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Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Angiotensin converting enzyme inhibitors-PRILS

A 
⬇️BP:⬇️constriction➡️⬇️resistance⬇️afterload.
Indications 
HTN 
Afterload reduction:CHF&MI
Protects renal
S/E
Nonproductive cough
Angioedema fatigue, dizziness, neutropenia
Contra indications
Hyperkalemia
Children, pregnant and lactating
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2
Q

Angiotensin 2 rececptor blocker (ARBS)-SARTANS

A

⬇️BP⬇️constriction➡️⬇️resistance➡️⬇️afterload
Indications
HTN: second line treatment
Afterload reduction:CHF&MI
Renal protection for diabetics
S/E & Contraindications same as ACE inhibitors
Except for respiratory infection, sinusitis, muscle weaknes.
No neutropenea

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3
Q

Beta blockers

OLOLS

A

SELECTIVE: Bind B1 receptors in ❤️’s electrical conduction sister
NONESELECTIVE: Block B1 & B2 receptors in the heart and lungs
⬇️BP ⬇️constriction ➡️⬇️resistance ⬇️afterload
⬇️HR negative chronotrope
⬇️myocardial contractility➡️⬇️O2 requirements - inotrope
Indications
HTN, Angina, Disrithmias
S/E CHF, disrhythmias(bradycardia)
Bronchospasm/constriction-dyspnea, wheezing

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4
Q 
Calcium channel blockers CCBs
Verapamil
Diltiazem
Amlodipine
Nifedipine
A

⬇️HR⬇️contractility⬇️oxygendemand
⬇️BP⬇️constriction⬇️resistance⬇️afterload⬇️HR⬇️coronary artery spasms
Indications
HTN, dysrhythmias, angina, Raynaud’s migraine headache
S/E: dysrhythmias( Brady/tachycardia)
Fluid overload, peripheral edema, heart rate
Constipation
Contraindications: acute MI dysrhythmias.

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5
Q

Loop (diuretic)

Furosemide

A

Contraindications: chronic renal failure, sulfa allergy

S/E hypokalemia

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6
Q

Potassium sparing/aldosterone inhibiting (diuretic)

Spironolactone

A

Indication: hyperaldosteronism
S/E hyperkalemia
Contraindications:chronic renal failure

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7
Q

Thiazide and thiazide-like- diuretics
Hydrochlorothiazide
Metolazone

A 
Does not alter the pH
S/E hypokalemia/hypercalcemia
Headache, dizziness.
Thrombocytopenia, pancreatitis 
⬆️lipids/glucose/uric acid
Contraindications: chronic renal failure
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8
Q

Osmotic diuretics

Mannitol

A

⬆️osmotic pressure…fluid pulled into intravascular space
Osmotic diurese⬇️effects on electrolytes⬇️cerebral edema⬇️ICP
⬇️fluid from kidneys in early renal failure
Contraindications: severe renal disease
S/E convulsions pulmonary congestion

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9
Q

Carbonic anhydrase inhibitors( diuretic)

Acetazolamide

A

⬇️aqueous humor production ⬇️intraocular presure
⬇️circulating Na+ bicarbonate NaHCO3➡️alter acid base balance
Indications: glaucoma, altitude sickness, alkalosis
Edema resistant to other treatments
S/E: acidosis , hypokalemia, parestherias

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10
Q

Alpha1 -antagonist (extras)
Doxazosin
Prazosin

A

Blocks A1 adrenergic receptor. Prevents norepinephrine from attaching ➡️smooth muscle relaxation
⬇️BP⬇️constriction➡️⬇️rraistance➡️⬇️afterload
Relaxes prostatic capsule and bladder neck
Indications HTN. Benign prostatic hypertrophy.
Precautions: hepatic or renal disease
Contraindications: acute heart failure
S/E: orthostatic hypotension. Dizziness, headache

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11
Q

A1 and B1 receptor blocker (extra)

Carvedilol

A

Smooth muscle relaxation
⬇️progression of ❤️failure
⬇️BP:⬇️constriction➡️⬇️resistance➡️⬇️afterload
⬇️HR➡️⬇️sinoatrial node firing
⬇️myocardial contractility⬇️O2 demand of myocardium. -inotrope
Indications Heart failure, HTN, angina
Precautions: Heart failure, disrhythmias( bradycardia). Mask evidence of hypoglycemia.
S/E: fatigue, depression, impotence

