2 basic mechanisms of Antilipemics

A
  1. Suppress lipoprotein formation

2. Accelerate removal (of lipoproteins)

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21
Q

Prototype Drug for Antilipemics

A

atorvastatin (Lipitor)

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22
Q

Statin means…

A

antilipemic

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23
Q

What is the classification of atorvastatin

A

Anti-lipid (HMG-CoA reductase inhibitor)

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24
Q

Action of atorvastatin (Lipitor)

A

Decreases the enzyme (HMG-CoA) which usually helps us make Cholesterol (which decreases the amount of cholesterol made)

Inhibits the enzyme thus decreasing cholesterol synthesis

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25
Q

Main 3 ADRs to Know for atorvastatin

A
  1. Muscle Issues
  2. Liver Function Issues (Serum Transaminase Levels)
  3. Peripheral Neuropathy
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26
Q

ADRs of Atorvastatin

A

Serum Transaminase levels (watch liver function)

Peripheral Neuropathy (tinglinh, numbing, fumbling in hands and feet)

Muscle: Pain, myalgia severe, myostitis, muscle weakness, rhabdomyolysis (muscle death or breakdown)

Other: Mild and transient GI disturbances, rash, HA, sleep issues, lupus like syndrome

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27
Q

When is atorvastatin given?

A

It can be given orally one time a day either with food or not

Older statins needed to be taken at night because as we sleep is when most cholesterol is made but the newer drugs do not need to worry about this

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28
Q

What 2 things should never be drunk with atorvastatin

A
  1. Alcohol - It can already cause liver disease/damage so taking alcohol will further increase this
  2. Grapefruit Juice - it inhibits statin metabolism causing toxic level buildup
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29
Q

What should be done at the beginning of atorvastating therapy and periodically throughout

A

liver function tests

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30
Q

When is atorvastatin contraindicated and why

A

Pregnancy

This is because cholesterol is important to the neurological system when the fetus is forming its neurological system from scratch so we do not want to prevent that

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31
Q

Atorvastatin may enhance the clinical effects of what other medicine

A

oral anticoagulants (bleeding risk)

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32
Q

What can you not eat while taking a statin drug

A

grapefruit juice

it inihibits statin metabolism meaning toxic level buildup can occur leading to toxic ADRs - even if its just once in a while

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33
Q

The important formula to know for Antihypertensive drugs is…

A

BP = CO x TPR (Total peripheral resistance0

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34
Q

TPR

A

Total Peripheral Resistance

It is how open or shut your arteries/arterioles are

If the vessels are tight and constricted BP will increase - also CO increases will increase BP

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35
Q

What prototype drugs are anti-hypertensives

A
  1. methyldopa (Aldomet)
  2. prazosin (Minipress)
  3. atenolol (Tenormin)
  4. hydralazine (Apresoline)
  5. verapamil (Calan, Isoptin)
  6. lisinopril (Prinivil)
  7. losartan (Cozaar)
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36
Q

What things do anti-HTN drugs influence to lower BP

A

CO

TPR

Vessels

The Heart

Variety of places

37
Q

What things determine CO

A

HR

Contractility

Blood Volume

Venous Return (less return means decreased BP out of the heart)

38
Q

What thing determines TPR

A

arteriolar constriction

39
Q

What are some Non-Pharmacological Approaches for BP

A

Exercise

Weight Reduction (even just a small %)

Lower sodium intake (most comes from restuarants/fast food)

Lower Alcohol intake (Not good for the heart)

Reduce Stress

Sleep (7-8 hours a night)

40
Q

What kind of exercise is best for BP

A

aerobic exercise (even just a walk)

41
Q

What is the general approach to using anti-hypertensives / lowering BP

A

Mixing non-pharm and drug methods, but the goal is to have the drugs being used working in different ways so they do not duplicate each other

42
Q

The overall goal (levels) for BP treatment are what

A

To reduce BP to <120/80!!! for most people WITH THE FEWEST SE (some people get dizzy and fall when that low)

