Cardiovascular (Lauren🌭) Flashcards by Lauren F

What effects does the Sympathetic Nervous system have on the cardiovascular system?

Increased HR (chronotropy)

Increased contractility (Inotropy)

Coronary vasodilation

Increased renin release

Blood vessels: α constricts (skin, splanchnic) and ß dilates (skeletal muslce)

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What kinds of physical exam findings would you expect from someone with CHF who stopped taking their diuretic?

Unable to complete full sentences

+JVD

Crackles in lung bases

3+ pitting edema

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What is the BEST class of drug for someone who is completely fluid overloaded that will get all the fluid off really fast

Loop diuretics

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What are the 4 loop diuretics?

Furosemide (Lasix)

Torsemide (Demadex)

Bumetanide (Bumex)

Ethacrynic Acid (Edecrin)

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What is the contraindication to 3 of the loop diuretics

Sulfa allergy

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Which loop diuretic is OK for someone with a sulfa allergy

Ethacrynic acid

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What is the big risk of ethacrynic acid

Ototoxicity 👂🏻

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What are the main side effects of all loop diuretics?

Hypokalemia

Hyponatremia

Hypocalcemia

Hyperuricemia (may precipitate gout at HIGH doses)

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What kind of supplement might you want to give your patient who is on a loop diuretic?

Potassium

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Is it ok to give Loop Diuretics or Thiazides to patients who are anuric (Don’t make pee)

NO you dumbass

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What are the 3 thiazide diuretics?

HCTZ (Microzide)

Chlorothiazide (Diuril)

Metolazone (thiazide related)

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What is the contraindication to HCTZ and Chlorothiazide?

Sulfa allergy

Metolazone, the thiazide-related diuretic just has a ~caution~ for sulfa allergy

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What are the side effects of thiazide diuretics?

Hypokalemia

Hyponatremia

Hyperuricemia (may precipitate gout at HIGH doses)

Hypercholesterolemia

Hyperglycemia

Erectile dysfunction

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What are the 2 drugs that are aldosterone antagonists?

Spironolactone (Aldactone)

Eplerenone (Inspra)

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What are the 2 drugs that are K+ sparing diuretics?

Triamterene (Dyrenium)

Amiloride

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What is the MOA of Triamterene (Dyrenium) and Amiloride?

Direct inhibitors of Na+ flux

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Which one of these diuretics can you use by itself:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

NONE of them.

They’re all weak diuretics and are used in combination with other diuretics. (May eliminate the need for K+ supplementation)

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What are the common contraindications oF all these:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

Hyperkalemia

Anuria

Severe kidney problems

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What is the side effect of all of these:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

Hyperkalemia

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What is a ~relative~ contraindication to these:
Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

If they are also on an ACE or ARB

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What 2 classes of drugs will reduce mortality and improve symptoms in someone with HF?

ACE inhibitors

ß blockers

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What are the absolute contraindications of ACE inhibitors

Angioedema

Pregnancy

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What is the MOA of ACE inhibitors?

Block ACE and stop the formation of angiotensin II

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ACE inhibitors decrease (preload/afterload/both)

Both

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What conditions are treated with ACE inhibitors/

HFrEF HTN STEMI

What are the side effects of ACE inhibitors?

Dry cough Orthostatic hypotension Hyperkalemia Angioedema Rash

Which two drug classes are considered first line for patients with diabetes, CKD, and HFrEF?

ACE inhibitors and ARBs ************************* (Had a blue star on it)

What are the contraindications to ß-blockers?

Severe bradycardia 2nd or 3rdº AV block Uncompensated HF Systolic BP under 100 Cardiogenic shock

What would happen if your patient who takes a ß-blocker goes on vacation and forgets to bring their medicine?

They’ll die Abrupt withdrawal can cause acute coronary events and severe increases in BP

What are the Non-Selective ß-blockers?

Propranolol (Inderal) Nadolol (Corgard) Timolol

What are the cardioselective ß-blockers?

Acebutolol (Sectral) Atenolol (Tenormin) Metoprolol (Lopressor) Nebivolol (Bystolic)

Which two ß-blockers have Intrinsic Sympathetic Activity?

Acebutolol (Sectral) Pindolol

What is the difference between Non-selective and cardioselective ß-blockers?

The non-selective ones are more likely to cause bronchospasm.

What are the side effects of ß-blockers?

Bronchospasm Fatigue Worsen CHF (when it’s decompensated) Raise lipids Impaired glucose tolerance Decreased libido/impotence Depression

If someone develops a bothersome cough on an ACE inhibitor, what could you give them instead?

ARB

What are the contraindications to ARBs

Angioedema Pregnancy

What drugs are ARBs?

Valsartan Other ones that end in -sartan

What are the side effects of ARBs?

Orthostatic hypotension Hyperkalemia

What effects does digoxin have on the heart?

