NYU Pharmacology Exam 1
Acute Heart Failure (HF) - ANSHeart muscle weakens and enlarges
Loses ability to pump blood adequately
Compensatory mechanisms fail
Lungs and periphery become congested
Digitalis (Digoxin) (Cardiac Glycoside) - ANSIndication: HF
- narrow tp range
-antidote: digoxin immune fab.
MOA: inhibits NA/k pump to inc Ca to DECREASE HR
Induces INC intracelluar sodium drives Ca into heart and INCREASE CONTRACTILITY
AE:
-bradycardia
-dysrhythmias
-anorexia, N/V
-headache
-blurred or yellow vision
TOXICITY:
- anorexia, N/V, green or yellow halos, bradycardia premature ventricular contractions, cardiac
dysrhythmias, confusion, delirium for elderly
R4 toxicity:
- low K+
-renal failure
-loop diuretics
-Hypercalcemia
Considerations:
- pulse full min apical prior to taking
-eyes on periph/pulm edema
-MONITOR K + CREATININE!
INTERACTIONS:
-duretics = hypoK
-Cortison= Na retention / hypoK
-antacids = dec digitalis absorption
,Classic (stable) angina - ANSStress, exertion induced, cause narrowing of arteries
Unstable (preinfarction) angina - ANSOccurs frequently with progressive severity unrelated to
activity; unpredictable regarding stress/exertion and intensity
DT artery narrowing/partial occlusion
Variant (vasospastic) angina - ANSOccurs during rest
Caused by vessel spasm (Vasospasm)
Nitroglycerin - ANSIndication: Angina
- subling = most comon= avoids first pass via liver = inc ABSORPTION
- max 3 doses, 5 mins apart
*TAKE DOSE 1 LAYING DOWN, CALL 911 IF PAIN PERSISTS +5MINS*
**AVOID WEATHER EXTREMES!**
**avoid alcohol + extreme exercise!**
*rotate patch site. PATCH OFF FOR BEDTIME!*
MOA:
- relax smooth musc + vasodilate
- dec myocardial 02 demand
-dec preload
-dec afterload
-dec peripheral vasc resistance
AE:
- headache tx w/ acetaminophen
- de BP/dizzy
-REBOUND MYOCARDIAL ISCHEMIA IF NOT TAPER!!!!
- reflex tachy if given to quickly
-circulatory collapse 911
Considerations:
-hypotension
- HOLD SBP <90!!!!
-sit/lay down esp 1st dose!!!!!
-DO NOT PLACE TOPICAL NITRO IN AREA OF CARDIOVERTER/DEFIB PADDLE
PLACEMENT!!!!!
INTERACTIONS:
- inc hypotension if given with
* beta blockers
* Ca channel blockers
* antiHTN
, * alcohol
-IV nitro dec heparin effectiveness
-CONTRAINDICATED FOR PTS WHO HAVE TAKEN SILDENAFIL W/IN 48 HOURS!!!
Beta blockers - ANSNONSELECTIVE: PROPANALOL (b1&b2)
SELECTIVE: METOPROLOL (b1)
indication:
- antianginal
- anidysrhythmic
-antiHTN
MOA:
- blocks beta 1 + beta 2 receptor sites
- decrease sympathetic NS, block action of catecholamines(epi/norephinephrine)
-DC HR+BP!!!!!!!
AE:
NON select b1/b2 propran= BRONCOSPAMS/IMPOTENCE!!!
Selective= monitor early use
CONSIDERATIONS:
- no abrupt stop. can cuase reflex tachy + recurrent angina
-DO NOT STOP PERIOP!!!!!!!
Contraindications:
- 2nd / 3rd degree av block = risk severe conduction disturbances and DEATH
Calcium Channel Blockers - ANSdiltiazem- inpt
nifedipine- outpt
INDICATIONS:
- classic angina
-variant angina
-dysrhytmias
-HTN
MOA:
- dec card contractility
-relax smooth muscle + coronary vasodilation (decrease worklaod, 02 demand, pre + afterload)
AE:
Acute Heart Failure (HF) - ANSHeart muscle weakens and enlarges
Loses ability to pump blood adequately
Compensatory mechanisms fail
Lungs and periphery become congested
Digitalis (Digoxin) (Cardiac Glycoside) - ANSIndication: HF
- narrow tp range
-antidote: digoxin immune fab.
