Pharmacology Exam 2

preload

volume of the blood received by the heart

afterload

pressure or resistance the heart has to overcome to eject blood (squeeze)

What are the 3 components responsible for creating pressure

cardiac output, systemic vascular resistance, blood volume

cardiac output

volume of blood pumped per minute (determined by the heart rate and stroke volume)

Stroke volume

the volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction

What factors effect stroke volume

preload, contractility, afterload

SVR

resistance of the arteries to blood flow. As the arteries constrict, the resistance increases and as they dilate, resistance decreases

What determines SVR

autonomic activity, pharmacologic agents, and blood viscosity

Blood viscocity

increased viscosity increases resistance

Blood volume

total amount of blood in the vascular system (fluid loss and fluid retention)

Question BP if systolic is less than

100

Cause of HTN

when the system is out of control

Types of HTN

primary and secondary HTN

Primary HTN

essential idiopathic (90% of cases)

Secondary HTN

known cause (10% of cases)

When does the RAAS system activate

when there is low BV

What does the kidneys excrete

angiotensin II, aldosterone, renin

What do all antihypertensives cause

dizziness and light headedness

What do diuretics do

decrease preload, decrease CO, and decreases total peripheral resistance. In all, decreases the workload of the heart and decreases BP

Thiazide Diuretic example

Hydrochlorothiazide

Thiazide-like diuretic example

chlorthalidone

Thiazide and Thiazide like diuretics MOA

inhibits tubular resorption of sodium, chloride, and potassium ions. Results in water, sodium, and chloride being excreted

Thiazide and Thiazide like diuretics side effects

dizziness and hypokalemia

Alpha 2 Receptor Agonists drug example

Clonidine

Clonidine MOA

decreases norepinephrine production, stimulates alpha 2 adrenergic receptors, thus reducing renin activity in the kidneys. Results in decreased BP

Clonidine side effects

orthostatic hypotension, fatigue, dizziness (high incidence of these occurring)

Clonidine considerations

do not stop abruptly, can lead to rebound HTN

Alpha 1 receptor blockers example

doxazosin

Doxazosin MOA

blocks alpha 1 adrenergic receptors and decreases BP, dilates arteries and veins, reduces peripheral resistance

Beta blockers examples

propranolol, metoprolol, atenolol

Beta blockers MOA

reduces the heart rate through beta 1 receptor blockage, reduces myocardial contractility, causes reduced secretion of renin, long-term use causes peripheral vascular resistance

Dual action alpha 1 and beta blockers examples

labetalol and carvedilol

Dual action alpha 1 and beta blockers MOA

dual antihypertensive effects of reduction in HR (beta 1 receptor blockade) and vasodilation (alpha 1 receptor blockade)

Adrenergic drugs adverse effects

bradycardia with reflex tachycardia, drowsiness, sedation

Angiotensin converting enzyme inhibitors (ACE) examples

lisinopril and enalapril

ACE Inhibitors MOA

blocks conversion from angiotensin I to angiotensin II, reduces BP by decreasing SVR

ACE

converts angiotensin I to angiotensin II

Aldosterone

stimulates sodium and water resorption, which can raise BP

ACE inhibitor side effects

dry cough, dizziness, hyperkalemia, angioedema, first dose hypotensive effect

ACE inhibitors lab values

potassium and serum creatinine

Angiotensin II receptor blockers ARBS example

Losartan

Losartan MOA

affect primarily vascular smooth muscle and the adrenal gland. Selectively blocks the binding of angiotensin II to of the type 1 angiotensin II receptors in these tissues. Blocks vasoconstriction and the secretion of aldosterone

Losartan Side effects

fatigue, hyperkalemia

Losartan indications

not safe for breastfeeding women and should not be used in pregnancy

Calcium channel blockers example

amplodipine

Amlodipine MOA

cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction, results in decrease peripheral smooth muscle tone, decreased SVR, decreased BP

Amlodipine adverse effects

dizziness, lightheadedness, lower extremity edema

Vasodilators examples

hydralazine, nitroprusside

Hydralazine and nitroprusside MOA

directly relax arteriolar or venous smooth muscle (or both), results in decreased SVR, decreased afterload, peripheral vasodilation

Nitroprusside indications

more for emergent situations, used in ICU situations IV route

Hydralazine adverse effects

headache, anxiety, tachycardia

Nitroprusside adverse effects

bradycardia, decreased platelet aggregation

Renal failure considerations

drugs can accumulate to high levels, medication doses may need to be adjusted, avoid nephrotoxic drugs (NSAIDS and ACEs)

