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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)