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12
Q

Alpha2 adrenergic receptor stimulants “agonist” centrally acting (extras)

A

Stimulates alpha2 receptors in the brain➡️⬇️sympathetic outflow⬇️production of norepinephrine, and ⬇️renin activity
T/E: ⬇️BP:⬇️constriction➡️⬇️resistance➡️⬇️afterload
Off label uses: migraine headaches/pain, withdrawal symptoms.
Precautions: recent MI, chronic renal/liver failure
Contraindications: acute❤️failure, concurrent MAO-I
PHENEZIL
S/E: orthostatic hypotension, fatigue, dizziness, syncope

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13
Q 
Direct vasodialators (extras)
Hydralazine
A

Direct smooth muscle relaxation
T/E:⬇️BP:⬇️construction➡️⬇️resistance➡️⬇️afterload
Indications: HTN/ malignant HTN
Precautions renal disease, stroke.
Contraindications: cerebral edema, acute MI

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14
Q

HMG-CoA reductase inhibitors “LIPIDS”

-statins

A

Decreases cholesterol synthesis works in the liver ⬇️enzyme activity
S/E: hyperglycemia.
Rhabdomyolysis
Headache, memory loss, confusion.
GI disturbances, liver dysfunction
Contraindications: pregnancy categoryX
Liver distinction, renal insufficiency due to rhabdomyolosis

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15
Q

Bike acid sequestrants (LIPIDS)
Cholesteramine
Colesevelam

A

Bind bile excretes it in the stool prevents cholesterol absorption
Caution: ⬇️GI motility, may bind other drugs
S/E: constipation, nause, abdominal pain
Contraindications: Bowel obstruction, phenylketonuria

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16
Q

Fabric acid derivatives “fibrates” (LIPIDS)

Gemfibrozil

A

⬇️hepatic uptake of free fatty acids➡️⬇️trygyceride production
Indications: hypertryglyceridemia
Caution: renal/hepatic dysfunction, interacts HMG-CoA reductase inhibitors. Bladder dysfunction.
S/E: GI discomfort, nausea, vomiting, headache.

17
Q

Cholesterol absorption inhibitor (LIPIDS)

Ezetemib

A

Blocks absorption of cholesterol in the small intestines
Caution GI disorders
Contraindications: pregnancy X, liver disease
S/E: abdominal pain, nause, diarrhea

18
Q

Platelet aggregation inhibitors( antiplatelet agent)
Aspirin(ASA) NSAID salicylate
Clopidrogel

A

Works in cyclooxygenase(COX) pathway in platelets➡️inhibits formation of thromboxane A2➡️decrease vasoconstriction and platelet aggregation
ADP inhibitor➡️prevents platelet membrane from receiving signal to agregate
Indications: CAD, MI Thrombotic stroke
Caution bleeding, clopidogrel given with PPI
Contraindications: active bleeding, GI ulcer, recent hemorrhagic stroke, thrombocytopenia.
S/E: GI upset

19
Q 
LABS platelets
Total cholesterol
High density lipoprotein
Low density lipoprotein
Tryglicerides
A

LFT; serum glucose
CBC hemogram of platelets
Homocysteine, -reactive protein

20
Q

Angina

Stable angina pectoris

A

Temporary & reversible

Caused by coronary ischemia, brought on by trigger. (Alcohol, tobacco, Sex, stimulants”cocaine”, anemia

21
Q

Prinzmetal’s or variant angina

A

Caused by coronary vasospasm, ➡️coronary ischemia. Seen with other vascular diagnosis(migraines, Raynaud,s
First line treatment CCB,s; nitrates

22
Q

Unstable angina

A

Due to coronary atherosclerosis( legion), or plaque rupture.
New onset of very intense pain, occurs at rest, unpredictable
Emergency treatment MONA
Nitroglycerin tablet SL*

