Cardiovascular Drugs 2 Flashcards
(95 cards)
1
Q
Define: Angiotensin
A
A peptide hormone that causes vasoconstriction and stimulates aldosterone and ADH release; parr to the RAAS system
2
Q
Define: Aldosterone
A
A hormone released from the adrenal cortex that increases the retention of sodium and water
3
Q
Define: ADH
A
Hormone released to increase water retention
4
Q
Define: Arteries
A
Vessels that take blood away from the heart
5
Q
Define: Automaticity
A
Property of heart cells to generate an action potential without an external stimulus
6
Q
Define the cardiac cycle
A
Period of cardiac muscle relaxation and contraction
7
Q
Define: Diastole
A
Resting phase of the heart in which blood is returned.
8
Q
Define Hydrostatic pressure
A
Pushing force of fluid against solid objects
9
Q
Define the sinoatrial (SA) node
A
Normal pacemaker of the heart and generates action potential
10
Q
Define systole
A
The contracting phase of the heart, blood is pumped out
11
Q
What is troponin?
A
A chemical in the heart muscle that prevents the reaction between actin and myosin, leading to muscle relaxation
12
Q
What causes troponin to be inactivated?
A
calcium during muscle stimulation. When actin and myosin react, it causes muscle contraction
13
Q
Purpose of the veins?
A
These vessels return blood to the heart
14
Q
Define afterload
A
Resistance against which the heart has to push
15
Q
Define cardiac output
A
The volume of blood being pumped by the heart
16
Q
What is the equation for cardiac output
A
HR * stroke volume= cardiac output
17
Q
What is cardiomyopathy?
A
It is a disease of the heart muscle that leads to a weakened heart and may lead to complete heart muscle failure and death
18
Q
What is cardiomegaly?
A
Enlargement of the heart, commonly seen with chronic hypertension, valvular disease, and heart failure
19
Q
What is dyspnea?
A
discomfort during respirations, often with a feeling of anxiety or difficulty breathing. Seen often in left-sided HR
20
Q
What is hemoptysis?
A
Blood-tinged sputum seen in left-sided HF when blood backs up into the lungs and fluid leaks into the lung tissue
21
Q
What is nocturia?
A
Getting up to void at night
22
Q
What does it mean to have a positive inotropic effect?
A
Describes an agent that causes an increased force of muscle contraction
23
Q
Define preload
A
Amount of blood that is brought back to the heart to be pumped throughout the body; this blood exerts pressure on the ventricles
24
Q
What is pulmonary edema?
A
Increased fluid in the lung tissue may be due to left-sided HF
25
What is tachypnea?
Rapid and shallow respirations that can be seen with left-sided HF
26
What is heart failure?
A condition in which the heart muscle has less ability to adequately pump blood around the CV system, leading to a backup or congestion of blood in the system
27
What conditions cause an increase in preload?
Hypervolemia, regurgitation of cardiac valves, heart failure
28
What conditions may cause increased afterload?
Hypertension, vasoconstriction
29
What is good to remember about the relationship between afterload and the overall workload on the heart?
When there is an increase in afterload, the workload increases as well
30
How do cardiac drugs work?
1. Drugs that affect contraction include calcium, digitalis preparations, and quinidine
2. Drugs that stimulate or inhibit the ANS influence contractions
3. Drugs that stimulate the SNS increase HR
4. Drugs that stimulate PNS decrease HR
31
What is activated in response to a decrease in cardiac output?
The RAAS system
32
What is the goal of the RAAS system?
to increase blood pressure and blood volume
33
What characteristics are common signs of left-sided HF?
Left-sided HF is characterized by tachypnea, dyspnea, orthopnea, hemoptysis, anxiety, and poor oxygenation of the blood
34
What characteristics are common signs of right-sided HF?
Right-sided HF is characterized by edema, liver congestion, elevated JVP, and nocturia
35
What is the purpose for cardiotonic agents?
