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Pharmacology > Week 5 ~ Drugs Affecting CVS/Renal/Electrolytes > Flashcards

Week 5 ~ Drugs Affecting CVS/Renal/Electrolytes Flashcards

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1
Q

2 Kinds of Positive Inotropic Drugs?

A
  1. Cardiac Glycosides: Digoxin
    ~ Obtained from Digitalis Plant Foxglove
  2. Phosphodiesterase Inhibitors: Milrinone
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2
Q

Cardiac Glycosides Mechanism of Action

A

~ Used for heart failure

~ Control ventricular response to arterial fibrillation and flutter

~ Increase myocardial contractility

~ Change electrical conduction properties of the heart

     - Decrease rate of electrical conduction
     - Prolong the refractory period, between SA node and AV node

~ Reduces heart rate and improves cardiac efficiency

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3
Q

Cardiac Glycosides Drug Effects

A
  1. Increases stroke volume
  2. Decrease venous blood pressure
  3. Increase in coronary circulation
  4. Promotion of diuretics due to improved blood circulation
  5. Positive Inotropic effect
  6. Negative chronotropic effect
  7. Negative dromotropic effect
  8. Palliative of exertion all and paroxysmal nocturnal dyspnea, cough,
    Cyanosis
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4
Q

What’s a Positive Inotropic Effect?

A

Increase in force of the heart

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5
Q

What’s a Negative Chronotropic Effect?

A

Reduced heart rate

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6
Q

What’s a Negative Dromotropic Effect?

A

Decreases the automaticity at SA node, decreases AV node conduction

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7
Q

Cardiac Glycosides Indications

A

Heart Failure

Supra ventricular Dysrhythmias
- Atrial Fibrillation and atrial flutter

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8
Q

Cardiac Glycosides Contraindications

A

Drug allergy

2nd or 3rd degree heart block

Ventricular tachycardia or fibrillation

Sub-aortic stenosis

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9
Q

Digoxin Adverse Effects

A

Very narrow Therapeutic window

Drug levels and electrolyte levels must be monitored

Low potassium levels increase its toxicity

Dysrthmias: Tachycardia or bradycardia

Headaches, fatigue, confusion, convulsions

Coloured vision (green, yellow, purple), halo

Anorexia, nausea, vomiting, diarrhea

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10
Q

Digoxin Toxicity Therapy

A

Hyperkalemia K> 5mmol/L can cause life threatening
Dysrhythmia

Digoxin immune Fab (antibodies) therapy

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11
Q

Phosphodiesterase Inhibitors Mechanism of Action

A

Work by inhibiting the enzyme phosphodiesterase

Results in a Positive Inotropic Response and Vasodilation

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12
Q

What’s the name of the only Phosphodiesterase Inhibitor in Canada?

A

Milrinone

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13
Q

Indications for Phosphodiesterase Inhibitors

A

Used for short term management of heart failure

Given when the patient hasn’t responded to treatment with digoxin, diuretics or vasodilators

Given as weekly 6 hour infusions

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14
Q

Phosphodiesterase Inhibitors Contraindications

A

Drug Allergy

Severe aortic or pulmonary valscular disease

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15
Q

Milrinone Adverse Effects

A

Dysthymia, mainly ventricular

Hypotension, angina, hypo kalmia, tremor, thrombocytopenia

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16
Q

Milrinone Drug Interactions

A

With Diuretics:

Hypovolemia
Reduced cardiac filling pressure

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17
Q

Digoxin Adverse Effects

A

Potentiates Inotropic Effects

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18
Q

What’s a Dysrhythmia?

A

Any deviation from the normal rhythm of the heart which can be seen on ECG

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19
Q

What are AntiDysrhythmic Drugs?

A

Drugs used for the treatment and prevention of disturbances in cardiac rhythm

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20
Q

3 Common Dysrhthmias

A
  1. Supra Ventricular Dysrhythmias
  2. Ventricular Dysrhythmias
  3. Conduction Blocks
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21
Q

Vaughan Williams Classification

A
  1. Class 1: Block Na Channels
    • class 1a
    • class 1b
    • class 1c
  2. Class 2: decrease spontaneous depolarization
  3. Class 3: prolong action potential duration
  4. Class 4: blocks Ca channels
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22
Q

What do Vaughan Williams Class 1 drugs do?

