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134 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is Automaticity?
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Automaticity - the ability to generate/initiate an impulse.
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What is Conductivity?
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Conductivity - the ability to conduct an impulse from cell to cell.
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What is Excitability?
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Excitability - the ability to respond to an impulse.
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What are the three main arteries of the Heart?
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LAD - Left Anterior Descending
RCA - Right Coronary Artery CB - Circumflex Branch |
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What is the vein of the Heart?
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GCV - Great Cardiac Vein
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What is the order of the cardiac conduction system?
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1) Sinoatrial Node (SA)
2) Intranodal tracts 3) Atrioventricular Node (AV) 4) Bundle of His 5) Right and Left Bundle Branches 6) Purkinje Fibers. |
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3 steps towards an Action Potential?
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1 - Depolarization
2 - Repolarization 3 - Resting Period |
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What is occurring during Depolarization?
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Phase 0 - Membrane becomes permeable to Na+ (sodium), which rapidly flows into the cell.
-90 to +20 |
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What is occurring during Repolarization?
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Phase 1 - Membrane potential becomes slightly positive because of the influx of Na+
Phase 2 - slow inward flow of Ca++ (Calcium) Phase 3 - Rapid outward flow of K+ (Potassium) |
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What is Occurring during the Resting Period?
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Phase 4 - Cell membrane actively transports Na+ outside and K+ inside, returning to a state of polarization
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Components of the Sympathetic Nervous System?
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1 - Adrenergic Receptors
2 - Norepi and Epi |
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Components of the Parasympathetic Nervous System?
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1 - Cholinergic Receptors
2 - Acetycholine (Ach) |
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Effects of stimulating Alpha 1?
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- Vasoconstriction of blood vessels
- Increased contractibility of heart |
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Drugs that affect Alpha 1?
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Epinephrine
Norepinephrine Phenylephrine Ephedrine Dopamine |
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Uses for Alpha 1 activators.
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1) Hemostasis - arrest of bleeding through Vasoconstriction
2) Elevation of Blood Pressure - through Vasoconstriction |
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Adverse Effects of Alpha 1 activators.
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1) Hypertension - caused by widespread vasoconstriction
2) Bradycardia - elevation of the blood pressure triggers barorecptor reflex, causing heart rate decline. |
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Effects of stimulating Alpha 2.
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- Limits or controls transmitter release
- Aggregation of Platlets - Contraction of Smooth Muscle |
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Clinical significance of Alpha 2.
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- reduction of sympathetic outflow to the blood vessels. (CNS)
- relief of severe pain. |
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Effects of stimulating Beta 1.
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- Increased acceleration of the Heart Rate. (Chronotropic effect)
- increased contractibility of the Heart. (Inotropic effect) - Increased automaticity and conduction velocity. (Dromotopic effect) |
Remember: You have ONE (1) Heart
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Drugs that activate Beta 1 Receptors.
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Epinephrine
Norepinephrine Isoproterenol Dopamine Dobutamine Ephedrine |
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Therapeutic Applications of Beta 1 receptors.
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- Cardiac Arrest - drugs can initiate contraction in a heart that has stopped beating.
- Heart Failure - because of the Inotropic effect can improve cardiac performance. - Shock - increases cardiac output and improve tissue perfusion - Atrioventricular Heart block - receptors enhance impulse conduction through the AV node. |
Note:
Drugs are not the preferred treatment for cardiac arrest. Mechanical thumping and direct-current stimulation. |
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Adverse effects of Beta 1 stimulation.
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- Altered Heart Rate or Rhythm - overstimulation of the receptors can produce tachycardia and dysrhythmias.
- Angina Pectoris - because stimulation of receptors increases cardiac oxygen demand, patients with compromised coronary circulation are at risk for anginal attack |
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Effects of Beta 2 stimulation.
