pharm 3 set 2

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pharm 3 set 2
2013-10-16 12:50:53

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  1. Ca channel blockers

    Therapeutic doses affect:
    prevent contraction of smooth muscles

    • T affect:
    • peripheral arterioles and arteries
    • cardiac muscle - decrease force of contract.
    • SA & AV node - dec. impulse speed/conduction
    • Coupling of cardiac Ca channels to Beta 1 receptors - Decrease force, rate, and conduction
  2. activating B1 receptors will cause a 2nd messenger to open Ca++ channels
    activating B1 receptors will cause a 2nd messenger to open Ca++ channels
  3. the "-pines" drugs
    Ca++ blockers

    affects only the arterioles and NOT the HR
  4. Verapamil / Calan


    Diltiazem / Cardizem
    2nd type of Ca++ blocker classification

    Affect the arterioles AND the HR
  5. Nifedipine / Procardia (Adalat)


    • Ca++ blocker
    • affects arteriole smooth muscle via vasodilation BUT NOT HR

    • Angina (coronary vasadialtion)
    • HTN
    • Migraines

    SE= Reflex Tachycardia
  6. Verapamil / Calan


    • Ca++ blocker
    • Affects arterioles AND HR
    • -vasodilation
    • -Dec. HR, force, and conduction
    • -Inc. coronary artery perfusion

    Angina, HTN, Dysrythmias

    SE= dizzy, headache, edema, constipation, and can cause more heart problems in a compromised heart

    NO Reflex Tachycardia
  7. Diltiazem / Cardizem


    • Ca++ blocker
    • affects arterioles AND HR

    DOC for A-Fib and SVT to slpw HR enough for the heart to convert to nl rhythm

    • -Peripheral arterioles= vasodilation
    • -Cardiac arteries and arterioles= INc coronary bld flow
    • -SA node= Dec. HR
    • -AV node= slow myocardial conduction
    • -Myocardium= Dec. force of contraction

    • prevent angina
    • HTN
    • Dysrhyth

    Se= same as previous Ca++ blocker
  8. Nimodopine / Nimotop*
    Special Ca++ blocker

    Provides selective blocking of Cerebral blood vessels ONLY

    Only used for rupture of Intracranial Aneurysm and used to prevent future vasospasm and re-bleed
  9. list of Vasodilators
    • ACE inhibitors (prils)
    • Angio II receptor blockers (sartens)
    • Ca+ blockers (pines)
    • Sympatholytics (alpha blockers)
    •   - prevent sympathetic vasocontriction
  10. What vasodilators do...
    • decrease the work load of the heart
    • work on resistance vessels (arterioles)
    • -reduce resistance to LV pumping
    • -decrease afterload
    • work on Capacitance vessels (veins)
    • -reduce amount of blood return to the heart
    • -decrease preload (and therefore BP)
  11. SE of vasodilators
    • Postural hypoTN
    • -venous relaxation
    • -blood pools in venous side

    • Reflex Tachycarida
    • -Central-sympathetic stimulation
    • -Peripheral- baroreceptors

    • Increase blood volume (over time)
    • -decrease renal blood flow (RAA)
    • -Na+ and h2o are reabsorbed
  12. Hydralazine / Apressoline
    • vasodilator
    • selective dilation of arteries (dec. afterload and BP)
    • -relax smnooth ms
    • -No effect on veins

    Used for HTN and HF (decrease workload)

    • HR and contractility can increase by reflex (tachycardia)
    • SLE like syndrome
    • tolerence may develope
  13. Minoxidil / Loniten
    • vasodilator
    • relaxes arteriole smooth muscle
    • Much stronger than Hydralazine with stronger SE

    Used ONLY when HTN is refractory of other drugs

    Now used for Male pattern baldness
  14. Sodium Nitroprusside / Nipride

    • DOC for HTN Emegencies
    • Arteriole and venous dilation
    • Immediate effects and short 1/2 life
    • Given very slowly IV push
    • Need to protect from light

    • thiocyanide is a metabolic by-product of use and can poison pt.
    • Need to check levels is Nipride in use for >3 days
  15. Diazoxide / Hyperstat IV
    selective dilation of arterioles

    go to drug for acute HTN emergencies if Nipride is not working

    can cause severe reflex tachycardia, angina, and MI

    given in mini-boluses now
  16. Nesiritide / Natrecor
    Naturally occuring peptides that respond to Fluid Overload/HTN used for severely decompensated HF

    • B-type nat peptide does 3 things:
    • -Inc vascular permeability (pull fluid out of vasc space)
    • -Inc. h2o and Na+ loss
    • -artery and venous dilation
    •    => theses 3 dec. BP and workload

    SE= hypoTN
  17. what does the EKG graph tell us?
    if the electricity is going the right speed and direction
  18. Classification of Antidysrhythmics

