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CARDIAC PHARMACOLOGY Flashcards

1
Q

Drugs used to treat angina:

A
  • Nitrates / Vasodilators
  • β – blockers
  • Ca⁺ channel blockers

Pump dysfunction; meds are focused on restoring the balance between oxygen supply and demand

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2
Q

Drugs used to treat arrythmias:

A
  • Sodium Channel blockers
  • Beta blockers
  • Ca+ channel blockers

Pump dysfunction, drugs that prolong repolarization

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3
Q

DRUGS USED TO TREAT CARDIOVASCULAR PUMP DYSFUNCTION

A
  • Angina: restoring the balance between oxygen supply and demand
    • Nitrates/Vasodilators, Beta Blockers, Ca channel blockers
  • Cardiac arrythmias: Drugs that prolong repolarization
    • Sodium channel blockers, Beta Blockers, Ca Channel Blockers
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4
Q

Nitrates are vasodilators that cause what in the heart?

A

Decreases workload on myocardium → decrease preload and afterload → decrease O2 demand
Used to ease chest pain, angina

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5
Q

in addition to nitrates, what other drugs may cause vasodilation?

A

Ca channel blockers, ACE inhibitors, Alpha blocker

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6
Q

what are the uses of nitrates/vasodilators?

A

angina, CHF, HTN, post myocardial infarction

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7
Q

what are the side effects of nitrates/vasodilators?

A
  • Reflex tachychardia
  • Dizzines, headaches
  • Hypotension/Orthostasis
  • Peripheral edema
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8
Q

which is the most common nitrate?
Route of administration?

A

Nitroglycerin

  • Tablet (sublingual) - at onset of anginal attack, pt will use at home, very fast acting
  • Patch - Used preventatively May lose effectiveness if on constantly
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9
Q

how do beta blockers work?

A

decrease HR by blocking type 1 beta adrenergic receptors (stimulate the heart)
→ blocking catecholamines (epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine)

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10
Q

β1-adrenergic receptor stimulation

A

Increases heart rate and force of contraction

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11
Q

β2-receptor stimulations

A

Increases vasodilation of capillary beds & relaxation in bronchial tract

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12
Q

High levels of circulating epinephrine cause

A

vasoconstriction

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13
Q

Lower levels of circulating epinephrine → β-adrenoreceptor stimulation dominates → producing an overall _______

A

vasodilation

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14
Q

β- blockers ↓ _________ stimulation of the heart, therefore ↓ HR and Cardiac Output → DECREASE WORKLOAD

(These changes will occur at rest and with exercise)

A

sympathetic​

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15
Q

Side effects of β- blockers

A
  • May decrease the HR too much causing low BP
  • Lightheadedness
  • Exacerbation of bronchospasm
  • Possible effects with sexual dysfunction/depressio
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16
Q
  • Metropolol / Lopressor
  • Propranolol / Inderal
  • Atenolol / Tenormin
  • Labetolol
A

Beta Blockers - Beta Adrenergic Blocking Agents

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17
Q

uses of Beta Blockers

A
  • Angina
  • After MI
  • Heart failure
  • Arrythmias, rate control/Afib
  • HTN
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18
Q

What is the impact of β- Blockers in PT Intervention?

A
  • decreases HR of the patient
  • May lead to a more productive exercise session as β-blockers help control Angina and Arrhythmias
  • May be necessary to exercise these patients sub-maximally
  • Use Borg Scale or Rate of Perceived Exertion
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19
Q

What ALPHA ADRENERGIC ANTAGONIST AGENTS do?

A

Decrease peripheral vascular tone by blocking alpha-1-adrenergic receptors → causing dilation of arterioles and veins and decreases BP

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20
Q

– Cardura (doxazosin)
– Minipress (prazosin)
– Hytrin (terazosin)

A

Alpha Blockers

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21
Q

What do Calcium (Ca ⁺) Channel Blockers do?