MOA: inhibits NA/k pump to inc Ca to DECREASE HR
Induces INC intracelluar sodium drives Ca into heart and INCREASE CONTRACTILITY
AE:
-bradycardia
-dysrhythmias
-anorexia, N/V
-headache
-blurred or yellow vision
TOXICITY:
- anorexia, N/V, green or yellow halos, bradycardia premature ventricular contractions, cardiac
dysrhythmias, confusion, delirium for elderly
R4 toxicity:
- low K+
-renal failure
-loop diuretics
-Hypercalcemia
Considerations:
- pulse full min apical prior to taking
-eyes on periph/pulm edema
-MONITOR K + CREATININE!
INTERACTIONS:
-duretics = hypoK
-Cortison= Na retention / hypoK
-antacids = dec digitalis absorption
,Classic (stable) angina - ANSStress, exertion induced, cause narrowing of arteries
Unstable (preinfarction) angina - ANSOccurs frequently with progressive severity unrelated to
activity; unpredictable regarding stress/exertion and intensity
DT artery narrowing/partial occlusion
Variant (vasospastic) angina - ANSOccurs during rest
Caused by vessel spasm (Vasospasm)
Nitroglycerin - ANSIndication: Angina
- subling = most comon= avoids first pass via liver = inc ABSORPTION
- max 3 doses, 5 mins apart
*TAKE DOSE 1 LAYING DOWN, CALL 911 IF PAIN PERSISTS +5MINS*
**AVOID WEATHER EXTREMES!**
**avoid alcohol + extreme exercise!**
*rotate patch site. PATCH OFF FOR BEDTIME!*
MOA:
- relax smooth musc + vasodilate
- dec myocardial 02 demand
-dec preload
-dec afterload
-dec peripheral vasc resistance
AE:
- headache tx w/ acetaminophen
- de BP/dizzy
-REBOUND MYOCARDIAL ISCHEMIA IF NOT TAPER!!!!
- reflex tachy if given to quickly
-circulatory collapse 911
Considerations:
-hypotension
- HOLD SBP <90!!!!
-sit/lay down esp 1st dose!!!!!
-DO NOT PLACE TOPICAL NITRO IN AREA OF CARDIOVERTER/DEFIB PADDLE
PLACEMENT!!!!!
INTERACTIONS:
- inc hypotension if given with
* beta blockers
* Ca channel blockers
* antiHTN
, * alcohol
-IV nitro dec heparin effectiveness
-CONTRAINDICATED FOR PTS WHO HAVE TAKEN SILDENAFIL W/IN 48 HOURS!!!
Beta blockers - ANSNONSELECTIVE: PROPANALOL (b1&b2)
SELECTIVE: METOPROLOL (b1)
indication:
- antianginal
- anidysrhythmic
-antiHTN
MOA:
- blocks beta 1 + beta 2 receptor sites
- decrease sympathetic NS, block action of catecholamines(epi/norephinephrine)
-DC HR+BP!!!!!!!
AE:
NON select b1/b2 propran= BRONCOSPAMS/IMPOTENCE!!!
Selective= monitor early use
CONSIDERATIONS:
- no abrupt stop. can cuase reflex tachy + recurrent angina
-DO NOT STOP PERIOP!!!!!!!
Contraindications:
- 2nd / 3rd degree av block = risk severe conduction disturbances and DEATH
Calcium Channel Blockers - ANSdiltiazem- inpt
nifedipine- outpt
INDICATIONS:
- classic angina
-variant angina
-dysrhytmias
-HTN
MOA:
- dec card contractility
-relax smooth muscle + coronary vasodilation (decrease worklaod, 02 demand, pre + afterload)
AE:
