Pharm 2 Exam 2 Drugs For Heart Failure.

Front 1

afterload

Back 1

pressure in the aorta that the left ventricle must overcome.

Front 2

preload

Back 2

??

Front 3

hypertension

Back 3

left ventricle must stretch more to pump blood harder through constricted arteries lefcausing.....

Front 4

left side-heart failure

Back 4

blood backs up in the left sides, and lungs become congested

s/s= fatigue weakness and crackles

Front 5

right sided heart failure

Back 5

blood backs up into the vascular system causing edema

s/s: JVD, enlarged liver, enlarged spleen, ankle swelling.

Front 6

angiotensin ll

Back 6

powerful vasoconstrictor

Front 7

aldosterone

Back 7

sodium saver

Front 8

hypertrophy

Back 8

this occurs when the heart works too hard and outgrows blood supply and stiffens.

Front 9

Vasodilators

Back 9

dialate arteries, lower bp, and decrease workload of the heart.

ex. hydralazine, nitrates (isosorbide, preparations, NTG)

Front 10

hydralazine

Back 10

increase vasodilation of arteries.

side effect=tachycardia and salt retention

Front 11

NTG and isosorbide

Back 11

increase venous vasodilation

Front 12

NTG

Back 12

increase venous vasodilation and increase blood flow to coronary arteries.

wear gloves for ointment bcuz it can cause headach if absorbed through the skin

Front 13

nitrates (NTG, preparations, isosorbide)

Back 13

side effects; hypotension, headache, dizziness, tachycardia,

adverse effects are rare

Front 14

Hydralazine

Back 14

this nitrate is safe for pregos and is used to treat pregnancy induce hypertension

Front 15

Cardiac Glycosides (Digoxin)

Back 15

slow heart rate and strengthen the heart beat.

improve cardiac output.

intended response: increase contractility and cardiac output, decreased heartrate.

side effects: fatigue, bradycardia, anorexia, n&v

very low therapeutic range (0.8-2mg/ml)

if toxicity is suspected draw for blood

before giving check apical pulse for 1 min.

after check heart rythm changes, potassium levels,

Front 16

spirolactones (aldactone)

Back 16

commonly used potassium-sparing diurectic

Front 17

Human B- Type Natriuretic Peptides

Back 17

ex. nesiritide (Natrecor)

intended responses: eliminate excess sodium and water, increase urine output, vasodilation, lower blood pressure, decrease SOA, and swelling.

side effects: hypotension, dizziness, light-headedness, frequent urination, N&V, nervousness, confusion, palpitations,

adverse effects=apnea,

before check bp and resp rate.

Front 18

Positive Intropes

Back 18

Heart pump drugs.

given intravenously for severe heart failure

ex. inamrinone, dobutamine, dopamine, milrinone

intended response: increase contractility, cardiac output, blood vessel dilation, decrease preloasd and afterload, increase heart funciton and circulation, lower bp.

side effects: hypertension, increased heart rate, premature ventricular contractions, other dysrythmias.

adverse effects: ventricular dysrythmias(with milrinone)

Front 19

potassium and magnesium

Back 19

these are given are replacement therapy to maintain normal levels.

side effects: n&v, diarrhea, gas, abdominal discomfort

Front 20

anticoagulants (heparin and warfarin)

Back 20

prevent blood clots.

Front 21

antidysrythmic drugs.

Back 21

amidarone, treat ventricular dysrhythmias, which can be life threatening.

Front 22

drugs that can be given down an ET tube in an emergency

Back 22

narcan

atropine

valium

epinephorine

lidocaine

Front 23

narcan

Back 23

for opiod reversal

Front 24

atropine

Back 24

bradycardia

Front 25

valium

Back 25

sedative

Front 26

epinephorine

Back 26

adrenaline for asystole

Front 27

lidocaine

Back 27

for ventricular drugs.

Front 28

atropine

Back 28

blocks the vagus nerve of the heart; for symptomatic bradycardia

intended responses to increase hr. and bp

side effects: drowsiness, anticholenergic effects, tachy, blurred vision,

adverese: dry mouth, urinary retention, rare= v. fib, increase o2 demands on the heart.

Front 29

digoxin

Back 29

increase contractility of heart and decrease conduction through AV node.

Really good for A. FIB

watch potassium levels.

no effect on ventricular system

decreases hr to allow for filling time and increase output and increase contractility.

really potent, small doses, monitor blood levels.

Front 30

adenosine

Back 30

decreases automaticity in the SA node

slow conduction through the AV node

prolongation of PR interval.

therapeutic uses= termination of paraoxysmal SVT.

could see their asystole, pause, normal sinus rhythm.

***not good for Afib, Aflutter, or Vtach

half life of 10sec. given rapidly.

max dose=12mg

side effects=usually pt. are awake and tell them they make feel like they hav been kicked in the chest, pain, and flushing, other transient dys, always have a crash cart available, metallic tasted in mouth, heaviness in chest and arms.