43
Q

What level is now considered HTN

A

above 130/80

44
Q

What are the groups of drugs/actions that are used for HTN

A

Promotion of salt excretion (Diuretics)

Decrease Sympathetic NS Activity

Vasodilators

Calcium Channel Blockers

Angiotensin II Inhibitors and Related Drugs

45
Q

What action/type of anti-hypertensive is most effective at decreasing BP

A

The ones that inhibit SNS function

*Ganglionic blockers work well too but they also affect the PNS so they can cause widespread effects - more used for antihypertensive crisis

46
Q

What is the most common side effect with all Anti-Hypertensives

A

HYPOTENSION (usually postural/orthostatic)

47
Q

Since Interference with SNS activity either centrally or peripherally make for the most effective BP drugs, what situations are they most used for

A

Mild to Moderate HTN

Those with impaired renal fxn too

48
Q

SNS interfering BP Drugs are often used with…

A

a thiazide diuretic

49
Q

methyldopa (Aldomet)

A

Anti-HTN Medicine

The one drug working on Alpha 2 Receptors

50
Q

Classification of methyldopa

A

Sympatholytic Anti_HTN, Alpha 2 Adrenergic AGONIST

51
Q

What does it mean to be an alpha 2 agonist

A

It connects to alpha 2 receptors in the brain, and when these are instigated they tell the brain to DECREASE/LOWER SNS Effects

52
Q

Is methyldopa (Aldomet) a first line anti hypertensive medication?

A

No it is a second line therapy

53
Q

Basically, methyldopa will …

A

inhibit SNS response (to decrease HTN)

54
Q

What is another use for methyldopa (Aldomet) in regard to lower BP

A

it can be used to drop HTN related to withdrawal from substance abuse

55
Q

Action of Methyldopa

A

Central Mechanism (Brain/Medulla) - Reduces sympathetic outflow

Reduces amount of Norepinephrine formed which results in decreased peripheral resistance and dropped SNS signalling

56
Q

With Methyldopa there is little to no…

A

cardiac output effect

57
Q

Absorption and Route of methyldopa

A

oral - good

58
Q

ADRs of Methyldopa

A
  1. POSTURAL/ORTHOSTATIC HYPOTENSION
  2. SEDATION (some CNS effects go away)
  3. Na/H2O RETENTION IF NOT RECEIVING A DIURETIC

Other: Depression, Dry Mouth, Nasal Congestion, HA, Fever, Decreased WBC + Platelet, Hepatic Dysfunction, Sexual Dysfunction

59
Q

Why do Anti-HTN meds often need a diuretic given with it (like methyldopa)

A

If BP is riding lower than the usual set point then the body recognized that and will try to hold onto Na and H2O to try and raise BP as a compensation mechanism

So, we need a diuretic to fight this issue

60
Q

When is methyldopa contraindicated

A

liver disease hx

Major Depression hx

61
Q

When is a special case of HTN where methyldopa can be utilized

A

PIH - pregnancy induced HTN 6-7 mo into the pregnancy

62
Q

Alpha 1 Blocker activation causes ____

A

vasoconstriction

63
Q

Prototype drug that is an antihypertensive, alpha 1 adrenergic antagonist (blocker)

A

prazosin (Minipress)

64
Q

Action of prazosin (Minipress)

A

Blocks Alpha 1 Stimulation (blocks vasoconstriction) which means vasodilation occurs (arterioles and veins open up) so BP will lower

Net Result: Antagonizes Alpha 1 to prevent constriction by alpha stimulation causing vasodilation and decreased TPR

65
Q

ADRs of prazosin (Minipress)

A
  1. ORTHOSTATIC HYPOTENSION
  2. REFLEX HR Response - palpitations, tachycardia
  3. First Dose Phenomenon

Other: HA, Dizziness, Syncope, Diarrhea, Dry Mouth, peripheral Edema, urinary urgency, IMPOTENCE

66
Q

What is the Reflex Response that occurs from prazosin (Minipress)

