Chapters 22 & 23 Flashcards Preview

Pharm 2 > Chapters 22 & 23 > Flashcards

Flashcards in Chapters 22 & 23 Deck (57):
1

Blood fluid coming back into heart. Stretch of ventricles.

Preload

2

Combination of cardiac output and systemic vascular resistance. Minimum pressure to push fluid throughout the body.

blood pressure

3

Persistent systolic bp over 150 and or diastolic over 90

hypertension

4

Amount of pressure against which the heart must work to eject blood during systole.

Afterload (SVR)

5

Cardiac output per minute

4-8L/min

6

Why is HTN called the silent killer

organs are being damaged

7

How do we decrease BP?

dilate the arteries

8

With higher bp how do the arteries react?

shears and damages inside arteries increasing risk of artherosclerosis

9

90% of the cases have this type of htn

Primary or idiopathic (essential HTN)

10

Non-pharm treatments usually used to begin with in patients with HTN

diet, exercise, salt reduction, yoga

11

Peripheral blockers work against SNS

Alpha 1/Beta 1

12

Central agonists work SNS

Alpha 2

13

What adverse effects to the adrenergics do against the SNS

Bradycardia, hypotension-syncope, CNS depression

14

How long could it take for full effects against the adrenergics?

4-6 weeks

15

Alpha 2 agaonists. Most commonly used method is patches.

Clonidine (Catapress)

16

Alpha 1 Blocker. Extended release tablets- caplet will be defecated. Make sure patient understands and knows that medication has been absorbed.

Doxazosin (Cardura)
Prazosin (Minipress)

17

Dual alpha/beta blocker that is used.

Carvedilol (Coreg)

18

Decrease the heart rate and myocardial contractility. Reduce cardiac output and workload

Beta-adrenergic antagonists

19

What do ACE inhibitors block?

bock conversion of angiotensin 1 to 2

20

When are ACE inhibitors given to patients

slow progression of heart failure
given after MI
Can delay progression of kidney failure in diabetes

21

Given PO, well tolerated. ACE Inhibitor meds. (pril meds)

Catopril (capoten)
Lisinopril (zestril)

22

Adverse Effects of ACE Inhibitors.

cough due to bradykinin excess, Hyperkalemia

23

Contraindications of ACE inhibitors

Renal failure pregnance in 2nd and 3rd trimester

24

Prevent angiotensin 2 from activating its target receptors. Have long half lives so can be given PO once daily.

Angiotensin 2 Receptor Blockers (ARB)

25

Report headaches/dizziness due to hypotension. ARB. Given if patient cannot tolerate ACE.

Losartan (Cozaar)

26

Why are ACE inhibitors used more?

Longer on the market so more research
cheaper
Docs more comfortable with this

27

Potent. Causes hypotension easily. Given PO, IM, IV. Dilates arteries= lower bp. PO encourage to take with meals- increases availability. IV reassess BP in 10 min after admin.

Hydralazine (Apresoline)

28

Nursing responsibilities of direct acting vasodilators?

Don't stop abruptly
Check for any swelling
Position changes slowly due to potential hypotension/syncope

29

Adverse effects of Direct-Acting Vasodilators

reflex tachycardia (coadminister with Beta-blocker)

30

BP lowers it causes the body to respond through the kidneys to hold on to fluid. What should be given?

diuretics

31

Untreated or poorly controlled HTN- stopping medications "cold turkey"

Hypertensive Emergency (lower bp 20-25%)

32

What med is given in hypertensive emergency?

Sodium nitroprusside (Nitropress)

33

Normal creatinine and potassium lab levels?

Creatinine: 0.5-1.4
Potassium: 3.5-5.2

34

First line agent that is used in htn in African Americans

HCTZ

35

Insufficient blood flow/chest pain

angina

36

Insufficient blood flow to the hart muscle from narrowing of coronary artery may cause....

chest pain

37

When there is obstruction of blood flow to the heart tissue due to blockage

MI

38

Very predictable. Chest pain that occurs with exertion and rest will relieve.

Chronic Stable Angina

39

Occurs when coronary arteries spasm. Caused by vasoconstriction= not necessarily r/t atherosclerosis. Unpredictable.

Vasospastic- Prinzmetal angina

40

Chest pain that is unpredictable, not related to exertion (so happen at rest), rest does not fix. An impending MI.

Unstable angina

41

Dilate veins, reducing the amount of blood returning to the hear. Dilate the coronary arteries, bringing more blood to the myocardium.

Organic nitrates

42

Short-acting nitrate. Sublingual or buccal to terminate acute angina.

Nitroglycerin (Nitro-stat, Nitro-bid)

43

Long acting nitrate. Oral or patch to decrease frequency and severity of episodes.

Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)

44

Adverse effects of nitrate medications

flushing of skin
headache
orthostatic hypotension/syncope

45

Do not take with 24 hours of _______ or other meds that cause hypotension.

Viagra

46

When should we hold Nitrate meds?

If BP is less than 90/60 or HR over 100

47

When is Beta Adrenergic Blockers beneficial

exercise and after MI

48

Beta Blockers Med for prophylaxis of chronic angina

Atenolol (Tenormin)
Metoprolol (Lopressor)

49

Adverse effects of Beta Blockers

Hypotension, fatigue, weakness, dizziness

50

If patient is taking beta blockers and is diabetic what should we monitor?

glucose frequently

51

Ions responsible to cause a cardiac contraction

Potassium (inside cell)
Sodium (outside)
Calcium (outside)

52

Dilate arterial smooth muscle, reducing blood pressure and decreasing cardiac workload. Some also decrease the heart rate, reducing the workload on the heart, and dilate the coronary arteries.

Calcium Channel Blockers

53

Reducing force of contraction is called.......

negative inotropic effect

54

Ca Channel Blocker. Used to treat HTN and angina. Little to no effect on myocardium itself.

Dihydropyridines (PO)
Amlodipine (Norvasc)

55

Ca Channel Blocker. Longest half-life=30-50 hours= once daily dosing.

Verapamil (Calan)

56

Adverse effects of Ca Channel Blockers.

Dizziness
Flushing
Hepatotoxicity, Heart Failure (RARE)
pulmonary edema (crackles or rhonchi in lungs)

57

Smooth muscle and myocardium. Used to treat HTN, angina and dysrhythmias. Have a negative inotrope effect. Lowers heart rate.

Nondihydropyridines
Diltiazem (Cardizem)