Pharmarcology - Cardio
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| HMG-CoA reductase inhibitors (Statins): Mechanisms of actions | Inhibits the manufacture of cholesterol or promotes the breakdown of cholesterol. Lowers the blood levels of cholesterol and serum triglycerides. Increases blood levels of HDLs.
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| Statins: Adverse Reactions | Headache, blurred vision, dizziness, insomnia, flatulence, abdominal pain, cramping, constipation, nausea.
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| Statins: Contraindicated in Patients | with hypersensitivity to the drugs, serious liver disorders; during pregnancy an lactation.
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| Statins: Use cautiously in patients with | history of alcoholism, acute infection, hypotension, trauma, endocrine disorders, visual disturbances, and myopathy.
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| Statins: Interactions | Coumadin: increase anticoagulation effect. Grapefruit juice: avoid large amounts during therapy; may increase risk of toxicity.
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| When is the best time to take coumadin? | Dose best taken in the evening, or bedtime.
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| HMG-CoA reductase inhibitors (statins): generic names | ends in "statin": atorvastatin; fluvastatin; lovastatin; pravastatin; rosuvastatin; simvastatin
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| What is bile? | Manufactured, secreted by liver, stored in the gallbladder, emulsifies fat, lipids. Once fats and lipids emulsified they can be absorbed.
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| Bile acid resin: action | Bind with bile acids to prevent them from being absorbed in intestine. Increased loss of bile acids in the feces-liver uses cholesterol to manufacture more bile thereby reducing cholesterol.
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| Bile acid resin: adverse reactions | Constipation; aggravation of hermorrhoids, abdominal cramps, flatulence, nausea, increased bleeding tendencies related to vitamin K malabsorption, and vitamin A and D deficiencies.
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| Bile acid resin: Uses | Hyperlipidemia; pruritus associated w/partial biliary obstruction.
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| Bile acid resin: generic/trade names | Questran (cholestyramine) Used for its adverse effect of constipation. Given to patient's to reduce diarrhea occasionally; colestid (colestipol); WelChol (colesevelam)
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| Fibric acid derivatives: adverse reactions | Nausea, vomiting, GI upset, diarrhea, cholelithiasis or cholectystitis.
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| Fibric acid derivatives: contraindicated | hypersensitivity to the drugs and those with significant hepatic or renal dysfunction or primary biliary cirrhosis.
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| Fibric acid derivatives: Used cautiously with | Peptic ulcer disease, diabetes, during pregnancy and lactation.
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| Fibric acid derivatives: trade names | TriCor(fenofibrate)Reduces VLDL; Stimulates catabolism of triglyceride-rich lipoprot; decreases plasma trigly, cholesterol. Lopid (gemfibrozil)increases excretion of cholesterol in feces, reduces production of trigly by liver, lowers serum lipid levels.
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| Niacin: Actions | Lowers blood lipid levels
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| Niacin: Uses | Adjunctive therapy for lowering very high serum triglyceride levels in patients who are at risk for pancreatitis. Used as an adjunct w/other antilipidemic drugs.
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| Niacin: Adverse reactions | Nausea, vomiting, abdominal pain, diarrhea, severe generalized flushing of the skin, sensation of warmth, severe itching or tingling.
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| Niacin: trade names | Niaspan, Niacor
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| Zetia (ezetimibe): Action | Inhibits the absorption of cholesterol in the small intestine.
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| Zetia: Uses | Used in combination with other antihyperlipidemics in liped lowering treatments.
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| Zetia: Adverse Reactions | diarrhea, back pain, sinusitis, dizziness, abdominal pain, arthralgia (joint pain), coughing, fatigue
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| Angiotensin converting enzyme (ACE) inhibitors "prils": Action | Work by inhibiting the conversion of angiotensin I to angiotensin II. Interrupts the chain of events, and sodium and water are not retained so BP decreases.
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| ACE Inhibitors: Adverse Reaction | COUGH, Cause fetal death, fameale patients should be on a reliable form of birth control even if beginning menopause as pregnancy could still occur.
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| ACE Inhibitors: Generic Names | ends in "pril" (benazepril, captopril, enalapril, fosinopril, lisinopril, quinipril, moexipril, ramipril).
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| Angiotensin II receptor blockers (ARBs) "sartans": Actions | Block binding of angiotensin II at receptor sites in vascular smooth muscle and adrenal gland, which blocks vasoconstrictive effect of renin angiotensin system and the release of aldosterone, resulting in blood pressure decrease.
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| ARBs: Generic names | ends in "sartan" (candesartan, irbesartan, losartan, olmesartan, valsartan,)
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| Calcium Channel Blockers: Uses | Contractions of cardiac and vascular smooth muscle depend on movement of extracellular calcium ions through specific ion channels. Dilate coronary arteries & arterioles; reduce response of electrical conduction system.
