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cardio pulm midterm > LECUTRE 3: cardiovascular meds > Flashcards

LECUTRE 3: cardiovascular meds Flashcards

1
Q

the goal for the medication is to reestablish the balance between myocardial O2 supply and demand … which disease is this for

A

ischemic heart disease

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2
Q

Goals of pharmacological management:
• Address the underlying contribution to heart failure
• Maintain CO
• Regulate fluid and salt intake
• Decrease preload / afterload
• Increase cardiac contractility
• Reduce cardiac workload
• Decrease sympathetic stimulation

for what disease

A

HF

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3
Q

which stages of heart disease is usually in hospital

A

stage b c d

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4
Q

Goals of pharmacological management:
• Inhibit abnormal impulse formation and conduction by altering
membrane permeability to specific ions
• Classified based on the:
• Ionic gates they control:
• Na+
• K+
• Ca+
• Cl-
• Location:
• Myocardial pacemaker cells (SA, AV)

for which disease

A

arrthymias

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5
Q

Goals of pharmacological management :
• Reduce fluid volume (diuretics)
• Limit sympathetic nervous system activity to:
• promote arterial and venous vasodilation
• reduce CO
• reduce the effects of the renin-angiotension-aldosterone system at the
kidney to:
• promote vasodilation
• reduce fluid volume

for which disease

A

HTN

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6
Q

what is the suffix for beta blockers

A

“lol”

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7
Q

beta blockers ____ beta receptor binding sites of ____ and ____

A

reduces
epinephrine
norepinephrine

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8
Q

what are the 2 selective beta blockers

A

Beta 1 and 2

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9
Q

when blocked , which selective beta blocker causes decrease HR ad myocardial contractility

A

Beta 1

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10
Q

when blocked , which selective beta blocker causes bronchoconstriction and vasoconstriction

A

beta 2

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11
Q

which beta receptor is locked on the heart ? lungs and peripheral mm?

A

beta 1
beta 2

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12
Q

what does nonselective beta blockers do

A

block both types of beta receptors

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13
Q

nonselective beta blockers are not indicated for individuals with

A

PVD or COPD

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14
Q

beta blockers block which system

A

SNS

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15
Q

beta blockers are clinically indicated for what

A

HTN
ischemic heart disease
HF
arrthymias

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16
Q

can beta blockers mask symptoms of hypoglycemia ?

A

yes

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17
Q

in some older people selctive beta blocker may promote what

A

hyperglycemia

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18
Q

someone with orthostatic Hypotensoin has a drop of systolic by ___ and HR by ____

A

20
30

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19
Q

beta blockers causes exaggerated cardiac responses like what

A

bradycardia
orthostatic hypotension
heart block
excess negative iontropic effect

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20
Q

what are calcium channels blockers clinically indicated for

A

ischemic heart diease
arrhythmias
BP control
reduction of re infarction in patient with non Q wave infarcts

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21
Q

what type of iontropic effect do calcium channel blockers have

A

negative

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22
Q

when the heart infarcts what releases

A

calcium

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23
Q

someone who is taking calcium chanel blockers may have negative iontropic effects which. may lead to PT using ___ during exercise as HR responses to exercise may be blunted

A

RPE

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24
Q

what suffix does calcium channel blockers have

A

pine

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25
Q

calcium channel blockers decrease arterial BP via

A

smooth mm relaxation
vasodilatation (decreases cardiac after load)

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26
Q

myocardial ischemia causes an influx on calcium which ____ HR and ______ ______

A

increase
myocardial contractility

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27
Q

calcium channel blockers reduce O2 demand which ____ HR and ____ contractions

A

slows
strengthen

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28
Q

what are nitrates clinically indicated for

A

HTN
ischemic heart disease ( angina)
heart failure

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29
Q

how does nitrates effect the HR

A

slows it down

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30
Q

nitrates reduce blood back to the heart by doing what

A

dilating veins (reduces preload)

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31
Q

since nitrates reduce blood to the heart by dilating veins which reduces preload , this causes the heart to contract with ___ force

A

less

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32
Q

how does nitrates effect BP

A

lowers it

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33
Q

if someone has a lower BP then there is ___ resistance in the heart to push blood from the chambers leading to a reduce ____

A

less
afterload

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34
Q

what is chest pain related to ischemia of the myocardium

A

angina

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35
Q

what is caaused by an imbalance in myocardial oxygen supply and demand

A

angina

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36
Q

someone with angina has a lack of oxygen which then stimulates ___ receptors within the heart

A

pain

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37
Q

nitrates tend to have what within the name of the drug

A

“nitr”

