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pharmheart
drugs for heart conditions
| Question | Answer |
|---|---|
| action of diuretics | increase urine output & decrease fluid volume |
| action of calcium channel blockers | block calcium ion channels in arterial smooth muscle from letting calcium in, promoting vasodilation |
| types calcium channel blockers | selective (only work on blood vessels) nonselective (work on blood vessels and the heart) |
| DONTS with calcium channel blockers | grapefruit juice (keeps mx in body longer, causing hypotension), generally not used as monotherapy (unless for dysryhthmias), avoid during heart failure |
| adverse effects of calcium channel blockers | flushed skin, peripheral edema, headache, dizziness, bradycardia (AV heart block), rebound hypertension |
| used 2nd in angina, after beta blockers | calcium channel blockers |
| examples of calcium channel blockers | verapamil "Calan" (non-selective);dilitiazen " Cardizem" (non-selective); amlodipine "Norvasc" (selective); nifedipine "Procardia" (selective) |
| CCB's are effective in these hard to treat populations | elderly & african americans |
| action of angiotensin II receptor blockers (ARB's) | Block the angiotensin II from reaching its receptors; causing vasodilation and decreased BP |
| ARB medications end in what suffix | "tan" |
| adverse effects of ARB's | headache, dizziness, orthostatic hypotension, rash. Cough and angioedema less likely; don't work well in african americans |
| Direct Renin Inhibitors | Act directly on renin-angiotensin system; inhibition of renin results in decreased formation of angiotensin II. (Ex.- aliskiren Tekturna) Side effects: cough, diarrhea |
| Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors) usually end in what suffix | "pril" |
| action of ACE inhibitors | Inhibit the formation of angiotensin I to angiotensin II and block aldosterone secretion, causing decreased peripheral resistance and decreased fluid volume (which lowers BP) |
| side effects of ACE inhibitors | dry irritating cough, insomnia, hyperkalemia, angioedema, postural hypotension (less effective in blacks) |
| nifedipine/Procardia | selective calcium channel blocker |
| beta blockers end in | "olol" |
| microalbuminurea | Early marker of diabetic nephropathy that may be prevented or delayed by taking ACE or ARB mxs |
| contraindications of beta-blockers | diabetics (mask signs of hyperglycemia), pts with COPD (may cause broncho-constriction) |
| beta blockers work by... | inhibiting sympathetic (fight/flight) response; decreases HR, reduced CO and lowers BP |
| beta blockers are used for: | HTN, heart failure, myocardial infarction, migraines, dysrhythmias (usually used for chronic conditions, not acute situations) |
| always check ___ prior to administering a beta blocker | apical pulse (don't give if less than 50) |
| s/e of beta blockers | Adverse effects: marked decrease in BP and HR, insomnia, depression, nightmares, fatigue, activity intolerance, decreased libido, erectile dysfunction, hypoglycemia, bronchospasm |
| abruptly stopping beta blockers may cause | rebound hypertension; need to wean off |
| 4 B's of beta blockers | bradycardia; blood pressure; bronchial constriction; mask low blood glucose |
| Alpha1 Adrenergic blockers work by | Inhibit sympathetic activation in arterioles, causing vasodilation (not considered first line drugs; used in combination usually with diuretics) |
| alpha 1 blockers end in | "sin" |
| alpha 1 indications | HTN, Useful in patient with lipid abnormalities or benign prostatic hypertrophy, seen in hypertensive urgency or emergency |
| alpha 1's interact with | anti-inflammatory drugs and nitrates |
| alpha 1 side effects | dizziness, nausea, fatigue, nervousness |
| alpha 2 agonists work by | Decreasing outflow of sympathetic nerve impulses from the brainstem to the heart and arterioles, causing vasodilation |
| indications for alpha 2's | pregnancy! (not considered a 1st line for HTN) |
| drugs that increase heart contractility | positive inotropic (ie epinephrine, dopamine, digoxin) |
| direct acting vasodilators | Direct action on smooth muscle of arterioles; used in hypertensive urgency or emergency |
| hydralazine (Apresoline) | direct acting vasodilator |
| action of nitroglycerin | form nitric acid to vasodilate blood vessels to improve blood flow to myocardium. Decrease preload and afterload |
| contraindications on nitro | Viagra or Cialis may cause life-threatening hypotension. Use with alcohol or anti-hypertensive drugs may cause additive hypotension; tolerance is easily built up! |
| teaching pt. about PRN nitro | take while sitting; h/a does not indicate whether working or not; teach about SL; take 1 every 5 minutes 3 times before calling 911 |
| anti-anginal tx's | nitro; CCB; Beta blockers |
| anti-dysrhythmic mx's | sodium channel blockers (lidocaine), potassium channel blockers (amiodarone), beta blockers, calcium channel blockers, adenosine/Adenocard |
| action of lidocaine | sodium channel blocker; anesthesia-like action; slows electrical impulses across the heart, decreases action potential and accelerates repolarization |
| indications for lidocaine | severe ventricular dysrhythmias |
| adverse effects of lidocaine | toxicity, drowsiness, confusion, seizures/convulsions, and can cause worsened or new dysrhythmias |
| action of amiodarone | potassium channel blocker; slows repolarization, lengthens refractory period and increases duration of action potential |
| indications for amiodarone | severe atrial and ventricular dysrhythmias (*1st in line for ACLS) |
| action of adenosine/Adenocard | terminates serious atrial tachycardia by slowing conduction through the AV node and decreasing automaticity of the SA node: is like "chemical defibrillation" |
| indications for adenosine | PSVT: paroxysmal supraventricular tachycardia |
| cardiac glycosides/ digoxin | Digitalis: increases heart's contractility, slows the heart rate; greater efficiency and greater cardicac output |
| indications for digoxin | usually advanced heart failure b/c doesn't decrease mortality and has a very narrow window of safety (>3 ng is toxic) |
| DDI for digoxin | antacids and herbals; low potassium (hypokalemia increases risk for toxicity) |
| s/s toxicity with digoxin | bradycardia (check apical pulse), cardiac dysrhythmias (heart block), blurred vision or halos, vomiting, fatigue, anorexia |
| antidote for digoxin | Digibind |
| action of dobutamine/Dobutrex | Increases myocardial contractility rapidly and effectively with minimal changes to HR or BP (acute situations: limited to 72 hours) Adverse effects: tachycardia and dysrhythmia |
Created by:
leh072487
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