    Class I
    Based on the site of action potential disruption

    I= blocks Na+ channels
  19. Class II
    Beta Blockers
  20. Class III
    K+ channel blockers
  21. Class IV
    Ca++ channel blockers
  22. some other classes of antidysrhythmics
    digoxin and adenosine
  23. ANY and ALL Dysrhythmic drugs can cause or worsen dysrhythmias 
    ANY and ALL Dysrhythmic drugs can cause or worsen dysrhythmias 
  24. 2 types of non-pharm therapy used for dysrhythmia
    • AICD
    • -atuomatic implanted cardiac defibrillators

    • Ablation
    • -radio waves to destroy abnl foci
  25. Quinidine

    Procainamide / Pronestyl
    • Class 1A Na blocker
    • from bark of Cinchona tree
    • Slows conduction
    • is a broad spectrum drug, so see a lot of SE's (diarrhea, hypoTN, tinnitus, N/V, blurry vision)

    • Pro= 2nd gen
    • less SE, but still a braod spectrum drug
  26. Lidocaine / Xylocaine

    Mexiletine / Mexitil
    • Call 1B Na+ blocker
    • for SHort Term Ventricular Arrythmias ONLY
    • Slows conduction on axons
    • given IV for dysrhythmis
    • given topically (needle) for local anesthetic

    SE= condusion, seizures, arrest: toxic effects when given IV

    Mex= 2nd gen oral version, doesn't work well
  27. Flecainide / Tambocor
    Propafenone / Rythmol
    • Class 1C Na blockers
    • Prodysrhythmic actions
    • can exacerbate and cause new dysrhythmias

    ONLY used for Refactory Arrhythmias when nothing else worked
  28. Propranolol

    Metroprolol / Lopressor
    Esmolol / Brevibloc
    • Class II Beta Blockers
    • used for tachydysrhythmias and PVC's

    • Prop= non-selective B1,2 blocker
    • =Slows HR, bronchocontrict
    • =Suppresses all conduction (not given with AV block)

    • Met= Most popular class II
    • Esmolol= IV form of Met
  29. Amiodarone / Cadarone
    • Class III K+ blocker
    • DOC for ANY dysrhythmias

    • -K+, Na+, and Ca++ channels blocked to produce overall reduction in conduction
    • -HIGHLY lipid soluble, accumulates in tissues, long 1/2

    • -Pulmonary toxicity
    • -Liver Failure
    • -can cause HF
  30. Sotalol / Betapace
    • Class III K+ blockers
    • used for refractory dysrhythmias ONLY
    • -has both K+ and beta blocking effects
    • -A-fib/flutter

    Pt. has really bad electricity if on this
  31. Dofetilide / Tikosyn
    • Class III K+ block
    • Used for Refractory Dyrhythmias ONLY
    • -a-fib/flutter
    • -some drugs interfere with excretion
  32. Ibutilide / Covert
    • Class III K+ block
    • Terminates A-fib, and flutter of recent onset
    • -used to convert to a nl sinus rhythm
    • -Pt. will flat line before rhythm resest
    • -can take up to 90 minutes to convert
    • -1 mg given twice after 10 minutes
  33. Verapamil / Calan

    Diltiazem / Cardizem
    • Class IV Ca+ block
    • do 3 things:
    • -slow HR
    • -Dec. velocity
    • -Dec. force of contraction

    • Terminate SVT's
    • Slow ventricular rate in A-fib
  34. Digoxin / Lanoxin
    Class IV Ca block

    • Supravent. dysrhytm
    • -Dec. rate
    • -(+) inotrope -> INc. force of contraction

    • SE= dysrhythm with toxicity
    • =narrow Ther range (0.5-2.0)
    • = will be worse with HypoKalemia
    • =many drug interactions
  35. Adenosime /Adenacard
    Class IV

    • naturally occuring nucleotide
    • DOC of r terminating Paroxysmal SVT ONLY
    • -Dec, automaticity of SA
    • -Dec. conduction of AV
    • Will stop heart temporarily

    • can give 3 doses in a row:
    • 6mgs, 12, and 12
  36. Angina:
    Chronic stable
    • C=inc with activity, emotions, etc.
    • =dec with rest

    V= coronary vasospasms (feel like MI but can't find anything wrong)

    • U= (Acute Coronary Syndrome)
    • = Medical emergency
    • =occurs at rest, is new onset, Pt. usually had previous Stable angina, but thiings got worse
  37. Angina Tx goal:

    3 types of drugs used to Tx
    Tx= reduce O2 demand of heart

    • Nitrates
    • Beta Block
    • Ca++ block
  38. Nitrates

    Beta Blocks

    Ca++ blocks
    N= dialte veins and decrease preload

    B=decrease rate and force of contrction

    C= Dilate arteriole, decrease afterload
  39. Nitroglycerine
    • 1st drug given for Angina
    • Acts directly on vascular smooth mucsle
    • Dilates veins and pulls fluid from heart, DECREASING Preload
    • -Give Tylenol to prevent Nitro headache

    • SE= Dec. BP
    • = drug interaction with Viagra
  40. Nitroglycerine routes and info
    Highly lipid soluble

    Sublingual - 3 doses, 5 min apart

    • Oral - sustained release (Prophylaxis ONLY)
    •   - Isosorbide/Imdur

    Transdermal - off at night

    • IV fusion - short term only
    •  - 5-50 ug/min