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CHF and CAD

Cardiac glycosides and antianginal

QuestionAnswer
Chest pain due to coronary artery disease (CAD) and myocardial ischemia Angina Pectoris
Chest pain, insufficient blood flow to the heart, caused by arthrosclerosis, spasm angina pectoris
Cause, risk factor, patient education for Angina pectoris Very high risk for MI, Life style change, avoid high cholesterol, exercise
What cause CAD? arthrosclerosis, plaque build up in the blood vessels
Main symptom of CAD? Angina pectoris, chest pain
Pharm tx and teaching for angina pectoris (CAD, Coronary Artery Disease) Mainly Nitroglycerine, Med (nitrate), if tablet, out of direct sun light, chock under the tongue to be felt, check blood pressure because it’s gonna lower, on a sitting position
Acute angina tx vs chronic angina tx different med/delivery Nitro SL for acute, transdermal patch or paste for chronic. Works for 30 to 35 min, not touch, BP before giving again
How is transdermal, nitro paste, nitro SL are different/same SL for acute, paste and transdermal for chronic, remove the old one before putting the new one (alternate side)
What are common side/adverse effect of nitro and calcium antagonists? Vasodilation, Headache (HA), decrease Heart rate, tachycardia, dizziness, constipation, nausea
Drugs Used to Treat CAD Nitrites and nitrates, Beta adrenergic blocking drugs, Calcium antagonists
Mechanism of Nitrites and Nitrates? Dilate blood vessel, blood flow increased, BP decreases
How many times can a Nitrate given? Up to 3 times, take BP in between, because it will decrease.
Why Beta blockers for CAD? Beta blocker create less work force on the heart
How do Beta Adrenergic Blockers works in relation with CAD? Sympathetic beta receptor stimulation of the heart increases heart rate, increases force of contraction, and increases oxygen consumption, Blockade of beta receptors decreases cardiac work and cardiac oxygen demand
Verapamil Calcium antagonist, works on heart
What are the common Ca+ channel blockers? Effects on heart 1 heart rate 2 force of contraction? Verapamil (on Heart and blood vessels), Nifedepine (only blood vessel), Diziltiazem (on Heart and blood vessels)
What is CHF? What happens? Weakening of the contractile function of the heart, blood and fluid accumulate in the heart, lungs, abdomen, and lower extremities, decreased cardiac output and blood pressure are unable to meet body requirements
How is CHF related to fluid excretion? If the heart doesn’t pump effectively, the kidney will not receive blood and will secrete renin, then angiotensin to compensate and create vasoconstriction which is bad again for the blood flow that was already low.
How are cardiac glycosides able to improve symptoms of CHF? Increase the force of contraction of myocardium and decrease the heart rate.
Cardiac glycosides effects on heart rate, effect on force of heart contraction, contraindications Increase the force of contraction and decrease the heart rate, contraindicated if HR at least 60
Where do Cardiac glycosides come from Plants
Compare and contrast Digoxin and Digitoxin Digoxin is water soluble and eliminated mostly unmetabolized by the urinary tract, less likely to be toxic, Digitoxin has to be metabolized, lipid (fat) soluble, long life. It’s more toxic
What impact can K+ levels have on therapeutic action of a cardiac glycoside? Low Potassium will increase drug toxicity can lead to cardiac arrhythmias; High Potassium will decrease the action of the cardiac glycosides (the drug will not work)
What to check before giving a cardiac glycoside? Pulse below 60, serum blood level at 0.5-2mg/mL Potassium not too high and not too low.
Describe common causes and symptoms of CHF weakening of contractility of heart muscles. Coughing, SOB, confusion, Anxiety, Edema, Fatigue,
Cardiac glycoside treat CHF and Atria arrhythmias and atria fibulation
Why diuretic treat CHF? If a patient has CHF, he has extra fluid in the body, he need diuretic to eliminate those extra fluid.
Review diuretic concerns (CHF, K+ levels, cardiac glycoside) Impact on K A diuretic has an impact on potassium level (the kidney is not functioning well, K+ stays in the body), it’s also going to decrease the action of the cardiac glycoside. Avoid K rich food, avoid fruits.
How does ACE inhibitors work with CHF? By causing vasodilation, less work on the heart, blood flowing more easily. They help the heart by working on the blood vessel.
PVC Premature ventricular contractions, very common, problem when 4/min
Ectopic beat Irregular heart beat
Afib Less serious than Vfib
Heparin and warfarin Heparin by injection, Warfarin/Coumarin PO
Which blood vessels will vasodilators work (have effect) on ? What will they do to cardiac O2 consumption? Both arteries and Veins. Cardiac will be less, cuz less pressure so less need O2
Main Diseases of the Heart Congestive heart failure (CHF), Coronary artery disease (CAD), Myocardial infarction (MI), Cardiac arrhythmias
Why edema in Pregnant women? Because double pump for baby, and the heart is squeezed in the cage, not pumping effectively
What does QRS complex shows? Contraction of ventricle
Swelling in the abdomen, fluid build up Ascites
Begins electrophysiology in the heart SA Node
Review parts of electrical conduction system of heart Begin with SA Node, every level has his level of electricity SA and AV node, bundle of His, bundle branches, and Purkinje fibers
Created by: fausfez