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Pharmacology > chapter 42: cardiac glycosides, antianginals, antidysrhythmics > Flashcards

chapter 42: cardiac glycosides, antianginals, antidysrhythmics Flashcards

1
Q

left sided HF causes blood to build up in the

A

lung tissue. the left ventricle does not contract sufficiently to pump the blood returned from the lungs and left atrium out through the aorta to the peripheral circulation

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2
Q

right sided HF causes blood to build up i the

A

peripheral tissues, causing peripheral edema

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3
Q

preload results from

A

an excess of blood volume in the ventricle after DIASTOLE

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4
Q

afterload results from

A

additional pressure or force caused by excess resistance in the aorta

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5
Q

cardiac glycosides inhibits _____, leading to an increase in _____ and ______

A

the sodium potassium pump, increase in intracellular sodium, influx of calcium, which causes the heart to pump more efficiently

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6
Q

digitalis preparations have three effects on heart muscle

A
  1. positive inotropic (increases stroke volume)
  2. negative chronotropic (decreases heart rate)
  3. negative dromotropic (decreases conduction of heart cells)
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7
Q

cardiac glycosides are used to correct ______ ______ and _____ _______ through two effects

A

corrects atrial fibrillation and atrial flutter through its negative chronotropic and negative dromotropic effects

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8
Q

what is the reference value of atrial natriuretic peptide?

A

20-77pg/mL or ng/L

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9
Q

an elevated what would indicate heart failure?

A

atrial natriuretic peptide

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10
Q

results of ANH secretion includes

A

a large volume of urine that decreases blood volume and blood prssure

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11
Q

reference values for brain natriuretic peptide

A

desired: less than 100 pg/mL

positive value: greater than 100 pg/mL

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12
Q

BNP helps to do what?

A

helps differentiate that dyspnea is due to HF rather than lung dysfunction

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13
Q

overdose of digoxin can result in

A

anorexia, diarrhea, N, V, premature ventricular contractions, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, yellow halos around objects), confusion and delirium

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14
Q

what is effective in treating digoxin induced ventricular dysrhythmias

A

the antidys. phenytoin and lidocaine

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15
Q

the antidoe for severe digitalis toxicity

A

digoxin immune fab

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16
Q

mode of action digoxin

A

inhibits sodium potassium ATPase, promoting increased force of cardiac contraction, cardiac output and tissue perfusion, decreases ventricular rate

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17
Q

milrinone is a

A

phosphodiesterase inhibitor

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18
Q

PD inhibitors do what?

A

promote a positive inotropic response and vasodilation, used to treate acute HF

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19
Q

herbs that increase digoxin level

A

ginseng (falsely elevates), hawthorn, licorice (promotes K loss), aloe, m-huang, ephedra,

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20
Q

herbs that decrease digoxin level

A

st. john’s wort, psyllium, goldenseal

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21
Q

arteriolar dilators act in three ways

A
  1. increase renal perfusion which increases fluid loss 2. improves circulation to the skeletal muscles 3. reduces afterload, which increases cardiac output
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22
Q

ACE inhibitors are prescribed for

A

heart failure

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23
Q

ACE inhibitors do 3 things

A

dilate venules and arterioles, improve renal blood flow, decrease blood fluid volume, decrease release of aldosterone, which in turn reduces sodium and fluid retention

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24
Q

ACE inhibitors can increase

A

potassium levels

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25
Q

spironolactone is what class of drug? and does what?

A

potassium sparing diuretic

blocks the production of aldesterone

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26
Q

serum potassium level should be monitored to prevent hyperkalemia for what drug?

A

spironolactone. occurence of hyperkalemia is rare unless patient is receiving 50 mg a day

27
Q 
nesiritide belongs to what class of drugs? how does it correct heart failure?
it is useful for treating patients with
A

atrial natriuretic peptide hormone that inhibits ADH by increasing urine sodium loss. it promotes vasodilation, natiruresis, and diuresis. useful for treating patients who have dyspnea at rest

28
Q

angina pectoris

A

a condition of acute cardiac pain caused by inadequate blood flow to the myocradium due to either plague occlusions or spasms of the coronary artery

29
Q

three types of anginal pain

A
  1. classic (occurs with predictable stress or exercise)
  2. unstable (preinfarction): occurs frequently with progressive severeity unrelated to activity, unpredictable regarding stress/exertion and intensity
  3. varient (prinzmetal, vasospastic): occurs during rest
30
Q

class and unstable angina is caused by

A

a narrowing or partial occlusion of the coronary arteries

31
Q

variant angina is caused by

A

vessel spasm

32
Q

three types of antianginal drugs

A
  1. nitrates
  2. calcicum channel blockers
  3. beta blockers
33
Q

major systemic effect of nitrates

A

reduction of venous tone, which decreases workload of heart and promotes vasodilation

34
Q

beta blockers and calcium channel blockers do what?

