Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
78 Cards in this Set
- Front
- Back
What is congestive heart failure?
|
A condition in which the heart is unable to pump enough blood to meet the peripheral tissues' needs
|
|
What tends to happen with CHF?
|
Fluid tends to accumulate
|
|
How is CHF a vicious cycle and what must you do?
|
Once there is a decline in heart function, other changes tend to occur that cause further decline in cardiac function
Must treat early! |
|
What are 2 primary goals of pharmacotherapy for CHF pts?
|
1. improve the heart's ability to pump
2. decrease heart work load (by decreasing the pressure the heart works against or decrease the volume the heart has to pump) preload vs afterload |
|
What drugs are used for CHF?
|
Positive inotropic agents such as Digitalis, phosphodiesterase (PDE) inhibitors and Dopamine (Intropin)
|
|
What are positive inotropic agents?
|
Agents that increase myocardial contraction force
|
|
What are 5 agents used to decrease cardiac workload?
|
1. ACE inhibitors
2. Angiotensin II receptor blockers (less aldosterone) 3. Beta adrenergic blockers 4. Diuretics 5. Vasodilators such as Prazosin (Minipress) alpha 1 blocker, nitrates |
|
What CHF drug is not often used as much as in the past?
|
Digitalis, agents that decrease caridac workload are use more often (ACE inhibitors, angiotensin II blockers, beta adrenergic blockers, diuretics, vasodilators)
|
|
What does "inotrophy" mean?
|
Muscular contractility
|
|
What does positive inotrophic effect mean?
|
To increase the heart's ability to pump blood
|
|
What is the mechanism of Digitalis (digoxin (Landoxin))?
|
For CHF:
Inhibits Na+/K+/ATPase activity Increases Na+ in cell and decreases Ca2+/Na+ exchanger activity Increases Ca2+ in the cell This allows increase muscle contractility due to increase Ca2+ in SR |
|
What are the 2 effects of Digitalis (digoxin (Landoxin))?
|
1. mechanical effect of increasing contractile force
2. directly inhibits SNS activity to treat arrhythmias |
|
What are 3 pros for using Digitalis (digoxin (Landoxin)) for CHF?
|
1. generally increase CO both in resting and in exercise
2. improves exercise tolerance 3. decreases symptoms of heart failure and the # of hospital visits |
|
What are 3 cons for using Digitalis (digoxin (Landoxin)) for CHF?
|
1. not clear whether life expectancy improves
2. long 1/2 life to which the drug takes longer to build up to therapeutic concentration 3. narrow therapeutic window where the effects take place close to toxic levels |
|
What are 4 adverse effects of taking Digitalis (digoxin (Landoxin)) for CHF?
|
1. toxicity b/c of narrow window (low T1)
2. arrhythmia (drug used to tx and also an adverse effect) 3. GI and heart disturbances 4. CNS problems |
|
What 2 CHF drugs are used for ACUTE or SEVERE, but not CHRONIC heart failure?
|
1. phosphodiesterase (PDE) inhibitor
2. dopamine (Intropin), dobutamine (Dobutrex) which is a beta 1 agonist |
|
What CHF drug is not given orally, rather by IV and is for ACUTE or SEVERE heart failure?
|
phosphodiesterase (PDE) inhibitor
|
|
What CHF drugs are given if digitalis or a derivative is not effective?
|
dopamine (Intropin), dobutamine (Dobutrex) which is a beta 1 agonist
|
|
What do dopamine (Intropin), dobutamine (Dobutrex) which are beta 1 agonists do to the heart for CHF pts?
|
Changes their contractility, but does NOT increase HR
|
|
What is hemostasis?
|
blood coagulation
|
|
What occurs if there is too much clotting of the blood?
|
Thrombogenesis (abnormal clotting)
|
|
What occurs if there is too little clotting of the blood?
|
Hemorrhaging
|
|
Explain the basic mechanism of clotting
|
both intrinsic and extrinsic systems form platelets with a net result of prothrombin forming thrombin
thrombin then interacts with fibrinogen to make fibrin to clot |
|
Explain the basic mechanism of breaking down a clot
|
Plasminogen forms plasmin (fibrinolysis) via tissue plasminogen activator to break down clot
|
|
What are 3 types of treatment for thrombogenesis problems (too much clotting)?
|
1. anticoagulants
2. antithrombotics 3. thrombolytics |
|
What is the general function of anticoagulants?
|
To control function and synthesis of clotting factors
|
|
What are anticoagulants often used for?
|
To prevent and treat abnormal clot formation or venous thrombosis (DVT)
|
|
Name 4 primary drugs for overactive clotting or thrombogenesis?
|
1. heparins (true heparin)
2. oral anticoagulants such as warfarin (Coumadin) 3. antithrombotics such as aspirin 4. thrombolytics such as tPA (Alteplase) |
|
What primary anticoagulant drug requires that the pt be closely monitored?
|
heparin
|
|
What primary anticoagulant drug is given parenterally, not orally?
|
heparin
|
|
What is the mechanism of heparin?
|
Potentiates activity of antithrombin III by binding to clotting factors and inactivated them
Increased antithrombin III activity reduces the tendency to clot |
|
What are the adverse effects of taking heparin?
|
hemorrhage and death
|
|
What type of heparin may be injected SQ, thus reducing risk of adverse effects?
|
low molecular weight heparin (heparin derivatives) rather than true heparin
|
|
What are 2 advantages to using heparin derivatives (low molecular weight heparin)?
|
1. Easier to administer and use at home since injecting SQ
2. Less side effects |
|
What is an example drug name that is a heparin derivative or low molecular weight heparin?
|
Enoxaparin (Lovenox)
|
|
What is Enoxaparin (Lovenox)?