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38
Q

what are some side effects of nitrate

A

hypotension
dizziness
reflex tachycardia (if BP drop fast then heart beats faster)
flushing of skin

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39
Q

if nitrates are taken before exercises it is important to measure ___ before and after meds are taken

A

vitals

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40
Q

nitrates can be administered via

A

enteral or parental routes
oral
sublingual
percutaneous spray

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41
Q

if a patient decribes their chest pain as an “elephant sitting on my chest” , chest pressure or tightness , or vice like , gripping or burning then we can suspect they have what

A

angina

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42
Q

if your patient is complaining of chest pain that radiates to the shoulder , in between the scalps , arm , throat or jaw or anywhere above the umbilicus what can we suspect

A

ischemic pain patterns

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43
Q

if ST segments downwardly shifts then what does that indicate

A

ischemia or infarction

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44
Q

what type of angina does a patient have if they have no pain at rest , pain last for several minutes , relived by rest or taking nitrates, and patient can reliably predict activities that will provoke discomfort

A

stable

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45
Q

what types of angina is it if a patient has an onset that is unpredictable or accelerating in frequency , severity or intensity , may occur at rest , pain last longer then 15 minutes

A

unstable

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46
Q

what types of angina is it if the patient has pain at rest and often in the morning , there is ST elevation on ECG

A

prinzmetals (variant)

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47
Q

what are some medications taken for angina

A

nitrates
beta blockers
calcium channel blockers

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48
Q

for someone with angina what do beta blockers do for the heart rate

A

decreases it , which then decreases the workload on the heart (decreases O2 demand)

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49
Q

for someone with angina , calcium channel blocked main coronary artery ___ and limits

A

vasodilation (increased o2 supply)
vasospasm

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50
Q

when the heart fails it releases ___ which can cause the mm spams in the heart

A

CA

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51
Q

if someone has angina and is taking nitrates that will causes ___ which ____ blood flow to myocardium and ___ venous return to the heart

A

vasodilation
increases
decreases

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52
Q

where is referred pain region for the lung and diaphragm

A

left shoulder and neck

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53
Q

where is the referred pain for the liver and gallbladder

A

right shoulder and neck and right upper ab area

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54
Q

what is an estimate of myocardial workload

A

rate pressure produce

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55
Q

if someone RPP is over ____ then we are not gonna exercise them

A

10000

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56
Q

which medication is clinically indicated for Blood clots formation in the coronary artery at the time of plaque rupture

A

thrombolytic agents

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57
Q

what is the suffix for thrombolytic agents

A

-are

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58
Q

Patients with clinical evidence of thrombus formation should be treated immediately via thrombolytics within ___ minutes

A

30

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59
Q

overall goal for a patient with clinical evidence of thrombus formation is to keep total ischemic time to less than ___ minutes from time of symptoms to repercussion

A

120

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60
Q

what is clinically indicated for Primary and secondary preventive measure to prevent thrombus formation

A

anti platelet agents

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61
Q

anti platelet agents ___ platelet adherence at site of injury

A

decreases

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62
Q

what are clinically indicated for prevention. of blood clots , prevent an emboli and inhibit the production of the hormonal thrombin

A

anticoagulants

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63
Q

what are the 3 commonly used anticoagulants

A

pradaxa, xarelto, eliquis

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64
Q

what are diuretics clinally used for

A

hypertension and HF

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65
Q

diuretics ____ circulating blood volume (preload)

A

decreases

66
Q

diuretics ____ circulating ventricular length-tension relationship which improves cardiac _____

A

decreases
contractility

67
Q

diuretics promotes ___ and ___ ____ and ____ reabsorption of water and Na+ at the kidneys

A

diuresis and electrolyte balance and decreases

68
Q

what suffix does diuretics tend to have

A

ide

69
Q

lasix is the most potent whatt

A

diuretic

70
Q

loop diuretics has a site of action where

A

loop of henle

71
Q

there is caution with aerobic exercise for people taking diuretics due to

A

hypotension (due to fluid loss) and arrthymias (due to K+ loss)

72
Q

what are sodium glucose transporter inhibitors used for

A

lower blood sugar for type 2 diabetics

73
Q

how much does sodium glucose transporter inhibitors reduce blood pressure by

A

SBP: 3-5 mmHg

74
Q

how much weight loss does sodium glucose transporter inhibitors promote

A

4-6 lbs

75
Q

T/F: sodium glycogen transporter inhibitors do not reduce cardiovascular deaths

A

F ( they do reduce cardiovascular deaths)

