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81 Cards in this Set
- Front
- Back
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MC cause of right sided heart failure
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left sided heart failure
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Define preload
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the pressure stretching the ventricular walls at the onset of ventricular contraction; related to left ventricular end diastolic volume/pressure
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Define afterload
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the load or force developed by the ventricle during systole
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What drugs are used to decrease preload?
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Diuretics, vasodilators, ACE inhibitors, ARBs, nitrates
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What drugs are used to decrease afterload?
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vasodilators, ACE inhibitors, ARBs, hydralazine
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What drugs are used to increase contractility?
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digoxin, phosphodiesterase inhibitors, beta agonists
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MOA of digoxin
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Digoxin inhibits the Na/K ATPase pump that leads to a positive inotropic action (increased intracellular Ca leading to increased force of contraction)
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____ inhibits the Na/K ATPase pump that leads to a positive inotropic action (increased intracellular Ca leading to increased force of contraction)
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MOA of digoxin
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What are two digitalis glycosidases?
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Digitoxin, digoxin
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What are the adverse effects of digoxin?
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arrhythmias, nausea, vomiting, anorexia, blurred vision, visual disturbances like YELLOW HALOS around light sources
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What electrolyte disturbances predispose to digoxin toxicity?
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hypokalemia, hypomagnesemia, hypercalcemia
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What electrolyte disturbances predispose to digoxin toxicity?
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hypokalemia, hypomagnesemia, hypercalcemia
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What electrolyte disturbances predispose to digoxin toxicity?
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hypokalemia, hypomagnesemia, hypercalcemia
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Digoxin causes what type of arrhythmias?
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Supraventricular tachycardias
AV nodal tachycardia AV block V fib |
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How do you treat digoxin toxicity?
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correct electrolyte disturbance
digitalis Fab antibodies (Digibind) |
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How do you treat digoxin toxicity?
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correct electrolyte disturbance
digitalis Fab antibodies (Digibind) |
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How do you treat digoxin toxicity?
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correct electrolyte disturbance
digitalis Fab antibodies (Digibind) |
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MOA of dobutamine in CHF
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Beta adrenergic agonist that increases force of contraction and vasodilation via increased cAMP
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MOA of dobutamine in CHF
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Beta adrenergic agonist that increases force of contraction and vasodilation via increased cAMP
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MOA of dobutamine in CHF
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Beta adrenergic agonist that increases force of contraction and vasodilation via increased cAMP
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MOA of amrinone and milrinone in CHF
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inhibit phosphodiesterase (PDE) thus increasing cAMP levels
increased cAMP levels leads to increased intracellular calcium (increased force of contraction) and vasodilation |
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MOA of amrinone and milrinone in CHF
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inhibit phosphodiesterase (PDE) thus increasing cAMP levels
increased cAMP levels leads to increased intracellular calcium (increased force of contraction) and vasodilation |
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MOA of amrinone and milrinone in CHF
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inhibit phosphodiesterase (PDE) thus increasing cAMP levels
increased cAMP levels leads to increased intracellular calcium (increased force of contraction) and vasodilation |
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MOA of diuretics (i.e. spironolactone) in CHF
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decrease intravascular volume thus decreasing preload
reduce pulmonary and peripheral edema |
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MOA of diuretics (i.e. spironolactone) in CHF
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decrease intravascular volume thus decreasing preload
reduce pulmonary and peripheral edema |
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MOA of diuretics (i.e. spironolactone) in CHF
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decrease intravascular volume thus decreasing preload
reduce pulmonary and peripheral edema |
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MOA of ACE inhibitors in CHF
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inhibition of angiotensin-II production decreases TPR and afterload, preventing left ventricular remodeling
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MOA of ACE inhibitors in CHF
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inhibition of angiotensin-II production decreases TPR and afterload, preventing left ventricular remodeling
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MOA of ACE inhibitors in CHF
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inhibition of angiotensin-II production decreases TPR and afterload, preventing left ventricular remodeling
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Define angina pectoris
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chest pain from a myocardial oxygen demand that is not met by adequate oxygen supply
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What type of angina is caused by spontaneous coronary vasospasm?
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Prinzmetal (variant) angina
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What type of angina is caused by spontaneous coronary vasospasm?
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Prinzmetal (variant) angina
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What type of angina is caused by atherosclerosis of coronary vessels and is precipitated by exertion?
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classic angina
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What type of angina can be acute in onset and is caused by platelet aggregation?
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unstable angina
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What type of angina can be acute in onset and is caused by platelet aggregation?
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unstable angina
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What two strategies are used in the treatment of angina?
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increase oxygen supply to the myocardium
decrease myocardial oxygen demand |
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What types of drugs can increase oxygen supply?
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nitrates, calcium channel blockers (CCB)
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What types of drugs can decrease oxygen demand?
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nitrates, calcium channel blockers, beta blockers
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Drug of choice for immediate relief of anginal symptoms?
