NCMA 216: Pharmacology Cardiovascular Drugs
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Questions and Answers

What is the primary function of the cardiac accelerator?

  • Decreases heart rate
  • Regulates blood pressure
  • Increases heart rate and cardiac contractility (correct)
  • Increases kidney perfusion

Which type of hypertension has a known cause?

  • Secondary Hypertension (correct)
  • Primary Hypertension
  • Transient Hypertension
  • Essential Hypertension

What triggers the activation of the Renin-Angiotensin-Aldosterone System (RAAS)?

  • A decrease in blood volume
  • An increase in heart rate
  • A decrease in blood pressure within the kidneys (correct)
  • An increase in blood pressure

Which of the following is NOT a risk factor for hypertension?

<p>High physical activity (C)</p> Signup and view all the answers

What is orthostatic hypotension?

<p>A sudden drop in blood pressure when changing position (C)</p> Signup and view all the answers

What is the primary therapeutic effect of digoxin?

<p>Increases intracellular calcium levels (B)</p> Signup and view all the answers

Which condition is NOT an indication for digoxin use?

<p>Hypertension (D)</p> Signup and view all the answers

What effect does increased renal blood flow have on the renin-angiotensin-aldosterone system (RAAS)?

<p>Interferes with RAAS Activity (B)</p> Signup and view all the answers

What is a critical consideration when prescribing digoxin?

<p>It is excreted unchanged in the urine. (B)</p> Signup and view all the answers

What pharmacokinetic characteristic of digoxin contributes to its rapid therapeutic onset?

<p>Rapid absorption after oral administration (C)</p> Signup and view all the answers

What is the main effect of alpha 2 agonists like Clonidine?

<p>Decrease in sympathetic outflow (B)</p> Signup and view all the answers

Which drug class primarily acts as blood-pressure raising agents?

<p>Sympathetic adrenergic agonists (B)</p> Signup and view all the answers

What condition is Midodrine specifically used to treat?

<p>Orthostatic Hypotension (A)</p> Signup and view all the answers

Which of the following is NOT an effect of sympathetic adrenergic agonists?

<p>Increase blood sugar (C)</p> Signup and view all the answers

What is a common adverse effect of sympathetic adrenergic agonists?

<p>Changes in peripheral blood flow (B)</p> Signup and view all the answers

Which statement about the action of Dobutamine is true?

<p>It increases the strength of cardiac muscle contraction (D)</p> Signup and view all the answers

Which of the following drugs is classified as an alpha-specific adrenergic agonist?

<p>Phenylephrine (C)</p> Signup and view all the answers

Which of the following is a contraindication for using sympathetic adrenergic agonists?

<p>Patients with impaired blood flow (C)</p> Signup and view all the answers

What is the heart rate classification for tachycardia?

<p>More than 100 bpm (A)</p> Signup and view all the answers

Which condition is characterized by early contraction in the ventricles?

<p>Premature Ventricular Contraction (PVC) (A)</p> Signup and view all the answers

Which drug is classified as a Class I antiarrhythmic agent?

<p>Procainamide (D)</p> Signup and view all the answers

Which of the following drugs is commonly used to treat tachyarrhythmias and belongs to Class II?

<p>Esmolol (C)</p> Signup and view all the answers

What is primarily disrupted in a heart block?

<p>Conduction of impulses (C)</p> Signup and view all the answers

Which drug reduces left ventricular ejection fraction and is classified as Class 0?

<p>Ivabradine (D)</p> Signup and view all the answers

Which condition is associated with stimulation from ectopic foci in the heart?

<p>Atrial fibrillation (B)</p> Signup and view all the answers

What is the mechanism by which Class I antiarrhythmic drugs operate?

<p>Block sodium channels (B)</p> Signup and view all the answers

Which antiarrhythmic agent is administered only intravenously?

<p>Ibutilide (C)</p> Signup and view all the answers

What is a significant adverse effect associated with Class III antiarrhythmic agents?

<p>Hepatic toxicity (D)</p> Signup and view all the answers

Which drug should not be taken with food due to decreased absorption?

<p>Sotalol (A)</p> Signup and view all the answers

Which statement about the pharmacokinetics of amiodarone is true?

<p>It is well-absorbed after oral administration. (B)</p> Signup and view all the answers

Which combination of drugs increases the risk of serious toxic effects?

<p>Amiodarone and Quinidine (D)</p> Signup and view all the answers

Which of the following is not a contraindication for Class III antiarrhythmic agents?

<p>High blood pressure (A)</p> Signup and view all the answers

Which of these drugs is likely to decrease the therapeutic effects of Sotalol?

<p>NSAIDs (B)</p> Signup and view all the answers

What is a common outcome of the use of Class III antiarrhythmic agents like Dronedarone and Dofetilide?

<p>QT interval prolongation (A)</p> Signup and view all the answers

What is the primary indication for the use of Verapamil and Diltiazem?

<p>Rapid supraventricular dysrhythmias (C)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect of Class IV agents like Verapamil and Diltiazem?

<p>Increased heart rate (A)</p> Signup and view all the answers

What is the mechanism of action for non-dihydropyridine calcium channel blockers?

<p>Block the movement of calcium ions across cell membranes (C)</p> Signup and view all the answers

Which condition is a contraindication for the use of these calcium channel blockers?

