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Flashcards in Pharmachology - CV Deck (71):
1

What is a Cardiac arrhythmia?

Change in automaticity, conductivity or both. Heart Without rhythm

2

What is Dysrhythmia?

Abnormal rhythm of the heart

3

What are Arrhythmias and Dysrhythmia brought on by?

Hypoxia
Ischemia
K levels - high or low

4

What are the 4 types of arrhythmias or Dysrhythmia ?

Sinus (bradycardia, tachycardia)
Atrial (fibrillation, flutter)
Nodal or junctional (AV node)
Ventricular (often life threatening: PVC, V tachycardia, V fibrillation)

5

Classifications of antiarrhythmic Meds:
Class I

Class I - Na channel blockers
Lidocaine (Xylocaine)

6

Classifications of antiarrhythmic Meds:
Class II

Class II Beta Adrenergic Blockers
Propranolol (Inderal)

7

Classifications of antiarrhythmic Meds:
Class III

Class III Potassium Channel blockers
Amiodarone (cordarone)

8

Classifications of antiarrhythmic Meds:
Class IV calcium

Channel blockers
Verapamil (calan)

9

Characteristics of Class I Anti arrhythmics:
Na channel blockers
Lidocaine (Xylocaine)

Blocks the movement of Na into cardiac cells
Slows conduction
Tx rapid ventricular arrhythmias.
Cardiac use only.
Must say on label "IV use for ventricular arrhythmias.
Metabolizes by liver and excreted by kidneys

10

Lidocaine common ADE

Hypotension, bradycardia, "lidocaine crazies"

11

Serious lidocaine ADE

Cardiac arrest and seizures

12

Lidocaine contraindications
(1st classification) Na channels blockers

Dig toxicity, heart failure/block and allergy to med

13

Characteristics of Class II Anti arrhythmics:
Beta Adrenergic blockers
Propranolol (Inderal)

Blocks the SNS and slows down ventricular conduction.
Neg chronotropic, inotropic. Used to treat rapid ventricular Arrhythmias, HTN and Angina

Common ADE: bradycardia, hypotension, lethargy
Serious ADE: bronchoconstricion

14

Characteristics of Class III Anti arrhythmics:
K channel blockers
Amiodarone (Cordarone)

Slow repolarization and prolongs the refractory period.
Use to treat life threatening arrhythmias ONLY. By ACLS this is the 1st line of defense recommended
Common ADE: tremors, n/v, hypotension
Serious ADE: pulmonary toxicity, exacerbation of arrhythmia, hepatotoxicity.

15

Characteristics of Class IV Anti arrhythmics:
Calcium channel blockers
Verapamil (Calan)

Slows depolarization and decrease ventricular rate
Also used to treat HTN and angina
Common ADE: constipation, dizziness, orthostatic hypotension, edema.
Serious: hypotension, dradycardia.

16

Non-pharmacological treatment of arrhythmias?

Treat underlying disorder. Valsalva or carotid artery massage. Defibrillate. Pacemakers, AICDs. Ablation

17

What happens in Angina ?

Increase myocardial O2 demand. (Exercise, stress, anxiety, smoking and cold weather

18

What happens in Angina II?

Decrease O2 supply to myocardium (atherosclerosis, arteriosclerosis, diabetes)

19

Types of Angina

Most common "classics or stable angina". Goes away when the patient rests. Patients can tell you intensity, triggers and is very predictable.

20

Antianginal medications

1- nitrates
2- beta blockers
3- calcium channel blockers
All work by decreasing myocardial O2 demand and/or increasing blood supply to the myocardium

21

Organic nitrates - Nitroglycerine (nitrostat)

Dilate veins
Dilates coronary arteries
Dilate arterioles

22

Preload

Think of terms of volume

23

Afterload

Pressure

24

Nitrates ADE

Common: headache, orthostatic hypotension
Serious: severe hypotension
Contraindications: hypotension, phosphodiesterase inhibitors (Viagra)

25

Heart pumps

5-6 L/min

26

Antianginal medication: Nitrates patch

Careful with hairy chest. Need skin contact. Dispose of it carefully. Cleanse the area where the patch was daily. As nurses wear gloves to avoid headaches