These inotropic agents stimulate more effective muscle contractions by affecting intracellular calcium levels.
36
What is the purpose of the cardiac glycoside digoxin?
To increase the force of contraction in the cardiac muscle ( by moving calcium into the muscle)
-Increased contractility increases blood flow to the kidneys (causing a diuretic effect), slows the HR, and slows conduction through the AV node
37
Where does digoxin derive from?
It derives from either the digitalis plant or foxglove
38
What is the prototype drug for cardiac glycosides?
Digoxin
39
In which conditions is Digoxin indicated?
HF, atrial flutter, A-Fib, and paroxysmal atrial tachycardia
40
What is a critical safety factor for Digoxin?
It has a narrow margin of safety
41
What are some contraindications and cautions for those using Digoxin?
1. Contraindicated in ventricular tachycardia or fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, electrolyte abnormalities
42
What are some undesirable effects for those using Digoxin?
Anorexia, nausea (1st sign of adult toxicity), upset stomach (1st sign in older child); vertigo, headache, depression, muscle weakness, drowsiness, confusion (1st sign of elderly). Bradycardia, ECG changes, heart block. Photophobia (yellow-green halos around visual images), flashes of light
43
What is the therapeutic range for Digoxin?
Between 0.8 ng/mL and 2.0 ng/mL.
-Levels less than 1.5 ng/mL in the absence of hypokalemia indicate digoxin toxicity is unlikely.
44
What is the antidote for Digoxin toxicity?
DigiFab
45
What are some drug-drug interactions for Digoxin?
-St. Johns wort and psyllium decrease the effectiveness of digoxin
-Increased digoxin toxicity has been shown with ginseng, hawthorn, and black licorice.
46
Define stable angina
Pain due to the imbalance of myocardial oxygen supply and demand; the pain is relieved by rest or stoppage of activity
47
Define unstable angina
An episode of myocardial ischemia with pain due to the imbalance of myocardial oxygen supply and demand when the person is at rest and/or at unpredictable times
48
Define prinzmetal angina
Drop in blood flow through the coronary arteries caused by vasospasm in the Carter
49
What is the pulse pressure?
It is the systolic pressure minus the diastolic pressure; it reflects the filling pressure of the coronary arteries
50
What is the purpose of Antianginal agents?
To help restore the appropriate supply-and-demand ratio in oxygen delivery to the myocardium. An imbalance to this ration, often manifested by pain, is most commonly caused by atherosclerotic cardiovascular disease (ASCVD)
-They work by either dilating the blood vessels or by decreasing the workload of the heart
51
What agents are used to treat angina?
Nitrates, beta-adrenergic blockers, calcium-channel blockers, and piperazine acetamides
-All antianginal meds are effective and may be used in combination to help with pain control
52
What is the goal of the use of nitrates?
The goal is to cause vasodilation and to decrease venous return and arterial resistance effects that decrease cardiac workload and oxygen consumption.
-Action is direct; they act directly on the smooth muscle to cause the relaxation and depress muscle tone
53
What is the drug of choice to treat an acute anginal attack?
Nitroglycerin
54
When are nitrates indicated?
Indicated for the prevention and treatment of attacks of angina pectoris
55
What are the two nitrates that I need to know for the exam?
Nitroglycerin and Isosorbide dinitrate
56
What are some contraindications/cautions for Nitroglycerin?
Hypersensitivity, closed-angle glaucoma, severe anemia, hypotension, early MI, head trauma, ICP, pregnancy, renal or hepatic disease. Caution for those taking antihypertensive or those who have hyperthyroidism
57
What is the prototype drug for nitroglycerins?
Nitroglycerin
58
What are some undesirable effects for NTG?
Headache (most common), hypotension, postural hypotension, syncope, dizziness, weakness, reflex tachycardia, paradoxical bradycardia
sublingual: burning, tingling sensation in the mouth
59
What are some drug-drug interactions for NTG?
