Pharm Exam 2 Heart Drugs

what are the three factors responsible for hypertension?

cardiac output, peripheral resistance, blood volume

what determines cardiac output?

stroke volume and heart rate

what does increase blood volume do to BP?

increases it

what affects blood volume?

fluid loss/retention

what raises BP?

epinephrine and norepinephrine injections, antidiuertic hormone

what is the primary homostatic mechanism for controlling BP?

renin-angiotensin-aldosterone system

what is true of primary hypertension?

there is no identifiable cause

what can cause secondary hypertension?

cushing’s, hyperthyroidism, chronic renal disease and certain drugs

what does untreated hypertension affect?

the heart, brain, kidneys and retina

what are some non-pharmacological methods to control hypertension?

limit alcohol intake, restrict sodium, reduce saturated fat and cholesterol, increase fruit and veg intake, increase aerobic physical activity, stop tobacco use, reduce stress and maintain a good weight

what is the first line of defense for pharmacologic management for hypertension?

diuretics, ACE inhibitors, ARBs, direct renin inhibitors, calcium channel blockers

what is the second line of defense for pharmacologic management for hypertension?

Beta-adrenegeric receptor blockers, alpha-1-adrenegric receptor, alpha-2-adrenergic agonists, direct-acting vasodilators, peripherally acting adrengic neuron blockers

what is the main way diuretics work to manage hypertension?

increase urinary flow — increase excretion of water and sodium — reduces blood volume and cardiac workload

what do diuretics reduce?

edema and pulmonary congestion

what type of hypertension can diuretics manage?

mild to moderate

what are the types of diuretics?

potassium-sparing, thiazide and thiazide-like, loop/high-ceiling

what is crucial to monitor with diuretics?

renal function, electrolyte level, gout, blood glucose and BUN, sodium intake, weight loss, fatigue and muscle cramps

non-potassium-sparing diuretics may cause what?

orthostatic hypotension and photosensitivity

what needs to be evaluated when using non-potassium sparing diuretics for hypertension?

laboratory electrolyte values, potassium levels, daily weights

intake and output assessment of edema and signs of fluid overload

what are side effects of non-potassium-sparing diuretics?

hypokalemia, hypomagnesemia, hypocalcemia

what population are non-potassium-sparing diuretics contraindicated for?

pregnant and lactating women

those with history of gout or kidney stones

what should be monitoring points for thiazide-like diuretics?

blood glucose and uric acid levels, potassium loss

what conditions are contraindicated for use of thiazide-like diuretics?

pregnancy and lactation, systemic lupus and those using digoxin

what needs to be monitored with loop diuretics?

severe potassium loss, hypokalemia, hypotension, hearing loss, glucose and uric acid levels

what is the specific calcium channel blocker drug?

nifedipine

what does nifedipine (calcium channel blocker) treat?

hypertension and other cardiovascular disease

how does nifedipine calcium channel blocker work?

blocks calcium ion channels which causes vasodilation and decreases BP

what conditions is nifediphrine used for?

HTN, angina and arrhythmias

what are the adverse effects of nifedipine?

dizziness, edema, headache, flushing

what do calcium channel blockers target?

some target channels in arterioles and other affect cardiac muscle

what needs to be monitored in patients taking calcium channel blockers?

heart rate and BP

signs of heart failure and reflex tachycardia

history of heart dysrhythmias and pregnancy

what should patients avoid when taking calcium channel blockers?

avoid drinking grapefruit juice

what is the specific ACE inhibitor we talked about?

enalapril

what does ACE stand for?

angitensin-converting-enzyme

what do ACE inhibitors affect?

renin-angiotension system

how do ACE inhibitors (enlalpril) work?

blocks the effects of angiotensin II (vasodilation occurs) — lowers peripheral resistance — decreases blood volume

what are ACE (enlapril) used for?

HTN, HF and diabetic neuropathy

what needs to be monitored with ACE inhibitors?

vitals, hypotension, angioedema, hypokalemia, cough, neutropenia, dizziness, light headedness

when do ACE (enalapril) inhibitors need to be avoided?

during pregnancy category D

what is the HTN beta-adrenegeic blocker discussed?

metoprolol

what does metoprolol (beta blocker HTN) do?

decreases heart rate and contractility by blocking beta1 receptors in juxtaglomerular apparatus — inhibits secretion or renin — reduces cardiac output and lowers systemic BP

what conditions is metoprolol (beta blocker) used for?