27

Antianginal medication. Beta blockers

Propranolol (Inderal). Decrease heart rate, neg chronotropic/neg inotropic.
Decrease BP --> decrease myocardial workload and oxygen demand
Po Long term management of angina. Also tx HTN, arrhythmias
Common: hypotension, bradycardia, lethargy
Serious: bronchoconstricion, heart block

28

Antianginal med: calcium channel blockers
Verapamil (Calan)

Slows the movement of extra cellular calcium in the cell --> coronary & peripheral heart dilation --> decrease Afterload --> increase blood supply to the heart and reduce workload of the heart.
Tx - use to treat Angina when NTG or BB don't work.

29

Diuretic medication

Diuresis: excretion of fluid, esp water

30

Categories of diuretics

Thiazides (hydrochlorothiazide)
Loop - Furosemide (Lasix)
Potassium sparing or Aldosterone antagonist
-spironolactone (Aldactone)
Osmotic - Mannitol (Osmitrol)

31

Diuretics: Thiazides (hydrochlorothiazide)

Not the choice if we need a patient to get rid of fluid immediately. Not for immediate diuresis.

32

Diuretics: Loop - Furosemide (Lasix)

Renal diuresis. They give a rapid immediate response if given PO 30- 45 min IV result in 5 min.

33

Diuretics: K+ Sparing

Don't loose K
Uses: HTN, liver disease
Not used in renal disease
Do not use K supplements

34

Diuretics: Osmotics. Mannitol

Uses: intracranial pressure (ICP), glaucoma, oliguria/anuria
Short term IV use only

35

Diuretics intervention

Watch the potassium K
Normal is 3.5 - 5.2

36

Meaning of weight for patients on Diuretics

1 Lt weights 1kg (2.2 lbs)

37

HTN risks

MI
CFH (congestive heart failure)
CVA and hemorrhage
Renal disease

38

What is primary HTN

90-95% of people. Not one cause. It is a variety of issues

39

What is secondary HTN

Hypertension that is secondary to something else. Example: renal issues, central nerves sys issues, renal arteries, use of Meds like long term steroids, Meds retaining water and sodium. To cure you must find the cause

40

Arteriosclerosis

Thickening of the vessels. They are not as flexible anymore

41

What are the target organs affected by HTN

Heart (MI heart attack)
Brain (CVA stroke)
Kidneys (renal failure)
Eyes (retinopathy)

42

HTN treatment

Stepped : use several different meds to attack the problem and minimized side effects
Lifestyle modification
Diuretics
Combination therapy
Add a third medication
Maximize drug doses

43

HTN treatment
ACE Inhibitors
Prevents Angiotensin I from becoming II
Captopril (Capoten)

Decrease afterload
Decrease preload
Thus decrease the workload of the heart

44

ACE Inhibitors effects?

Well tolerated but common side effect:
Dry cough
Serious ADE: angioedema

Black Box: avoid 2nd and 3rd trimester of pregnancy
Note: great to tx DM as it preserves kidney function

45

HTN treatment:
Angiotensin II receptor blockers
Losartan (Cozaar)
ARB

Blocks the Angiotensin II
Txs HTN and HF (CHF)
Common ADE: Upper respiratory infection, dizziness, orthostatic, hypotension.
Serious ADE: angioedema

46

HTN treatment:
Calcium channel blockers
Verapamil (calan)

Slows the movement of extra cellular Ca into the cell.
Decrease afterload
Good for patients with migraine and asthma (who cannot take beta blockers)
Common ADE: constipation, dizziness edema
Serious ADE: profound hypotension and bradycardia

47

HTN treatment
2nd line Anti-hypertensive drugs

Beta blockers
Propranolol (Inderal)
First choice for pt's with history of MI, stable HF, angina

48

Treatment for Hypertensive Crisis?

HTN BP > 210/120
Sodium nitroprusside (Nitropress)
Decrease BP slowly and systematically
Med must be mixed in IV fluids b/c can cause excessive hypotension
Cyanide toxicity - almond breath

49

Causes for Heart Failure?