1. Increased effects if combined with alcohol, antihypertensive, beta-blockers, CCBs. Decreases effects of heparin
60
What are some nursing considerations/interventions for NTG?
1. Monitor apical pulse before dose and periodically after
61
What is the usual indication for Isosorbide dinitrate?
It is taken before chest pain begins when exertion or stress can be anticipated to help prevent angina in adults; it is taken daily for the management of chronic angina
62
Define hemodynamics
The forces that move blood throughout the CV system
63
Define premature atrial contraction (PAC)
An early contraction caused by an ectopic focus in the atria that stimulates an atrial response
64
Define premature ventricular contraction (PVC)
An early contraction caused by an ectopic focus in the ventricles that stimulates the cells
65
What physiological disturbances can cause arrhythmias?
Electrolyte disturbances, decreases in oxygen delivered to the cells, structural damage in the conduction pathway, drug effects, acidosis, or the accumulation of waste products
66
What is the goal of antiarrhythmic agents?
These drugs alter the action potential of the heart cells and interrupt arrhythmias.
-Used in emergencies when the hemodynamics arising from the arrhythmia are severe and possibly fatal or when the arrhythmia significantly decreases a patient's quality of life
67
What are the different classes of Antiarrhythmic agents?
Class 0, I, II, III, and IV
-Classified based on their mechanisms of action
68
What is the purpose of Class I antiarrhythmics?
They block sodium channels and depress phase 0 of the action potential, often slowing conduction and automaticity.
-This class is further broken down into 3 subclasses
69
What is the Class I Antiarrhythmic I need to know?
Lidocaine- Class 1b
70
What do class 1B antiarrhythmics do?
Depress phase 0 somewhat and shorten the duration of the action potential
71
What are the usual indications for Class 1 antiarrhythmic?
-The drugs are local anesthetics or membrane-stabilizing agents
- The drugs are preferable in conditions like tachycardia
-Indicated for potential life-threatening ventricular arrhythmias and should not be used to treat ventricular arrhythmias that aren't life-threatening
72
What are the usual indications for lidocaine?
The management of acute ventricular arrhythmias during cardiac surgery or MI; treatment of refractory ventricular arrhythmias
-PVCs, ventricular tachycardia, and ventricular fibrillation
73
What are some contraindications/cautions for Class 1 antiarrhythmic?
1. Contraindicated in the presence of allergy, bradycardia or heart block, with HF, hypotension, or shock
2. Caution in renal or hepatic dysfunction,
74
What are some undersirable effects for CLass 1 antiarrhythmic?
Arrhythmias, bradycardia, heart block, hypotension, confusion, drowsiness (1st sign of toxicity), nausea, vomiting, seizures, cardiac arrest
75
What are some drug-drug interactions for Class 1 antiarrhythmic?
1. Increased risk of bleeding effects if they are combined with warfarin
76
What is the purpose for Class II antiarrhythmic?
They're beta-adrenergic blockers that prevent sympathetic stimulation.
77
What are some therapeutic actions and indications for Class II antiarrhythmic?
Therapeutic action is decreased HR, cardiac excitability, and cardiac output, a slowing of conduction through the AV node, and a decrease in renin release.
These drugs are indicated for treating rapid AF, atrial flutter, paroxysmal SVTs, HTN, angina, PVCs, and ventricular tachycardia.
78
What are some contraindications/cautions for class II antiarrhythmic?
1. Contraindicated in the presence of sinus bradycardia and AV block, with cardiogenic shock or respiratory depression
2. Caution with diabetes and thyroid dysfunction, asthma or COPD, pregnancy/lactation, and renal and hepatic dysfunction
3. Adenosine is contraindicated in patients with 2nd or 3rd-degree AV block, sinus node disease, or hypersensitivity to adenosine
79
What are some undesirable effects of Class II antiarrhythmic?