What lab tests monitor renal function

UA, serum creatinine, BUN, GFR

Acute kidney injury cause and symptoms

renal hypoperfusion, OD, UTI. Reduced urine output, swollen lower exremities, weakness, fatigue, HTN, confusion

Causes of renal hypoperfusion

dysrhythmias, dehydration

Chronic kidney failure symptoms

abnormal blood and urine tests, swelling in the face, hands, feet. Headaches, HTN

HF causes

MI, coronary artery disease, systemic HTN, congenital abnormalities

Right sided HF

systemic venous congestion, pedal edema, JVD, ascites, hepatic conjunction, weight gain, fluid retention

Left sided HF

pulmonary edema, coughing, SOB, dyspnea, weight gain, fluid retention

Positive inotropic drugs

increase the force of myocardial contraction

Positive chronotropic drugs

increase HR

Positive dromotropic drugs

accelerate cardiac conduction

Loop Diuretic Example

Furosemide

Furosemide MOA

acts directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption. Increases renal prostaglandins which results in the dilation of blood vessels and reduced peripheral vascular resistance (increases urinary output)

Loop Diuretics Side effects

dizziness, hypokalemia, tinnitus

Potassium soaring diuretics example

spironolactone

Spironolactone MOA

blocks reabsorption of sodium and water usually induced by aldosterone

Potassium sparing diuretics side effects

dizziness and hyperkalemia

Potassium sparing diuretics interactions

lithium, ACE inhibitors, potassium supplements, NSAIDs

Angiotensin receptor-Neprilysin Inhibitors (ARNI) Example

valsartan

Valsartan MOA

blocks the degradation of vasoactive peptide by inhibiting neprylisin enzyme (combination of ARBs and neprilysin inhibitor)

Valsartan adverse effects

HTN, hyperkalemia, increased serum creatinine, lower BP

Aldosterone Antagonists MOA

blocks the activation of the RAAS system and causes increased levels of aldosterone, which causes retention of sodium and water, which leads to edema that can worsen HF

Aldosterone antagonist and potassium sparing diuretic example

spironolactone

Cardiac Glycosides example

Digoxin

Digoxin MOA

Last resort medication, positive inotropic effect, negative chronotropic effect, and negative dromotropic effect. Increases the force and velocity of myocardial contraction without an increase in oxygen consumption, reduces HR, decreases automaticity at the SA node, decreases AV nodal conduction

Digoxin adverse effects

narro therapeutic windo (can get to toxic levels fast), low potassium levels increase toxicity

Digoxin considerations

assess apical pulse for 1 full minute, hold the med if HR is below 60.

HF Patient consdierations

patients should notify healthcare professionals if they gain more than 2lbs in a day and 5lbs in a week

What foods are high in potassium

bananas, broccoli, potatoes

What is CAD

the most common type of heart disease in the US caused by plaque build up in the walls of the arteries that supply blood to the heart

Plaque

made up of deposits of cholesterol and other substances in the artery

Artereosclerosis

plaque build up causes the inside of the arteries to narrow over time, which can partially or totally block the blood flow

LDL

bad cholesterol

HDL

good cholesterol because it recycles the cholesterol

HMG-CoA Reductase Inhibitors examples

Atorvastatin and Simastatin

HMG-CoA inhibitors MOA

inhibits HMG-CoA reductase, which is used by the liver to produce cholesterol. Lowers the LDL production by 50%

HMG-CoA reductase inhibitors adverse effects

myopathy, rhabdomyolysis, myoglobinuria, acute renal failure, death, elevations in liver enzymes or liver disease

Bile acid sequestrants example

colestipol

Colestipol MOA

prevent resorption of bile acids from small intestine

Colestipol Adverse Effects

constipation

Fibric Acid Derivatives example

fenofibrate

Fenofibrate MOA

inhibits the synthesis of triglycerides in the liver, decreases triglycerides and can increase HDL by 25%

Fibric acid derivatives adverse effects

prolonged prothrombin time, should not be used in conjunction with statins because of increased risk of rhabdomyolysis and should not be taken with anticoagulants

Herbal Products for CAD

Omega 3 Fatty acids

Omega 3 fatty acids

OTC fish oil products, prescription products, used to reduce cholesterol, may cause rash, belching, potential interactions with anticoagulant drugs

What causes angina pectoris

when the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle aches

Types of angina

chronic stable angina, unstable angina, vasospastic angina, stable angina

Chronic stable angina

predictable angina that happens when patients are physically exerting themselves and the chest pain occurs, the patient rests and the pain goes away nonemergent