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Chap. - 25


most antiarrhythmics __ pulse rate and blood pressure lower
procainamide & quinidine can cause tachycardia
antiarrhythmic agents can __ existing arrhythmias or cause new arrhythmias worsen
when other cardiac drugs are administered concomitantly there can be an additive or __ effect antagonistic
propanolol (Inderal) & atenolol (Tenormin) are in the class of beta-adrenergics blockers
verapamil (Calan, Isoptin) are in the class of calcium channel blockers
disopyramide (Norpace), quinidine, & procainamide (Pronestyl) all have __ mechanism of action similar
antihypertensives do not __ hypertension cure
antihypertensives only __ hypertension control
if antihypertensive medication is stopped, blood pressure will return to __ __ to those before treatment w/medication levels similar
defined as systolic range 120-139 and diastolic 80-89; new category to identify patients who are at higher cardiovascular risk based on BP pre-hypertension
lifestyle changes are the only management of blood pressure at the pre-hypertension stage
most frequently prescribed diuretic for high blood pressure. hydrochlorathiazide
peripheral vasodilator hydralazine (Apresoline)
central-acting alpha-adrenergic agent methyldopa (Aldomet)
angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec) & lisinopril (Prinivil, Zestril)
calcium channel blocker amiodipine (Norvasc)
beta-adrenergic blocker metoprolol (Lopressor)
thiazide diuretic hydrochlorathiazide (HydroDIURIL)
cardiac glycoside; administration PO: tablets, liquid-filled capsules; elixir; intermediate duration; trade name for digoxin Lanoxin, Lanoxicaps
cardiac glycoside; administration: IV, dosage varies; maximum dose 0.125mg (long-term in older adults) digoxin
antiarrhythmic; administration PO, 50mg/day or IV 5-10mg; beta blocker; trade name for atenololª Tenormin
antiarrhythmic; administration PO, 10-30mg/3-4x/day or IV 0.5-3mg; beta blocker; trade name for propranololª Inderal
antiarrhythmic; administration PO, 240-480mg or IV 2.5-10mg; calcium channel blocker; trade name for verapamilª Isoptin, Calan
antiarrhythmic; administration IM or IV diluted (check IV dilution directions); local anesthetic-type; trade name for lidocaine Xylocaine
antiarrhythmic; administration IV or PO dose varies; antiarrhythmic & vasodilator; for Medication Guide now required; trade name for amiodarone Cordarone
antiarrhythmic; administration PO dose varies IV/IM for emergency; local anesthetic, anticholinergic; trade name for procainamide Pronestyl, Procanbid
antiarrhythmic; administration PO 150-300mg q8h; membrane stabilizer for ventricular arrhythmias; trade name for propafenone Rythmol
antiarrhythmic; administration PO 225-425mg q12h; membrane stabilizer for ventricular arrhythmias; trade name for propafenone Rythmol SR
antiarrhythmic; administration PO tabs, ER, IV, IM dose varies; myocardial depressant, anticholinergic quinidine
antiarrhythmic; administration PO 150mg q6h; myocardial depressant, anticholinergic properties, not for older adults; trade name for disopyramide Norpace
antiarrhythmic; administration PO 300mg q12h; myocardial depressant, anticholinergic properties, not for older adults; trade name for disopyramide Norpace CR
atenololª, propranololª, & verapamilª: the (ª) denotes contraindications for patients with other heart conditions
are contraindicated for patients w/bradycardia, heart block, & CHF beta blockers
adrenergics (i.e. epinephrine/isoproterenol), anticholinergics, & tricyclic antidepressants are __ of beta blockers antagonists
diuretics & other hypertensives (i.e. calcium channel blockers) as well as phenothiazine/other tranquilizers, potentiate the __ effect of propranolol hypotensive
cimetidine (Tagamet) will __ __ of propranolol slow metabolism
use of propranolol with other cardiac drugs (i.e. quinidine) may potentiate __ effects toxic
when used with propranolol, they may precipitate hypotension, dizziness, confusion, &/or sedation alcohol, muscle relaxants, & sedatives
are contraindicated for patients w/heart block (causes bradycardia), severe heart failure,hypotension, certain arrhythmias, or angina calcium channel blockers
calcium channel blockers when used w/other cardiac drugs (i.e.) digoxin) can potentiate __ & __ effects good; adverse