A

When the baroreceptors in the brain detect a BP decrease, and it is unable to control the vessels (antibypertensive) or evn Na and H2O levels (diuretic) then it will increase HR

So whenever you dilate blood vessels there is a natural tendency of the heart to try and up BP using this reflex

67
Q

First Dose Phenomenon

A

prazosin (Minipress)

One dose causes a massive drop in BP

Make sure the patient is sitting down or lying down so they do not fall over

68
Q

What 2 situations can prazosin (Minipress) (or Alpha 1 Stimulation) be useful in

A
  1. HTN

2. BPH - relaxes smooth muscles and allows easier urination/pressure

69
Q

Beta blocker drugs usually end in what

A

-olol / -lol

70
Q

Selective Beta Adrenergic Inhibitor

A

Beta Blocker (Selective)

Only blocks Beta 1 Receptors

71
Q

Non-Selective Beta Adrenergic Inhibitor

A

Beta Blocker (Non-selective)

Blocks both Beta 1 and Beta 2 –> More SE than seletive Beta Blocker

72
Q

What type of drug may also be given a selective beta adrenergic inhibitor

A

an Alpha 1/Antihypertensive because beta 1 blockers can prevent the reflex tachycardia seen with vasodilators

73
Q

Why might you never give a Beta 2 Blocker to someone with something like COPD

A

it may cause bronchoconstriction

74
Q

What is the main reason beta blockers are used

A

to decrease cardiac workload (decrease heart rate, cardiac output, etc)

75
Q

Someone post-MI cannot leave the hospital without….

A

beta blockers - the heart has been injured and we need to decrease the workload on it

76
Q

Prototype Drug that is a Selective Beta 1 Adrenergic Inhibitor

A

atenolol (Tenormin)

77
Q

Action of atenolol (Tenormin)

A

Blocks Beta 1 Adrenergic Receptors to cause AntiHTN, AntiAnginal, AntiArrhythmic

78
Q

3 Important Effects of atenolol (Beta 1 Blocker)

A
  1. Anti HTN
  2. Anti Anginal (reduce myocardial O2 consumption)
  3. Anti Arrhythmic (Blocks B-adrenergic effect in SA node and Purkinje Fibers)
79
Q

How might the Anti HTN effect of a beta 1 blocker occur

A
  1. decreased HR adn force of contraction (slow heart and decrease power of contraction)
  2. depress RAA system (decrease holding onto fluid) or
  3. (maybe some) Central Action
80
Q

atenolol is given orally and has…

A

extensive first pass - 50% absorbed

81
Q

ADRs of atenolol

A
  1. CV: Bradycardia, CHF, Intensify AV Block, Hypotension
  2. Fatigue (Dampening SNS Beta 1 Activity)
  3. Respiratory -Bronchospasm (in COPD and asthma(

Other: NVD, cramps, allergies

82
Q

It is always important to do what before giving atenolol

A

check apical and radial pulse, and BP before giving

83
Q

What causes the CV ADRs of atenolol

A

if you decrease things too much with the beta 1 blocker and the heart is not beating enough

84
Q

atenolol as an anti-hypertensive is generally used in combination with…

A

a thiazide DIURETIC and a VASODILATOR

85
Q

When is atenolol primarily used as an anti-arrhythmic

A

for supraventricular arrhythmias

86
Q

Black Box Warning of Atenolol

A

DO NOT STOP ABRUPTLY - slowly taper before discontinuing

Quitting cold turkey can lead to HR and BP rising fast and if they have a weaker heart they could end up with an MI - Make sure they wont run out of Beta Blockers

87
Q

Caution using Atenolol with what patients

A

Patients with CHF, asthma, COPD, or diabetes

88
Q

What is another use for Beta Blockers besides as an anti-hypertensive

A

Migraine prophylaxis, MI Prophylaxis, Panic Attacks, Benign Essential tremor, and PTSD

Prevents some peoples issues in these areas when taken in low doses (often by decreasing/slowing down SNS response)

NURS 365 - Pharmacology in Nursing (15 decks)

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