Pharm 14.1 - 14.4

14.1 - "diuretics and sympatholytics" are cards 1-26, 14.2 - "vasodilators, renin-ang drugs, ccbs" are cards 27-50, 14.3 - "anti-angina drugs and anti-arrhythmics" are cards 51-82, 14.4 - "Treatment of Heart Failure" are cards 83-end

cardiovascular

___________________ medications are the largest area of pharmacology

diuretics

_________ act on the kidneys to increase sodium and water excretion

several indications

CV meds often wear several hats, meaning that one medication may have __________ ___________

fluid

diuretics decrease _________ in the vascular system

htn, congestive heart failure

diuretics are often used for __________ and _____________________ to reduce some of the load on the heart

diuretics

thiazides, loop diuretics, and potassium sparing agents are examples of __________

imbalances, depletion

potential adverse effects and rehab concerns with diuretics are possible electrolyte __________ and fluid ____________

sympatholytics

______________ are beta blockers that bind to the heart and block the effects of epinephrine and norepinephrine

decrease

sympatholytic beta blockers (increase/decrease) HR and contraction force

sympathetic responses

beta blockers can also produce a more general decrease in ________________________

beta blockers

_________________ can be used for HTN, angina, arrythmias, heart failure, recovery from MI/heart attack, migraines, raynaud’s disease, and situational anxiety/stage fright

-olol

the suffix for beta blocker is ________

cardioselective, nonselective

common beta blockers are grouped into two categories: _____________ and _______________

beta-1

cardioselective drugs have a higher affinity to the (beta-1/beta-2) subtype receptor

heart

the beta-1 subtype predominates on the _______

nonselective

________________ beta blockers bind to both beta-1 and beta-2 subtype receptors

lungs

the beta-2 subtype predominates on the _______

beta blockers

bronchoconstriction, orthostatic hypotension, psychotropic effects, and decreased maximal exercise capacity are all adverse effects/rehab concerns of ______________

orthostatic hypotension

_______________ is a common side effect of any drug that is used to lower blood pressure

20-30

beta blockers will reduce maximal HR about ___-___ BPM

nonselective

a _______________ beta blocker will also block beta-2 receptors on the lungs with can cause bronchoconstriction, especially if the pt has asthma or any condition of the lung sensitizing airway smooth muscle to constriction

antihypertensive

alpha blockers, presynaptic adrenergic inhibitors, centrally-acting agents, and ganglionic blockers are all examples of other sympatholytic _________________ medications

alpha blockers

________________ blocks the alpha 1 receptor on the arteriole and will cause vasodilation

presynaptic adrenergic

______________________ inhibitors inhibit the release of norepinephrine at the arteriole to relax the arteriole and reduce pressure

centrally-acting

_________________ agents reduce sympathetic drive at its origin in the brainstem

ganglionic blockers

______________________ go to the sympathetic chain ganglia to block transmission and are usually used in emergencies

vasodilators

___________ act directly on vascular smooth muscle and inhibit contraction; helpful for htn and heart failure

vasodilators

reflex tachycardia, orthostatic hypotension, dizziness, headaches, edema, and fluid retention, are adverse effects of ________________

systemic heat

with any type vasodilators, _______________ should be avoided to prevent excessive lowering of blood pressure

renin-angiotensin

the ____________________ system is a neuroendocrine response that helps control BP and other physiological reaction in various tissues

increased

some people have excessive RAS responses that cause (increased/decreased) BP and damage to CV system and kidneys

renin

angiotensinogen is converted to angiotensin I by _________________

kidneys

renin is produced/released by the ____________-

angiotensin converting enzyme

angiotensin I is converted to angiotensin II by _______________

vasoconstrictor

angiotensin II is the most powerful _________________

angiotensin II

chronic effects of _____________________ include vascular remodeling and occlusion

ACE inhibitors

__________________ inhibit the angiotensin converting enzyme and decrease formation of ang.II

vasoconstriction, vascular hypertrophy

ACE inhibitors prevent acute ______________ and _________________

HTN, heart failure

ACE inhibitors are commonly used for _________________ and ______________

pril

the suffix -_____ is common for common ACE inhibitors

Ang-II receptor blockers

________________ block angiotensin II receptors to prevent detrimental effects of Ang II on the heart and vasculature

ang-II receptor blockers

which may have fewer side effects, ACE inhibitors or Ang-II receptor blockers?

direct renin inhibitors

_____________________ inhibit renin’s ability to convert angiotensinogen to Ang-I, preventing the precursor to Ang-II

dry cough

ACE inhibitors can cause a _______________ due to increased bradykinin

allergic reactions, angioedema

RAS drugs can cause ____________ and ____________ which should be reported immediate

calcium channel blockers or CCBs

__________________________ limit calcium entry into vascular smooth muscle and cardiac muscle to promote vasodilation and stabilization of HR

htn, angina pectoris, arrhythmias

calcium channel blockers are used for __________, ______________, and ___________