calcium channel blockers have a(n) __ __ w/barbiturates, salicylates, phenytoin/rifampin, & lithium antagonistic effect
calcium channel blockers, when taken w/diuretics, ACE inhibitors, beta-blockers, & quinidine, potentiate hypotensive effect
adverse effects are potentiated when calcium channel blockers are taken with grapefruit juice
occur in nature or can be prepared synthetically; act directly on myocardial contractions; primarily used in treatment of CHF cardiac glycosides
cardiac glycosides are called __ because they strengthen the heartbeat cardiotonic
cardiac glycosides are sometimes used w/antiarrhythmic agents to slow heart rate in certain kinds of __ or atrial fibrillation/flutter tachycardia
in patients w/CHF cardiac glycosides act by increasing force of __ __ w/out increasing O2 consumption, thereby increasing cardiac output cardiac contractions
result of cardiac glycosides increasing efficiency of the heart, the heart beats slowly, __ __, & diuretic action decreases edema size shrinks
most commonly used cardiac glycosides are digitalis products
most commonly used digitalis product digoxin (Lanoxin) is used because administration available orally/parenterally & has intermediate duration of action
process of establishing correct therapuetic dose of digitalis for maintaining optimal functioning of heart w/out toxic effects digitalization
careful monitoring of cardiac rate/rhythm w/EKG, cardiac function, side effects, & blood digitalis is required to determine __ __ __ of digitalis therapuetic maintenance dose
checking the __ __ before administering digitalis is an important part of the monitoring process apical pulse
if apical pulse rate is below 60, digitalis should be withheld until physician consulted
includes variety of drugs that act in different ways to suppress various types of cardiac arrhythmias, incl atrial/ventricular tachycardias, atrial fibrillation/flutter, & arrhythmias that occur w/digitalis toxicity or during surgery & anesthesia antiarrhythmic agents
assessment of type of arrhythmia, frequency, cardiac/renal/other pathological condition(s), & current signs/symptoms are factors in the __ of antiarrhythmic agent choice
most of the antiarrhythmic agents have potential for __ BP & __ heartbeat lowering; slowing
signs of hypotension & bradycardia, when antiarrhythmic agents are administered, can lead to cardiac arrest
antiarrhythmic agents which may cause tachycardia, instead of intended effects of slowing heart rate procainamide & quinidine
when other cardiac drugs are administered w/antiarrhythmic agents concomitantly, cardiac effects may be additive or antagonistic
antiarrhythmic agents can __ existing arrhythmias or cause new arrhythmias worsen
very important, for patients taking antiarrhythmic agents, especially for hyperkalemia electrolyte surveillance
combat arrhythmias by inhibiting adrenergic (sympathetic) nerve receptors beta-adrenergic blockers
non-selective beta-blocker, effective in mngmt. of some arrhythmias & loss effective w/others; used in treatment of hypertension & some forms of chronic angina propranolol (Inderal)
selective beta-antagonist, used w/caution & in low doses may be used in patients w/lung conditions that cause bronchospasms atenolol (Tenormin)
counteract arrhythmias by suppressing action of calcium in contraction of heart muscle, thereby reducing cardiac excitability & dilating main coronary arteries calcium channel blockers
calcium channel blockers are used in treatment of angina & hypertension
antiarrhythmic similar to procainamide & quinidine, which is a synthetic agent that decreases myocardial excitability, inhibits conduction, & may depress myocardial contracitility disopyramide (Norpace)
disopyramide (Norpace) has significant __ properties anticholinergic
2nd choice behind alternative agents (i.e. IV amiodarone) for treatment of ventricular arrhythmias lidocaine
primarily used as prophylactic therapy to maintain normal rhythm after conversion by other methods; usually administered orally in antiarrhythmic therapy procainamide (Pronestyl)
procainamide (Pronestyl) __ anticholinergic properties possess
one of oldest antiarrhythmic agents; acts by decreasing myocardial excitability & may depress myocardial contracitility quinidine (Quinaglute, Cardioquin)
quinidine (Quinaglute, Cardioquin) is used primarily in __ therapy prophylactic
defines as SBP of >140 or DBP of >90 hypertension
