Term
|
Definition
Diphenylalkylamines
Benzothiazepines
Dihydropyridines |
|
|
Term
|
Definition
Verapamil (Calan, Isoptin) SR
(only 1 in this class)
Can be short acting or sustained |
|
|
Term
|
Definition
| Diltiazem (CardizemCD, Tiazac, dilacor) |
|
|
Term
|
Definition
Nimodipine (Nimotopp)
Nifedipine (Procardia)
Amlodipine (Norvasc)
Nicardipine (Cardene)
Isradipine (Dynacirc)
Felodipine (Plendil) |
|
|
Term
| Which CCBs are short-acting and used for pre-term labor? |
|
Definition
Nifedipine (Procardia)
Nicardipine (Cardene) |
|
|
Term
| Which CCBs are long acting? |
|
Definition
Amlodipine (Norvasc)
Felodipine (Plendil) |
|
|
Term
| How do Diphenylalkylamines and Benzothiazepines work? What is it good for? |
|
Definition
As anti-arrhythmics:
1. Depress SA node
2. Depress automaticity
3. Delay AV nodal conduction |
|
|
Term
| How does Nimodipine work? |
|
Definition
| Preferentially dilates cerebral blood vessels. |
|
|
Term
| What are the indications for CCBs? |
|
Definition
Hypertension
Angina (classic/prinzmetal)
Decrease sequelae of hemorrhagic stroke (SAH)
Prevention of migraine headaches
Raynaud’s disease
Urinary Incontinence
Dementia
Esophageal motor disorders
Premature labor
Asthma (exercise-induced) |
|
|
Term
| what is classical angina? |
|
Definition
|
|
Term
| what is prinzmetal angina? |
|
Definition
|
|
Term
|
Definition
| CCB is better because BB have lots of side effects |
|
|
Term
| Function of Calcium in the body |
|
Definition
Enzymatic reactions
Bone metabolism
Electrical activation of excitable cells
Coupling of membrane excitation with muscular contraction |
|
|
Term
| Role of Calcium in Heart Muscle |
|
Definition
| calcium binds to troponin, moves it, allows actin to bind to myosin =contraction |
|
|
Term
| Role of Calcium in Vascular muscle |
|
Definition
| calcium binds to calmodulin and activates myosin kinase. myosin kinase phosphorylates myosin which gives it the energy to interact with actin =contraction =vasoconstriction |
|
|
Term
| Where are the most calcium channels and most extracellular calcium? |
|
Definition
| vascular muscle >cardiac muscle> skeletal |
|
|
Term
| How do CCBs work at the cellular level? |
|
Definition
| blocks the movement of extracellular calcium from moving into the cell therefore preventing contraction. |
|
|
Term
|
Definition
| decrease vascular resistance by coronary and peripheral/systemic dilation |
|
|
Term
|
Definition
| can cause transient hypostension |
|
|
Term
|
Definition
| can cause bradycardia, AV block, and ventricular asystole |
|
|
Term
| verapamil and SA node disease |
|
Definition
| unstable AV block and shock |
|
|
Term
|
Definition
| absorbed well by the liver, 30% is bioavailable, grapefruit juice can block liver enzymes |
|
|
Term
|
Definition
| constipation, headache, dizziness, nervousness |
|
|
Term
|
Definition
| N/V/D anorexia constipation dyspepsia skin eruptions, bradycardia |
|
|
Term
|
Definition
| **edema** ** worsening angina, dizziness, light headedness, flushing, HA, nausea, heartburn, muscle cramps, nervousness, mood changes |
|
|
Term
| how many people have hypotension or angina from nifedipine |
|
Definition
| hypotension 15% worsening angina 10% |
|
|
Term
| what CCB used to be used in hypertensive emergencies? |
|
Definition
| nifedipine short acting gel cap, cut open and squeezed under the tongue |
|
|
Term
|
Definition
| Clinical syndrome results from the inability of the heart to pump sufficient amount of oxygenated blood to meet the metabolic demands of the body |
|
|
Term
|
Definition
Intrinsic cardiac disease
Increased metabolic demands
Excessive workload |
|
|
Term
| examples of increased metabolic demands |
|
Definition