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- Bronchodilation - increased blood flow
- Activation of Glycogenolysis - Increased Renin Secretion - Uterus relaxant |
Note: you have TWO (2) Lungs
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Drugs used to activate Beta 2 receptors.
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Epinephrine
Ephedrine Isoproterenol Terbutaline |
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Clinical applications for Beta 2 agonists.
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- Asthma - characterized by inflammation and bronchoconstriction. Think about why. HMMMMMMM
- Delay of Preterm Labor - activation in the uterus relaxes uterine smooth muscle. |
Note:
- For therapy of Asthma - Selective Beta 2 agonists (ex Terbutaline). especially if the patient already suffers from Tachycardia or Angina Pectoris. |
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Adverse effects of Beta 2 activation.
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- Hyperglycemia - activation of receptors in the liver and skeletal muscles that promotes glycogenolysis.
- Tremor - activation of Beta 2 receptors in skeletal muscle enhance contraction. |
notes:
- Hyperglycemia occurs only in diabetic patients and should be regulated with insulin. - Tremor is the most common side effect. - Tremor generally fade over time and can be minimized by initiating therapy at low doses. |
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the two CV responses to Autonomic Nervous System stimulation.
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- Sympathetic - fight or flight
- Parasympathetic - rest or digest |
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Drugs that mimic sympathetic response are referred to as?
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- Sympathomimetics
- Adrenergic Stimulating Agents - Adrenergic Agonists |
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Drugs that block sympathetic response are referred to as?
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- Sympatholytics
- Adrenergic blockers - Adrenergic Antagonists - Beta Blockers |
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What is a normal Heart rate?
Tachycardia? Bradycardia? |
Normal - 60 to 100
Tachycardia - 101+ Bradycardia - 59- |
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What are the four variables talked about in class that affect Heart Rate (HR)?
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- Stress
- Hydration - Temperature - Medications |
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What are the three components of Stroke Volume (SV)?
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- Preload
- Afterload - Contractility |
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What is Preload?
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- end diastolic volume
- Defined as - the volume of blood presented to the left and right ventricle |
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What affects the Preload?
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- the compliance of the ventricles to stretch will affect the preload.
- Fluids increase Preload - Vasodilators and diuretics decrease Preload. |
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What is Afterload?
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Defined as the pressure or "resistance" in the aorta that the left ventrilce must overcome to open the aortic valve and eject its volume.
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What is Afterload affected by?
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- Blood viscosity or volume
- Aortic Impedance - Peripheral Vascular Resistance - Hypertension - Increases the Afterload - Shock - Decreases Afterload |
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What is Contractility?
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- the hearts contractile force
- referred to as "inotrophy" |
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What affects Contractility?
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- Sympathetic activity
- Electrolyte Balance - Oxygenation - Body Temperature - pH |
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What is Angina?
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- A clinical syndrome characterized by chest pain
- results from an imbalance between myocardial oxygen demand and supply delivered by the coronary vessels. |
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What are the three classifications of Angina?
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- Stable Angina
- Unstable Angina - Variant / Prinzmetals Angina |
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What is a Stable Angina
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- Increase in O2 demand and a reduction in O2 supply
- Triggered by an increase in physical activity. - Artery is partially occluded by plaque, and blood flow is reduced. - underlying cause is Coronary Artery Disease. |
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What are the treatments of a Stable Angina?
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- Increase Cardiac Oxygen Supply
- Decrease Oxygen Demand. |
Increasing the Cardiac Oxygen supply is not valid because it is not logical
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How can we Decrease Oxygen Demand in a Stable Angina?
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- decrease the HR
- decrease Contractility - decrease Preload - decrease Afterload |
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What drugs can we use to treat a stable angina?
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- Organic Nitrates
- Beta Blockers - Calcium Channel Blockers |
- all of these decrease oxygen demand
- Ranolazine - can be combined for additional benefit. |
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How can we prevent a stable angina?
