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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
Q

Name 4 ALPHA-1 BLOCKERS

A
  1. terazosin
  2. prazosin
  3. doxazosin
  4. tamsulosin
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26
Q

What is key to remember about the ALPHA-1 BLOCKERS?

A

1st dose precipitous hypotension –> use low 1st dose

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27
Q

How do the ALPHA-2 AGONISTS work?

A

vasodilation

ALPHA-2 stimulates CNS –> inhibits NE release –> inhibits vasoconstriction –> VASODILATION

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28
Q

Name 2 ALPHA-2 AGONISTS

A
  1. clonidine

2. methyldopa

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29
Q

What is clonidine used for?

A
  1. hypertension

2. relaxation

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30
Q

METHYLDOPA is rarely used; what do we use it for, and what is unique about it?

A

hypertension

one of the rare BP meds that are okay to use in pregnancy

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31
Q

What beta blocker is good for heart failure as it also has an alpha-blocking effect?

A

carvedilol

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32
Q

Name 7 beta blockers

A
  1. metoprolol
  2. labetalol
  3. atenolol
  4. bisoprolol
  5. esmolol
  6. carvedilol
  7. nebivolol
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33
Q

What beta blocker is nonselective, but selective at very low doses?

A

nebivolol

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34
Q

What beta blocker is good for aortic dissection because it cuts down on the shear force?

A

labetalol

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35
Q

What beta blockers also have alpha blocking effects?

A

labetalol

carvedilol

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36
Q

What to watch for with beta blockers?

A

BRONCOCONSTRICTION due to blocking of beta-2, especially in asthmatics
(BETA-2 agonism causes broncodilation)

BRADYCARDIA
HYPOTENSION

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37
Q

Why do we often prefer selective beta blockers?

A

less likely to block beta-2 and cause issues for asthmatics

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38
Q

What can happen with abrupt withdrawal of beta blockers?

A

hypertension

tachycardia

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39
Q

When can rebound hypertension or tachycardia (from beta blocker withdrawal) cause ANGINA or MI?

A

in a patient with CAD

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40
Q

What can happen with beta blockers and cholesterol?

A

elevated LDL; low HDL (difficult to manage cholesterol when on a beta blocker)

41
Q

What kinds of drugs have effects similar to beta blockers?

A

vasodilators and calcium channel blockers

42
Q

Name 4 vasodilators

A

nitroprusside (IV)
nitroglycerin (IV, SL, PO, patch)
hydralazine (IV, PO)
minoxidil (PO)

43
Q

What to watch for with nitroprusside?

A

cyanide toxicity

44
Q

What vasodilator is okay for use in pregnancy?

A

hydralazine

45
Q

What side effect do we watch for with minoxidil use?

A

HYPERTRICHOSIS (abnormal amount of hair growth)

46
Q

Name the 2 categories of calcium channel blockers

A
  1. dihydropyridines

2. nondihydropyridines

47
Q

What to watch for with calcium channel blockers?

A

bradyarrhythmias

hypotension

48
Q

Why is calcium important in the cardiac system?

A

Need it for muscle contraction

49
Q

How do the calcium channel blockers work?

A

prevent calcium from entering cells –> decrease vascular smooth muscle contraction

DECREASE CARDIAC CONTRACTILITY
DECREASE CARDIAC CONDUCTION RATE

50
Q

What drug category is helpful for large vessel stiffness in older adults?

A

calcium channel blockers

51
Q

Name 4 dihydropyridine calcium channel blockers

A
  1. amlodipine
  2. nifedipine
  3. nimodipine
  4. nicardipine
52
Q

name a phenylalkylamine nondihydropyridine calcium channel blocker

A

verapamil

53
Q

name a benzothiazepine nondihydropyridine calcium channel blocker

A

Diltiazem

54
Q

What adverse effect should we monitor for with amlodipine use?

A

peripheral edema (patients d/n like it)

55
Q

What is RENIN?

A

renin is released when kidneys believe blood volume is low

56
Q

What does renin do?

A

stimulates release of ANGIOTENSIN 1 from the liver

57
Q

What is the difference between ANGIOTENSIN 1 and ANGIOTENSIN 2?

A

ANGIOTENSIN 1 is inactive
ACE converts ANGIOTENSIN 1 to ANGIOTENSIN 2
ANGIOTENSIN 2 is a potent vasoconstrictor

58
Q

What does ANGIOTENSIN 2 do?

A

a potent vasoconstrictor which increases blood pressure
stimulates pituitary to release ADH
stimulates adrenals to release ALDOSTERONE

59
Q

What does Aldosterone do?

A

Aldosterone stimulates reabsorption of sodium and water to increase blood volume and excretion of potassium

60
Q

Name 6 ACE Inhibitors

A
  1. lisinopril
  2. enalapril
  3. captopril (shortest acting)
  4. quinapril
  5. fosinopril
  6. benazepril
61
Q

What to watch for with ACE inhibitors

A

renal failure
hyperkalemia
creatinine tends to bump up, but not by a ton
cough (troublesome, but not usually dangerous)
ANGIOEDEMA

62
Q

What causes ANGIOEDEMA with ACE Inhibitors?

