chapter 42: cardiac glycosides, antianginals, antidysrhythmics

Question 1

left sided HF causes blood to build up in the

Answer 1

lung tissue. the left ventricle does not contract sufficiently to pump the blood returned from the lungs and left atrium out through the aorta to the peripheral circulation

Question 2

right sided HF causes blood to build up i the

Answer 2

peripheral tissues, causing peripheral edema

Question 3

preload results from

Answer 3

an excess of blood volume in the ventricle after DIASTOLE

Question 4

afterload results from

Answer 4

additional pressure or force caused by excess resistance in the aorta

Question 5

cardiac glycosides inhibits _____, leading to an increase in _____ and ______

Answer 5

the sodium potassium pump, increase in intracellular sodium, influx of calcium, which causes the heart to pump more efficiently

Question 6

digitalis preparations have three effects on heart muscle

Answer 6

1. positive inotropic (increases stroke volume)
2. negative chronotropic (decreases heart rate)
3. negative dromotropic (decreases conduction of heart cells)

Question 7

cardiac glycosides are used to correct ______ ______ and _____ _______ through two effects

Answer 7

corrects atrial fibrillation and atrial flutter through its negative chronotropic and negative dromotropic effects

Question 8

what is the reference value of atrial natriuretic peptide?

Answer 8

20-77pg/mL or ng/L

Question 9

an elevated what would indicate heart failure?

Answer 9

atrial natriuretic peptide

Question 10

results of ANH secretion includes

Answer 10

a large volume of urine that decreases blood volume and blood prssure

Question 11

reference values for brain natriuretic peptide

Answer 11

desired: less than 100 pg/mL

positive value: greater than 100 pg/mL

Question 12

BNP helps to do what?

Answer 12

helps differentiate that dyspnea is due to HF rather than lung dysfunction

Question 13

overdose of digoxin can result in

Answer 13

anorexia, diarrhea, N, V, premature ventricular contractions, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, yellow halos around objects), confusion and delirium

Question 14

what is effective in treating digoxin induced ventricular dysrhythmias

Answer 14

the antidys. phenytoin and lidocaine

Question 15

the antidoe for severe digitalis toxicity

Answer 15

digoxin immune fab

Question 16

mode of action digoxin

Answer 16

inhibits sodium potassium ATPase, promoting increased force of cardiac contraction, cardiac output and tissue perfusion, decreases ventricular rate

Question 17

milrinone is a

Answer 17

phosphodiesterase inhibitor

Question 18

PD inhibitors do what?

Answer 18

promote a positive inotropic response and vasodilation, used to treate acute HF

Question 19

herbs that increase digoxin level

Answer 19

ginseng (falsely elevates), hawthorn, licorice (promotes K loss), aloe, m-huang, ephedra,

Question 20

herbs that decrease digoxin level

Answer 20

st. john’s wort, psyllium, goldenseal

Question 21

arteriolar dilators act in three ways

Answer 21

1. increase renal perfusion which increases fluid loss 2. improves circulation to the skeletal muscles 3. reduces afterload, which increases cardiac output

Question 22

ACE inhibitors are prescribed for

Answer 22

heart failure

Question 23

ACE inhibitors do 3 things

Answer 23

dilate venules and arterioles, improve renal blood flow, decrease blood fluid volume, decrease release of aldosterone, which in turn reduces sodium and fluid retention

Question 24

ACE inhibitors can increase

Answer 24

potassium levels

Question 25

spironolactone is what class of drug? and does what?

Answer 25

potassium sparing diuretic blocks the production of aldesterone

Question 26

serum potassium level should be monitored to prevent hyperkalemia for what drug?

Answer 26

spironolactone. occurence of hyperkalemia is rare unless patient is receiving 50 mg a day