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- prevent overexertion
- prevent heavy meals - prevent emotional stress - prevent exposer to cold |
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What are some Important Risk factors in a a stable angina?
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- smoking
- obesity - hypertension - hyperlipidemia - sedentary lifestyle |
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What are the drugs used to treat Anginas?
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- Nitrates
- Beta Blockers - Calcium Channel Blockers - Antiplatlets - Anti-hyperlipidemics |
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What are the goals of Angina therapy?
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- Relieve chest pain
- Decrease the number of CP episodes - Increase exercise tolerance - Improve quality of life / prevention of further disease. |
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What is a Variant / Prinzmetal Angina?
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- Caused by coronary artery spasm - that restricts blood flow to the heart.
- can produce pain at anytime. even during rest and sleep. |
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What are treatment strategies for Variant angina?
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- reduce the severity and incidence
- increasing oxygen supply |
Note:
in contrast to stable which is an increase in demand, variant is the decrease in oxygen supply. |
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What drugs are used to treat Prinzmetal's angina?
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- Calcium Channel Blockers
- Organic Nitrates |
Note:
- vasodilators - these prevent or relieve coronary artery spasm. |
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What is an Unstable Angina?
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- result from severe CAD complicated bu vasospasm, platelet aggregation, and transient coronary thrombi or emboli
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Note:
- is a medical emergency |
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What is the treatment of an Unstable Angina?
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- maintain oxygen supply
- decrease oxygen demand - goal is to reduce pain and progression towards MI |
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What Drugs can be used to treat Unstable Angina?
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- Nitroglycerine
- Beta Blocker - Supplemental Oxygen - IV morphine Sulfate - Antiplatelet therapy |
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What are the two subclasses for CCB?
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- Non-dihydropyridines
- Dihydropyridines |
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What are two non-dihydropyridines?
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- Diltiazem
- Verapamil |
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What effects does Non-dihydropyridines have?
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- negative inotropic effects
- negative chronotropic effects - negative dromotropic effects |
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What effec does dihydropyridines have?
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- no effect on conduction
- great vasodilators |
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Role of Beta Blockers in CHF.
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- Decrease sympathetic nervous system output
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Role of Beta Blockers in angina?
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- increase diastolic filling time by decreasing heart rate.
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Role of Beta Blockers in HTN?
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- decreases Resistance
- blocks Renin |
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Role of Beta Blockers in arrhythmia?
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- Slow AV nodal conduction
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What does the suffix -pine mean in medications?
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CCB
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What are the ME-ME-ME?
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- Brain
- Heart - Urine |
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What is the total cholesterol goal?
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- less than 200 mg/dl
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What is the LDL goal for 0 or 1 risk?
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- less than 160 mg/dl
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What is the LDL goal for a greater than 2 risk?
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- less than 130 mg/dl
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What is the LDL goal for a CHD or diabetic or equivalent?
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- less than 100 mg/dl
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What is the HDL goal?
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- greater than 40 mg/dl
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How much does diet and exercise decrease LDL levels?
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- by about 20%
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What medications lower LDL levels?
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- Statins
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What is the ratio of HDL to LDL?
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- 1 HDL for every 4 LDL
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What increases HDL levels?
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- exercise
- redwine - red grapes (welches) - niacin, fribric acid agents (fenofibrates) |
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What is the Triglyceride goal?
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- Less than 150 mg/dl
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What drugs can be used to lower Triglyceride levels?
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- niacin
- fenofibrates |
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Where does Heparin intervene?
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- at Factor XA
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Were does Coumadine intervene?
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At factors
- 2 - 7 - 9 - 10 |
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What works faster, Coumadine or Heparin?
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Heparin
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what does aspirin do?
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- inhibits platelet aggregation
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What does Plavix do?
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- inhibits platelet sticking
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What do anticoagulants do?
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- prevent formation or extension of new clots
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What do Antiplatelet Agents do?
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- Prevent Platelet aggregation
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What do Thrombolytics do?