A
  1. Membrane stabilizing drugs
  2. Fast sodium channel blockers
  3. Increase the action potential duration (APD)

~Divided into 3 different classes

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23
Q

Class 1a Drugs

A

Procainamide

Quinidine

Disopyramide

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24
Q

Class 1b Drugs

A

Phenytoin

Lidocaine

Mexiletine

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25
Class 1c Drugs
Propafenone Flecainide
26
Class 1 Drugs Mechanism of Action and Indications
Atrial/Ventricular fibrillation Premature atrial/ventricular contractions Ventricular Tachycardia Wolff Parkinson White Syndrome
27
What is Wolff Parkinson White Syndrome?
A condition in which there is an extra electrical pathway of the heart. The condition can lead to tachycardia.
28
Class 2 Drugs Mechanism of Action and Indications
B-Blockers Reduce or block sympathetic nerve system Used as antianginal and anti hypertensive drugs
29
Class 2 B-Blocker drugs
1. Acebutolol 2. Esmolol 3. Propranolol
30
Class 3 Drugs Mechanism of Action and Indications
Increase action potential duration Used for Dysrhythmias that are difficult to treat
31
Class 3 drugs
1. Amiodarone | 2. Sotalol (Also exhibits class 2 properties)
32
Class 4 Drugs
1. Verapamil | 2. Diltiazem
33
Class 4 Drugs Mechanism of Action and Indications
~ Calcium Channel blockers ~ Inhibit slow channel (calcium dependant) pathways ~ Reduce AV node conduction * used for paroxysmal Supra Ventricular tachycardia, rate control for atrial fibrillation and flutter
34
What are Unclassified AntiDysrhythmic Drugs?
Have properties of several classes and are not placed into one particular class
35
What's the name of an Unclassified AntiDysrhythmic drug?
Adenosine
36
What does Adenosine do?
Slows conduction through the AV node Has a very short half life - less then 10 sec Ad instead only as intravenous push
37
AntiDysrhythmic Drug Adverse Effects
*ALL can cause Dysrhythmias!* Hypersensitivity reactions Nausea, vomiting, diarrhea Dizziness, blurred vision, headache
38
AntiDysrhythmic Drug Interactions
Commonly potentiates anticoagulant activity of warfarin (Coumadin)
39
What is Acute Coronary Syndrome?
Group of clinical symptoms compatible with acute myocardial Ischemia
40
What's Angina?
When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart and the heart muscle "aches"
41
Drugs for Angina
1. Nitrates and Nitrites 2. B-blockers 3. Calcium Channel Blockers
42
2 Nitrate/Nitrite Drugs
1. Isosorbide Dinitrate | 2. Nitroglycerin
43
Nitrate/Nitrite Mechanism of Action
Potent vasodilator, mainly affecting the venous vascular bed Dose dependant effect atrial vasodilator effect
44
What's the Prototypical Nitrate?
Nitroglycerin Has large first pass effects with oral forms
45
Nitrate Indications
1. Stable, unstable angina and vasospasm 2. Rapid acting forms are used to treat acute anginal attacks 3. Hypertensive emergencies * Long acting Nitrates are used to prevent anginal episodes in Hypertensive emergencies*
46
Nitrate/Nitrite Contraindications
Drug Allergy Severe anemia Closed Angle Glaucoma Hypotension Severe head injury
47
Nitrate/Nitrite Adverse Effects
Headaches Tachycardia, postural hypotension Tolerance
48
What is Tolerance?
Occurs in patients taking long acting formulations or taking them continuously
49
How to prevent Nitrate Tolerance...
Transdermal forms Remove patch at bedtime for 8hours and apply a new patch in the morning
50
Nitrate/Nitrite Drug Interactions
Addictive hypotensive effects when taken with: - alcohol - B-blockers - Calcium Channel Blockers - Phenothiazines - Sildenafil
51
B-Blocker Drugs
Atenolol Metoprolol Propranolol Nadolol
52
What is CardioProtective?
After MI, high level of circulating Catecholamines can be blocked by B-Blockers
53
3 Calcium Channel Blocker Drugs
1. Benzodiazepines - Diltiazem Hydrochloride 2. Dihydropyridines - Nifedipine - Amlodipine Besylate - Nimodipine - Felodipine 3. Phenylalkylamines - Verapamil Hydrochloride
54
Calcium Channel Blockers Mechanism of Action
Cause coronary artery vasodilation Cause peripheral arterial vasodilation, decreasing systemic vascular resistance Reduce the workload of the heart, decrease myocardial oxygen demand
55
Calcium Channel Blockers Indications
