patho EXAM 5 - drugs for HTN, CAD, HF, and dysrhythmias, and diuretics - with Kacie Altom

what is first-line therapy for hypertension?

thiazide diuretics

what are the prototype angiotensin-converting enzyme (ACE) inhibitors (3)?

captopril, enalapril, lisinopril

what drug class ends in -pril?

ACE inhibitors

what is the action of ACE inhibitors?

block the enzyme (angiotensin converting enzyme) from converting angiotensin I to angiotensin II

what do ACE inhibitors treat?

hypertension and heart failure

what drug is the first choice to treat chronic heart failure?

ACE inhibitors

what are common adverse effects of ACE inhibitors?

persistent, dry cough and life-threatening angioedema

what is the BBW on ACE inhibitors?

discontinue if pregnant because drug can cause injury and even death to a developing fetus

what should we assess in patients on ACE inhibitors?

blood pressure! and pulse

what drug class ends in -sartan?

ARBs

what is the action of ARBs?

blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II at various receptor sites

ARBs resemble ACE inhibitors in action but they are less likely to cause __________ or ___________

hyperkalemia; cough

what is the BBW on ARBs?

discontinue if pregnant because drug can cause injury or even death to a developing fetus

what are the prototype calcium channel blockers (CCBs) (3)?

amlodipine, nifedipine, diltiazem

which drug class ends in -dipine?

calcium channel blockers

what is the action of calcium channel blockers?

prevent calcium influx into the myocardial smooth muscle by decreasing force of contraction and preventing vasoconstriction

what do calcium channel blockers treat?

HTN, CAD, angina, dysrhythmias

what are common adverse effects of CCBs (nifedipine)

hypotension and peripheral edema (hands, ankles, feet), rebound tachycardia

what should be monitored in pts taking CCBs?

BP (hypotension)

avoid concurrent use with ________ when taking CCBs

simvastatin (statins)

avoid abrupt ___________ of any CCB because it may increase frequency and duration of chest pain

discontinuation

what can abrupt discontinuation of NIFEDIPINE cause?

rebound tachycardia

what are the types of antiadrenergics?

alpha1-adrenergic receptor blockers, alpha2-receptor agonists, and beta-adrenergic blockers

what do antiadrenergics do?

inhibit activity of the sympathetic nervous system

what specific effects do antiadrenergics have on the body and heart?

decreased HR, force of myocardial contraction, cardiac output, and BP

what drug class ends in -lol or -olol?

beta-blockers

what is the action of beta-adrenergic blockers (beta-blockers)?

inhibit/slows heart rate, force of contraction (decreases blood pressure), and vasoconstriction by blocking the effects of receptors beta1, beta2, and alpha (essentially blocks effects of SNS)

what do beta-blockers treat?

HTN, CAD, ventricular dysrhythmias

what are the two types of beta-blockers?

cardioselective and non-cardioselective

what are cardioselective beta-blockers?

ability of drugs in this class to selectively block beta1 receptors

what are examples of cardioselective beta-blockers?

atenolol, metoprolol

what beta-blocker is commonly used in CAD?

atenolol

cardioselective beta-blockers don't interfere with ___________ or ___________ ____________

bronchodilation or peripheral vasodilation

what are noncardioselective beta-blockers?

block beta1 AND beta2 receptors

what are examples of noncardioselective beta-blockers?

propranolol, carvedilol

what should we monitor with noncardioselective beta-blockers?

bronchoconstriction (they affect the lungs!)

what two beta-blockers block both beta and alpha receptors, decreasing peripheral and coronary vascular resistance?

labetalol and carvedilol

what are common adverse effects of atenolol (Tenormin)?

negative chronotropy (causing slow of HR), bradydysrhythmias, bronchospasm, and masking of hypoglycemia

what is the BBW on beta-adrenergic blockers?

abrupt withdrawal of oral forms for pts with CAD has resulted in exacerbation of angina, the incidence of ventricular dysrhythmias, and the occurrence of MIs

beta 1 beta blockers affect the...

heart

beta 2 beta blockers affect the...

lungs

taking beta adrenergic blockers with alcohol increases the risk of...

hypotension

taking beta adrenergic blockers with digoxin increases the risk of...

bradycardia

organic nitrates relieve anginal pain by...

venous dilation (decreasing preload), coronary artery dilation, and arteriole dilation (decreasing afterload)

what routes can organic nitrates be given?