Increased contractility (inotropy) Decreased HR (Chronotropy) Increased cardiac output

We all know that digoxin has a narrow margin of safety, but which patients are at a particular risk of toxicity?

Reduced renal clearance Hypokalemia

What labs/tests do you need to keep an eye on if you put a patient on digoxin?

ECG Electrolytes Renal function Serum digoxin concentrations

What is normal BP?

Less than 120/80 | Both systolic AND diastolic need to be below 120/80

What is considered Prehypertension?

Systolic: 120-139 Diastolic: 80-89

What BP is considered Stage 1 hypertension?

Systolic: 140-159 Diastolic: 90-99

What BP is considered stage 2 hypertension?

Systolic: 160+ Diastolic: 100+

What are the 4 first line drugs for HTN?

HCTZ ACE ARB CCB

Which of the big 4 HTN meds are better for black patient?

HCTZ CCB

Which HTN meds are better for non-black patients?

ACE ß-blocker

Which of the big 4 HTN meds is best for patients with kidney disease?

ACE or ARBs

At what BP do we start HTN meds for someone who is 60+ and does not have diabetes or kidney disease

150/90

At what BP do we start HTN meds for anyone who is less than 60 or who has DM or CKD?

140/90

A 74 year old lady takes lisinopril (an ACE) for her HTN. She does not have DM or CKD. Her BP today is 148/90. What do we need to do to her meds?

Nothing!! She is over 60 without DM or CKD, so her goal BP is less than 150/90.

What are the rules for using more than one HTN meds?

There really aren’t any you can do whatever you want. Maximize 1st med before adding 2nd OR Add second med before reaching max dose of first OR Start with 2 separate classes

What class of HTN meds can actually CAUSE peripheral edema?

Short acting CCBs ex: amlodipine

What are the 2 types of CCBs?

Dihydropyridines Non-dihydropyridines

Which drugs are dihydropyridine CCBs?

Nifedipine Amlodipine Other ones that end in -dipine

Which drugs are non-dihydripyridine CCBs?

Verapamil (Calan) DIltiazem (Cardizem)

Which one has a bigger effect on the HEART vs the vasculature: Dihydropyridines or Non-dihydropyridines

Heart: Non-dihydropyridines (verapamil and diltiazem) Vasculature: dihydropyridines

What is the caution for using dihydropyridine CCBs?

What are the cautions for using non dihydropyridine CCBs

ß-blockers SA or AV node abnormalities

What drugs are the α1-blockers?

Selective: Prazosin (Minipress) Doxazosin (Cardura) Terazosin Non-selective: Phenoxybenzamine (Dibenzyline)- pretty much only used for pheochromocytoma

What is the BIG side effect of α-blockers

Orthostatic hypotension

Which class of drugs is associated with the “first dose phenomenon?”

α-blockers

What is the first dose phenomenon?

First time you take an α-blocker it knocks you on your ass due to the orthostatic hypotension

Other than HTN, what other condition can α-blockers help with?

BPH 🌰

What class of drugs can help a guy with BPH go pee pee

α blockers

Which drugs are Central α-agonists?

Clonidine (Catapres) Methyldopa

What are the side effects of central α-agonists?

Orthostatic hypotension Sedation Xerostomia

If you are taking Clonidine or Methyldopa and you take a trip to Mexico without your meds, what’s gonna happen

You die due to a hypertensive crisis

Which classes of drugs in this lecture should NOT be stopped abruptly?

ß-blockers Central α-agonists

Which 2 HTN drugs are CLASSICALLY associated with being used during preganncy

Methyldopa Labetalol

What labs do you have to monitor if someone is on Methyldopa?

CBC Liver enzymes Coombs test RISK OF HEMOLYTIC ANEMIA🔪

What is the most appropriotate drug to give someone who is diagnosed with stable angina?

Sublingual nitro PRN

What are the side effects of sublingual nitro?

Throbbing headache Hypotension Tachycardai

What are the instructions you need to give your patient for taking their sublingual nitro?

One dose every 5 min for up to 3 doses. If chest pain doesnt go away, call 911 If after 1 dose it doesn’t get even little better, call 911

Nitroglycerin decreases (preload/afterload/both)

Both

What are the contraindications to nitroglycerin?

Within 24 hours of taking viagra Hypertrophic Cardiomyopathy (HCM) RV infarction

What is the difference between Nitroglycerin and Isosorbide dinitrate/mononitrate

Nitroglycerin= rapid acting Isosorbide dinitrate/mononitrate= long acting (oral or topical)

What would you use long acting nitrates (isosorbide dinitrate/mononitrate) for?

Long term management of chronic stable angina

Is it easy to develop a tolerance to long acting nitrates (Isosorbide dinitrate/mononitrate)?

Yes, tolerance delvelops quickly

Can ß-blockers and CCBs be used as long term management of chronic angina?

Yes

What is the best class of drug for Vasospastic (Prinzmetals) angina?

CCBs

Cardiovascular (Lauren🌭) Flashcards

(82 cards)