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51 Cards in this Set

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Cardiovascular disease is an umbrella term for...
a variety of diseases of the heart and blood vessels.
Cardio diseases (5)
1) Hypertension

2) Angina

3) Coronary artery disease

4) Cerehrovascular accident

5) Congestive heart failure
What is the leading cause of death in the US?
Cardiovascular disease
Is it possible for a patient to have several Cardiovascular diseases?
Yes. And they may be on a medication for each
How long can a cardiovascular drug be given for?
It can often given for a lifetime.
Congestive heart failure.

- occurs when the heart...
- When the heart can't keep up with the body's oxygen demands.

- The pumping mechanism is inefficient due to injury to the heart muscle.

- The heart can fail on the left or right side
Drug used to treat Congestive Heart Failure
- Example
Cardiac / Digitalis Glycosides

EX. Digoxin (most commonly used)
--> Some times perscribed with other drugs
Cardiac Glycosides
- Pharmacolofic effects (3)
1) Increase force & strength of contraction of myocardium

2) Reduces edema that occurs with CHF by producing diuresis

3) Useful in treating arrhythmias
Cardiac Glycosides
- Uses (3)
1) CHF

2) Atrial arrhythmias (A fib)

3) Research shows that it does not decrease mortality,
--> so its use as a first line of therapy
Other drugs used for Heart Failure (6)
1) Angiotensin-converting enzyme inhibitors (ACEI)
2) Angiotensin Receptor Blockers (ARB)
3) Beta adreneric blockers
4) Vasodilators
5) Diuretics
6) Aldosterone antagonists
ACE Inhibitors if Heart Failure
- used when?
- time it take to improve symptoms
- given along with what?
- Used as first line of therapy

- Improves symptoms with in 4 to 12 weeks

- Beta blockers are given at the same time.
Arrhythmias are...
abnormal rhythms from abnormal impulse generation or abnormal impulse conduction

- automaticity is impacted
2 Ablsolute contraindications for elective treatment
1) Acute / recent myocardio infarction within preceeding 3-6 months

2) Significant, uncontrolled hypertension.
Anti-arrhythmic Agents
- Fx
- Drug used to treat arrythmias
Fx - depress part of the heart that beats abnormaly

Drug - Digoxin is used to treat certain types of arrhytmias
Angina =
a common CV disease characterized by...
- pain/discomfort in chest radiating to left arm/shoulder
- may also radiate to the lower jaw (which can be confused as toothache)
Angina occurs when....
coronary arteries do not supply enough oxygen to the myocardium
Examples of Anti-anginal drugs (3)
1) Nitroglycerin (used most often) or nitro-like compounds

2) Beta adrenergic blockers

3) Calcium channel blockers
Pharmacologic effects of anti-anginal drugs
reduce workload of the heart by decreasing
- cardiac output
- peripheral vascular resistance
- or both
How are Anti- anginal drugs taken?
Often taken sublingually
Nitroglycerin-Like Compounds
- mechanism of action
1) vasodilator (nitric oxide is potent vasodilator)

2) Reduces workload on heart by decreasing oxygen demand --> decreasing pain

3) Sublingually used to treat acue attacks w/ rapid onset
Nitroglycerin
- Sublingual drug
- Where to find
- Onset and effect lasting
Avail (tablet or spray)

Find in emergency kit,
but patient should be asked to bring their own to apts

Rapid onset (few minutes)
Effects lasting up to 30 mins.
Nitroglycerin Adverse Rxns
- occur because of...
- symptoms (6)
Occurs because of effect on vascular smooth muscle

Symptoms
1) headache
2) flushing
3) hypotension (enhanced by alcohol & hot weather)
4) lightheadedness
5) syncope
6) can produce burning/tingling under the tongue
Nitroglycerin
- Drug interactions
- Example
- Causes
Interacts with Phosphodisterase 5 inhibitors that are used to treat ED (erectile dysfunction).