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| Calcium Channel Blockers: Action | Blockers act by inhibiting the movement of calcium ions across cell membrane. Relax blood vessels & increse the supply of oxygen to the heart. Reduce the heart's workload(lowers B/P by dilating arteries. slow down heart rate.)
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| Calcium Channel Blockers: Generic Name | ends in "dipine" (amlodipine, felodipine, nifedipine, nisoldipine) verapamil, diltiazem.
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| Diuretics: Uses | Treatment of edema, hypertension, renal disease, cerebral edema, acute glaucoma and increased IOP.
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| Diuretics: Actions | Increases the excretion of urine by the kidneys.
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| Diuretics: Adverse reactions | Dizziness, lightheadedness, weakness, fatigue, orthostatic hypotension, electrolyte imbalances (Specifically hypokalemia (except for potassium sparing diuretics))
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| Thiazide diuretics(Weakest): Uses | Work to prevent reabsorption of sodium & chloride thru direct action on end of ascending loop & beginning of distal tubule of loop of Henle in distal kidney tubule. Act directly to dilate smooth muscles in arterioles, smallest vessels in arterial system.
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| Thiazide diuretics: Generic Names | chlorothiazide, metolazone, hydrochlorothiazide
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| Loop diuretics(strongest): Actions | Act by blocking active transport of chloride, sodum, and potassium in thick ascending loop of Henle. Often used in pts w/kidney disease, & treat congestive heart failure. These drugs act at all 3 sites of renal tubule, which increases their effectiveness.
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| Loop diuretics: Generic names | Bumetanide, furosemide, torsemide
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| Potassium sparing diuretics(weak side): Uses | Increase the excretion of water and sodium but save potassium.
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| Potassium sparing diuretics: Generic Name | Spironolactone, triamterene
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| Osmotic diuretics: Uses | Prevents reabsorption of water, increases sodium and chloride excretion.
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| Osmotic diuretics: generic names | mannitol, urea
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| Carbonic anhydrase inhibitors: Uses | Used for glaucoma, they decrease the production of aqueous humor in the eye, which in turn decreases intraocular pressure.
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| Carbonic anhydrase inhibitors: generic names | acetazolamide and methazolamide
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| Vasodilators: Uses | Relaxes smooth muscles of blood vessels causing vasodilation and decreased blood pressure.
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| Peripheral acting vasodilators: Adverse Reactions | Headache, weakness, tachycardia, flushing, postural hypotension, dysrhythmias, confusion, severe rash, nervousness, tingling, and sweating.
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| Peripheral acting vasodilators: Action and Uses | Peripheral vasodilators, Relax the smooth muscles of peripheral arterial vessels to increase peripheral circulation. Used to treat leg pain caused by vasoconstriction.
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| Peripheral acting vasodilators: generic names | Hydralazine, minoxidil(will increase the heart rate, monitor pt and notify if HR 20bpm above basal rate), nitroprusside(used for hypertensive emergencies. hemodynamic monitoring req'd throughout the course of therapy).
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| Antianginals: Uses | Used often; relieves chest pain or pressure by dilating coronary arteries, increasing the blood supply to the myocardium. Dilating peripheral arteries to decrease the workload of the heart.
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| What are the antianginal drugs? | Nitrates and Calcium channel blockers
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| Nitrates: Action and Uses | "universal vasodilator" directly cause vascular smooth muscle to relax in arterial & venous circulation, decrease myocardial oxygen use. Increase collateral-vessel circulation to heart. For acute & chronic anginal attacks, reduce workload of heart.
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| Nitrates: Adverse Reactions | Flushing, postural hypotension, tachycardia, confusion, dizziness, fainting, headache, lightheadedness, vertigo, weakness.
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| Nitrates: Patient teaching on taking med | headache common decrease w/cont therapy; sit or lie after taking; seek med attention for chest pain not relieved by nitro; don't swallow or chew sub or transmucosal tablets; aerosol spray nitrates used 5-10 mins before activities;
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| Nitrates: Patient teaching on handling med | Do not shake canister before use; check expiration date; store casules & tablets in original containers to protect from light; Nitro will lose its potency if stored in plastic or mixed w/other drugs; deteriorates on contact w/air, put lid on immediately.
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| Nitrates: Drug interactions | Major interactions between these drugs & phosphodiestrase inhibitors used for erectile dysfunction. Severe hypotension & cardiovascular collapse may occur. Make sure you ask the man coming into ER w/chest pain if he takes Viagra before giving him Nitro!
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| Nitrates: Generic Names | isosorbide; isosorbide mononitrate; nitroglycerin, oral; nitroglycerin ointment; nitroglycerin transdermal systems.
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| Nitroglycerin, oral dosage | Sublingual nitro may be reapeated every 5 mins X 3(if 3rd dose doesn't work call DR.); 1-2 sprays of Translingual nitro spray may be used to relieve angina, but no more than 3 metered doses are recommended w/in 15 mins.