IV drip, SL, PO, topical

what can nitroglycerin be used to treat fast-acting?

sudden-onset angina

what can nitroglycerin be used to treat by PO sustained-release and transdermal routes?

management of recurrent, chronic angina

what can nitroglycerin be used to treat via IV?

angina associated with MI

what are common adverse effects of nitroglycerin?

dizziness, syncope, hypotension, orthostatic hypotension

you should avoid taking nitroglycerin if you have...

severe anemia, hypotension, or hypovolemia

you should be cautious taking nitroglycerin if you...

have a head injury or cerebral hemorrhage, use other antihypertensives, have renal impairment

what is a key point of nitroglycerins?

men taking any nitrate should NOT use phosphodiesterase enzyme type 5 inhibitors (sildenafil/Viagra and vardenafil/Levitra) for erectile dysfunction because it can cause life-threatening hypotension

if systolic BP is below ____ or if it is ____ mmHg below their normal, you should HOLD nitroglycerin

90; 30

what two things decrease the effectiveness of nitroglycerin?

acetaminophen and vitamin C

when using SL nitroglycerin outside of the hospital, what administration teaching should you give?

max of 3 doses, 5 min apart; if the third doesn't relieve angina, seek medical attention

why would we need to titrate nitroglycerin?

tolerance commonly develops within 24 hours so we need to check the effectiveness on the patient

what drug can be used to treat Raynaud's phenomenon?

nifedipine

how does aspirin aid in CAD?

reduce mortality during an evolving MI and prevent cardiovascular events

how does alteplase aid in CAD?

used following a STEMI to dissolve thrombi and reestablish blood flow quickly

how does atorvastatin aid in CAD?

management of patients with major risk factors for atherosclerosis, CAD, stroke, and peripheral arterial insufficiency

what is the prototype cardiac glycoside?

digoxin (Lanoxin)

what is the action of cardiac glycosides?

produce positive inotropic effects that improve the contractility and pumping ability of the heart, all by inhibiting sodium, potassium, and adenosine triphosphatase

what do cardiac glycosides treat?

HF, a-fib

what is a major adverse effect of digoxin?

digoxin toxicity

what does digoxin toxicity cause?

N/V, abdominal pain, vision changes, life-threatening heart rhythm disturbances (bradycardia and PVCs), slow to rapid ventilations

why is it important to be careful when administering digoxin?

it has a narrow therapeutic index with a level of 0.5-2 ng/mL

what should you assess with digoxin administration?

- apical pulse (full minute) - hold if less than 60 bpm

- for cardiac dysrhythmias and GI issues (indicate toxicity)

what is the antidote for digoxin?

Digibind/DigiFab

what is preload?

volume of blood in ventricles at end of diastole

what is afterload?

resistance left ventricle must overcome to circulate blood

what do angiotensin receptor-neprilysin inhibitors treat?

HF

what is the prototype loop diuretic?

furosemide (Lasix)

when are loop diuretics the first choice over other diuretics?

when rapid effects are required and when renal function is impaired (low GFR)

what do loop diuretics treat?

HTN, acute pulmonary edema, HF, hepatic and renal disease

what are adverse effects of furosemide?

fluid and electrolyte imbalances, ototoxicity

you shouldn't take furosemide if you...

have anuria or are pregnant

furosemide is known to be _________ wasting, so it's important that we monitor it

potassium

what routes can furosemide be given?

IV and PO

what dietary restrictions are there with furosemide?

restrict sodium

what increases the risk of hypokalemia when taking furosemide?

digoxin

antidysrhythmic drugs have the potential to cause new dysrhythmias. This is called the...

Prodysrhythmic effect

what is the prototype class III potassium channel blocker?

amiodarone (Cordarone)

what is the action of class III potassium channel blockers?

block cardiac potassium channels - prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles

what does amiodarone treat?

ventricular and atrial dysrhythmias

what does PO amiodarone treat?

- recurrent ventricular tachycardia or ventricular fibrillation

- to maintain normal sinus rhythm after conversion of afib or aflutter

what does IV amiodarone treat?

acute suppression of refractory, hemodynamically destabilizing vtach and vfib

what does a low dose amiodarone treat?

recurrent afib

what are common adverse effects of amiodarone?

CNS - malaise, fatigue, dizziness, ataxia

can develop more serious AE such as cardiac dysrhythmias, bradycardia, hypotension, etc.

contraindications of amiodarone

allergy to Iodine, heart block, hypokalemia

what drugs should you avoid taking with amiodarone?

beta-blockers, oral anticoagulants, digoxin, phenytoin

what is the BBW on amiodarone?

only use in pts with life-threatening dysrhythmias because of the risk of the development of potentially fatal pulmonary toxicity