*related to the effects of blocking the SNS effects
1. anticipate a loss of libido, decreased exercise tolerance, and alterations in blood glucose levels
2. Adenosine is known to cause flushing, headache, and shortness of breath.
80
What are some drug interactions for Class II antiarrhythmic?
1. Risk of additive CV effects increases if these drugs are taken with verapamil or diltiazem
2. Risk of masked hypoglycemic effects when beta-blockers are taken with antidiabetic meds
3. Methylxanthines decrease therapeutic effect
81
What 2 Class II antiarrhythmics do I need to know?
Adenosine and propranolol
82
What class III antiarrhythmic do I need to know?
Amiodarone
83
What class IV antiarrhythmic drug do I need to know?
Diltiazem
84
What are some therapeutic actions/indications for Class III antiarrhythmic?
Indicated for the treatment of life-threatening ventricular arrhythmias and for the maintenance of sinus rhythm in patients with symptomatic AF or atrial flutter.
85
What type of drug is Diltiazem also?
Antihypertensive
86
What are some undesirable effects of Class III antiarrhythmic?
*Related to the changes they cause in action potential
1. Amiodarone has been associated with potential fatal liver toxicity, ocular abnormalities, lung fibrosis, phototoxicity, and the development of serious cardiac arrhythmias.
87
What is the main indication for amiodarone?
Treatment of life-threatening VENTRICULAR arrhythmias
88
What are some undesirable effects of Class IV antiarrhythmic?
Adverse effects are associated with the vasodilation of the blood vessels, slowing HR and causing negative inotropic effects.
1. CNS: dizziness, weakness, fatigue, depression, constipation, headache,
2. GI: GI upset, nausea, vomiting
3. Hypotension, HF, shock, arrhythmias, AV block, and edema
89
What are some contraindications/cautions for Class III antiarrhythmic?
1. Caution in the presence of shock, hypotension, or respiratory depression; with a prolonged QTc interval; renal or hepatic disease
2. Caution amiodarone with thyroid or pulmonary disease due to the increased risk of thyroid hormone abnormalities and pulmonary toxicity
90
What are some contraindications/cautions for Class IV antiarrhythmic?
1. Contrainidcated with a known allergy to any CCB, patients with sick sinus syndrome or heart block (unless an artificial pacemaker is in place), and severe HF or hypotension
2. Caution in pregnancy/lactation, idiopathic hypertrophic subaortic stenosis, impaired renal or liver function
91
What are some drug interactions for Class III antiarrhythmic?
1. Can cause serious toxic effects if combined with digoxin or quinidine
2. Increased risk of arrhythmias if combined with antihistamines, phenothiazines, or tricyclic antidepressants
3. Grapefruit juice can lead to amiodarone toxicity
92
What are some drug interactions for Class IV antiarrhythmic?
1. Diltiazem can increase the serum levels and toxicity of cyclosporine
2. Increased risk of HTN, bradycardia, and heart block when the drug is administered with other antihypertensive and/or neg chronotropic meds
3. Increased risk of HF exacerbation if given with other neg inotropic medications
4. Risk of severe cardiac effects if drugs are given IV within 48 hours of IV beta-adrenergic drugs
93
What is the purpose of Class IV antiarrhythmic?
They are calcium channel blockers that shorten the action potential, disrupting ineffective rhythms and rates.
94
What are some nursing considerations/interventions for Class IV antiarrhythmic?
1. Assess the patient's neurological status
2. Assess cardiac status closely
3. Monitor respiratory rate and depth
4. Inspect the abdomen for evidence of distention
5. evaluate the skin
6. Monitor labs: CBC, renal and liver function
95
What are some nursing considerations/interventions for Class II antiarrhythmic?
1. Assess I&Os, electrolytes (K, Na, and Cl), liver, and thyroid studies, liver and renal function tests
2. Monitor cardiac effects closely
3. Administer with meals if Gi symptoms occur