| fever, preg, anemia, thyrotoxicosis |
|
|
Term
|
Definition
| arrhythmias, PE, excessive salt intake, drugs, increased metabolic states |
|
|
Term
| types of arrhythmias assoc with CHF |
|
Definition
| rapid or slowed ventricular rate |
|
|
Term
| excessive salt can come from |
|
Definition
|
|
Term
| drugs that may be assoc with CHF |
|
Definition
| corticosteriods, androgens, estrogens, NSAIDS, doxirubicin daunimyacin |
|
|
Term
| compensatory mechanisms for CHF |
|
Definition
Cardiac dilatation
Cardiac hypertrophy
Increased sympathetic tone
Sodium and water retention |
|
|
Term
| Why is there cardiac dilation in CHF? |
|
Definition
| due to increased end distolic volume in ventricle after systole |
|
|
Term
| how does cardiac hypertrophy cause CHF |
|
Definition
| larger heart demands more oxygen, decreased tissue profusion=increased cardiac output, positive inotropic effect |
|
|
Term
| how does increased sympathetic tone cause CHF |
|
Definition
| vasocontriction, causes: tachy, sweating, cyanosis, pallor. Nocturia because when laying edematous fluid is released |
|
|
Term
| how does sodium and water retention cause CHF |
|
Definition
| RAAS causes increased blood volume, edema and therefore weight gain |
|
|
Term
| Signs and symptoms of left heart failure |
|
Definition
Weakness, fatigue, and cyanosis
Left ventricular hypertrophy
S3 gallop
Tachycardia, sweating, pallor and cyanosis
Nocturia
Weight gain and edema
DOE
productive cough
rales
PE |
|
|
Term
| Signs and symptoms of right heart failure |
|
Definition
Dependent pitting edema
Hepatomegaly
Hepatic tenderness
Ascites
Anorexia
Jugular venous distention
+hepato-jugular reflex |
|
|
Term
| right heart failure and anorexia |
|
Definition
| seen with CHF, also seen with high levels of Dig |
|
|
Term
| what is high output failure |
|
Definition
| Fails to pump enough blood to meet metabolic demand of the tissues |
|
|
Term
| who has high output failure |
|
Definition
Hyperthyroid pts
Anemic patients |
|
|
Term
| what is low output failure? |
|
Definition
congestive failure. more common.
Heart is unable to pump all the blood presented to it |
|
|
Term
| what happens to the heart in low output failure? |
|
Definition
| Increased cardiac workoad and impaired myocardial contractility |
|
|
Term
|
Definition
| forces acting on the venous side of the circulation |
|
|
Term
|
Definition
| is regulated by the resistance or impedance against which the ventricle must pump during ejection |
|
|
Term
| lifestyle modifications to prevent CHF |
|
Definition
Stop smoking
Stop excessive alcohol
Dietary sodium restriction- don’t eat out.
Fluid restriction
Weight loss
Moderate exercise |
|
|
Term
|
Definition
Diuretics
ACE Inhibitors or ARBs
Beta blockers
Digoxin
Aldosterone antagonists |
|
|
Term
|
Definition
| improve quality of life by getting rid of excess Na and therefore water, decreasing congestive symptoms and edema |
|
|
Term
|
Definition
| Do not improve survival- constantly in and out of hospital |
|
|
Term
|
Definition
| Don’t typically use HCTZ alone (not for renal), they use loops- lasix 20-40 mg/day. Lose about a pound of fluid a day |
|
|
Term
| side effects of diuretics |
|
Definition
|
|
Term
|
Definition
| improve survial rate, reduce hospitalizatons |
|
|
Term
| what do ACEs do for CHF patients |
|
Definition
Delay HF progression
Relieve symptoms
Improve quality of life in pts with mild, moderate, or severe symptoms |
|
|
Term
| ACEs used for CHF examples |
|
Definition
captopril (Capoten)
Enalapril (Vasotec)
Ramipril (Altace)
Lisinopril (Prinivil and Zestoril) Benazepril (Lotensin) |
|
|
Term
|
Definition
|
|
Term
| how do arbs work compared to aces |
|
Definition