MI
HTN
Anything that decrease the pumping ability or increase the workload of the heart and drops the CO

50

Drug therapy for heart failure

ACE
Beta blockers
Diuretics (decreasing preload)
Inotropic: Digoxin
Antianginal meds
Vasodilators

51

What happens in blood coagulation?

Thrombus - blood clot
Embolus - piece of blood clot breaks off and travels to the heart, brain and lungs.

52

Drugs affecting blood coagulation

Anticoagulants: best in preventing venous thrombus

53

Drugs affecting blood coagulation

Anti platelet drugs are best in preventing arterial thrombus

54

Drugs affecting blood coagulation

Thrombolytics: lyse (break off) thrombus

55

Anticoagulants IV or subq?

Prototype: Heparin
Use to treat deep vein thrombosis, pulmonary emboli
ADE: bleeding
Serious: more bleeding, drop in platelets
Pt need labs for PTT: Norm 25-35 sec
Therapeutic PTT : 1 1/2 to 2 times normal 38 to 70 sec
Metabolize in liver and excreted in the kidneys

56

What is an antidote for heparin?

Protamine sulfate

57

Anticoagulant oral use?

Warfarin (Coumadin)
PT - 12-13 seconds
Therapeutic 18 seconds
ADE: bleeding
Serious: bleeding from anywhere (bloody nose, vomiting blood, coughing blood, in the urine/stool, bruising).
Antidote: vitamin K

58

Antiplatelet drugs?

Prevent arterial thrombus. Interferes with platelet adhesion
ASA- aspirin (one a day and usually 81mg)
NSAID- bind with platelet only as long as the NSAID is in the system (about 4 hours)
Clopidogrel (Plavix)
ADE: bleeding



59

Thrombolytic drugs?

Alteplase (Activase)
Dissolve or lyse the clot
Treatment acute thromboembolic events: MI, PE, femoral thrombus
Goal: re establish blood flow and prevent tissue damage
"Limit time"

60

Drugs for hyperlipidemia

This meds are gonna lower lipids level in the blood which reduces mortality and morbidity.

61

Blood lipids? What do we talk about?

Cholesterol 60 (healthy one - preventitive)
LDL N:

62

Drugs for hyperlipidemia

Lovastatin (Mevacor)
Common ADE: v/d, constipation
Pt teaching: continue w lifestyle changes. Take at bed time

63

Drugs for hyperlipidemia
Lovastatin (Mevacor)

Serious ADE:
Rhadomyolysis, Hepatotoxicity

64

Current recommendations for AHA for all patients with CVD

Statin
ACE inhibitor
Beta blocker
ASA daily
Nitro sl prn

65

What is the physiology of the CV system?

It is composed of: heart, blood vessels and blood.
Function: transport supplies to the cell and remove waste products.
Efficiency of CV system: ability to pump, patency of blood vessels, quality of blood and quantity of blood.

66

What is the conduction of the heart?

SA : 60-100 bpm
AV : 40-60 bpm
Ventricles: 20-40 bpm
ANS

67

What is the composition of blood?

55% plasma

45% solid particles
RBC (erythrocytes) - hct male 42% - 50% female 40% - 48%. Hgb male 13-18 and female 12-16
WBC (leukocytes) 5,000 to 10,000
Thrombocytes (platelets) 100,000 to 400,000

68

What do inotropics do?

They increase the force of myocardial contraction
Prototype: digoxin (lanoxin)

69

Uses of inotropic Digoxin?

Tx of heart failure
Tx of atrial arrhythmias
Tx sinus tachycardia
Common ADE: n/v, anorexia, blurred vision, diplopia, halos, bradycardia, tachycardia
Serious: ventricular fibrillation

70

What is digoxin toxicity?

N/v, confusion, blurred vision, bradycardia
Treatment: stop digoxin.
KCL, anti-arrhythmic, atropine for bradycardia and digibind

71

Who is at high risk for dig toxicity?

Hypokalemia (low K)
Renal or liver failure
Large loading dose
Large maintenance dose
Infants and aged
Hypothyroidism
Hypoxia