Adverse effects: cardiac arrest, MI, Vtach.

Front 31

mag sulfate

Back 31

torsades de pointes

intended response: decrease excitability of heart muscle.

side effects: bradycardia, hypotension, drowsiness.

adverse (rare): severe brady, resp. arrests, heart block.

Front 32

drugs for tachydysrhythmias

Back 32

work one of three ways:

reduce automaticity of heart muscle

slow down conduction of electrical impulses through the heart.

prolong refractory period of heart cells.

goal of treatment=prevent, relive, and prolong life.

Front 33

Class 1a Sodium channel blockers

Back 33

decreased use due to side effects.

decrease heart muscle excitability , slow conduction of electrical impulses through the heart

side effects: hypotension, loss of appetitses, abdominal cramping, diarrhea, nausea

adverse effects:

-quinadine: hypertension, torsades de pointes

-procainamide: seizures, heart block, asystole, decreased WBC (used when other drugs fail or refractory dys.)

-disopyramide: heart failure.

Front 34

class 1b sodium channel blockers

Back 34

inhibit ability of ventricle to contract prematurely.

ex. Lidocaine: numbs the cardiac cells and increases mortality rate.

side effects: toxicity, confusion, drowsiness, numbness with lidocainse.

adverse effects:

lidocaine: cause cardiac arrest

Mexiletine, tocainide: dys. may worsen.

Front 35

class 1c sodium channel blockers

Back 35

slow heart's electrical impulse conduction

side effects: dizziness, conduction system abnormalities leading to heart blocks, altered sense of tate, constipation, n&v

adverse effects: supraventricular and ventricular dys. (heart blocks, ventricular tachy

before giving check for hx of bronchospasms. (propafenone contraindication)

teach=visual disturbances, fever, sore throat, chills, unusual bleeding/brusing, chest pain, SOA, excessive sweating.

Front 36

Class 11 beta blockers

Back 36

treat SVT, rapid a. fib or flutter.

block effects of epinepherine (adrenaline) on the heart.

only 4 approved:

propanolol

acebutolol

esmolol

sotalol

adverse effects: brady, heart block (know bp, can block Beta 2 in lungs so watch for bronchospams)

Front 37

class 111 potasium channel blockers.

Back 37

uses: for life-threatening ventricular dys., recurrent ventricular fibrillation, ventricular tachy, convert a. fib/flutter to normal sinus rythym.

ex. Amnidarone and dofetilide (tikosyn)

side effects: dizziness, fatigue, malaise, brady, hypotension, lost appetite, constipation, n&v, ataxia, involuntary movement, numbness and tingling, poor coordination, tremor.

adverse effectrs (mainly amnidarone)

ARDs, pulmonary fibrosis, heart failure, worsening heart dys, decrase liver functino, toxic epidermal necrosis, skin reactions.

Front 38

amniodarone

slowing of the heart

Back 38

this potassium channel blocker: 1st line drug for ventricular and aterial dys. after epinephorine.

improves QT interval

can be PO or IV

side effects: photosensitivity, hypothyroidism, peripheral neuropathy, microdeposits on cornea.

levels can be increased by grapefruit juice.

combining this with beta-blocker, verapamil, or diltiazem can lead to excessive....

levels can be reduced by cholestryamine which will decrease the absorption.

Front 39

dofetilide (tikosyn)

Back 39

this potassium channel blocker: given to maintain normal sinus rythym in ppl with refractory (recurrent) a. fib., hard to dose and pt. must be compliant, need to be one continuous monitoring and to recieve you have to be inpatient and increase risk for torsades.

Front 40

potassium channel blockers

Back 40

check before: signs of pulmonary probs or hypothryroidism, follow up labs(liver, thyroid funciton, ECG)

teach: sided effects may not appear for several days/weeks. (particulary pulmonary)

eye exams needed every 6 months to 1 years. (microdeposits on cornea)

Front 41

classlV calcium channel blockers

Back 41

uses: slow ventriculat rate (a.fib, a. flutter) slow SA node conduction

terminate SVT caused by an AV node reentrant circuit.

decrase workload of heart.

side effects=constipation, decreasebp, flushing, rash, edema in lower extremites, men=gynomastia

adverse= brady, worning heart failure, (monitor pulmonary edema, weight gain, steven johnson syndrome.

Front 42

mag sulfate

Back 42

safe in pregos.

Front 43

heparin and warfarin

Back 43

treat a. fib in pt at increased risk for blood clots.

Front 44

implantable cardioverter-defibrillators AICD

Back 44

whole body will jerk from being shocked

Front 45

radiofrequncy catheter ablation

Back 45

dys. occur bcuz of abnormal pathways. go in and find abnormal pathway and burn it.