CCBs

swelling in feet and ankles, orthostatic hypotension, altered HR, and potential for increased risk of heart attack are adverse effects of ________________

vasodilation

CCBs can cause (vasoconstriction/vasodilation)

reduce

CCBs (reduce/increase) blood pressure by altering cardiac contraction force and peripheral vasodilation

anginals

organic nitrates are anti-_______________

nitroglycerin

__________________ is a main anti-anginal drug

sublingual, transdermal

the two routes of administration for nitroglycerin are _____________ and _______________

angina pectoris

___________________ is the primary indicator/condition for the use of nitroglycerin

dilate

nitrates (constrict/dilate) peripheral vasculature

preload

venous dilation causes decreased (preload/afterload)

afterload

arterial dilation causes decreased (preload/afterload)

pre

___load is the blood returning to the heart

after

____load is the pressure the heart pumps against

cardiac workload, oxygen demand

the two primary effects of nitrates are decreased __________ _________ and decreased _________ _________

short

nitrates are (short/long) acting

tolerance

nitrate __________ can occur with continuous administration, but goes away when nitrates are discontinued

nitrates

adverse effects and rehab concerns of ___________ are headache, dizziness, orthostatic hypotension, increased vasodilation and exaggerated response to systemic heat; sublingual doses need to be checked for viability

before

for sublingual nitrate doses, have the drug ready (before/after) the rehab session

decrease; peripheral vasculature

nitrates such as nitroglycerin help decrease symptoms of angina pectoris because they ________ myocardial oxygen demand by vasodilating the _______________________

cardiac arrhythmias

sodium channel blockers, beta blockers, drugs that prolong repolarization, and calcium channel blockers are all categories of drugs for _________________

beta blockers

class II drugs are ___________________ and decreases excessive sympathetic stimulation of the heart

calcium channel blockers

class IV drugs are __________________ and limit calcium excitation of SA and AV nodes

sodium channel blockers

class I drugs are ______________________ and inhibit abnormal na channel openings in cardiac cells to stabilize excitability

sodium channel

subclasses IA, IB, and IC are categories of ____________ blockers

IA

subclass ___ sodium channel blockers moderate slowing of depolarization and action potential conduction, prolonging repolarization

IB

subclass ___ sodium channel blockers shorten cardiac repolarization

IC

subclass ___ sodium channel blockers shows marked slowing of depolarization and action potential conduction

prolong repolarization

class III drugs are drugs that _____________________________

III

class ____ drugs lengthen the time interval before the next action potential can be generated

potassium

class III drugs probably work by decreasing __________ efflux/exit during repolarization

T

T/F: class III drugs can sometimes have properties of the other classes (I, II, IV)

I, sodium channel blockers

class ___ antiarrhythmic drugs are _________________________ and are used for various arrhythmias, especially premature ventricular contractions (PVCs) and ventricular tachycardia

II, beta blockers

class ___ antiarrhythmic drugs are _________________________ and are used for atrial fibrillation and ventricular tachycardia

III, prolong repolarization

class ___ antiarrhythmic drugs are drugs that _________________________ and are used for atrial fibrillation, ventricular tachycardia, and ventricular fibrillation

IV, calcium channel blockers

class ___ antiarrhythmic drugs are _________________________ and are used for atrial fibrillation and supraventricular tachycardias

proarrhythmic effect

the __________________________ refers to the idea that treating one arrhythmia can cause or uncover another new/different arrhythmia

diuretic

the effects of __________ drugs on heart failure is reducing cardiac workload by reducing fluid accumulation in the body

beta blocker

the effects of _________ drugs on heart failure is normalizing HR by reducing sympathetic stimulation of heart and vasculature

vasodilators

the effects of _________ drugs on heart failure is reducing cardiac afterload by reducing pressure in the arterial system

renin-angiotensin

the effects of _________ drugs on heart failure is decreasing harmful effects of angiotensin-II on the heart and vasculature

inotropism

_____________ refers to the force of contraction

positive inotropic

___________________ drugs help increase cardiac output and reduce symptoms, especially in systolic heart failure

digitalis

___________ is a primary positive inotrope derived from the foxglove plant

200

digitalis has been used for over ______ years

congestive heart failure

the primary indication for the use of digitalis is _______________________________

mechanical, autonomic

digitalis has both ___________ effects and ____________ effects

T

T/F: digitalis can make the heart beat more strongly

Na-K pump, sodium

digitalis inhibits the ____________ in cardiac cells, resulting in the accumulation of _______ in cells

stronger

because digitalis causes increased intracellular sodium, less calcium leaves the cell causing increased intracellular calcium which causes a (stronger/weaker) cardiac contraction

calcium

increased _________ ion concentration in cells causes increased actin-myosin binding

decreases

autonomic effect of digitalis ______________ heart rate by stimulating vagus nerve and inhibiting sympathetics to the heart

increases

sympathetic effects normally ___________ heart rate

digitalis toxicity

______________________ is fairly common and can occur even if serum levels are within the normal range

digitalis toxicity

GI distress, depression, fatigue, blurred vision, confusion, and arrhythmias are all common symptoms of _______________________________