Question 27

``` nesiritide belongs to what class of drugs? how does it correct heart failure? it is useful for treating patients with ```

Answer 27

atrial natriuretic peptide hormone that inhibits ADH by increasing urine sodium loss. it promotes vasodilation, natiruresis, and diuresis. useful for treating patients who have dyspnea at rest

Question 28

angina pectoris

Answer 28

a condition of acute cardiac pain caused by inadequate blood flow to the myocradium due to either plague occlusions or spasms of the coronary artery

Question 29

three types of anginal pain

Answer 29

1. classic (occurs with predictable stress or exercise) 2. unstable (preinfarction): occurs frequently with progressive severeity unrelated to activity, unpredictable regarding stress/exertion and intensity 3. varient (prinzmetal, vasospastic): occurs during rest

Question 30

class and unstable angina is caused by

Answer 30

a narrowing or partial occlusion of the coronary arteries

Question 31

variant angina is caused by

Answer 31

vessel spasm

Question 32

three types of antianginal drugs

Answer 32

1. nitrates 2. calcicum channel blockers 3. beta blockers

Question 33

major systemic effect of nitrates

Answer 33

reduction of venous tone, which decreases workload of heart and promotes vasodilation

Question 34

beta blockers and calcium channel blockers do what?

Answer 34

decrease the workload of the heart and decrease oxygen demands

Question 35

beta blokers are the only kind of antianginal drug that cannot treat this type of angina

Answer 35

variant (vasospastic) may aggravate it

Question 36

after a dose of nitroglycerin, a pt may experience

Answer 36

headaches, dizziness, faintness

Question 37

when nitroglycerin ointment or transdermal patches are discontinued, the dose should be _______ over _____ _____ to prevent ______ _______ which is ?

Answer 37

tapered over several weeks to prevent myocardial ischemia which is lack of blood supply to the heart

Question 38

reflex tachycardia may occur if which drug is given too rapidly?

Answer 38

nitrates

Question 39

IV nitroglycerin may antagonize the effects of

Answer 39

heparain

Question 40

patients who have these three things should not take beta blockers

Answer 40

decreased heart rate, lowered blood pressure, second or third degree AV block

Question 41

nonselective beta blockers

Answer 41

``` PROPANolol NADolol PINDolol SOTAlol TIMolol ```

Question 42

selective beta blockers

Answer 42

``` atenlolol metoproplol BISOprolol ESMOlol METOPROlol ```

Question 43

nitroglycerin is contraindicated in

Answer 43

increased intercranial pressure, severe anemia, cardimyopathy

Question 44

mode of action of nitroglycerin

Answer 44

decreases myocardial demand for oxygen, decreases preload and afterload

Question 45

alcohol while taking nitroglycerin can cause

Answer 45

hypotension, weakness and faintness

Question 46

notify HCP when taking nitroglycerin if

Answer 46

chest pain is not alleviated

Question 47

if hypotension occurs from SL nitroglcyerin, pt should be placed in

Answer 47

supine position

Question 48

cardiac disrhthmias can occur from

Answer 48

following an MI, hypoxia, hypercapnia, thyroid disease, coronary artery disease, cardiac surgery, excess catecholamines, electrolyte imbalance

Question 49

four classes of antidysrhythmic

Answer 49

1. sodium channel blockers 1A, 1B, 1C 2. beta blockers 3. drugs that prolong repolarization 4. calcium channel blockers

Question 50

acebutelol drug class

Answer 50

beta 1 blocker: cardioselective beta adrenergic antagonist

Question 51

what kind of drugs should be administered by IV push or bolus over 2-3 minutes

Answer 51

antidysrhthmic

Question 52

calcium channel blockers

Answer 52

diltiazem and verapmil

Question 53

ace inhibitors have a favorable or unfavorable impact on cardiac remodeling (of left ventricle)

Answer 53

favorable, does NOT cause cardiac remodeling

Question 54

ACE inhibitors have three hemodynamic benefits

Answer 54

arterioloar dilation venous dilation suppression of aldosterone release

Question 55

what are the drugs that should be avoided in heart failure

Answer 55

calcium channel blocker, should only be used as a last result if other meds have been tried and BP is not going down. it causes fluid retention as well antidysrhythmic drugs: worsen heart failure NSAIDS: caue fluid retention and peripheral vasoconstriction

Question 56

what do african american adults and older adults NOT respond well to? they do respond well, if it is taken with

Answer 56

ACE inhibitors, only if taken with diuretic

Question 57

two drugs of aldosterone antagaonists what are they used for? what are the major adverse effects?

Answer 57

eplerenone and spironolactone used for HF and HTN major adverse effect is HYPERkalemia

Question 58

negative chronotropic drugs are used in

Answer 58

HF with uncontrolled afib (HR > 100)

Question 59

two drugs that are adrenergic agonists

Answer 59

dopamine and dobutamine

Question 60

dopamine activates what? and when is it used?

Answer 60

activates beta 1 and alpha 1 receptors it is only used for a short term for severe, acute cardiac failure

Question 61

dobutamine is a what? and it activates what?

Answer 61

synthetic catecholamine | only activates beta 1 receptors

Question 62

phosphodiesterase enzyme (PDE3)

Answer 62

inotropic and vasodilators only use short term for severe HF when not responding to RAAS inhibitors, iduretics, and digoxin.

Question 63

arterial dilator decreases ____, venodilator decreases _____

Answer 63

arterial decreases afterload | venodilator decreases preload

Question 64

antidysrhythmic drugs that prolong ____ levels cause risk for ________ __ _______ which leads to _____ __ ____

Answer 64

drugs that prolong QT intervals cause risk for torsades de pointes which leads to fatal V fib