cardiovasular

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Author:
BodeS
ID:
305324
Filename:
cardiovasular
Updated:
2015-07-23 17:11:15
Tags:
pharmacology
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Description:
HTN, ANGINA, DYSRHYTHMIA, MI, CHF, HF
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  1. pump
    myocardial muscle contraction
  2. rhythm
    automatic electrical conduction
  3. angina pectoris
    • s/s: chest pain
    • cause: coronary artery disease
    • plaque
    • atherosclerosis
    • dyslipidemia
    • drugs: beta blocker
    • Ca++ blockers
    • Nitrates
  4. HF
    s/s: left side
    • s/s: dyspnea
    • cough
    • fatigue
    • cause: blood
    • back flow into lungs
  5. HF
    s/s: right side
    • s/s: jugular distension
    • edema
    • hepatomagaly
    • ascites
    • cause: muscle
    • stiffens
    • weak pump
  6. HF
    • cause: pump
    • muscle tissue not receiving O2
    • ex: CHF
    • chronic HF
    • impaired myocardial fxn
    • lower force
    • less filling
    • drugs: decrease force
    • risk: compensation
  7. HF
    compensation
    • NEURAL
    • afterload
    • sympathetic activation
    • adrenal cortex
    • HORMONE 
    • kidney
    • cathecholemines
    • Renin-Aldosterone-AngioII
    • VASCULAR
    • preload
    • venous overfill 
    • h2o retention
    • Na+ retention
  8. preload
    • venous return
    • end diastolic volume
  9. afterload
    • arterial resistance
    • end systolic volume
  10. dysrthymia
    • cause: eletrical
    • SA/AV node 
    • ex: A Fib
    • conduction
    • supraventricular
    • drugs: beta blockers
    • Ca++ blockers
  11. propranolol
    • trade: Inderal
    • ID: antiadrenergic
    • antihypertensive
    • antiarrhythmics
    • antianginals
    • beta blocker
    • therapy: HTN
    • A Fib
    • supraventricular dysrhythmia
    • CAD
    • action: decrease HR
    • decrease force
    • decrease C.O.
    • reduce Renin releaes
    • location: R atrium
    • AV node
    • beta1 receptors
    • heart
    • contraindication: pulmonary edema
  12. verapamil
    • trade: Calan
    • ID: calcium channel blocker
    • antiarrhythmics
    • antianginals
    • therapy: A Fib
    • CAD
    • HTN
    • supraventricular dysrhythmia
    • action: dysrhythmia/angina-
    • block Ca++
    • from myocardial cell
    • reduce contractility
    • reduce automaticity
    • HTN-reduce afterload
    • relax smooth muscle in blood vessels
    • location: myocardial cell
    • heart
    • risk: constipation
    • cough
    • dyspnea
    • bradycardia
    • edema
  13. Nitroglycerin
    • trade: Nitro-Stat
    • ID: antianginal
    • therapy: short-IV
    • long-patch
    • dose: 3 times MAX
    • 5 mins apart 
    • action: dilate coronary arteries
    • vasodilation- veins
    • reduce pre/after loads
    • risks: cerebral vascular headache
    • orthostatic hypotension
    • reflex trachycardia
  14. carvediolol
    • trade: Coreg
    • ID: antiarrhythmics
    • beta blocker
    • therapy: short- 1st line HF
    • long- CHF
    • dose: lower in CHF 
    • action: block sympathetic effects on heart
    • reduce C.O.
