Cardiovascular Phamacology Flashcards

Question

Atherosclerosis

Answer 1

* When excess cholesterol deposits on cells and on the inside walls of blood vessels it forms an atherosclerotic plaque * The first step of atherosclerosis is injury to the endothelium which results in atherosclerotic lesion formation * When the plaque ruptures, blood clots form which lead to decreased blood flow, resulting in cardiovascular events

Answer 2

•Macrovascular complications –Unstable angina (chest pain) –Myocardial infarction (heart attack) –Ischemic cerebrovascular disease (stroke) –Coronary artery disease (heart disease) •Microvascular complications –Retinopathy (vision loss) –Nephropathy (kidney disease) –Neuropathy (loss of sensation in the feet and legs)

Answer 3

* High fat intake * Obesity * Type 2 diabetes mellitus * Advanced age * Hypothyroidism * Obstructive liver disease * Genetics * Drug induced: glucocorticoids, thiazide diuretics, beta blockers, protease inhibitors, sirolimus, cyclosporine, progestins, alcohol

Answer 4

•The fasting lipid profile (TC, LDL-C, HDL-C, TG) is analyzed •The following individuals should be screened at least once every 5 years –All adults 20 years and older should be screened at least once every 5 years –Individuals with family history of premature cardiovascular disease should be screened more frequently * History and physical examination * An individual with a combination of lipid profile with history and physical exam will be treated accroding to the ATP III guideline

Answer 5

•LDL-C –\< 100mg/dL Optimal –100-129mg/dL Near or above optimal –130-159mg/dL Borderline high –160-189mg/dL High –\> or = 190mg/dL Very high •Total-C –\<200mg/dL Desirable –200-239mg/dL Borderline high –\> or = 240mg/dL High •TG-C –\<150mg/dL Optimal –150-199mg/dL Borderline high –200-499mg/dL High –\> or = 500mg/dL Very high •HDL cholesterol –\<40mg/dL Low –\>60 or =60mg/dL High

Answer 6

* Reduce total cholesterol and LDL (bad) cholesterol * Prevent the formation of atherosclerotic plaques and stop the progression of established plaques * Prevent heart disease * Prevent morbidity and mortality

Answer 7

•Lipid lowering therapy should be started with lifestyle modification for at least 12 weeks –Increase physical activity –Weight reduction –Diet modification

Answer 8

•If non-pharmacological treatment is not successful, a lipid-lowering drug should be started, especially in high risk populations •1st step –Initiate LDL-lowering drug therapy –Start with statins, bile acid sequestrants, or nicotinic acid –Evaluate after 6 wks •2nd step –If goal is not reached, intensive lipid-lowering treatment should be started –Increase dose of statins –Bile acid sequestrants, or nicotinic acid should be added –Evaluate after 6 wks •3rd step –If goal is not reached, intensive lipid-lowering should be continued or individual should be referred to a lipid specialist –If goal was reached, other lipid risk factors should be treated •4th step –Monitor response and compliance

Answer 9

* Statins (HMG CoA Reductase Inhibitors) * Atorvastatin (Lipitor®) * Simvastatin (Zocor®) * Lovastatin (Mevacor®) * Pravastatin (Pravachol®) * Fluvastatin (Lescol®) * Rosuvastatin (Crestor®)

Answer 10

* Reduce LDL cholesterol by 18-55% * Decrease TG by 7-30% * Raise HDL cholesterol by 5-15% * Statins are the most effective in lowering LDL cholesterol * Statins are the most effective in patient who has low HDL and high LDL

Answer 11

•MOA –Statins inhibit HMG-CoA reductase (enzyme involved in cholesterol synthesis) thus decreasing mevalonic acid production and stimulating LDL breakdown •S/Es: muscle aches, muscle break down leading to renal failure (rhabdomyolisis – caution when taken with fibric acids/niacin, increased liver enzymes, fatigue, HA, mild GI disturbances, rash

Answer 12

•Cholestyramine (Questran®), Colesevelam (Welchol®), Colestipol (Colestid®) •MOA –Bind to bile acids in the intestine, thus inhibits uptake of intestinal bile salts into the blood and increases the fecal loss of bile salt-bound LDL •S/Es: stomach upset, constipation accompanied by heartburn, nausea, and bloating •Effectiveness –Reduces LDL cholesterol by 15-30% –Increases HDL cholesterol by 3-5% –Increases TG

Answer 13

•Niacin, Niacor, and Slo-niacin •MOA –Nicotinic acid decreases the clearance of ApoA1 to increase HDL; it inhibits the synthesis of VLDL •Effectiveness –Decreases LDL cholesterol by 5-25% –Increases HDL cholesterol by 15-35% –Decreases TG by 20-50% –Most potent drug that increases HDL cholesterol •S/Es: flushing, hyperglycemia, gout, liver toxicity, GI distress, muscle weakness

Answer 14

•Gemfibrozil (Lopid®), Fenofibrate (Tricor®) •MOA –Up-regulates fatty acid transport protein and fatty acid oxidation; thus it reduces the formation of VLDL, increases formation of HDL, and enhances the breakdown of TG •Effectiveness –Reduces LDL cholesterol by 20-50% with normal TG –Increases LDL cholesterol with high TG –Reduces TG by 20-50% –Increases HDL cholesterol by 10-20% –Fibric acids are very effective in lowering TG and preventing pancreatitis –Reduce VLDL but might increase LDL and total cholesterol •S/Es: dyspepsia, gallstones, muscle ache, rash, weakness, tiredness, elevations in muscle enzymes