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- promote the digestion of fibrin
-increasing the dissolving of clots |
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MOA of Nitrates?
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- relax the smooth muscles of the blood vessel walls, there by dilating them and increasing blood flow.
- Decreasing Preload - Decreases venus return to the heart - Decreasing Afterload - Arterial relaxation reduces systemic vascular resistance - Decreases oxygen requirements by pooling peripheral blood. |
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Treatment uses of Nitrates?
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- to treat pain of Angina Pectoris
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Contraindications of Nitrates?
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- Hypersensitivity
- Uncontrolled HYPOtension |
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Common interactions when on Nitrates?
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- alcohol
- vasodialtors - erectile dysfunction medications |
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Adverse side effects of Nitrates?
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- Flushing
- Headache (throbbing) - Visual disturbances - GI symptoms - Drowsiness - Dizziness (postural) - Hypotension - Reflex Tachycardia |
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What are the three classifications of Beta Adrenergic Blocking Agents?
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- Cardioselective
- Noncardioselective - Long Acting Beta Blocker |
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What are the noncardioselective Beta Blocking drugs?
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- Carvedilol (Carvedilol)
- Propanolol (Inderal) |
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What are the cardioselective Beta Blocking Drugs?
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- Metoprolol (lopressor)
- Atenolol (Tenormin) |
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What is the long acting beta blocker?
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- Toprol XL
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What is the MOA of Beta adrenergic blockers?
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- Reduce the Heart's oxygen demand
- Blocks renin - Increases diastolic filling time (decreasing HR) |
Note:
- Decreases morbidity and mortality post MI |
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Contraindications of Beta Adrenergic Blocking Agents?
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Caution with
- Hypotension - Asthma - Heartblock - Pregnancy |
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Common interactions with Beta Adrenergic Blocking agents?
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- Vasodilators
- Cardiodepressants - MAOI |
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Side effects with Beta Adrenergic Blocking Agents?
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- Bradycardia
- Hypotension - Fatigue - Vivid Dreams - Hallucinations - Depression - N, V, D - Hypoglycemia - Bronchospasm - Sexual Dysfunction |
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What are the drugs of Dihydropyridines?
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- Nifedipine
- Amlodipine |
Note:
remember suffix -pine |
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MOA of CCB?
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- Dilates main coronary Arteries and arterioles
- inhibits coronary artery spasm and increases Myocardial Oxygen supply - Decreases SA and AV node conduction |
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Clinical uses for CCB?
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- Variant Angina
- Arrhythmias - HTN - Subarachnoid hemorrhage |
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Contraindications for CCB?
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- Hypersensitivty
caution with - hypotension - bradycardia - heart block - Sick Sinus Syndrome - Wolff-Parkinson-White Syndrome - Pregnancy category C - Elderly |
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Adverse side effects of CCB?
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- Excessive Hypotension
- Bradycardia - Peripheral Edema - Congestive Heart Failure - when given with Beta Blocking Agents - Dizziness / light headedness - Flushing - Headache - Weakness |
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Interactions with CCB?
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- Beta Blocking Agents
- Antiarrhythmics - with negative inotropic effects - digitalis glycosides |
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What are the six categories of Anti-Hyperlipidemic Agents?
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- Bile
- HMG-COA - Fibric Agents (fibrates) - Niacin - Zetia (Ezetimibe) - Herbal |
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What are the three Bile medications?
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- Sequestering Agents (resins)
- Cholestyramine (Questran) - Colestipol (Colestid) |
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What is HMG-COA also know as?
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- Statins
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What are the Statins medications?
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- Lovastin (Mevacor)
- Slmvastin (Zocor) - Pravastatin (Pravachol) - Water Soluable - Flurastatin (Lescol) - Atorvastatin (lipitor) - Crestor - Water Soluable |
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What is the MOA of Bile medications?
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- binds to bile acids in the intestine preventing absorption, producing the insoluble complex to be excreted in feces.