A

decrease the workload of the heart and decrease oxygen demands

35
Q

beta blokers are the only kind of antianginal drug that cannot treat this type of angina

A

variant (vasospastic) may aggravate it

36
Q

after a dose of nitroglycerin, a pt may experience

A

headaches, dizziness, faintness

37
Q

when nitroglycerin ointment or transdermal patches are discontinued, the dose should be _______ over _____ _____ to prevent ______ _______ which is ?

A

tapered over several weeks to prevent myocardial ischemia which is lack of blood supply to the heart

38
Q

reflex tachycardia may occur if which drug is given too rapidly?

A

nitrates

39
Q

IV nitroglycerin may antagonize the effects of

A

heparain

40
Q

patients who have these three things should not take beta blockers

A

decreased heart rate, lowered blood pressure, second or third degree AV block

41
Q

nonselective beta blockers

A 
PROPANolol
NADolol
PINDolol
SOTAlol
TIMolol
42
Q

selective beta blockers

A 
atenlolol
metoproplol
BISOprolol
ESMOlol
METOPROlol
43
Q

nitroglycerin is contraindicated in

A

increased intercranial pressure, severe anemia, cardimyopathy

44
Q

mode of action of nitroglycerin

A

decreases myocardial demand for oxygen, decreases preload and afterload

45
Q

alcohol while taking nitroglycerin can cause

A

hypotension, weakness and faintness

46
Q

notify HCP when taking nitroglycerin if

A

chest pain is not alleviated

47
Q

if hypotension occurs from SL nitroglcyerin, pt should be placed in

A

supine position

48
Q

cardiac disrhthmias can occur from

A

following an MI, hypoxia, hypercapnia, thyroid disease, coronary artery disease, cardiac surgery, excess catecholamines, electrolyte imbalance

49
Q

four classes of antidysrhythmic

A
  1. sodium channel blockers 1A, 1B, 1C
  2. beta blockers
  3. drugs that prolong repolarization
  4. calcium channel blockers
50
Q

acebutelol drug class

A

beta 1 blocker: cardioselective beta adrenergic antagonist

51
Q

what kind of drugs should be administered by IV push or bolus over 2-3 minutes

A

antidysrhthmic

52
Q

calcium channel blockers

A

diltiazem and verapmil

53
Q

ace inhibitors have a favorable or unfavorable impact on cardiac remodeling (of left ventricle)

A

favorable, does NOT cause cardiac remodeling

54
Q

ACE inhibitors have three hemodynamic benefits

A

arterioloar dilation
venous dilation
suppression of aldosterone release

55
Q

what are the drugs that should be avoided in heart failure

A

calcium channel blocker, should only be used as a last result if other meds have been tried and BP is not going down. it causes fluid retention as well

antidysrhythmic drugs: worsen heart failure

NSAIDS: caue fluid retention and peripheral vasoconstriction

56
Q

what do african american adults and older adults NOT respond well to? they do respond well, if it is taken with

A

ACE inhibitors, only if taken with diuretic

57
Q

two drugs of aldosterone antagaonists

what are they used for?

what are the major adverse effects?

A

eplerenone and spironolactone

used for HF and HTN

major adverse effect is HYPERkalemia

58
Q

negative chronotropic drugs are used in

A

HF with uncontrolled afib (HR > 100)

59
Q

two drugs that are adrenergic agonists

A

dopamine and dobutamine

60
Q

dopamine activates what? and when is it used?

A

activates beta 1 and alpha 1 receptors

it is only used for a short term for severe, acute cardiac failure

61
Q

dobutamine is a what? and it activates what?

A

synthetic catecholamine

only activates beta 1 receptors

62
Q

phosphodiesterase enzyme (PDE3)

A

inotropic and vasodilators

only use short term for severe HF when not responding to RAAS inhibitors, iduretics, and digoxin.

63
Q

arterial dilator decreases ____, venodilator decreases _____

A

arterial decreases afterload

venodilator decreases preload

64
Q

antidysrhythmic drugs that prolong ____ levels cause risk for ________ __ _______ which leads to _____ __ ____

A

drugs that prolong QT intervals cause risk for torsades de pointes which leads to fatal V fib

Pharmacology (10 decks)

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