23
Q

Unstable angina continued treatment

A 
Morphine for pain
             Visodialation
Nitroglycerin tablet SL ( short acting)
Isosorbide mononitrate (long acting)
N. Transdermal patch/ N. ointment. ( topical)
PLT aggregation inhibitors
B blockers 
Calcium channel blockers
       Verapamil
       Diltiazem
       Amlodipine 
       Nifedipine
Surgery PCI
24
Q

MI

A

Sustained coronary ischemia leading to irreversible cell death
S&S: intractable chest pain unrelieved by treatment
Assessment findings: changes in vital signs, heart tones, cardiac rhythm. May find pulmonary crackles, dyspnea, fatigue, diaphoresis, N/V. Cardiac enzymes
Complications: Dysrhithmias; pericarditis, ❤️failure, cardiogrnic shock
Gen. Treat. O2, electrolytes K+,mg++, control dysthymias
Meds: pain, vasodialation, PLT inhibitors, B blockers,
CCB

25
Q

Anticoagulants
1 Warfarin
2 Heparin
3 Lovenox

A

Exerts action in clothing cascade, prevents clot formation
Indications
CAD, MI, heart failure
Heart valve replacement
History of thrombotic stroke
DVT prophylaxis/ treatment
PE prophylaxis/ treatment
Caution: blood dyscrasias
Contraindications: pregnancy active bleeding
S/E: N/V, hypotension, dysthymias,thrombocytopenia (heparin)
1: vitamin k, categoryX prego 2:protamine sulfate 3: protamine sulfate, is low molecular weight heparin

26
Q

Fibrinolitics

Alteplase

A 
Plasmid breaks down clots
     Indications
Presence of MI P specific criteria
Thrombotic stroke
DVT
PE
    Cautions 
Blood dyscrasias
Recent surgery 
Intracranial bleed
S/E: N/V, hypotension, cardiac dysrythmias
27
Q

CHF

A

Impaired pumping action of the ❤️;⬇️ myocardial contractility
Left side pulmonary edema
Right side peripheral edema; jugular vein distention (JVD)
MEds: pain, fluid volume (loop, k sparing), afterload reduction (1st ACE-I, 2nd B adrenergic blockers “carvedilol”, 3rd CCBs, nitrates, vasodilator), PLT inhibitor, anticoagulant

28
Q

Drugs affecting myocardial cantractility
(digoxin)
pharm class: cardiac glycoside.

A 
⬆️myocardial contractility. + inotrope
⬇️HR -cronotrope
Indications heart failure; some dysrhythmias; resting HR control
Caution: renal; baseline hypokalemia. Symptomatic bradycardia.
S/E: visual disturbances yellow halos
Loading dose 1 mg over 24 hrs
Maintenance dose: 0.125-0.25mg
Therapeutic level: 0.5-2ng/ml
29
Q

Cardiac dysrhythmias

A

Myocardial cells able to generate electrical impulses.
Pacemaker cell generate an electrical impulse, regulate rate and rhythm
Influences:
Myocardial irritability
Nervous system
Catecholamines
Electrical stimulus
Cardiac surgery
Treatment: O2, correct cause, electrical conversion

30
Q

Conduction system review

A

Sinoatrial node (SA) node Pacemaker of the ❤️conducts to left atrium and atrioventricular (AV) node. ➡️conduction of the bundle his, and to top area of ventricular septum; then splits to form the bundle branches, then the right, left bundle branches run down through the ventricular septum in ventricles, the branches bifurcate further into purkinje fibers and intervals the ventricular wall.

31
Q 
Drugs to treat dysrhythmias
Vaughan Williams classification of antidysrhythmic drugs
Class 1 
Provainamide
Lidocaine
Propafenon
Class2 Propranolol
Metoprolol
Class3
Amiodaron
Class 4 
Verapamil.           Diltiazem.
A

Class1 fast sodium channel blockers
Class2 beta blockers
Class3 potassium channel blockers
Class4 calcium channel blockers CCB

32
Q

Adenosine

A

Drug to treat dysrhythmias
Class nucleoside; treats ⬆️HR
Used for testing last about 10 seconds then it’s gone

33
Q

Digoxin

A

Treats dysrhythmias

Pharmacology (4 decks)

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