HTN, post MI and heart failure

what is the mechanism of action for metoprolol?

block cardiac action of sympathetic nervous system to slow heart rate and BP, reducing workload of heart

what type of effect does metroprolol have?

inotropic

what are adverse effects of metoprolol?

fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia,

what needs to be monitored when taking metroprolol?

heart and glucose

can you stop taking metoprolol abruptly?

no

what else should be monitored with metoprolol (beta blocker)?

worsening symptoms, liver function/hepatic toxicity, blood pressure/pulse

what do alpha-1 adrenergic antagonists (doxazosin) do?

block sympathetic receptors in arterioles

second line drug used in comb with diuretics

what do alpha 2- adrenergic antagonists do?

decrease outflow of sympathetic nerve impulses from the CNS to heart and arterioles

what are the monitoring points for alpha adrenergic antagonists?

vital signs

heart block and rebound hypertension

blood glucose for diabetics

what direct vasodilators was discussed?

hydralazine

what does hydralazine cause?

vasodilation by direct relaxation of arterial smooth muscle

what are direct vasodilators only used for?

severe hypertension and hypertension crisis

what are the serious adverse effects of hydralazine?

reflex tachycardia, sodium and fluid retention

what are direct vasodilators contraindicated for?

Hypersensitivity, coronary artery disease
Rheumatic mitral valve disease, cerebrovascular disease
Renal insufficiency, systemic lupus erythematosus

what are the monitoring points for direct vasodilators?

V/S, ECG and pulse ox

direct vasodilators, specifically hydralazine, what can be an adverse effect?

lupus like syndrome

what needs to be monitored with IV diazoxide (direct vasodilator)?

sodium and water output

what needs to be monitored with use of minoxidil (Loniten) (direct vaso)?

orthostatic hypotension

what can a nitroprusside IV (direct vaso) be used for?

hypertensive emergencies during labor and delivery to lower blood pressure instantaneously

what is the drug choice ACE inhibitor for heart failure?

lisinoprill

what does lisinopril do?

reduce afterload and increases cardiac output

how does lisinopril work?

enhance excretion of sodium and water — lowers peripheral resistance and reduces blood volume — decreases BP

in order to increase the survival of MI what are patients given?

captopril or lisinopril

what are the adverse effects of lisinopril?

first does hypotension, cough, hyperkalemia, renal failure

what needs to be monitored when taking lisinopril?

CBC, hypotension, impaired kidney function, hyperkalemia, autoimmune, sodium and potassium restrictions

what should you not us with lisinopril?

other medications, OTCs, herbals and vitamins

what are ARBs?

angiotensin 2 receptor blockers

what do ARBs act similar to?

ACE inhibitors, block angiotension 2

what are ARBs used for?

patients who are unable to tolerate adverse effects of ACE inhibitors

what needs to be monitored in patients taking ARBs?

hyperkalemia, K+, renal function

what type of drug is digoxin?

cardiac glycoside

what does digoxin do?

increases force of heartbeat and slows heart rate

what is the MOA for digoxin?

inhibt Na+/K+ ATPase and increase calcium

what is digoxin used for?

heart failure and Afib to improve cardiac output

what is the primary use of digoxin?

increase contractility or strength or myocardial contraction

what are the adverse effects of digoxin?

neutropenia, dysrhythmias, digitalis toxicity = visual halos, arrhythmias

what is true of digoxin?

second line treatment of HF and narrow therapeutic range

what needs to be monitored with digoxin?

ventricular dysrhythmias, renal function, drug interactions, pulse rate, weigh gain and digoxin levels

what can increase the risk of dogoxin toxcicity?

gensing

what can decrease the affects of digoxin?

antidiarrheals and antacids

what should patients taking digoxin eat?

foods high in potassium

what type of drug is milrinone?

phosphodiestaerase inhibitor

what is the mechanism of action for milrinone?

block enzyme phosphodiesterase in cardiac and smooth muscle which increases cAMP, calcium and contractility and cardiac output

what does milrinone cause?

positive inotropic response and vasodialation

what does milrinone increase and decrease?

increases contractility and decreases afterload

what is milrinone used for?

short term therapy for acute HF

what are the adverse effects of milrinone?

hypokalemia, hypotension, ventricular dysrhythmias

what are the monitoring points and report points for milrinone?

hypotension, renal impairments, ventricular dysrhythmias, irregular or rapid heart rate, fever of 101 or higher or increase in chest pain

what is coronary artery disease?

narrowing or occlusion of a coronary artery leading to myocardial ischemia, one of th eleading causes of death

what is angina pectrois?

acute chest pain due to insufficent oxygen to myocardium

what is stable angina?

fairly predictable frequency, intensity and duration, relieved by rest

what is an unstable angina?

episodes occur more frequently, more intensly and during periods of rest

what is vasospastic angina?

caused by spasms of coronary arteries

what is silent angina?

occurs in absence of angina pain

what are non-pharmacological management for angina?

lifestyle changes (tobacco, diet, booze, exercise)

percutaneous coronary intervention

coronary artery bypass graft for severe cases

what is the goal of pharmacological intervention for angina?

to reduce intensity and frequency of episodes and improve exercise tolerance

what are the two categories of pharmocalogic aids for angina?

those that terminate acute episodes and those that decrease frequency

how do drugs for angina reduce myocardial demand?

slow heart rate, reduce preload, reduce contractility, lower blood pressure