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| Nitroglycerin ointment dosage/application | Measured in inches or mm; wear gloves to prevent contact w/ointment; express prescribed amt onto paper; Use paper to gently spread thin uniform layer over 2 1/2 by 3 1/2" area; applied to chest or back; rotate site; may secure w/ non-allergenic tape.
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| Nitroglycerin transdermal system instructions | convenient & easy to use; Pt may develop tolerance, patch applied a.m & removed at bedtime; Leaving patch off 10-12 hrs delays tolerance; sites incl chest, abs, & thigh (avoid distal extremities); initial date & time; cleanse old site w/soap & warm water.
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| Digoxin(cardiotonics): Digitalization | Rapid digitalization(accomplished by administering loading dose); gradual digitalization(maintenance dose given, allowing therapeutic drug blood levels to accumulate gradually)
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| Digoxin: Actions | Increase the contraction strength or force of the heart muscle(positive inotropic action- makes heart beat stronger); slow the heart rate (neg. chronotropic action); increases stroke volume
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| Digoxin: Uses | Treatment of CHF and rapid or irregular heartbeats(A fib, A flutter, freq PVC's or paroxysmal atrial tachycardia)
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| Digoxin: Adverse Reactions | Headache, weakness, drowsiness, visual disturbance
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| Signs of Digitalis toxicity | anorexia (first sign), nausea, vomiting, diarrhea, weakness, lethargy, headache, drowsiness, visual disturbance (blurred, yellow/green vision, halo effect), confusion, disorientation, delirium, changes in pulse, EKG changes (brady, tachy, pvc)
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| Digoxin: pt teaching and nursing implications | Before administering take apical pluse for 1 min. pulse >60 or <100bpm, w/hold drug & notify DR. Hypokalemia makes heart more sensitive to digitalis, increasing possibility of digitalis toxicity. blood drawn before next dose or 6-8 hrs after last dose.
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| Anticoagulants: Actions | Commonly called "blood thinners" they do not thin blood; Prevent formation & extension of blood clots; used prophylactically; Have no direct effect on existing thrombus; Do not reverse any damage from thrombus, but prevents additional clots from forming.
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| Anticoagulants: Uses | Prevention and treatment of DVT(deep vein thrombosis and PE(Pulmonary Embolism); prevention & treatment of atrial fibrillation w/embollization; Adjuvant treatment of MI; Prevention of thrombus formation after valve replacement surgery.
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| Anticoagulants: Adverse Reactions | Bleeding
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| Anticoagulants: Contraindications | Pregnant or lactating patients, active bleeding
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| Anticoagulants: Interactions | Aspirin & NSAIDs, Antibiotics (increased risk for bleeding) Oral Contraceptives, diuretics & Vit K (decreased effectiveness of anticoagulant)
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| Warfarin (Coumadin) | Drug of choice for pts req long term therapy. Peak activity 1.5-3 days after therapy initiated. Monitor PT/INR regularly (amt time takes for blood to clot)
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| Heparin: Uses | Used prophylactically in pts who are at high risk for clot formation; Monitor PTT levels to adjust dose.
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| PTT for Heparin | 1.5-2.5X normal
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| Low-molecular weight heparins (LMWH): Generic Names | ends in "parin" Dalteparin; enoxaparin
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| Enoxaparin (LMWH): Uses | Given SQ postop to prevent thrombosis; TX lasts 7-14 days; More effective for orthopedic pts; do not need to monitor anticoagulation tests due to stability of response when admin at recommended doses; bleeding less likely to occur w/LMWH than w/heparin
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| Antiplatelet drugs prevent | thrombus formation in the arterial system.
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| Anticoagulant drugs prevent | thrombosis in the venous system.
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| Antiplatelets: uses and actions | Decrease platelet ability to stick together (aggregate) in the blood to form a clot; treats pts at risk for acute coronary syndrome, MI, stroke, and intermittent claudication.
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| Antiplatelets: adverse reactions | Heart palpitations, bleeding, dizziness, headache, nausea, diarrhea, constipation and dyspepsia
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| Antiplatelets: Contraindications | Pregnant or lactating pts, active bleeding; Antiplatelet drugs should be discontinued 1 week before any surgical procedure.
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| Antiplatelet: Generic Names | Anagrelide; Cilostazol, Clopidogrel, Dipyridamole, Eptifiatide, Ticlopidine
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| Thrombolytics | Drugs that help to eliminate the clot by dissolving clots that have already formed within the walls of a blood vessel and reopen blood vessels after they become occluded.