A

decreased breakdown of bradykinin (probably also causes cough)

63
Q

What do ACE Inhibitors tend to end with?

A

“-PRIL”

64
Q

What do ARBs tend to end with?

A

-SARTAN”

65
Q

What is an ARB? What does it do?

A

Angiotensin II Receptor Blocker

after angiotensin II is produced, it blocks receptor sites

66
Q

Name 5 ARBs

A
  1. losartan
  2. candesartan
  3. valsartan
  4. olmesartan
  5. telmesartin
67
Q

ARBs tend to have less hyperkalemia; why?

A

they do not affect aldosterone

68
Q

Why do we not tend to use direct renin inhibitors?

A

they are new
brand name
expensive
not any more effective than ACE-Is or ARBs

69
Q

What are aldosterone receptor antagonists also known as?

A

potassium sparing diuretics

70
Q

Name 2 potassium sparing diuretics

A
  1. spironolactone

2. eplerenone

71
Q

Eplerenone is newer and more expensive. What is the advantage of eplerenone over spironolactone?

A

no gynecomastia

72
Q

What to watch for with potassium sparing diuretics like spironolactone?

A

hyperkalemia

gynecomastia

73
Q

What to watch for with diuretics?

A 
hypokalemia
electrolyte imbalance
dysrhythmias
fluid imbalance
renal failure due to removing too much fluid
74
Q

Name 2 diuretics that work on the proximal convoluted tubule. What are these diuretics called?

A
  1. mannitol
  2. acetazolamide

“OSMOTIC DIURETICS”

75
Q

Name 2 diuretics that work on the ascending limb of the Loop of Henle. What are these diuretics called?

A
  1. furosemide
  2. bumetanide

“LOOP DIURETICS”

76
Q

Name 2 diuretics that work on the distal convoluted tubule. What are these diuretics called?

A
  1. hydrochlorothiazide
  2. metolazone

“THIAZIDE DIURETICS”

77
Q

Name 2 diuretics that work just past the distal convoluted tubule. What are these diuretics called?

A
  1. spironolactone
  2. triamterene

“POTASSIUM SPARING DIURETICS”

78
Q

What to watch for with thiazide diuretics like HCTZ?

A

AGRANULOCYTOSIS

  • -extreme leukopenia
  • -fever
  • -ulcerations of mucous membranes
79
Q

For whom are thiazide diuretics contraindicated?

A

people with a sulfa allergy

80
Q

Which diuretic is very potent when given in combination with Loop diuretics? How is it given?

A

Metolazone

give 15-30 minutes prior to loop diuretic dose

81
Q

Why are thiazide diuretics weaker?

A

the decrease reabsorption of water, sodium, bicarbonate, and chloride; BUT most sodium has already been reabsorbed by this point

82
Q

What to beware of with Loop diuretics?

A

agranulocytosis

SJS

83
Q

What is AGRANULOCYTOSIS?

A
  • -extreme leukopenia
  • -fever
  • -ulcerations of mucous membranes
84
Q

For whom are loop diuretics contraindicated?

A

people with sulfa allergies

pregnant women

85
Q

How do osmotic diuretics work?

A

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
Q

What to remember for Bronchospastic Airway Disease?

A

avoid beta blockers with active symptoms also taking long-acting beta agonists
if necessary, choose a cardioselective agent

87
Q

What to remember for pregnant patients?

A

avoid ACE-I/ARB in 3rd trimester (teratogenic)

ok for HTN: methyldopa, hydralazine

88
Q

What to remember for PVD?

A

beta blockers can worsen symptoms of claudication

89
Q

What to remember for renal insufficiency?

A

avoid potassium-sparing diuretics and aldosterone antagonists (as these patients probably already have difficulty clearing potassium)

90
Q

What to remember with gout?

A

diuretics can aggravate/initiate a gout flare

91
Q

What to remember in patients who have experienced angioedema?

A

avoid ACE-I and ARB

92
Q

What classes of drugs are used to treat heart failure?

A
  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
Q

For heart failure treatment, what beta blockers to use?

A

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
Q

According to JNC8 guidelines, what are the targets for blood pressure management?

A

60+ <150/90

<60 <140/90

95
Q

If a patient has CKD, to manage hypertension, what drug class should be chosen first?

A

ACE-I or ARB

96
Q

In the black population, what are the preferred drug classes for managing hypertension?

A

thiazide diuretic or CCB

97
Q

What drug classes are used to manage CAD/Angina?

A

nitrates
beta blockers
CCBs (dihydropyridines)

98
Q

What are the long-acting nitrates?

A

isosorbide-dinitrate

isosorbide-mononitrate

NURS 804: Pharmacology (42 decks)

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