    • reduce Renin release
    • improve LV fxn
    • vasodilation
    • fxn: longer life
  15. HF 
    therapy types
    • 1st line drugs
    • vs
    • treat symptoms
  16. 1st line drug therapy
    • treat: HF
    • drugs: ACE Inhibitors
    • ARBs
    • beta blockers
  17. treat symptom heart therapy
    • glycosides: increase contractility
    • diuretics: reduce volume load
  18. difference between carvediolol and propranolol
    • carvediolol: 1st line drug for HF
    • lower dose, long term for CHF
    • propranolol: HTN
    • A. Fib
  19. ACE Inhibitors
    • class: angiotensin-converting enzyme inhibitors
    • drug: lisinopril
    • captopril 
    • ID: antihypertensives
    • therapy: 1st line HF
    • prevention HTN, HF
    • action: block enzyme in alveolar cells
    • location: lungs
  20. lisinopril vs losartan
    • ACE vs ARB
    • enzyme vs receptor
    • lungs vs smooth muscle tissue
    • prils vs less side effects
    • 1st dose phenomenon
    • hyperkalemia
    • HTN
    • 1st line HF
  21. lisinopril
    • trade: ACEs
    • ID: antihypertensive 
    • therapy: HTN
    • 1st line drug chronic HF
    • prevention HTN, HF
    • action: inhibit enzyme that converts angiotensin I into II
    • inhibit Aldosterone 
    • decrease Na+/H2O retention
    • location: lungs
    • contraindication: K+ sparing diuretics
    • diabetes
    • NSAIDS
    • risk: hyperkalemia
    • side effects: 1st dose phenomenon
    • orthostatic hypotension
    • "prils"
    • cough
  22. ARBs
    • angiotensin II receptor blockers
    • drug: losartan
    • ID: antihypertensives
    • therapy: 1st line drug HF
    • reduce afterload
    • HTN
    • prevention storke
    • reduce preload
    • action: block receptors at site of tissue
    • reduce hormone compensation
    • location: tissue
  23. losartan
    • class: ARBs
    • ID: antyhypertensive
    • therapy: HTN
    • 1st line HF
    • prevention HTN, HF, stroke
    • action: block angioII receptors at site of tissue
    • block vasoconstrictor
    • decrease aldosterone
    • decrease Na+/H2O retention
    • decrease afterload
    • location: tissue 
    • smooth muscle
    • contraindication: K+ sparing diuretics
    • risk: hyperkalemia w spironolactone
  24. priority w 1st line drugs
    • pair with loop and K+ sparing diuretics
    • benefit from aldosterone receptors
    • increase antihypertensive effects
    • treat HF and HTN
  25. prozasin
    • trade: Minipres
    • ID: antihypertensives
    • peripherally acting antiadrenergic
    • alpha1 antagonist
    • therapy: HTN
    • action: block alpha1 receptor sites
    • stop vasoconstriction
    • dilates arteries/veins
    • decrease after/preload
    • location: synapse
    • risk: 1st dose phenomenon
    • long term- Na+/H2O retention
  26. clonidine
    • trade: Catapres
    • ID: centrally acting adrenergic
    • alpha2 agonist
    • antihypertensive
    • therapy: HTN
    • action: suppress afterload
    • risk: AV node block
    • hypotension
    • drug-drug: bradykardia
    • w beta blockers
    • verapamil
    • digoxin
  27. clonidine vs. prozasin
    • Catapres vs Minipres
    • centrally acting vs peripherally acting
    • alpha2 vs alpha1
    • agonist vs antagonist
    • supress afterload vs. decrease after/preload
    • antihypertensive
    • risk Na+/H2O retention long term effect
  28. Thiazides
    • drug: hydrochlorthiazide [HCTZ]
    • ID: antihypertensive
    • diuretic
    • therapy: HTN
    • cirrhosis
    • conjunctive therapy: glucocorticoid
    • estrogen
    • action: inhibit DCT
    • dilate arteries 
    • reduce afterload
    • reduce Na+/H2O retention
    • location: early DCT
    • risk: hypokalemia
    • w digoxin
    • glucocorticoids
    • estrogen
  29. flurosemide
    • trade: Lasix
    • ID: loop diuretic
    • therapy: HTN
    • HF
    • edema
    • hepatic impairment
    • renal disease
    • action: inhibit Na+/Cl- retention
    • reduce water weight
    • location: ascending loop of Henle
    • drug-drug: 10x stronger than Thiazides
    • risk: hypokalemia
    • hypotension
  30. spironolactone
    • trade: Aldactone
    • ID: K+ sparing diuretic
    • therapy: HTN
    • HF
    • combo: loop diuretics
    • furosemide [Lasix]
    • w 1st line HF drugs
    • reduce edema
    • action: block aldosterone receptors
