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33 Cards in this Set
- Front
- Back
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Describe Angina |
- Chest Pain, heaviness, tightness, neck/jaw/arm pain - Diabetics wont feel angina due to neuropathy, SOB |
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Supply and Demand: Angina |
Supply: Coronary Arteries -Flow into arteries -Pressure -Resistance against flow Demand of Myocardium -HR -Systolic BP -Myocardial Wall Tension ----Ventricle has to be able to accept blood in - damage/scarring makes it less compliant |
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What are the two ways to reduce angina thru meds? |
Reduce demand or improve supply Nitrates Beta Blockers Calcium Channel Blockers |
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What are the indications and Effects of Nitrates? |
Angina/Ischemia --Extended release (tablet) - preventative --Sublingual/Spray - immediate relief (wait 5 min - up to 3 doses) Dilate Coronary arteries Induce Systemic vasodilation IV NTG early post MI limits infarct size |
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Side effects of Nitrates |
Dizziness Headaches Hypotension (positional) |
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Precautions/Contraindications with Nitrates |
Watch for Dizziness Precautions when used with viagra Precaution with Low BP Interaction: may cause hypotension especially w/ use w/ other antihypertencives and acute ingestion of alcohol |
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Indications for Beta Blockers |
-Management of hypertension -Management of angina (lower workload on heart - dec myocardial O2 consumption) -Management post MI or CABG to lower workload on heart to improve mortality |
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What is the effect of a Beta Blocker |
**Sympatholytic-Opposing effects of SNS (Cuts off Sympathetic) -Blocks Stimulation of Beta 1+2 adrenergic receptor sites -Decreases Contractility of myocardium -Lowers HR and Systolic BP -Post MI limits ventricular remodeling by decreasing early ventricular dilation |
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Side effects of Beta Blockers |
Fatigue, Weakness, Drowsiness, Impotence Insomnia, Depression, Memory loss, nightmares Bradycardia, hypotension, peripheral vasoconstriction Broncho-constriction - bronchospasm, especially in non-cardio selective beta blocker |
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Precautions/Contraindications for Beta Blockers |
Cautious with Hepatic or renal Impairment Cautious with pulmonary dysfunction and/or asthma Cautious with diabetics: blocks response to hypoglycemia (dizziness, fatigue, sweating) Contraindicated in uncompensated heart failure, pulmonary edema, cardiogenic shock and heart block |
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Indications for Calcium Channel Blockers |
Hypertension Supraventricular arrythmias Vasodilation - (coronary arteries) Vasospasm |
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Calcium Channel Blockers effects |
Dec Contractility Dec Heart Rate Dec Conduction Velocity (Negative Iono/Chronotropic) Vasodilation -- afterload reduction Smooth Muscle Relaxation |
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Side Effects of Calcium channel blockers |
Dizziness Orthostatic Hypotension |
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Indications for Diuretics |
Management of hypertension Edema due to CHF or other causes Potassium sparing diuretics have weak antihypertensive properties (Should be on supplemental potassium) |
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Effects of Diuretics |
Inc Excretion of H2O Inc Excretion of electrolytes Works on Renal systems |
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Diuretics and Kidneys |
Filtration of blood thru the loop of henley Na+ and electrolytes reabsorbed throughout various portions of the nephron Diuretics inhibit reasborption of sodium in the kidneys Water comes with sodium Therefore more water and more sodium is excreted |
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Side effects of Diuretics |
-Hypokalemia -Hyperuricemia -Dehydration -Dizziness -Lethargy -Weakness -Dec in BP -Anorexia, Cramping -Hyponatremia -Muscle Cramps |
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Indications for Cardiac Glycosides |
Treat CHF, Tachyarrythmias, Treatment of atrial fibrillation and flutter |
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Effects of Cardiac Glycosides |
-Increases cardiac output (+ Ionotropic) ---Inhibits Sodium/potassium ATP-ase (allowing calcium to accumulate) in myocytes and increasing contractility -Prolongs refractory period of AV node -Parasympathomimetic - decreases conduction through SA and AV node - slows HR ((Mimicking parasympathetic)) |
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Side effects of Calcium Glycosides |
Fatigue Bradycardia Nausea/Vomiting Arrythmias (block node conduction) Anorexia |
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Precautions for Cardiac Glycosides |
–Uncontrolledventricular arrhythmias –AVBlock –Idiopathichypertrophic subaortic stenosis–Constrictivepericarditis –Knownalcohol intolerance –Electrolyteimbalances –Renalimpairment (need to decrease dosage: normal doqsage 0.25, w/renal impairment use0.125) –Obesepatients |
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What are other Ionotropic positive meds |
•IVdobutamine (direct B stimulant, less rise in HR and peripheralvasoconstriction) •IVdopamine (B1 adrenergic; precursor of norepinephrine) used for shock •Amioderone(inocor) IV or infusion for short term treatment of HF (sideeffects thrombocytopenia, nausea) •Milrinone(primocor) hasbeen associated with a fib and tacharrhy) |
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What are ACE inhibitors for? |
Manage hypertension Manage CHF Reduction of risk of death or development of CHF following MI Slow progression of LV dysfunction into overt heart failure Decrease progression of diabetic nephropathy Prevention of migraine headache |
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Effects of Ace Inhibitors? (Slide 37 flow chart) |
Blocks conversion of Angiotensin 1-2 (blocks vasoconstriction) Inhibits degradation of vasodilator Bradykinin and other prostalgandins Inc plasma renin levels and reduce aldosterone levels Results in vasodilation Side effect: coughing |
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What are the indications for thrombolytics? |
Acute management of coronary thrombosis (MI) -Pulmonary Emboli -DVT -Acute ischemic stroke |
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Effects of thrombolytics |
Activates plasminogen -Coverts plasminogen to plasmin --> plasmin degrades fibrin in clots |
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Precautions/Contraindications for Thrombolytics |
Recent surgery, trauma, GI bleed Severe hepatic or renal disease Subacute bacterial endocarditis or acute pericarditis Interactions: Concurrent use with aspirin NSAIDS, warfin, heparin |
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Indications for Cholesterol lowering drugs |
To reduce blood lipids in order to reduce morbidity |
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Effects of Cholesterol lowering drugs |
Acts on liver - inhibition of production of cholesterol Effects cholesterol absorption in GI tract |
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What are lipid lowering meds? |
Statins/Fibrates- block cholesterol production in the liver Niacin - reduces production of lipids in the liver Zetia - works on small intestine to decrease absorption |
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Side effects of Zetia/Vytorin |
May cause diarrhea Toxicity: may cause myopathy --Watch for muscle pains and cramping at rest and overnight --Uuually seen within first 6 months of starting medication |
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Describe Anti-arrhythmia meds |
*Many cause arrythmias* Most widely used -Beta blocker -Calcium blockers (supravent tachy arrhy) -Amiodorone - A fib (severe pulmonary toxicity) |
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What is the GOLD STANDARD for life threatening arrythmias |
ICD |