strong & consistent relationship between BP and risk of cardiovascular disease
increases risk of MI, heart failure, stroke, & kidney disease; requires aggressive treatment high BP
patients w/pre-hypertension are at a higher risk for developing __ hypertension in later years sustained
purpose of __ __ is to encourage patients to initiate/continue healthy lifestyle practices, rather than antihypertensive drug therapy pre-hypertension classification
medications used in treatment/mngmt. of all degrees of hypertension antihypertensives
if antihypertensives are to be DC, dosage should be gradually reduced, as abrupt withdrawal can cause rebound hypertension
stages of hypertension mild, moderate, severe
stage of hypertension, other physical factors (esp. other cardiac/renal complications), & effectiveness are the factors that determined antihypertensive agent prescribed
antihypertensive side effects are common & __ __ signs must be monitored closely vital signs
most common side effect of antihypertensive agents is hypotension, postural
side effect common to many of the antihypertensive agents bradycardia
antihypertensive agent which causes tachycardia hydralazine (Apresoline)
lowers BP by decreasing vasoconstriction; no significant changes in heart rate/cardiac output ACE inhibitors
good choice for patients w/ other serious conditions, incl. heart failure, diabetes, renal disease, & cerebrovascular disease ACEIs
ACEIs can be used for patients w/hypertension & nephropathy because they __ __ of the renal disease slow progression
side effect of ACEIs can be __ so requires monitoring of serum potassium levels periodically hyperkalemia
ACEIs taken w/diuretics can potentiate __; watch BP closely hypotension
ACEIs taken w/NSAIDs & salicylates antagonize effects of ACEIs & increase deterioration of renal function
similar to ACEIs but they both block hormone causing vasocontriction they interrupt different sites ARBs
losartan (Cozaar) & valsartan (Diovan) block effects of __, decreasing BP w/out marked change in heart rate angiotensin II
low dose thiazide diuretics w/ARBs significantly improves hypertensive efficacy
side effects include dizziness, URIs & hyperkalemia angiotensin receptor blockers (ARBs)
central-acting alpha-adrenergic agent used for moderate-severe hypertension; administered w/diuretic; drug of choice for hypertension is pregnant women because of safety for fetus methyldopa (Aldomet)
peripheral vasodilator, sometimes used for treating moderate-severe hypertension (esp. w/CHF) because increases heart rate & cardiac output; generally used w/another hypotensive agent & diuretic hydralazine
tachycardia/palpations, orthostatic hypotension, & edema/weight gain are side effects of hydralazine
patients w/systematic lupus erythematous, renal disease, coronary artery disease, rheumatic heart disease hydralazine drug therapy is contraindicated
hydralazine used in pregnancy is normally contraindicated, although many regards as hypertensive of choice during preeclampsia
central-acting alpha-adrenergic agent; used mainly to treat hypertension, but also successful in nicotine/opiate withdrawal, vascular headaches, glaucoma, ulcerative colitis, Tourette's. & pain mngmt for severe pain in cancer patients clonidine (Catapres)
peripheral-acting alpha-adrenergic blocker; primary use to treat hypertension; other agents in its class used to treat benign prostatic hypertrophy (BPH) Prazosin (Minipres)
medications used in treatment of angina, to dilate coronary arteries & stop attacks, or control frequency when administered prophylactically coronary vasodilators
insufficient blood supply to part of the body ischemia
ischemia can results in acute pain
most common type of angina pectoris
chest pain resulting from decreased blood supply to heart muscle; obstruction/constriction of coronary arteries angina pectoris
nitrates, beta-blockers, & calcium channel blockers are the coronary vasodilators used in __ & __ mngmt of angina treatment; prophylactic
nitrates most commonly used for relief of acute angina pectoris, as well as for long-term prophylactic mngmt are nitroglycerin & isosorbide (Isordil, Sorbitrate)
if initial single dose of nitroglycerin doesn't provide relief during acute attack, additional tablets may be administered at 5min intervals but no more than 3 doses given in 15 min period