A

Decrease entry of calcium into vascular smooth muscle cells → vasodilation, decreased myocardial contraction, and decreased oxygen demand of the heart

Decrease heart’s pumping strength and relax blood vessels → vasodilation in peripheral vessels

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22
Q

some uses of Calcium (Ca ⁺) Channel Blockers

A
  • Angina
  • HTN
  • A-fib
  • Coronary vasospasm
  • Paroxysmal supraventricular tachycardia
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23
Q

Ca⁺ Channel Blockers adverse side effects

A
  • Headache
  • Dizziness
  • Hypotension
  • Brady arrhythmias
  • Pedal edema
  • GI upset
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24
Q

Amlodipine / Norvasc
Nifedipine / Procardia
Diltiazem / Cardizem
Verapamil / Calan/Verlan

A

Ca⁺ Channel Blockers

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25
Amlodipine / Norvasc Nifedipine / Procardia
Ca⁺ Channel Blockers more selective for **vasculature**
26
**Diltiazem / Cardizem Verapamil / Calan/Verlan**
Ca⁺ Channel Blockers - More selective for myocardium
27
what are the classes of drugs considered **ANTIARRYHTHMICS**
* Class I: Sodium Channel Blockers * Class II: β – blockers * Class III: Drugs that prolong repolarization * Class IV: Ca ⁺ channel blockers
28
What do sodium (Na+) Channel Blockers do?
* Antiarryhtmic * **Control myocardial excitability** by stabilizing sodium channels on heart cell membranes
29
Lidocaine (Xylocane)
* Sodium (Na+) Channel Blockers * Antiarrhythmic * Drug of choice; * Used for prophylaxis and therapeutically in acute myocardial ischemia
30
Side effects of Sodium Channel Blockers: (lidocaine, quinine)
* N/V * dizziness * drowsiness * fatigue * possible orthostasis
31
Drugs that Prolong Repolarization are
Antiarrhythmics
32
Amiodarone, Bretylium
* Antiarrhythmics: drugs that prolong repolarization * Lengthens time between heartbeats (diastole) * Useful in treating **tachycardia**
33
drugs used to treat cardiovascular pump failure
* Angiotensin-Converting Enzyme (ACE) Inhibitors * Diuretics * **Digitalis** – Cardiac Glycosides: * Digitoxin/Lanoxin * Digoxin
34
ACE inhibitors, what do they do?
* “Inhibits” enzyme that converts angiotensin I to **angiotensin II** (a vasoconstrictor) * Decrease peripheral & arterial vasoconstriction → decrease BP * Relaxation of arteries * Increase CO
35
uses of ACE inhibitors
HTN, CHF, CAD
36
side effects of ACE inhibitors
* Dry cough * Hypotension - high incidence of lightheadedness, dizziness for the first few days * Kidney problems secondary to K+ retention
37
– Capto**_pril_** / Capoten – Quini_pril_ / Vasotec – Rama**_pril_** / Zestril – Accu**_pril_** / Altase
ACE Inhibitors
38
Angiotensin II Receptor Blockers
* Newer drug * Bind and occupy angiotensin II receptor on cardiovascular tissues → so limit vasocontriction and stimulation of vascular tissue * Losartan / Cozaar
39
**Losartan** / Cozaar
Angiotensin II Receptor Blockers Newer drud
40
**Diuretics** act on the kidneys to:
* ↑ excretion of Na ⁺ and H₂O * ↓ Na⁺ and H₂O = ↓ fluid in the vascular system * ↓ BP via ↓ fluid in the peripheral vasculature * ↓ cardiac workload via ↓ the amount of fluid the heart must pump (preload)
41
diuretics are useful in the treatment of:
* HTN * heart failure * edema
42
diuretics prescription depends on...
* age * medical history * adverse drug interactions
43
problems with diuretics may occur when...
* Overdose & excrete too much Na+ and K+ from the body * When severely restricts fluid intake
44
diuretics adverse side effects
– Hypotension – Dehydration – Electrolyte imbalance – Hyperglycemia
45
patient taking diuretics can become....
– Confused – Dizzy – Unreasonable – Fatigued – Depressed
46
supplement to combat fatigue from diuretics include
potassium
47
– Furosemide(g)/Lasix (t) – Bumetanide(g)/Bumex(t)
Diuretics
48
what are the effects of glycosides?
Inhibits the Na+/K+ pump, which allows Ca+ to come in → Increases cellular Ca+ → Increases heart contractility → Increases contraction FORCE → **Increases pump ability**
49
**glycosides** side effects
* GI problems * ↓ appetite * CNS disturbances (ataxia, visual disturbances) * Fatigue * Confusion * Small therapeutic window