|
heparin derivative or low molecular weight heparin that is a anticoagulant drug
|
|
What is the mechanism of warafin (Coumadin)?
|
Impairs vitamin K-dependent synthesis of clotting factors
|
|
What can a pt be given if there is too much warafin (Coumadin) given?
|
Can be given plasma and vitamin K
|
|
What are 2 disadvantages for using oral anticoagulants such as warfarin (Coumadin)?
|
1. contraindication for pregnant women (will cross BBB)
2. not effective for several days |
|
What are the adverse effects to using warafin (Coumadin)?
|
Hemorrhage and death
|
|
If a pt is too slow with their clotting process, then what can be given?
|
Vitamin K to help speed up the clotting process
|
|
Why must newborns being given vitamin K?
|
Newborns cannot synthesize vitamin K in order to clot
|
|
What is the onset like for heparin?
|
Fast
|
|
What is the onset when using enoxaparin (Lovenox)?
|
Fast--it is a heparin anticoagulant
|
|
Which anticoagulant is used for acute DVTs and safe for pregnant women?
|
Heparins (enoxaparin (Lovenox)
|
|
Which anticoagulant is used for long term DVTs and is not safe for pregnant women?
|
warafin (Coumadin)
|
|
What does the American College of Chest Physicians say about pts with acute DVTs?
|
Recommend early ambulation in preference to initial bed rest when this is feasible.
Anticoagulation and early ambulation with leg compression led to faster pain and swelling reduction (similar for PEs) |
|
What is the function of antithrombotics?
|
inhibits platelet formation
|
|
What do antithrombotics prevent?
|
prevents thrombus formation in the arteries resulting in MIs and ischemic CVAs
|
|
What drug is an antithrombotic?
|
aspirin
|
|
What are 2 adverse effects of antithrombotics?
|
1. high risk of hemorrhage (hemorrhagic CVA)
2. possible GI irritation |
|
What are 2 tissue plasminogen activator (tPA (Alteplase)) functions?
|
1. facilitate the destruction of blood clots
2. reestablish blood flow through vessels that have been occluded by thrombi |
|
When must thrombolytics be given to those who've suffered a heart attack?
|
MI--treatment within 12hrs
|
|
When must thrombolytics (tPA) be given to those who've suffered a stroke?
|
within 3hrs
|
|
How are thrombolytics (tPA) administered?
|
IV
|
|
What is the mechanism of thrombolytics?
|
convert plasminogen to plasmin (fibrinolysis) to break down the clot
|
|
What is an adverse effect of using tPA (tissue plasminogen activator) a thrombolytic?
|
Risk of hemorrhage
|
|
How can you treat hemophilia?
|
Replaces missing clotting factors
|
|
How can vitamin K deficiencies develop? (2)
What are the consequences? How this be managed? |
1. can't absorb vitamin K
2. poor diet Cannot clot blood! Give exogenous vitamin K (can be oral or parenteral) to bypass GI or improve diet if pt can absorb |
|
What are 5 PT implications for those pts who cannot form clots?
|
1. cautious of trauma, falls and bruising
2. careful with deep tissue massage 3. aware of wounds/not cause cuts 4. avoid high impact exercise 5. aware of risk for joint hemorrhage (hemoarthrosis) |
|
What is hyperlipidemia and what are its consequences?
|
increase in plasma lipids that can lead to atherosclerosis which can increase clotting and related disease
|
|
What lipoproteins remove cholesterol from arterial walls?
|
HDLs (good guys)
|
|
What lipoproteins transport and deposit cholesterol on the arterial walls?
|
LDLs and VLDLs (bad guys)
|
|
What is the pharmacological treatment usually emphasizing? (2)
|
1. increase HDLs
2. decrease LDLs and VLDLs |
|
What are 4 antihyperlipidemic drugs?
|
1. statins (Lipitor)
2. fibric acids (fibrates) 3. niacin (Niaspan) 4. ezetimibe (Zetia) |
|
Why are antihyperlipidemic drugs used?
|
to decrease cholesterol levels and risk for CVD
|
|
What are the side effects of using antihyperlipidemic drugs?
|
Rare serious effects
Potential for myopathies from statins causing muscle weakness and pain |
|
What is Lipitor? What is its function?
|
statin that is an antihyperlipidemic drug
to lower total cholesterol and LDL |
|
What is the effect of statins (Lipitor)?
|
Lower total cholesterol and LDL
|
|
What are 2 contraindications for using Lipitor (a statin)?
|
1. avoid grapefruit which will interfere with statin breakdown (leaves more statin in body)
2. avoid with pregnancy and young children |
|
Why is grapefruit harmful when taking Lipitor?
|
Will interfere with statin breakdown in the body (leaves more statin)
|
|
What is the effect of fibric acids (fibrates)?
|
decrease triglycerides and VLDLs
|
|
What is the effect of niacin (Niaspan)
|
A broad spectrum of benefits to cholesterol profile
|
|
What is the effect of Ezetimibe (Zetia)?
|
lower cholesterol absorption from GI tract (thus lowering total cholesterol)
Excreted out of the bloodstream |
|
Which antihyperlipidemic drug's effect is decreasing total cholesterol and LDL?
|
Lipitor
|
|
Which antihyperlipidemic drug's effect is decreasing triglycerides and VLDLs?
|
Fibric acid (Fibrates)
|
|
Which antihyperlipidemic drug's effect is decreasing cholesterol absorption in the GI, thus lowering total cholesterol?
|
Ezetimibe (Zetia)
|
|
Which antihyperlipidemic drug's effect is a broad spectrum of benefits to cholesterol profile?
|
niacin (Niaspan)
|