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sublingual notrogylcerin
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MOA of nitrates
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nitrates form nitrites which in turn form NO
NO activates guanylyl cyclase to increase cGMP increased cGMP leads to increased relaxation of vascular smooth muscle |
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MOA of nitrates
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nitrates form nitrites which in turn form NO
NO activates guanylyl cyclase to increase cGMP increased cGMP leads to increased relaxation of vascular smooth muscle |
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MOA of nitrates
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nitrates form nitrites which in turn form NO
NO activates guanylyl cyclase to increase cGMP increased cGMP leads to increased relaxation of vascular smooth muscle |
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How does cGMP lead to relaxation of vascular smooth muscle?
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causes dephosphorylation of myosin light chains
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How does cGMP lead to relaxation of vascular smooth muscle?
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causes dephosphorylation of myosin light chains
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How does cGMP lead to relaxation of vascular smooth muscle?
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causes dephosphorylation of myosin light chains
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How do nitrates increase oxygen supply?
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dilation of coronary vessels which leads to increased blood supply
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How do nitrates increase oxygen supply
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dilation of coronary vessels which leads to increased blood supply
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How do nitrates decrease oxygen demand?
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dilation of large veins leads to preload reduction, which decreases the amount of work done by the heart
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How do nitrates decrease oxygen demand?
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dilation of large veins leads to preload reduction, which decreases the amount of work done by the heart
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Adverse effects of nitrates
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headache, hypotension, reflex tachycardia, facial flushing, methemoglobinemia
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Methemoglobin formation, from amyl nitrite, can be used to treat what type of poisoning?
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cyanide
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Methemoglobin formation, from amyl nitrite, can be used to treat what type of poisoning?
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cyanide
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MOA of beta blockers in treatment of angina
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inhibition of beta1 receptors leads to decreased CO,HR, and force of contraction -> reducing workload and oxygen demand
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MOA of beta blockers in treatment of angina
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inhibition of beta1 receptors leads to decreased CO,HR, and force of contraction -> reducing workload and oxygen demand
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MOA of Calcium channel blockers (CCBs) in angina
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block vascular L-type calcium channels which leads to decreased heart contractility and increased vasodilation
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CCB that works predominantly on the myocardium
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verapamil
diltiazem |
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CCBs that work mainly on peripheral vasculature
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Dihydropyridines: nifedipine, amlodipine, felodipine, isradipine, nicardipine
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CCB that works predominantly on the myocardium
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verapamil
diltiazem |
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CCBs that work mainly on peripheral vasculature
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Dihydropyridines: nifedipine, amlodipine, felodipine, isradipine, nicardipine
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What is the Blood Pressure equation?
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BP = CO x TPR
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What is responsible for the moment to moment changes in BP?
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baroreceptor reflexes (autonomic nervous system)
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Where are the baroreceptors located that are responsible for moment to moment changes in BP?
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aortic arch (carotid SINUSES)
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Where is aldosterone synthesized?
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zona glomerulosa of the adrenal cortex
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What is the function of aldosterone in BP regulation?
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increases reabsorption of Na in exchange for K, water follows Na
Thus aldo leads to Na and water retention, increasing BP |
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Most common thiazide diuretic used to treat HTN
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hydrochlorothiazide
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Most common thiazide diuretic used to treat HTN
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hydrochlorothiazide
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Site of action of thiazide diuretics
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distal convoluted tubules
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Site of action of thiazide diuretics
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distal convoluted tubules
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What are the immediate and chronic effects of thiazide diuretics?
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Immediate: increased Na, Cl, and water excretion -> decreased blood volume
Chronic: decreased TPR |
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What are the immediate and chronic effects of thiazide diuretics?
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Immediate: increased Na, Cl, and water excretion -> decreased blood volume
Chronic: decreased TPR |
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What transporter in the distal convoluted tubule is inhibited by thiazide diuretics?
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Na/Cl transporter
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What transporter in the distal convoluted tubule is inhibited by thiazide diuretics?
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Na/Cl transporter
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What transporter in the distal convoluted tubule is inhibited by thiazide diuretics?
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Na/Cl transporter
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Thiazides cause increased renal calcium absorption, making them a treatment option for__
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calcium stones
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Loop diuretics act on the
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Loop of Henle (thick ascending limb)
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Furosemide
Bumetanide Ethacrynic acid Torsemide |
Examples of loop diuretics
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Furosemide
Bumetanide Ethacrynic acid Torsemide |
Examples of loop diuretics
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What transporter is inhibitied by loop diuretics?
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Na/ K/ 2 Cl transporter
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What transporter is inhibitied by loop diuretics?
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Na/ K/ 2 Cl transporter
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This loop diuretic is the most ototoxic but can be given to pts with sulfa allergies
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ethacrynic acid
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This renal tubular segment is responsible for the majority of Na reabsorption
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proximal convoluted tubule
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