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| Another term to describe thrombolytics | Fibrolytic
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| Thrombolytics: Generic names | ends in "ase" (ase = enzyme) Alteplase, streptokinase, tenecteplase, urokinase
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| Urokinase: actions | Break down fibrin clots by converting plasminogen to plasmin. Plasmin is an enzyme that breaks down the fibrin of a blood clot. Because thrombolytic drugs dissolve all clots encountered, bleeding is a concern.
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| Urokinase: Uses | Used to treat acute MI by breaking up blood clots in the coronary arteries; Blood clots causing pulmonary emboli and DVT; Suspected occlusions in central venous catheters
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| Urokinase: Adverse Reactions | Bleeding (Do not give w/active bleeding)
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| Urokinase: Contraindications | Active bleeding History of stroke, aneurysm, and recent intracranial surgery, major surgery w/in 10 days
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| Antidysrhythmics: Uses | To treat cardiac arrhythmias
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| Antidysrhythmics: Adverse Reactions | Lightheadedness, weakness, somnolence, hypotension, arrhythmias, bradycardia, urinary retention
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| What are antiarrhythmic drugs capable of causing? | New arrhythmias, as well as exacerbating existing arrhythmias. Nurse must report any changes to physician.
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| antiarrhythmic Class I (Sodium Channel Blockers) | Have a membrane stabilizing or anesthetic effect on the cells of the myocardium; Contains the largest number of drugs of the four classifications.
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| antiarrhythmic Class I: Generic Names | Lidocaine, disopyramide, Flecainide, Procainamide, Quinidine.
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| antiarrhythmic Class II (Beta adrenergic blockers): Actions | Indirectly block calcium channels and catecholamine caused dysrhythmias
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| antiarrhythmic Class II: Uses | Reduce the influence of the sympathetic nervous system on the heart and kidney, decreasing the excitability of the heart and the release of Renin; lowers the HR and B/P. membrane stabilizing effects.
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| antiarrhythmic Class II: Generic Name | Propranolol
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| antiarrhythmic Class III (Potassium Channel Blockers): Uses | Prolongs repolarization
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| antiarrhythmic Class III: Actions | Acts on cardiac cell membranes to prolong the refractory period and repolarization and increasing the ventricular fibrillation threshold.
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| antiarrhythmic Class III: Generic Name | Amiodarone, Sotalol
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| antiarrhythmic Class IV (Calcium channel blockers): Uses | Depress polarization, and lengthen repolarization.
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| antiarrhythmic Class IV : Actions | Inhibit movement of calcium thru channels across the myocardial cell membranes & vascular smooth muscle. This dilates the coronary and peripheral arteries, & decreases the force of contraction. Also reduces HR by slowing conduction thru the SA & AV nodes.
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| antiarrhythmic Class IV: Generic Names | Verapamil
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| Adrenergic Agents: Side Effects | Most common: Dry mouth, drowsiness, Sedation, Constipation
Other: Headache, sleep disturbances, Nausea, rash, palpitations. HIGH INCIDENCE OF ORTHOSTATIC HYPOTENSION
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| Beta Blockers: Uses | Reduces vascular resistance, heart rate, contractility, and renin release & cardiac output by diminishing the sympathetic nervous system response. Antihypertensives, Antianginals, and Antidysrhythmics
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| Beta Blockers: Generic names | atenolol, bisoprilol, metoprolol, nadolol, nebivolol, propranolol
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| Propranolol (inderal): Uses | B2, non-selective, not specific to cardiac, also causes bronchoconstriction. Do not give to someone with asthma. Even cardio-selective beta blockers should be used with caution in pts predisposed to bronchospasm.
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| Alpha Blockers: Uses | Alpha adrenergic blocking drugs
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| Alpha Blockers: Actions | Alpha adrenergic nerves are vasoconstrictors, blockers result in vasodilation, have most effect on vascular system. Used for hypertension caused by pheochromocytoma.
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| Alpha/Beta blockers: Uses | Block stimulation of both alpha and beta adrenergic receptors resulting in peripheral vasodilation: end in "lol"(Carveldilol and labetalol)
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| Antiadrenergic Drugs (Centrally acting): Actions | Act on the central nervous system to decrease some of the activity of the sypathetic nervous system. Blocks the alpha-adrenergic receptors, resulting in vasodilation and decreased blood pressure. Help maintain the renal blood flow rate.
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| Antiadrenergic Drugs: Generic (oral) | guanfacine, methyldopa, clonidine (catapres)
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| Antiadrenergic Drugs: Generic (transdermal patch) | Clonidine (catapres-TTS) kept in place for 7 days comes w/an adhesive overlay.
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| Antiadrenergic Drugs (peripherally acting): Actions | Inhibits the release of norepinephrine from certain adrenergic nerve endings in the perpheral nervous system.
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| Antiadrenergic Drugs: Generic Drugs | ends in "osin" "pine" & "mine" (Doxazosin, prazosin, reserpine, mecamlamine, terazosin, tamsulosin)
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