Angina, hypertension and supraventricular tachycardia (first line) Treat coronary artery spasms (Prinzmetal's Angina) Short term management of atrial fibrillation and flutter
56
Calcium Channel Blockers Adverse Effects
Hypotension Tachycardia Bradycardia Constipation Nausea Dyspnea
57
Calcium Channel Blockers Drug Interactions
~ Diltiazem interferes with metabolism and elimination of cyclosporine ~ Grapefruit juice can reduce the metabolism of Calcium Channel Blockers
58
Antihypertensive Drug Ethnocultural Considerations
B-Blockers and Angiotension-converting enzyme (ACE) inhibitors are more effective in White patients over Black patients Calcium Channel Blockers (CCBs) and diuretics are more effect in Black patients then White patients
59
What's the Canadian Hypertension Education Program?
Endorses: 1. Home blood pressure monitoring 2. Annual Bp assessment for pre hypertension 3. Ongoing routine assessment LifeStyle Modifications: 1. Regular exercise 2. Stress reduction 3. Moderation in alcohol 4. Healthy diet and reduction in sodium Treat to Target: 1. Less then 140/90 mm Hg 2. Less then 130/80 mm Hg in those with diabetes/chronic kid disease
60
What are Positive Inotropic Drugs?
Drugs that increase the force of myocardial contraction. These drugs are used to treat heart muscle failure
61
6 Antihypertensive Drugs
1. Adrenergic Drugs 2. Angiotensin - converting enzyme inhibitor 3. Diuretics 4. Vasodilators 5. Angiotensin 2 receptor blockers (ARBs) 6. Calcium Channel Blockers
62
4 ACE Inhibitors
1. Benazepril Hydrochloride 2. Captopril (Can be used in liver dysfunction) - short half life 3. Enalapril - oral/Parenteral forms 4. Lisinopril and Quinapril - newer drug, long half life, once a day dosing
63
ACE Inhibitor Mechanism of Action
Block the angiotensin converting enzyme thus preventing the formation of angiotensin 2 Prevent the breakdown of Bradykinin - result in vasodilation, decreased systemic vascular
64
ACE Inhibitor Indications:
Hypertension Heart Failure Drugs of choice for diabetic patients
65
ACE Inhibitor Contraindications
Drug Allergy Lactating women and children Bilateral rental artery stenosis or hyperkalemia
66
ACE Inhibitor Adverse Effects
Fatigue Headache Impaired Taste Dry Cough Dizziness Mood Changes
67
ACE Inhibitor Drug Interactions
Lithium can result in lithium toxicity No steroidal anti-inflammatory drugs can reduce the effect Potassium supplements and potassium sparing diuretics may result in hyperkalemia
68
Angiotensin 2 Receptor Blockers Mechanism of Action
*Newer class, well tolerated and doesn't cause a dry cough!* Allow angiotensin 1 to be converted to angiotensin 2 but block the receptors that receive angiotensin 2 Block vasoconstriction and release of aldosterone
69
2 Angiotension 2 Receptor Blocker Drugs
1. Losartan Potassium | 2. Valsartan
70
Angiotension 2 Receptor Blocker Indications
Used primarily in patients who can't tolerate ACE inhibitors Diuretics Hypertension Adjunctive drugs from the treatment of heart failure
71
Angiotension 2 Receptor Blocker Contraindications
Drug Allergy Pregnancy Lactation
72
Angiotension 2 Receptor Blocker Adverse Effects
Upper respiratory infections Headache Dizziness Inability to sleep Diarrhea Dyspnea Heartburn Nasal Congestion Back pain Fatigue
73
Angiotension 2 Receptor Blocker Drug Interactions
Cimetidine Phenobarbital Rifampin
74
Calcium Channel Blockers Mechanism of Action
Cause smooth muscle relaxation by blocking the binding of calcium to its receptors and preventing muscle contraction This causes decreased peripheral smooth muscle tone and decreased systemic vascular resistance Decreased blood pressure results
75
Calcium Channel Blocker Indications
Angina Hypertension Dysrhthmias Migraines Raynaud's Disease
76
Diuretics ~ Thiazide Mechanism of Action
Most commonly used and first line Anti-Hypertensives in the CHEP guidelines Decrease the plasma and extra cellular fluid volumes Decreased pre-load Decreased total peripheral resistance Decreased workload of the heart and decreased blood pressure
77
3 Types of Vasodilators
1. Hydralazine Hydrochloride 2. Minoxidil 3. Sodium Niitroprusside
78
Vasodilator Mechanism of Action
Directly relax arteriolar and venous smooth muscle Result in decreased systemic vascular response, decreased after load and peripheral vasodilation
79