50
Group of meds called **statins**, what do they do?
**Directly inhibit hepatic cholesterol production** * Decrease total cholesterol * Decrease plasma LDL/VLDL * Slightly decrease triglycerides * Slightly increase HDL * Help decrease atherosclerotic plaque formation
51
adverse effects of statins (Antihyperlipidemia Medication)
* Stomach Pain * Nausea * Diarrhea * Gas * Heartburn * Muscle cramps * Severe weakness and/or fatigue
52
– Lipitor – Crestor – Zocor
* *Antihyperlipidemia** **Medication** * *statins**
53
**Fibric Acids** action
* Decrease triglycerides * Decrease VLDL * Increase HDL
54
**Tricor Lopid**
**Fibric Acids** | (Antihyperlipidemia Medication​)
55
Colestid Questran
**Bile acid sequestrants medications** | (Antihyperlipidemia Medication)
56
Action of **bile acid sequestrants medications**
* ↓ total cholesterol * ↓ LDL * Adheres to bile acids in the GI tract
57
Adverse side effects associated with bile acid sequestrants meds and meds that inhibit cholesterol absorption from the GI tract
* **GI problems** * Nausea * Stomach pain * Gas * Diarrhea
58
Niacin Zetia
Inhibit cholesterol absorption from the GI tract (Antihyperlipidemia Medication)
59
contraindications for smoking cessation medications
* s/p MI, s/p CVA, * Angina and life threatening arrhythmias
60
insulin preparations
* vials * prefilled syringes * jet injector (expensive) * insulin pump
61
– Humulin – Novolin – Lantus
**insulin**
62
side effects of insulin
* Hypoglycemia * Lipodystrophy * Skin reaction at site of injection * Insulin allergy (RARE as humulin—human insulin—is nonallergenic)
63
**Oral Hypoglycemic Agents** are used to
lower blood glucose levels
64
avandia
Oral Hypoglycemic Agent (Thiazolidinediones)
65
Smoking Cessation Medications:
* **Nicotine replacement therapy** (N, HA) * **Bupropion/Zyban** (dopamine↑; dry mouth, insomnia) * **Verenicline****/Chantix** (nicotine receptors antagonist; HA, drowsiness, GI problems)
66
**Sympathetic appetite suppressants**, what do they do?
Increase influence of norepinephrine and dopamine in the brain → **decrease appetite** **– Benzphetamine – Methamphetamine**
67
Sympathetic appetite suppressants, side effects
HTN and cardiac arrhythmias (these can be severe)
68
**Lipase inhibitors,** mechanism of action
Decrease fat absorption by inhibiting fat breakdown in the GI tract **Used to Treat Obesity** – Alli (t) – Xenical (t)
69
lipase inhibitors, side effects:
GI problems
70
Serotonin-norepinephrine reuptake inhibitors:
Increase effects of serotonin & norepinephrine in the brain → **Supress** **appetite** Side Effects: Increase blood pressure – Dry mouth – Insomnia – Dizziness – Nausea
71
types of **Anti-Clotting Medications**
* **Anticoagulants:** Heparin Coumadin * **Antithrombotic Agents:** Aspirin * **Thrombolytics:** Streptokinase, tPA (tissue plasminogen activator)
72
Lab monitoring: **PTT/aPTT** used to assess for:
heparin
73
# lab monitorin **PT/INR** used to assess for \_\_\_\_\_\_\_\_\_\_
**coumadin**
74
**Coumadin/Warfarin**, mechanism of action
Impairs the hepatic synthesis of clotting factors → **helps to break up clots**
75
types of anticoagulants:
* **Heparin** * **Coumadin/Warfarin**
76
**Aspirin**, mechanism of action
Anti-platelet drug → prevents platelets from sticking to one another (classifies as Antithrombotic Agent)
77
Drugs that block effects of adenosine diphosphate (ADP) on platelets
Other **Antithrombotic Agents**
78
Glycoprotein (GP) IIb—IIIa Inhibitors
Inhibit effects of other platelet stimulating substances (ex: fibrinogen) Antithrombotic Agents
79
Thrombolytics are used to
acutely destroy (lyse) or decrease clot formation
80
Thrombolytics side effects
– Bleeding/hemorrhage – Not tissue specific, potential for bleeding elsewhere…
81
– Streptokin**ase** – Alteplace – Urokin**ase** – tPA (tissue plasminogenactivator)
**Common Thrombolytics** (often the “-ase” drugs)
82
Thrombolytics, mechanism of action
Facilitate conversion of plasminogen to plasmin – Facilitate process to lyse clots

Cardiac Pathologies (13 decks)

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