EX. Viagra, Levitra, Cialis

Causes - BP to go dangerously low (movie: Somethings Gotta Give)
Nitroglycerin
- Storage (4)
1) Degraded by heat / moisture; light is okay

2) Kept in glass because it can be absorbed by plastic

3) Unopened is good till expiration date

4) Expires in 3-6 months after opened
Calcium Channel Blockers
- Mechanism of action (2)
1) Inhibits movement of Ca during contraction of cardiac & vascular smooth muscle

2) Vasodilation, decrease in peripheral resistance;
--> decreases work of the heart
Calcium Channel Blockers
- Other uses other than for Heart Failure (2)
1) arrhythmias

2) hypertension
Calcium Channel Blockers
- Examples (2)
1) Verapamil

2) Nifedipine
Beta Adrenergic Blockers
- examples (3)
1) propanolol

2) metaprolol

3) atenolol
Drugs ending in "-olol" are what type of drug?
Beta Adrenergic Blockers
If a patient has never had angina before this attack, they should do what?
Go straigt to the ER
--> Send someone to accompany them.
Hypertension is know as?
the silent killer
The most common Cardiovascular disease is ?
Hypertension
Treatment of Hypertension (2)
1) Lifestyle modifications
--> weight loss, exercise, healthy diet, lower alcohol consumption, smoking cessation

2) Drugs
--> most patients require 1 or 2 drugs to control
Types of Diuretics (3)
1) Thiazides (most common used)

2) Loop

3) Potassium Sparing
Diuretic Thiazides
- mechanism of action (4)
1) Exact ation not determined

2) Work at the ascending loop of Henle in kidney

3) Reduces extracellular fluid volume initially

4) Changes sodium/calcium concentrations
How do NSAIDS interact with Diuretic Thiazides? (3)
1) They reduce the effectiveness of the tiazide diuretics

2) Takes a few days for the interaction to develop
--> so a few doses of NSAID can be used for acute pain

3) With long term NSAID use, BP will have to be closely monitored
How do NSAIDS interact with Diuretic Thiazides? (3)
1) They reduce the effectiveness of the tiazide diuretics

2) Takes a few days for the interaction to develop
--> so a few doses of NSAID can be used for acute pain

3) With long term NSAID use, BP will have to be closely monitored
Diuretic Thiazides
- Example (1)
1) Hydrochlorothiazide (HCTZ)
Diuretic Loop
- Mechanism of action (2)
1) Inhibit reabsorbtion of sodium with concurrent loss of fluids
--> more loss than thiazides

2) Work at the loop of henly in kidney
Diuretic Loop
- adverse rxns
- drug interaction
- example
Adverse rxns - similar to thiazides

Drug interaction - with NSAID

Example - furosemide
Diuretic Potassium Sparing
- mechanism of action (2)
1) Acts at a different site in kidney than the thiazide or loop

2) Designed to reduce amount of potassium loss
Diuretic Potassium Sparing
- example (2)
1) Spironolactone

2) Triamterene
How do diuretics and potassium relate?
Thiazides and Loops cause loss of potassium
--> the lack of potassium must be managed

Potassium salts are often taken during diuretic therapy
Why is potassium important?
It is necessary for...
- nerve impulses
- normal renal fx
- contraction of smooth muscle, cadiac muscle, and skeletal muscle
General types of Beta Blokers (2) for Hypertension
1) Selective to B1 & B2

2) Non-selective
Beta Blockers for Hypertention
- Examples (2) & are the selective or non-selective?
1) Propanolol
--> non-selective

2) Metoprolol
--> B1 selective more than B2 selective
Calcium Channel Blockers for Hypertension
- mechanism of action (1)
1) Inhibits movement of extracellular calcium into cells producing systemic vasodilation
--> reducing load on heart
Calcium Channel Blockers for Hypertension
- pharmacological effects (2)
1) Smooth muscle relacation; dialation of arteries

2) Reduce heart rate and contractility
Calcium Channel Blockers for Hypertension
- Examples (2)
1) verapamil

2) nifedipine
Calcium Channel Blocker Drugs end in...?
"-dipine"
Ca Channel Blockers
- drug interactions (1)
1) Carbamazepine

--> a drug used for managing trigeminal neuralgia (sometimes used in dentistry)

--> May increase toxicity from carbamazipine