    • reduce Na+/H2O retention
    • reabsorb K+
    • location: late DCT
    • collecting duct
    • risk: hyperkalemia
    • w ACE/ARBs
  31. mannitol 
    • trade: Osmitrol 
    • ID: osmotic diuretic
    • therapy: edema
    • ascites
    • renal failure
    • action: increase solute load
    • increase osmotic pressure
    • push H2O into blood
    • pull from extravascular sites
    • increase blood volume
    • decrease water retention
    • decrease water weight in tissue
    • location: PCT
    • glomerular filtrate
    • risk: extravasation
  32. heparin
    • class: anticoagulants
    • ID: antithrombotics
    • therapy: SHORT-ACTING
    • immediate intervention
    • in hospital 
    • prophylaxis/treatment
    • thromboembolic disorders
    • action: inhibit thrombin
    • prevent fibrin conversion
    • block blood-clotting cascade
    • location: blood vessels
    • priority: mandatory lab monitoring 
    • risk: hepatitis
    • bleeding
  33. warfarin
    • class: anticoagulants
    • ID: antithrombotics
    • therapy: LONG-ACTING
    • 3-5 days before effects
    • at home
    • prophylaxis/treatment
    • thromboembolic disorders
    • action: interferes w hepatic vit K
    • location: liver
    • risk: bleeding
  34. lovenox
    • official name: low molecular weight heparin
    • class: anticoagulant
    • ID: antithrombotics
    • therapy: short acting
    • in hospital
    • based on weight of patient
    • action: inhibit thrombin
    • prevent fibrin conversion
    • block blood-clotting cascade
    • priority: no lab monitoring necessary
  35. alteplase [t-PA]
    • trade: Activase
    • ID: thrombolytic agent
    • route: IV only 
    • therapy: emergency room
    • pulmonary embolism 
    • action: dissolve clots
    • plasminogen activator
    • re-establish blood flow
    • location: blood vessels 
  36. HMO CoA reductase inhibitors
    • official name: statins
    • ID: lipid lowering agent
    • therapy: treat dyslipidemia
    • lower cholesterol plaque build up
    • reduce inflammation
    • target atherosclerosis
    • treat symptoms of heart attack
    • stroke
    • CAD
    • angina
    • action: prevent cholesterol synthesis
    • inhibit enzyme
    • location: liver
    • contraindicated: geriatrics
    • side effects: muscle atrophy
    • fatigue 
    • memory loss
  37. prophylaxis of blood clotting
    • 1) major illness [MI, HF, stroke]
    • 2) surgery
    • 3) thrombophlebitis
    • 4) bed rest > 5 days
  38. digoxin
    • class: glycoside
    • trade: Lanoxin
    • ID: antiarrhythmics
    • therapy: dysrhythmia
    • A Fib
    • symptoms of HF
    • CHF
    • dose: loading=digitalizing
    • rapid- A Fib
    • slow- HF
    • CHF
    • narrow therapeutic range
    • action: increase force cardiac contraction
    • decrease heart rate
    • priority: monitor for toxicity
    • monitor K+ levels
    • drug-drug: K+ losing diuretics
    • risk: toxicity
    • hypokalemia
    • sinus bradycardia
    • AV/SA block
    • GI irritation
  39. atherosclerosis
    • ID: build up of cholesterol plaques in the coronary arteries and on the arteries and arterioles throughout the body.
    • cause: stroke, HF, angina, CAD, peripheral vascular disease
    • drugs: HMO CoA reductase inhibitors 
    • [statins]
  40. drugs that treat symptoms of HF
    • thrombolytic agent (emergency)
    • glycosides
    • diuretics
    • anticoagulants
    • antiplatelets
    • lipid lowering agent
  41. drugs that treat dysrhythmia
    • digoxin
    • beta blockers
    • calcium channel blockers
  42. drugs that treat angina
    • nitrates [emergency]
    • beta blockers
    • calcium blockers
    • lipid lowering agents
  43. drugs that treat HTN
    • alpha2 agonist
    • alpha1 antagonist
    • diuretics
    • beta blockers
  44. drugs that treat both HTN and HF
    • 1st line: 
    • ARBs
    • ACEs
    • beta blockers
    • symptoms:
    • diuretics
  45. drugs that treat HF
    symptoms: glycosides
  46. digoxin 
    nursing process
    • give drug after meals to avoid GI irritation
    • run ECG lab test BEFORE giving drug
    • LOADING DOSE equals digitalizing dose
    • long half life
    • watch for toxicity-induced dysrhythmias 
    • toxicity-induced sinus bradycardia

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