Inhibit the activity of angiotensin II more completely
Does not affect bradykinin |
|
|
Term
|
Definition
| Inhibit the increased Sympathetic NS activity that occurs in response to heart failure therefore Improve symptoms and functional status |
|
|
Term
|
Definition
Reduce hospitalizations
Improve survival |
|
|
Term
|
Definition
| Carvedilol, metoprolol, bisoprolol |
|
|
Term
|
Definition
| Inhibit the increased Sympathetic NS activity that occurs in response to heart failure |
|
|
Term
|
Definition
Reduce hospitalizations
Improve survival
Improve symptoms and functional status (tachy etc |
|
|
Term
|
Definition
| Carvedilol, metoprolol, bisoprolol |
|
|
Term
| who should you use BB in? |
|
Definition
| Brady, hypotension, worseing CHF. Only use in stable patients |
|
|
Term
|
Definition
| Optimize diuretic therapy first |
|
|
Term
| contraindications for BB and HF |
|
Definition
| Don’t use if heart block, or sick sinus syndrome, or airway disease |
|
|
Term
|
Definition
| If they’re not improving on the other drugs. |
|
|
Term
| Digoxin effects on the heart |
|
Definition
| Increases force of contraction- ionoptropic effect by increasing calcium in the cell and allowing contraction. Decreases end diastolic volume and pressure |
|
|
Term
| how does digoxin affect systemically |
|
Definition
| Appears to attenuate activation of SNS and RAAS |
|
|
Term
|
Definition
Improvement of symptoms
Improve quality of life and exercise capacity
Hospitalizations reduced
Does not improve survival |
|
|
Term
|
Definition
| Recommended as adjunct to ACEIs, ARBs, BetaBlockers, and a diuretic |
|
|
Term
|
Definition
Estrogen like effects: unilateral or bilateral gynecomastia
Low potassium, low magnesium or high Calcium increases risk for toxicity
Has a positive ionotropic, but negative chronotropic effect. |
|
|
Term
|
Definition
| anorexia, N/V, abdominal distention, diarrhea |
|
|
Term
|
Definition
| hazy yellow green vision, halos, nightmares, hallucinations |
|
|
Term
|
Definition
| any type of arrhythmia…unifocal and multifocal PVCs including bigeminy and trigeminy |
|
|
Term
| aldosterone receptor blockers and survival |
|
Definition
Decrease mortality
Improve symptom control
Reduce hospitalizations |
|
|
Term
| ex. of aldosterone receptor blockers |
|
Definition
| Spirnolactone (aldactone) and Eplerenone (inspra) |
|
|
Term
| aldosterone receptor blockers as a diuretic |
|
Definition
| Not good as a diuretic alone unless cirrhosis or nephrotic syndrome. |
|
|
Term
| s/e of aldosterone receptor blockers |
|
Definition
HYPERKALEMIA
High doses=gynecomastia (not typical dose for CHF) |
|
|
Term
| nitrates and hydralizine and CHF survival |
|
Definition
Improve survival
Increases exercise tolerance |
|
|
Term
| nitrates and hydralizine v ACE and ARB |
|
Definition
| Survival benefit less than with ACEIs and ARBs with more side effects- so only use for patients with ACEs or ARBs intolerance, such as blacks |
|
|
Term
| nitrates and hydralizine example |
|
Definition
|
|
Term
|
Definition
| Used to treat atrial arrhythmias common in HF |
|
|
Term
|
Definition
| May decrease mortality independent of the presence of arrhythmias |
|
|
Term
|
Definition
| May increase dig levels, additive effect with anticoagulants |
|
|
Term
| Ex. Selective Alpha-adrenergic blockers |
|
Definition
Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura)
Tamsulosin (Flomax)
Alfuzosin (Uroxatral) |
|
|
Term
| Prazosin (Minipress) half life |
|
Definition
|
|
Term
| Terazosin (Hytrin) half life |
|
Definition
|
|
Term
| Doxazosin (Cardura) half life |
|
Definition
|
|
Term
| Non Selective Alpha Adrenergic Blockers |
|
Definition
Phenoxybenzamine (dibenzyline)
Phentolamine (Regitine) |
|
|
