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Physical Assessment > Pharmachology - CV > Flashcards

Pharmachology - CV Flashcards

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1
Q

What is a Cardiac arrhythmia?

A

Change in automaticity, conductivity or both. Heart Without rhythm

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2
Q

What is Dysrhythmia?

A

Abnormal rhythm of the heart

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3
Q

What are Arrhythmias and Dysrhythmia brought on by?

A

Hypoxia
Ischemia
K levels - high or low

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4
Q

What are the 4 types of arrhythmias or Dysrhythmia ?

A

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

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5
Q

Classifications of antiarrhythmic Meds:

Class I

A

Class I - Na channel blockers

Lidocaine (Xylocaine)

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6
Q

Classifications of antiarrhythmic Meds:

Class II

A

Class II Beta Adrenergic Blockers

Propranolol (Inderal)

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7
Q

Classifications of antiarrhythmic Meds:

Class III

A

Class III Potassium Channel blockers

Amiodarone (cordarone)

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8
Q

Classifications of antiarrhythmic Meds:

Class IV calcium

A

Channel blockers

Verapamil (calan)

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9
Q

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

A

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

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10
Q

Lidocaine common ADE

A

Hypotension, bradycardia, “lidocaine crazies”

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11
Q

Serious lidocaine ADE

A

Cardiac arrest and seizures

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12
Q 
Lidocaine contraindications 
(1st classification) Na channels blockers
A

Dig toxicity, heart failure/block and allergy to med

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13
Q

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

A

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

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14
Q

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

A

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.

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15
Q

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

A

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

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16
Q

Non-pharmacological treatment of arrhythmias?

A

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

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17
Q

What happens in Angina ?

A

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

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18
Q

What happens in Angina II?

A

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

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19
Q

Types of Angina

A

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

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20
Q

Antianginal medications

A

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

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21
Q

Organic nitrates - Nitroglycerine (nitrostat)

A

Dilate veins
Dilates coronary arteries
Dilate arterioles

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22
Q

Preload

A

Think of terms of volume

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23
Q

Afterload

A

Pressure

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24
Q

Nitrates ADE

A

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

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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 ```

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