76
Q

• Invokana (canagliflozin):
• Farxiga (dapagliflozin):
• Jardiance (empagliflozin)

are examples of what

A

sodium glucose transporter inhibitors

77
Q

what are some side effects of sodium glucose transporter inhibitors

A

hypoglycemia
hypotension
UTIs
diabetic ketoacidosis

78
Q

Drugs affecting the RAAS system is clinically indicated for

A

hypertension and HF

79
Q

drugs affecting the RAAS system can be considered as

A

vasodilators and antihypertensives

80
Q

what are the 3 drugs affecting the RAAS

A

ACE inhibitors
angiotensin receptor blockers (arb)
aldosterone antagonists

81
Q

what prevents the conversion of angiotensin 1 to angiotensin 2

A

ace inhibitors

82
Q

What does Angiotension 2 stimulate

A

aldosterone

83
Q

does angiotensin 2 causes vasoconstriction or vasodilitation

A

vasoconstriction

84
Q

angiotension 2 causes renal water and sodium ___

A

retention

85
Q

what suffix does ACE inhibitors have

A

RIL

86
Q

what limits the effects of angiotension 2 at the vasoreceptors of the arterial beds

A

angiotensin receptor blockers (ARBs)

87
Q

what can be used as an alternative ACE inhibitors for patients who are intolerant to them

A

angiotensin receptor blockers

88
Q

what is the suffix for angiotensin receptors blockers

A

sartan

89
Q

what drug is a combination of ARB and Neprolysin inhibitors

A

entresto

90
Q

what is entresto used for

A

pateint with HF

91
Q

if potassium is to high what can that lead to

A

arrthymias

92
Q

neprolysin inhibitor causes Na ___ and K ___-

A

excretion and retention

93
Q

Angioedema is a side effect of what

A

ace inhibitors and ARBs

94
Q

what is angioedema

A

tongue swelling for no reason

95
Q

spironolactone is an example of what

A

aldosterone antagonist

96
Q

aldosterone antagonists causes ____ renal fluid and ___ retention

A

decreased and NA

97
Q

aldosterone antagonists causes ___ renal excretion of na+

A

increased

98
Q

side effects of aldosterone antagonists

A

hyperkalemia
orthostatic hypotension

99
Q

what is the effects of aldosterone antagonists on BP

A

decreases it

100
Q

positive iontropes is clinically indicated for what

A

HF

101
Q

what is the purpose of positive iniotropes

A

increase strength of contraction

102
Q

what type of cardiomyopathy is positive ionotropes : cardiac glycosides used for

A

dilated

103
Q

waht does positive inotropes : cardiac glycosides do to HR

A

slows it down

104
Q

positive inotropes: cardiac glycosides is indicated for what

A

atrial fib

105
Q

what are the 2 main drugs for positive inotropes : cardiac glycosides

A

digitalis
digoxin

106
Q

which has a shorter half life and less toxic , digitalis or digoxin

A

digoxin

107
Q

someone who is taking positive inotropes: cardiac glycosides , why may toxicity occur?

A

interaction with other drugs
decreased renal function
altered GI absorption

108
Q

what are the signs and symbols of digitalis toxicity in the GI

A

Anorexia
• Nausea
• Vomiting
• Diarrhea

109
Q

what are the signs and symbols of digitalis toxicity in the cardiovascular

A

Palpitations
Arrhythmias
Syncope

110
Q

what are the sings and symptoms of digitalis toxicity on neuro

A

Malaise
• Fatigue
• Vertigo
• Insominia
• Depression
• Colored vision
• Facial pain

111
Q

what are the signs and symptoms of digitalis toxicity on neuro

A

high digoxin / low K+
altered BUN /creathinine

112
Q

if a patient is taking digoxin due to atrial fibrillation then patient may have am ____ HR

A

irregular

113
Q

if a patient is taking digoxin due to a fib and has a resting HR > ____ then they may need to be reassessed by physician

A

110

114
Q

digoxin controls a fib due to increased ___ interval

A

PR

115
Q

how long should resting pulses be taken whenever a pateint has a irregular heart rhythm

A

one full min

116
Q

cardiac glycosides should not be used for patient with __ or ___ degree AV block

A

2nd or 3rd

117
Q

which positive inotropes is indicated for the parenteral use of acutely compromised heart failure patient

A

sympathomimetics

118
Q

sympathomimetics mimic the actions of what system

A

SNS

119
Q

sympathomimetics are used for a ___ periodd of time to minimize the possibility of sympathetic receptor
desensitization

A

short

120
Q

selective Beta 1 receptors for sympathomimetics stimulate influx of ___ into the myocardium to increase contractility

A

Ca+

121
Q

selective beta 1 r3ecptors of sympathomimetics increase __ and __ node firing and conduction