- the liver increases the rate of oxidation of cholesterol to compensate for the loss of bile acids - Net Result - Decrease in serum cholesterol and LDL Chol |
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Interaction of Bile Anti-Hyperlipidemic Agents.
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- Interferes with absorption of other drugs
- Administer prior to meals |
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What is the MOA of HMG-COA?
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- Inhibits enzymes needed for cholesterol synthesis
- Decrease in LDL - Decrease in TGL - Increase in HDL - Anti-inflammatory actions |
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What are the Side Effects of Bile medications?
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- Primarily GI
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What are the interactions with Statins?
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- Do not give with Lopid
Monitor when given with - Coumadin - Amiodarone - Hepatotoxic drugs - Cyclosporine - Immunosuppressive drugs - Antifungals - Erythromycin Caution with - Grapefruit |
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What are the side effects of Statins?
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- Elevated serum liver enzymes (Hepatotoxicity)
- Muscle aches / myopathy - Diarrhea - Constipation - Headache - Photosensitivity - Rash, Prutitis |
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What is the MOA of Fibric Acid Agents?
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- decrease Triglycerides
- stimulates lipoprotein lipase enzymatic activity - increases HDL |
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What are some interactions with Fibrates?
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Caution use with
- Statins Monitor PT with - Coumadin |
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Adverse side effects of Fibrates?
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- myopathy (Muscle Aches)
- GI Distress - Hepatotoxicity |
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What is the MOA of Herbal medications?
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- Decrese TGL
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What are the medications of the Herbal class?
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- Fish oil
- supplements |
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What are the drug of the Fibrates classification?
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- Gemfibrozil (Lopid)
- Fenofibrate (Tricor) |
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What are the drugs of the Niacin classification?
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- Niaspan (Longacting)
- Advicor (Niacin with Lovastatin) |
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What is the MOA of Niacins?
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- Increase lipoprotein lipase activity
- Decrease TGL - Decrease LDL - Increase HDL |
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What are the side effects with Niacins?
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- Flushing
- Pruritus - Muscle Aches and Hepatotoxcity when used with statins - Use cautiously with gout, DM, compromised LFT's |
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What is the MOA of Zetia?
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- Acts on the brush border of the small intestine to inhibit absorption of cholesterol.
-Decrease LDL |
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What are the classifications of Anticoagulant agents?
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- Heparin (unfractionated)
- Enoxaprin (Lovenox) - Oral Form (Coumadin) - Anti Platelet Drugs |
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What is the MOA of Heparin?
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- Interferes with the clotting by inactivating Factor Xa.
- prevents prothrombin to thrombin - Rapid onset |
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What is the LMWH?
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- Enoxaparin (Lovenox)
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Contraindications for Heparin?
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- Uncontrolled bleeding
- Severe kidney / liver disease |
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WHat is the MOA of Warfarin sodium?
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- depresses hepatic synthesis of vitamin K dependent coagulation factors.
- 2 - 7 - 9 -10 |
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Uses for coumadin?
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- prevent of extension of an existing clot.
- prophylaxis for emboli when thrombi exist. |
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Contraindications for Coumadin?
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- NOT SAFE FOR PREGNANCY
- contraindications are the same as heparin. |
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What are the Anti Platelet drugs?
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- Aspirin
- Plavix - Glyco Protein 2b, 3a Inhibitors |
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What are the glyco protein 2b, 3a inhibitors?
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- Abciximab (ReoPro)
- Integrilin |
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What is the MOA of Asprin?
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-Prevents platelet aggregation
- block synthesis of thromboxane A2 |
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What is the MOA of Plavix?
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- Inhibits ADP
- effects are irreversible in platelet aggregation |
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What is the MOA of Glyco Protein 2B, 3A inhibitors?
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- Blocks the glycoprotein receptor
- Used with PCTA, MI, Intracoronary Stents |
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