Vasodilator Indications
Hypertension *Sodium Nitroprusside is reserved for the management of hypertensive emergencies*
80
Vasodilator Contraindications
1. Drug Allergy 2. Hypotension 3. Cerebral Edema 4. Head injury 5. Acute myocardial infarction (MI) 6. Coronary Artery Disease
81
Vasodilator Hydralazine Adverse Effects
``` Dizziness Headache Anxiety Tachycardia Nausea/Vomiting Dyspnea Edema Anemia Diarrhea Nasal Congestion ```
82
Vasodilator Sodium Nitroprusside Adverse Effects
Bradycardia | Hypotension
83
How much of the human body is water (TBW)?
60%
84
3 main compartments that TBW is distributed?
1. Intracellular Fluid (ICF) 2. Interstitial Fluid (ISF) 3. Plasma Volume (PV)
85
What is Crystalloids?
IV fluids that supply water and Na to maintain osmotic gradient between extravascular and intravascular compartments
86
Types of Crystalloids?
1. Normal Saline (0.9% Sodium Chloride) 2. Hypertonic Saline (3% Sodium Chloride) 3. Lactated Ringer's 4. D5W 5. Plasma-Lyte
87
Crystalloids Indications
``` Dehydration Acute Liver Failure Acute Nephrosis Burns Adult Respiratory Distress Syndrome Shock Kidney Dialysis Reduction of the risk of deep vein thrombosis Hypotroteinemia ```
88
Crystalloids Contraindications
Drug Allergy Hypervolemia Severe electrolyte disturbance *Drug interactions are rare!*
89
Crystalloids Adverse Effects
Edema, especially peripheral and pulmonary May dilute plasma proteins May have sort lived effects
90
What are Colloids?
Increase Colloid Oncotic Pressure Protein substance that move fluid from interstitial compartment to plasma compartment
91
3 Types of Colloids
1. Albumin + Na + Cl 2. Dextran + Na + Cl 3. Hetastarch + Na + Cl
92
Colloid Indications
Superior to Crystalloids in plasma volume expansive but more expensive
93
Colloid Contraindications
Drug Allergy Severe electrolyte disturbance *Usually safe adverse effects*
94
What are Blood Products?
Blood products pull fluid from extravascular space into intravascular space RBC products carry oxygen Blood products increase the body's supply of various products such as clotting factors and hemoglobin
95
3 Types of Blood Products and their Indications
1. Cryoprecipitate and Plasma Protein Fractions - Manage acute bleeding 2. Fresh Frozen Plasma - Increase clotting factor levels 3. Packed red cells and Whole Blood - Loss of blood
96
Blood Products Adverse Effects
Anaphylaxis Incompatibility with recipients immune system Transmission of pathogens such as hep, Hiv
97
Types of Electrolytes
Potassium Sodium Cations Chloride Cations Calcium Magnesium Phosphorus
98
What is Hypokalemia?
Serum Potassium levels less than 3.5 mmol/L
99
Causes of Hypokalemia?
Digoxin Therapy Corticosteroids Loop Diuretics Vomiting/Diarrhea Ketoacidosis
100
Potassium Contraindications
Drug allergy Severe Kidney Disease Acute Dehydration Severe hemolytic disease
101
Potassium Adverse Effects
Diarrhea Nausea/Vomiting GI bleeding Ulcerations
102
Potassium Drug Interactions
ACE inhibitors With diuretics and amphotericin B
103
Sodium Adverse Effects
Nausea/Vomiting Cramps Can cause phlebitis with IV route administration
104
What is a normal Sodium concentration?
135 - 145 mmol/L
105
What is Hyponatremia?
When sodium serum levels are below 135 mmol/L *Same causes as Hypokalemia*
106
What is Sodium responsible for?
~ Control of fluid and electrolyte balance ~ Participate in Acid-Base balance
107
How is Sodium administered?
Available as intravenous normal saline or lactated Ringer's solution
108
3 Types of Fluids given in hospital?
1. Crystalloids 2. Colloids 3. Blood Products
109
3 Types of Hydralazine?
1. Adrenergics 2. Antihypertensive 3. Monoamine oxidase inhibitors
110
Type of Minoxidil?
Antihypertensives/ Thiazides
111
Monoamine oxidase inhibitor mechanism and result?
M --> Altered Biotransformation R --> Increased Hypotensive Effect
112
Antihypertensives/Thiazides Mechanism and Result?
M --> Additive Effects R --> Increased hypotensive effect
113
Antihypertensives Mechanism and Result?
M --> Additive Effects R --> Increased Hypotensive effect
114
Adrenergics Mechanism and Result?
M -->Antagonism R --> Decreased Hypotensive effect
115
What's the only drug that has a Decreased Hypotensive Effect?
Hydralazine --> Adrenergics

Pharmacology (6 decks)

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