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Cardiac Pathologies > CARDIAC PHARMACOLOGY > Flashcards

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
Q

Amlodipine / Norvasc
Nifedipine / Procardia

A

Ca⁺ Channel Blockers more selective for vasculature

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26
Q

Diltiazem / Cardizem
Verapamil / Calan/Verlan

A

Ca⁺ Channel Blockers - More selective for myocardium

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27
Q

what are the classes of drugs considered ANTIARRYHTHMICS

A
  • Class I: Sodium Channel Blockers
  • Class II: β – blockers
  • Class III: Drugs that prolong repolarization
  • Class IV: Ca ⁺ channel blockers
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28
Q

What do sodium (Na+) Channel Blockers do?

A
  • Antiarryhtmic
  • Control myocardial excitability by stabilizing sodium channels on heart cell membranes
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29
Q

Lidocaine (Xylocane)

A
  • Sodium (Na+) Channel Blockers
  • Antiarrhythmic
  • Drug of choice;
  • Used for prophylaxis and therapeutically in acute myocardial ischemia
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30
Q

Side effects of Sodium Channel Blockers:

(lidocaine, quinine)

A
  • N/V
  • dizziness
  • drowsiness
  • fatigue
  • possible orthostasis
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31
Q

Drugs that Prolong Repolarization are

A

Antiarrhythmics

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32
Q

Amiodarone, Bretylium

A
  • Antiarrhythmics: drugs that prolong repolarization
  • Lengthens time between heartbeats (diastole)
  • Useful in treating tachycardia
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33
Q

drugs used to treat cardiovascular pump failure

A
  • Angiotensin-Converting Enzyme (ACE) Inhibitors
  • Diuretics
  • Digitalis – Cardiac Glycosides:
    • Digitoxin/Lanoxin
    • Digoxin
34
Q

ACE inhibitors, what do they do?

A
  • “Inhibits” enzyme that converts angiotensin I to angiotensin II (a vasoconstrictor)
  • Decrease peripheral & arterial vasoconstriction → decrease BP
  • Relaxation of arteries
  • Increase CO
35
Q

uses of ACE inhibitors

A

HTN, CHF, CAD

36
Q

side effects of ACE inhibitors

A
  • Dry cough
  • Hypotension - high incidence of lightheadedness, dizziness for the first few days
  • Kidney problems secondary to K+ retention
37
Q

– Captopril / Capoten
– Quini_pril_ / Vasotec
– Ramapril / Zestril
– Accupril / Altase

A

ACE Inhibitors

38
Q

Angiotensin II Receptor Blockers

A
  • Newer drug
  • Bind and occupy angiotensin II receptor on cardiovascular tissues → so limit vasocontriction and stimulation of vascular tissue
  • Losartan / Cozaar
39
Q

Losartan / Cozaar

A

Angiotensin II Receptor Blockers

Newer drud

40
Q

Diuretics act on the kidneys to:

A
  • ↑ 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
Q

diuretics are useful in the treatment of:

A
  • HTN
  • heart failure
  • edema
42
Q

diuretics prescription depends on…

A
  • age
  • medical history
  • adverse drug interactions
43
Q

problems with diuretics may occur when…

A
  • Overdose & excrete too much Na+ and K+ from the body
  • When severely restricts fluid intake
44
Q

diuretics adverse side effects

A

– Hypotension
– Dehydration
– Electrolyte imbalance
– Hyperglycemia

45
Q

patient taking diuretics can become….

A

– Confused
– Dizzy
– Unreasonable
– Fatigued
– Depressed

46
Q

supplement to combat fatigue from diuretics include

A

potassium

47
Q

– Furosemide(g)/Lasix (t)
– Bumetanide(g)/Bumex(t)

A

Diuretics

48
Q

what are the effects of glycosides?

A

Inhibits the Na+/K+ pump, which allows Ca+ to come in →
Increases cellular Ca+ → Increases heart contractility → Increases contraction FORCE → Increases pump ability

49
Q

glycosides side effects

A
  • GI problems
  • ↓ appetite
  • CNS disturbances (ataxia, visual disturbances)
  • Fatigue
  • Confusion
  • Small therapeutic window
50
Q

Group of meds called statins, what do they do?

