Pharmacology - Cardiovascular Drugs

Front 1

Cardiovascular disease is an umbrella term for...

Back 1

a variety of diseases of the heart and blood vessels.

Front 2

Cardio diseases (5)

Back 2

1) Hypertension

2) Angina

3) Coronary artery disease

4) Cerehrovascular accident

5) Congestive heart failure

Front 3

What is the leading cause of death in the US?

Back 3

Cardiovascular disease

Front 4

Is it possible for a patient to have several Cardiovascular diseases?

Back 4

Yes. And they may be on a medication for each

Front 5

How long can a cardiovascular drug be given for?

Back 5

It can often given for a lifetime.

Front 6

Congestive heart failure.

- occurs when the heart...

Back 6

- 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

Front 7

Drug used to treat Congestive Heart Failure
- Example

Back 7

Cardiac / Digitalis Glycosides

EX. Digoxin (most commonly used)
--> Some times perscribed with other drugs

Front 8

Cardiac Glycosides
- Pharmacolofic effects (3)

Back 8

1) Increase force & strength of contraction of myocardium

2) Reduces edema that occurs with CHF by producing diuresis

3) Useful in treating arrhythmias

Front 9

Cardiac Glycosides
- Uses (3)

Back 9

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

Front 10

Other drugs used for Heart Failure (6)

Back 10

1) Angiotensin-converting enzyme inhibitors (ACEI)
2) Angiotensin Receptor Blockers (ARB)
3) Beta adreneric blockers
4) Vasodilators
5) Diuretics
6) Aldosterone antagonists

Front 11

ACE Inhibitors if Heart Failure
- used when?
- time it take to improve symptoms
- given along with what?

Back 11

- Used as first line of therapy

- Improves symptoms with in 4 to 12 weeks

- Beta blockers are given at the same time.

Front 12

Arrhythmias are...

Back 12

abnormal rhythms from abnormal impulse generation or abnormal impulse conduction

- automaticity is impacted

Front 13

2 Ablsolute contraindications for elective treatment

Back 13

1) Acute / recent myocardio infarction within preceeding 3-6 months

2) Significant, uncontrolled hypertension.

Front 14

Anti-arrhythmic Agents
- Fx
- Drug used to treat arrythmias

Back 14

Fx - depress part of the heart that beats abnormaly

Drug - Digoxin is used to treat certain types of arrhytmias

Front 15

Angina =

Back 15

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)

Front 16

Angina occurs when....

Back 16

coronary arteries do not supply enough oxygen to the myocardium

Front 17

Examples of Anti-anginal drugs (3)

Back 17

1) Nitroglycerin (used most often) or nitro-like compounds

2) Beta adrenergic blockers

3) Calcium channel blockers

Front 18

Pharmacologic effects of anti-anginal drugs

Back 18

reduce workload of the heart by decreasing
- cardiac output
- peripheral vascular resistance
- or both

Front 19

How are Anti- anginal drugs taken?

Back 19

Often taken sublingually

Front 20

Nitroglycerin-Like Compounds
- mechanism of action

Back 20

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

Front 21

Nitroglycerin
- Sublingual drug
- Where to find
- Onset and effect lasting

Back 21

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.

Front 22

Nitroglycerin Adverse Rxns
- occur because of...
- symptoms (6)

Back 22

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

Front 23

Nitroglycerin
- Drug interactions
- Example
- Causes

Back 23

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)

Front 24

Nitroglycerin
- Storage (4)

Back 24

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

Front 25

Calcium Channel Blockers
- Mechanism of action (2)

Back 25

1) Inhibits movement of Ca during contraction of cardiac & vascular smooth muscle

2) Vasodilation, decrease in peripheral resistance;
--> decreases work of the heart

Front 26

Calcium Channel Blockers
- Other uses other than for Heart Failure (2)

Back 26

1) arrhythmias

2) hypertension

Front 27

Calcium Channel Blockers
- Examples (2)

Back 27

1) Verapamil

2) Nifedipine

Front 28

Beta Adrenergic Blockers
- examples (3)

Back 28

1) propanolol

2) metaprolol

3) atenolol

Front 29

Drugs ending in "-olol" are what type of drug?

Back 29

Beta Adrenergic Blockers

Front 30

If a patient has never had angina before this attack, they should do what?

Back 30

Go straigt to the ER
--> Send someone to accompany them.

Front 31

Hypertension is know as?

Back 31

the silent killer

Front 32

The most common Cardiovascular disease is ?

Back 32

Hypertension

Front 33

Treatment of Hypertension (2)

Back 33

1) Lifestyle modifications
--> weight loss, exercise, healthy diet, lower alcohol consumption, smoking cessation

2) Drugs
--> most patients require 1 or 2 drugs to control

Front 34

Types of Diuretics (3)

Back 34

1) Thiazides (most common used)

2) Loop

3) Potassium Sparing

Front 35

Diuretic Thiazides
- mechanism of action (4)

Back 35

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

Front 36

How do NSAIDS interact with Diuretic Thiazides? (3)

Back 36

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

Front 37

How do NSAIDS interact with Diuretic Thiazides? (3)

Back 37

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

Front 38

Diuretic Thiazides
- Example (1)

Back 38

1) Hydrochlorothiazide (HCTZ)

Front 39

Diuretic Loop
- Mechanism of action (2)

Back 39

1) Inhibit reabsorbtion of sodium with concurrent loss of fluids
--> more loss than thiazides

2) Work at the loop of henly in kidney

Front 40

Diuretic Loop
- adverse rxns
- drug interaction
- example

Back 40

Adverse rxns - similar to thiazides

Drug interaction - with NSAID

Example - furosemide

Front 41

Diuretic Potassium Sparing
- mechanism of action (2)

Back 41

1) Acts at a different site in kidney than the thiazide or loop

2) Designed to reduce amount of potassium loss

Front 42

Diuretic Potassium Sparing
- example (2)

Back 42

1) Spironolactone

2) Triamterene

Front 43

How do diuretics and potassium relate?

Back 43

Thiazides and Loops cause loss of potassium
--> the lack of potassium must be managed

Potassium salts are often taken during diuretic therapy

Front 44

Why is potassium important?

Back 44

It is necessary for...
- nerve impulses
- normal renal fx
- contraction of smooth muscle, cadiac muscle, and skeletal muscle

Front 45

General types of Beta Blokers (2) for Hypertension

Back 45

1) Selective to B1 & B2

2) Non-selective

Front 46

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

Back 46

1) Propanolol
--> non-selective

2) Metoprolol
--> B1 selective more than B2 selective

Front 47

Calcium Channel Blockers for Hypertension
- mechanism of action (1)

Back 47

1) Inhibits movement of extracellular calcium into cells producing systemic vasodilation
--> reducing load on heart

Front 48

Calcium Channel Blockers for Hypertension
- pharmacological effects (2)

Back 48

1) Smooth muscle relacation; dialation of arteries

2) Reduce heart rate and contractility

Front 49

Calcium Channel Blockers for Hypertension
- Examples (2)

Back 49

1) verapamil

2) nifedipine

Front 50

Calcium Channel Blocker Drugs end in...?

Back 50

"-dipine"

Front 51

Ca Channel Blockers
- drug interactions (1)

Back 51

1) Carbamazepine

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

--> May increase toxicity from carbamazipine