Answer 15

•MOA –Inhibits absorption of cholesterol in the small intestine =\> decreases the delivery of cholesterol to the liver and increases the clearance of cholesterol from the blood •Effectiveness –Reduces LDL by 15-20% •S/Es: chest pain, dizziness, diarrhea, abdominal pain

Answer 16

•Garlic- 6 out of 10 studies found garlic to be effective TC¯24.8mg/dl, LDL ¯15.3mg/dl & TG¯38mg/dl Can not be recommended due to low methodological quality of studies. •Omega 3 Fatty Acids- 10 studies found TC ¯11.6%, LDL¯32.5%, TG¯11.6%. Not recommended to replace lipid lowering medications. Methodology of studies was weak

Answer 17

* Encourage compliance with pharmacologic and nonpharmacologic methods to lower plasma lipids * Help design and implement exercise programs that enable patients to lose weight and increase plasma levels of HDL =\> maximizing effects of drug therapy

Answer 18

* Pain in the chest region resulting from myocardial ischemia =\> metabolic, electrophysiologic, and contractile changes in the heart (accumulation of lactic acid) * Sensation of intense compression and tightness in the retrosternal region, with pain radiating to the jaw or left arm * Precipitated by physical exertion but may occur at rest or sleep

Answer 19

•Goal: restore or maintain the balance between myocardial oxygen supply and myocardial oxygen demand •Two drug groups –Decreases myocardial oxygen demand •Organic Nitrates •Beta blockers –Increases myocardial oxygen supply •CCBs: Calcium Channel Blockers

Answer 20

nitroglycerin (Nitrostat, Nitro-Bid, etc); isosorbide dinitrate (Imdur) •MOA –Dilate vascular smooth muscle –Prodrugs (drug precursors) that get converted to nitrous oxide within vascular smooth muscle –Decrease the amount of blood returning to the heart (preload) =\> decreased cardiac afterload =\> decrease in amount of work the heart needs to perform =\> decrease in myocardial oxygen demand

Answer 21

•Nitroglycerin –Oral, buccal (ER), sublingual, ointment, patch –Administered for both the prevention and the treatment of anginal attacks •Isosorbide dinatrate –Administered for both the prevention and the treatment of anginal attacks –Anitanginal and hemodynamic effects last longer with isosorbide •S/Es: HA, dizziness, and orthostatic hypotension, nausea

Answer 22

•Antagonize beta-1 receptors on the myocardium =\> decrease HR and the force of myocardial contraction =\> decrease in the work by the heart =\> decrease myocardial oxygen demand •Therapeutic consideration –Nonselective beta blockers may induce bronchoconstriction in patients with asthma or similar respiratory problems =\> give these patients more cardioselective beta antagonists like atenolol or metoprolol

Answer 23

•MOA –Block the entry of calcium into vascular smooth muscle =\> relaxation and vasodilation =\> increase supply of oxygen to the myocardium –Small degree of systemic vasodilation =\> decreased in myocardial oxygen demand =\> decreased in cardiac preload and afterload (similar to organic nitrates) –Limit the entry of calcium into cardiac striated cells =\> decreasing myocardial contractility and oxygen demand –Can also affect myocardial excitability by altering the conduction of electrical activity throughout the myocardium (more important for treatment of arrhythmias)

Answer 24

•Nondihydropyridines –Diltiazem (Cardizem) – less S/Es than other CCBs •Vasodilates the coronary arteries and peripheral vasculature •Produces some depression of electrical conduction in the sinoatrial and artrioventricular nodes =\> slight bradycardia –Verapamil (Calan, Isoptin) * Vasodilates coronary arteries * Moderately effective compared to other agents in treatment of angina •Dihydropyridines –Selective for vascular smooth muscle as compared to cardiac striated muscle –Vasodilate the coronary arteries and peripheral vasculature without exerting any major effects on cardiac excitability or contractility * Nifedipine (Procardia) * Amlodipine (Norvasc)

Answer 25

* Must be aware of patients who are taking medications for angina pectoris for prophylaxis or during the attack * Activities in rehab increase myocardial oxygen demand =\> anginal attacks may occur during the therapy session (make sure that patients bring nitroglycerin to therapy) * Be aware of the cardiac limitations in patients with angina and use caution in not overtaxing the heart * Some patients may experience an increase in exercise tolerance because they are not limited by symptoms of angina * Beta blockers and certain CCBs can blunt the ability of the heart to respond to an acute exercise bout by slowing down heart rate and decreasing myocardial contractility during exercise =\> adjust exercise workloads accordingly since the heart will not be able to handle some workloads * Nitrates and CCBs produce peripheral vasodilation =\> hypotension. Conditions that produce peripheral vasodilation, such as heat or exercise, may produce additive effect on the drug-induced hypotension =\> dizziness and syncope

Cardiovascular Phamacology Flashcards

(51 cards)