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41 Cards in this Set

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What is congestive heart failure? What does the word congestive mean in this phrase?
Condition where the heart is unable to pump enough blood to meet the need of peripheral tissues
Congestive referes to the fact that fluid tends to accumulate in the lungs and peripheral issues b/c heart is unable to maintain proer circulation
What causes CHF?
Any CVD or dysfuntion will eventually cause CHF (ie. MI, angina, MVP, etc.)
Why is CHF considered a vicious cycle?
Once there is a dec in cardiac fxt, other changes tend to occur that further decrease cardiac functino
ie. Inc vascular resistnance and inc fluid volume
Primary goals of Pharmacotherapy
Inc hearts ability to pump
Decrease cardiac workload (by dec pressure heart must work against)
How can drugs decrease cardiac workload?
Decreaseing pressure heart must work against
Dec volume of blood (HTN meds) or direct effect on heart
What are positive inotropic agents? Examples?
Drugs that inc cardiac contractility
Digitalis glycosides
Inotropic definition
The force of mm contraction
Two main types of drugs used to treat CHF
Positive inotropic agnets
HTN meds that dec cardiac workload (ACE inhib, ANG II receptor blockers, vasodilators, Beta andrenergic blockers, diuretics)
What type of vasodilators may be used to treat CHF?
Prazosin (Minipress) - alpha 1 blocker
Nitrates
Explain the MOA for digitalis (Lanoxin)
Inhibits the Na-K pump = inc intracellular Na
This dec Ca/Na exchanger activity = more Ca in cell
Inc Ca release during AP = inc contractility
2 beneficial effects of Digitalis (Lanoxin)
Mechanical - inc contractility
ANS - inhibit SNS (think heart and BVs)
Electrophysilogical - treat arrhythmias by slowing conduction thru myocardium
PROs vs. CONS of digitalis
PROs: Inc CO (resting and ex), improves ex tolerance
Dec s/s of HF and # of hospitalizations associated w/ CHF
CONs: Not clear if improves life expectancy
Long half-life
Narrow therapeutic window
Adverse effects of Digitalis
Toxicity, arrhythmia (counterintuitive?)
Possible GI, CNS issues
Phosphodiesterase (PDE) inhibitors
Inotropic agent - used for ACUTE or SEVERE HF - not for chronic use
Dopamine (Intropin) and Dobutamine (dobutrex)
Used for ACUTE or SEVERE HF - not for chronic use
Used if digitalis or derivative is not effective
B1 agonist that do NOT inc HR (only contractility)
Hemostasis: definition, function, problems
Blood coagulation/clotting
Prevent hemorrhage
Too little clotting = blood loss
Too much clotting = thrombus/embolis/fibrosis
4 factors important for clot formation
Prothrombin creates thrombin
Fibrinogen is converted to fibri in the presence of thrombin
How is a clot degraded? What factors are needed?
Plasminogen gets converted to plasmin by TPA. Plasmin degrades the clot
3 types of tx for overactive clotting
Anticoagulants
Antithrombotics
Thrombolytic
General fxt and use of Anticoagulants. What drugs?
Fxt: control synthesis of clotting factors
Use: prevent/treat abnormal venous clot formations (DVTs)
Heparins and oral anticoagulants
MOA for heparin?
Potentiates activity of antithrombin III.
Antithrombin III binds to and inactivates clotting factors
Administration of heparin vs. heparin derivatives
Parenterally
Some derivatives can be injected subQ and have lower risk of adverse effects
When is hepain most often used?
Initially for DVT
MOA for oral anticoagulants (warfin, Coumadin)
Impair Vit K-dependent synthesis of clotting factors
Inhibits Vit K-epoxide reductase
Advantages/Disadvantages of oral anticoagulants
warfarin (Coumadin)
Can be taken orally
Contraindicated in pregnancy (bad for babay)
Not effective for several days
Adverse effects of anticoagulants?
Hemorrhage and death for both Heparin and orals (Coumadin)
When would you use heparin vs. Coumadin?
Heparin acutely and Coumadin for long term use
Should you ambulate with a DVT?
American College of Chest Physicians recommends early AMB as opposed to bed rest for acute DVTs
Anticoagulation and early AMB with leg compression led to faster pain and swelling reduction
Same incidience of PE as compared to bed rest
Function and indications for Antithrombotics
Inhibit platelet function
Used to prevent thrombus formation in arteries
Used to treat/prevent MI nd possibly prevent ischemic CVA
Example of antithrombotic drug? Adverse effects?
Aspirin
Inc risk of hemorrhage and GI irritation
MOA for thrombolytics?
Activates tissue plasminogen activator, which converts plasminogen to plasmin
alteplase
Indication for thrombolytics? Adverse effects?
ACUTE MI or ischmic CVA
Risk of hemorrhage
How do you treat the following:
Hemophilia
Vit K-def clotting factor deficiency
Excessive bleeding due to excessive plasmin breakdown of clots
Replace missing clotting factors
Administer Vit K
Administer antifibrnolytics/antiplasmin agents
Why is hyperlipidemia bad?
Inc plasmin lipids which can lead to atherosclerosis, whichcan lead to clotting disorders
HDLs vs. LDL and VLDL
HDL removes chol from arterial wall
LDL/VLDL transport and deposit chol on arterial wall
Characterisitcs of antihyperlipidemic drugs
Used in combo with diet change
Used in combo with other antihyperlipidemic drugs
Serious side effects rare (myopathy with statins possible)
4 types of hyperlipidemic drugs
Statins
Fibric acids (fibrates)
Niacin (Niaspan)
Ezeimibe (Zetia)
Primary effect of Statins (Lipitor). Adverse effects? Contraindications
Dec total and LDL chol
Myopathy possible
Avoid grapefruit and don't use with prego and young kis
Primary effect of Fibric acids (fibrates)
Dec TGs and VLDL
Primary effect of Niacin (Niaspan)?
Broad spectrum benefits to chol proile
Primary effect of Ezetimibe (Zetia)
Dec chol absorption from GI tract (dec total chol)