PC 707 Module 4 Cardiac Exam Questions & Answers 100% Solved

First line agents for HTN - Answer Diuretics, Calcium Channel Blockers, & ACE inhibitors or ARBs. MOA of Thiazide diuretics - Answer Increase urinary excretion of sodium & chloride in equal amounts Inhibit sodium & chloride reabsorption in the distal tubule Deplete sodium and potassium & decrease excretion of calcium & uric acid S/E of Thiazide Diuretics - Answer Hyperglycemia (careful with DM), may alter glycemic control Hyperuricemia (careful with gout) Hypertriglyceridemia & hypercholesteremia (monitor lipids) Hypokalemia (can increase risk for cardiac arrhythmias) Hyponatremia Contraindications of Thiazide Diuretics - Answer Contains sulfa (careful with certain sulfa drugs depending on allergy history; sulfonamide-derived drugs) Significant renal impairment Pre-existing hypokalemia Indications for Thiazide Diuretics - Answer HTN Edema Pearls for Thiazide Diuretics - Answer Great as add-on agent for HTN as it can potentiate effectiveness of the initial drug Can be useful for women with osteoporosis and HTN because of the calcium-sparing effects MOA of ACEI - Answer Angiotensin II is a potent vasoconstrictor, so by inhibiting it, less constriction occurs S/E of ACEI - Answer Cough Hyperkalemia Renal function deterioation Angiodema abdominal pain *Women & African-Americans have increased risk of developing angioedema Indications for ACEI - Answer HTN Post-MI HF Pearls for ACEI - Answer Drug of choice for HTN & DM Protective in chronic mild kidney disease *Renal protective early on but later on in DM & renal disease may be harmful Do not combine ACEI with?? - Answer ARBs What should be monitored with ACEI? - Answer Renal function- *baseline *1-2 wks after initiation *periodically thereafter Potassium levels MOA of ARBs - Answer Blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the angiotensin II receptor found in many tissues (less binding results in less constricting) S/E of ARBs - Answer Hyperkalemia Angioedema Renal function deterioation Indications for ARBs - Answer HTN HF Pearls for ARBs - Answer If intolerant of ACEI try ARBs Helpful for pt w/ HTN & DM Cautious & monitor w/ kidney disease Do not give if bilateral renal stenosis Monitor renal function and potassium levels *DO not combine w/ ACEI MOA of Calcium Channel Blockers (CCBs) - Answer Inhibit the movement of calcium ions across the cell membrane. This results in depression of mechanical contraction of myocardial and smooth muscle and depression of impulse formation & conduction velocity. The result is muscle relaxation & vasodilation. CCB classifications - Answer Dihydropyridine (DHPs) Non-Dihydropyridine (non-DHPs) DHPs - Answer 1st gen- Nifedipine 2nd gen- Isradipine Nicardipine Felodipine 3rd gen- Amlodipine non-DHPs - Answer Phenilakylamines- Verapamil Benzothiazepines- Diliazem DHP MOA & indication - Answer Act predominantly in the periphery causing arterial vasodilation. Because of their high vascular selectivity, these drugs are primarily used to reduce systemic vascular resistance and arterial pressure and are therefore commonly used to treat hypertension. non-DHP MOA & Indication - Answer Act predominantly centrally to decrease heart rate (chronotropy) and contractility (inotropy). These drugs have a very important role in treating angina (by reducing myocardial oxygen demand and reversing coronary vasospasm) and in managing arrhythmias. (e.g., Cardizem (Diltiazepam) & Verapamil (Calan)). S/E of CCBs - Answer Heart block or bradycardia (depresses cardiac muscles and AV node) Reflex tachycardia (risk with dihydropyridines) Ankle edema (considered benign, due to vasodilation) Headaches (due to vasodilation) Mood changes Contraindications of CCBs - Answer 2nd and 3rd degree heart blocks Severe bradycardia (non-DHPs) CCBs can worsen??? - Answer HF Indications for CCBs - Answer HTN Angina A-fib (rate control) PSVT & SVT Pearls for CCBs - Answer Calcium channel blockers (non-DHPs) can lead to worsening HF in patients with cardiac dysfunction Work particularly well in treating HTN in African Americans MOA of Loop Diuretics - Answer Inhibit the sodium-potassium-chloride pump of the kidneys at the loop of Henle and inhibit the reabsorption of sodium and chloride Has greater diuretic effect than thiazides Indications for Loop Diuretics - Answer HTN Edema HF S/E for Loop Diuretics - Answer Fluid/Electrolyte Loss Hypokalemia (increases risk of arrhythmias) Hyponatremia Hypomagnesemia Contraindications for Loop Diuretics - Answer Anuria MOA of Aldosterone Receptor Antagonists - Answer Antagonize the action of aldosterone and increase the elimination of water in the kidneys, while conserving K+ Type of diuretic S/E of Aldosterone Receptor Antagonists - Answer Gynecomastia Hyperkalemia Vomiting, diarrhea, stomach cramps Post-menopausal bleeding Erectile dysfunction Contraindications for Aldosterone Receptor Antagonists - Answer Hyperkalemia Renal insufficiency Indications for Aldosterone Receptor Antagonists - Answer HF Edema HTN *others (BPH) MOA for Alpha-1 Blocker/Antagonist - Answer Antiadrenergic effect Potent Vasodilator Indication for Alpha-1 Blocker/Antagonist - Answer HTN S/E of Alpha-1 Blocker/Antagonist - Answer Dizziness, postural hypotension *Severe hypotension with reflex tachycardia Pearls for Alpha-1 Blocker/Antagonist - Answer Give at bedtime. This can help with first dose phenomenon which can cause dizziness, faintness, palpitations, or syncope. Start low and go slow Can be useful for male patients with BPH too as it relaxes smooth muscle of the bladder neck and the prostate gland, relieving obstructive voiding symptoms MOA of Beta-Adrenergic Blockers - Answer Reduce BP by blocking central and peripheral beta receptors. This results in decreased cardiac output and sympathetic outflow. They also block effects of epinephrine. -receptors on kidneys decrease stimulation of RAAS = decreased BP Location of beta receptors - Answer *beta 1 receptor- heart & kidneys *beta 2 receptor- lungs Use caution of BBLs in pt's w/?? - Answer Asthma, COPD, chronic bronchitis, & emphysema DM as may potentiate hypoglycemia or mask symptoms Myasthenia gravis Contraindications of BBLs - Answer 2nd or 3rd degree heart block Severe bradycardia (<45 bpm) Indications of BBLs - Answer HTN MI Angina HF Off-label for BBLs - Answer Thyrotoxicosis A-fib (rate control)