A

Directly inhibit hepatic cholesterol production

  • Decrease total cholesterol
  • Decrease plasma LDL/VLDL
  • Slightly decrease triglycerides
  • Slightly increase HDL
  • Help decrease atherosclerotic plaque formation
51
Q

adverse effects of statins (Antihyperlipidemia Medication)

A
  • Stomach Pain
  • Nausea
  • Diarrhea
  • Gas
  • Heartburn
  • Muscle cramps
  • Severe weakness and/or fatigue
52
Q

– Lipitor
– Crestor
– Zocor

A
  • *Antihyperlipidemia** Medication
  • *statins**
53
Q

Fibric Acids action

A
  • Decrease triglycerides
  • Decrease VLDL
  • Increase HDL
54
Q

Tricor
Lopid

A

Fibric Acids

(Antihyperlipidemia Medication​)

55
Q

Colestid
Questran

A

Bile acid sequestrants medications

(Antihyperlipidemia Medication)

56
Q

Action of bile acid sequestrants medications

A
  • ↓ total cholesterol
  • ↓ LDL
  • Adheres to bile acids in the GI tract
57
Q

Adverse side effects associated with bile acid sequestrants meds and meds that inhibit cholesterol absorption from the GI tract

A
  • GI problems
    • Nausea
    • Stomach pain
    • Gas
    • Diarrhea
58
Q

Niacin
Zetia

A

Inhibit cholesterol absorption from the GI tract

(Antihyperlipidemia Medication)

59
Q

contraindications for smoking cessation medications

A
  • s/p MI, s/p CVA,
  • Angina and life threatening arrhythmias
60
Q

insulin preparations

A
  • vials
  • prefilled syringes
  • jet injector (expensive)
  • insulin pump
61
Q

– Humulin
– Novolin
– Lantus

A

insulin

62
Q

side effects of insulin

A
  • Hypoglycemia
  • Lipodystrophy
  • Skin reaction at site of injection
  • Insulin allergy (RARE as humulin—human insulin—is nonallergenic)
63
Q

Oral Hypoglycemic Agents are used to

A

lower blood glucose levels

64
Q

avandia

A

Oral Hypoglycemic Agent

(Thiazolidinediones)

65
Q

Smoking Cessation Medications:

A
  • Nicotine replacement therapy (N, HA)
  • Bupropion/Zyban (dopamine↑; dry mouth, insomnia)
  • Verenicline/Chantix (nicotine receptors antagonist; HA, drowsiness, GI problems)
66
Q

Sympathetic appetite suppressants, what do they do?

A

Increase influence of norepinephrine and dopamine in the brain → decrease appetite

– Benzphetamine
– Methamphetamine

67
Q

Sympathetic appetite suppressants, side effects

A

HTN and cardiac arrhythmias (these can be severe)

68
Q

Lipase inhibitors, mechanism of action

A

Decrease fat absorption by inhibiting fat breakdown in the GI tract

Used to Treat Obesity
– Alli (t)
– Xenical (t)

69
Q

lipase inhibitors, side effects:

A

GI problems

70
Q

Serotonin-norepinephrine reuptake inhibitors:

A

Increase effects of serotonin & norepinephrine in the brain → Supress appetite

Side Effects: Increase blood pressure – Dry mouth – Insomnia – Dizziness – Nausea

71
Q

types of Anti-Clotting Medications

A
  • Anticoagulants: Heparin Coumadin
  • Antithrombotic Agents: Aspirin
  • Thrombolytics: Streptokinase, tPA (tissue plasminogen activator)
72
Q

Lab monitoring: PTT/aPTT used to assess for:

A

heparin

73
Q

lab monitorin

PT/INR used to assess for __________

A

coumadin

74
Q

Coumadin/Warfarin, mechanism of action

A

Impairs the hepatic synthesis of clotting factors → helps to break up clots

75
Q

types of anticoagulants:

A
  • Heparin
  • Coumadin/Warfarin
76
Q

Aspirin, mechanism of action

A

Anti-platelet drug → prevents platelets from sticking to one another

(classifies as Antithrombotic Agent)

77
Q

Drugs that block effects of adenosine diphosphate (ADP) on platelets

A

Other Antithrombotic Agents

78
Q

Glycoprotein (GP) IIb—IIIa Inhibitors

A

Inhibit effects of other platelet stimulating substances (ex: fibrinogen)

Antithrombotic Agents

79
Q

Thrombolytics are used to

A

acutely destroy (lyse) or decrease clot formation

80
Q

Thrombolytics side effects

A

– Bleeding/hemorrhage
– Not tissue specific, potential for bleeding elsewhere…

81
Q

– Streptokinase
– Alteplace
– Urokinase
– tPA (tissue plasminogenactivator)

A

Common Thrombolytics (often the “-ase” drugs)

82
Q

Thrombolytics, mechanism of action

A

Facilitate conversion of plasminogen to plasmin
– Facilitate process to lyse clots

Cardiac Pathologies (13 decks)

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