A

SA and AV

122
Q

dobutrex and levophed are examples of what

A

selective B1 sympathomimetics

123
Q

non selective beta 1 and beta 2 sympathomimetics increase ______ (B1) and ____ afterload due to ______ (b2)

A

contractility
reduce afterload
due to vasodilation

124
Q

Adrenalin Chloride and Isuprel are examples of what

A

non selective B1 and B2 sympathomimetics

125
Q

what is used when heart failure is present with systemic hypotension

A

dopamine (iontropin)

126
Q

dopamine stimulates ___ myocardial , D-1. and alpha vascular receptors to increase

A

B1

127
Q

what is indicated for patients with a combination of severe CHF

A

phosphodiesterase inhibitors

128
Q

phosphodiesterase inhibitors are used to ____ the myocardial contraction

A

strengthen

129
Q

Phosphodiesterase Inhibitors are typically used for pateint who did not respond to what other meds

A

Sympathomimetics
• Cardiac glycosides

130
Q

inocor acts as a ____ inotropes and ____ which promotes preload /afterload balancing

A

positive and vasodilators

131
Q

vasodilators are clinically indicated for what

A

hypertension
heart failure
ischemic heart disease

132
Q

vasodilators are effective for ____ hypertension

A

systolic

133
Q

what are examples of vasodilators

A

Ca+ channel blockers
ACE inhibitors
Nitrates

134
Q

if there is vasodilators to arterial system then there is a ___ cardiac afterload

A

reduced

135
Q

venodilators ___ cardiac preload and is effective for ___ hypertension

A

reduce
diastolic

136
Q

vasodilators : alpha adernegric antagonists is used to mange ___ and not HF

A

hypertension

137
Q

mini press and hytrin are examples of what

A

α1 adrenergic antagonists

138
Q

what are side affects of α1 adrenergic antagonists

A

reflex tachycardia

139
Q

nipride affects vascular bed of what

A

both systems (arterial and venous)

140
Q

how is nipride given anf what is the onset of action

A

parenterally (IV) and rapid onset

141
Q

basically nipride reduces ___ and ____

A

afterload and preload

142
Q

morphine is a vasodilators that ____ pre load via venodilation

A

decreases

143
Q

what reduces anxiety and effort associated with severe heart failure

A

morphine

144
Q

T/F: can vasodilators causes compensatory sympathetic activation like tachycardia , vasoconstriction

A

true

145
Q

what medication work to regulate BP

A

anti hypertensives

146
Q

what drug classes are often used to control hypertension

A

SNS blockers
Ca+ blockers
ACE inhibitors
vasodilators
diuretics

147
Q

what are the class 1 and class 2 anti arrhythmias membrane stabilizers

A

class 1: xylocaine
class 2: beta blockers

148
Q

what class of anti arrhythmias are clinally indicated for Ventricular and supraventricular tachycardia and Atrial fib

A

class 1 : xylocaine

149
Q

class 1 ( xylocaine) anti arrthymics reduced influx of ___ into the cell

A

Na+ which causes the heart to not contract well

150
Q

what class of anti arrhythmics are clinally indicated for Ventricular and supraventricular arrhythmia post MI and exercise

A

class 2 beta blockers

151
Q

Class 2 (beta blockers) of anti arrhythmics blocks ____ excitation fo the heart to control heart rhythm

A

sympathetic

152
Q

what are class 3 and 4 for anti arrthymics

A

class 3” cordarone
class 4: calcium channel blockers

153
Q

class 3 (cordarone) anti arrhythmics are clinically indicated for what

A

Ventricular and supraventricular tachycardia

154
Q

in patients with hemodynamic instability ____ amiodarone is the antiarrythmic medication most often used

A

IV

155
Q

one important side effect of membrane stabilizers is that it can cause

A

exacerbation of arrhythmias

156
Q

class IV: Ca+ blockers help prolong the ___ period

A

refractory

157
Q

digitalis is a cardiac glycosides that enhances the ______ tone in the healthy heart

A

parasympathetic

158
Q

what is the net effect of digitalis (cardiac glycoside) as an anti arrhythmics

A

slows the heart and depresses AV node conduction

159
Q

which anti arrhythmic drugs is clinally indicated for bradydysrhythmias

A

atropine

160
Q

adenosine is an anti arrhythmic drug that is given ___ and slows conduction in the re entry pathway thru the ___ node

A

intavenously
AV

161
Q

adenosine is an anti arrhythmic drug that is indicated for what

A

supraventricular tachycardia

162
Q

Patients who receive hydroxychloroquine or azithromycin
in combination with antiarrhythmic drugs are at risk of
prolonged ____ interval and torsades de pointes.

A

QT

cardio pulm midterm (11 decks)

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