Flashcards in Quiz 3 Study Guide: Cardiovascular Therapeutics Deck (49)
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1
By what 2 mechanisms is angina treated?
1. Vasodilation (Increase flow)
-Nitrates and Nitrites
2. Decrease O2 consumption
- B Blockers; Ca++ channel blockers
2
How do Nitrates/Nitrites work to treat angina?
Metabolize Nitric oxide to increase cGMP therefore relaxing smooth muscle and dilating cardiac vessels
3
What are some examples of Nitrates/Nitrites?
Nitroglycerine
Amyl nitrate
4
Characteristics of Nitroglycerine...
-Sublingual Administration
-Volatile (Sealed Glass bottle)
Long-lasting patches (8hrs)
5
Characteristics of Amyl-Nitrate
-Crushed ampule and fumes inhaled
-Short acting
6
Side effects of Nitrates/Nitrites
Orthostatic hypertension
Tachycardia (reflex to dilation)
Throbbing headache (Vasodilation)
Tolerance develops rapidly
7
How do Ca++ Channel Blockers work to treat angina?
Blocks contraction of smooth and cardiac muscle to reduce O2 demand.
8
What are Ca++ Channel Blockers used for?
Prophylaxis of angina (4-8 hour duration)
"take in the morning to prevent angina during the day"
9
What are examples of Ca++ Channel Blockers?
Verapamil
Nifedipine
Diltiazem
*also used as hypertensives
10
What Toxic side effects can be present with Ca++ Channel Blockers?
-Cardiac depression and bradycardia (Heart Failure)
-Flushing and dizziness.
11
How do B Blockers (B1) work to treat angina?
Decreases Blood output by decreasing the HR, causing BP and contractility to decrease.
*Not a vasodilator
*Prophylactic use
12
What are some examples of B blockers used to treat angina?
Propanolol (Nonselective - Pulmonary problems)
atemolol (B1 selective - less lung problems)
13
What Toxic side effects can be present with B Blockers?
-Asthma
-acute heart failure
14
What are non-drug lipid and cholesterol-lowering treatments?
Dietary
-15-20% daily intake of fat calories
-avoid red meats
-Exercise
15
What do Statins do?
They are competitive inhibitors of HMG-COA Reductase.
*they reduce the synthesis of cholesterol (LDL) and reduce coronary events.
16
What are some examples of Statins?
Lovastatin (Mevacor)
Atorvastin (Lipitor)
Simvastatin (Zocor)
17
What are side effects of Statin Toxicity?
Liver Damage
Weakness in skeletal muscles.
18
What do Fibrates do?
Increases lipolysis in liver and muscles
*reduces VLDL, modest effect on LDL, and moderate increase in HDL. Reduces Triglycerides.
19
What is an example of a fibrate?
Fenobrate (Tricor)
*side effect is GI symptoms
20
What does Niacin (nicotinic acid) do?
Decreases triglyceride and LDL
*Tolerance develops
21
What is a side effect of Niacin?
Fairly pronounced Mild Flushing.
22
What do Bile acid-binding agents do?
Reduces reabsorption of bile acids and metabolite.
Toxicity: Constipation and Bloating
23
What is and example of a Bile acid-binding agent?
Cholesteramine
24
What do inhibitors of intestinal sterol absorption do?
Inhibits intestinal absorption of cholesterol and reduces LDL.
25
What is an example of and inhibitor of intestinal sterol absorption drugs?
Ezetimibe
26
What is the objective of treatment for patients with heart failure?
Reduce symptoms and slow progression
27
What are the 6 types of drugs that treat heart failure?
Positive Ionotropic Drugs
B1 adrenoceptor agonists
Diuretics
ACE Inhibitors
Vasodilators
B adrenoceptor blockers
*Na+ restriction as dietary non-drug treatment
28
What do Positive Ionotropic drugs do?
Increases intracellular Ca++ and Cardiac contractility therefore increasing blood ejection.
29
What are examples of Positive Ionotropic Drugs?
Digitalis (foxglove)
Milrinone -this is really a Bipyridine drug
30
What are side effects of Positive Ionotropic Drugs?
Premature depolarization (arrhythmias)
Ectopic beats
Affects all excitable tissues
31
What is an example of a B1-adenoceptor agonist?
Dobutamine
*can cause arrythmias
32
What do diuretics do?
-Reduce salt and H2O retention and edema
-Reduce venous pressure and ventricular preload
33
What is an example of a diuretic?
Furosemide
34
What do ACE inhibitors do?
Reduce peripheral resistance by reducing salt and water
35
What is an example of an ACE inhibitor?
Captopril
36
What does a Vasodilator do?
Relax smooth muscle
37
What is an example of a Vasodilator?
Hydralazine
38
What does a B adrenoceptor blocker do?
Reduce heart rate and block the Sympathetic Nervous System
39
What is and example of a B adrenoceptor blocker?
metoprolol
40
What are characteristics of Cardiac Arrhythmias?
-80% with history of Myocardial Infarct
-Requires treatment if there is significant reduction in cardiac output
-Treatments themselves can cause arrhythmias
41
What types of drugs treat Cardiac Arrhythmias?
Na+ channel blockers
B adrenergic blockers
Prolong refractory
Ca++ channel blockers
42
What do Na+ channel blockers do to treat cardiac arrhythmias?
Slows action potential conduction
Effective for most A or V arrhythmias.
*can precipitate new arrhythmias.
43
What is an example of a Na+ channel blockers used to treat cardiac arrhythmias?
Procainamide
Quinidine
Lidocaine
(Class 1)
44
Which drug is the 1st choice for ventricular arrhythmias.
Lidocaine
*low toxicity
45
What are Prolong refractory drugs used for when treating cardiac arrhythmias?
A fib. or V. arrhythmias
46
What is an example of a Prolong Refractory Drug?
Amiodarone
(Class III)
47
What is and example of a B blocker used for arrhythmias?
propanolol
(Class II)
48
What do Ca++ channel blockers do to treat cardiac arrhythmias?
Prolong refractory time
Peripheral Vasodilation
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