<p>Sick sinus syndrome (D)</p> Signup and view all the answers

Which pharmacokinetic property is associated with Verapamil and Diltiazem?

<p>Highly protein bound (C)</p> Signup and view all the answers

What should be monitored due to the risk of drug-to-drug interaction when administering Verapamil?

<p>Risk of cardiac depression with beta blockers (B)</p> Signup and view all the answers

Which nursing consideration is crucial when administering Class IV antiarrhythmic medications?

<p>Titrate the dose to the smallest amount needed (D)</p> Signup and view all the answers

Which of the following scenarios would warrant caution when using Diltiazem?

<p>Patient with severe heart failure (C)</p> Signup and view all the answers

Which of the following effects does Diltiazem have on the heart?

<p>Slows automaticity and conductivity (B)</p> Signup and view all the answers

What should be avoided alongside calcium channel blockers due to potential adverse interactions?

<p>Beta-adrenergic agents (B)</p> Signup and view all the answers

Flashcards

Cardiac Accelerator

Part of the cardiac control center that increases heart rate and strength of contraction.

Cardiac Decelerator

Part of the cardiac control center that decreases heart rate and strength of contraction.

Renin-Angiotensin-Aldosterone System (RAAS)

A system activated when blood pressure in the kidneys falls, triggering a response to maintain blood flow.

Hypertension

Sustained high blood pressure.

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Orthostatic Hypotension

Lowering of blood pressure when changing positions, causing decreased blood flow to the brain.

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Alpha 2 Agonists

Drugs that stimulate alpha 2 receptors in the CNS, reducing sympathetic outflow and lowering blood pressure.

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Clonidine

An alpha 2 agonist that decreases sympathetic outflow from the CNS, leading to lower blood pressure.

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Guanfacine

Another alpha 2 agonist that helps decrease blood pressure.

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Sympathetic Adrenergic Agonists

Drugs that stimulate the sympathetic nervous system, increasing heart rate, blood pressure, and blood flow.

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Dobutamine

A sympathetic adrenergic agonist that increases heart rate and strength of contraction.

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Midodrine

A medication used to treat orthostatic hypotension, an alpha-specific adrenergic agonist that increases blood pressure.

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Droxidopa

A medication that increases norepinephrine levels, used to treat orthostatic hypotension.

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Cardiac Glycosides

Drugs derived from foxglove plants, like digoxin, used to treat heart failure symptoms by increasing calcium in heart muscle cells, which strengthens contractions.

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Positive Inotropic Effect

Increased force of myocardial contraction, leading to stronger heartbeats and improved blood flow.

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Cardiac Output

Amount of blood pumped by the heart each minute.

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Digoxin's Effect on Heart Rate

Slows heart rate by slowing down the rate at which heart cells re-charge, reducing conduction velocity in the AV node.

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Narrow Therapeutic Index

A small difference between the effective dose and the toxic dose, making it crucial to monitor for side effects.

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Tachycardia

A heart rhythm that is faster than normal, typically over 100 beats per minute.

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Bradycardia

A heart rhythm that is slower than normal, typically under 60 beats per minute.

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Premature Atrial Contraction (PAC)

An early heartbeat that originates in the atria, causing an abnormal contraction.

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Premature Ventricular Contraction (PVC)

An early heartbeat that originates in the ventricles, causing an abnormal contraction.

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Heart Block

Disruption in the electrical signal's pathway through the heart, causing a delay or blockage.

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Class I Antiarrhythmic Agents

Drugs that block sodium channels in the cell membrane during an action potential, affecting the heart's rhythm.

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Class II Antiarrhythmic Agents

Drugs that block beta-receptors, slowing the heart rate and reducing contractility.

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Class III Antiarrhythmic Agents

Drugs that prolong the action potential duration, affecting the heart's rhythm.

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Amiodarone Route

Amiodarone can be administered orally or intravenously.

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Dofetilide, Dronedarone, Sotalol Route

Dofetilide, Dronedarone, and Sotalol are only available for oral administration.

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Ibutilide Route

Ibutilide is only administered intravenously.

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Class III Antiarrhythmic Contraindications

Class III antiarrhythmics (like Amiodarone, Dofetilide, Dronedarone, Ibutilide, and Sotalol) are contraindicated in patients with AV block, shock, hypotension, respiratory distress, and thyroid or pulmonary disease.

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Class III Antiarrhythmic Adverse Effects

Class III antiarrhythmics can cause adverse effects such as GI distress, bradycardia, AV block, QT prolongation, hepatic toxicity, lung fibrosis, and cardiac arrhythmias.

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Class III Antiarrhythmic Drug Interactions (1)

Class III antiarrhythmics interact with digoxin and quinidine, increasing the risk of serious toxic effects.

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Class III Antiarrhythmic Drug Interactions (2)

Class III antiarrhythmics can interact with various drugs like antihistamines, phenothiazines, TCAs, ketoconazole, cimetidine, verapamil, NSAIDs, aspirin, antacids, beta-blockers, and diltiazem, affecting their efficacy or increasing the risk of adverse events.

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Sotalol and Food

Sotalol's absorption is decreased when taken with food.

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Class IV Calcium Channel Blockers

These drugs block calcium channels in heart and blood vessels, slowing heart rate and relaxing blood vessels.

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Verapamil & Diltiazem

These are the two main drugs in Class IV, used to treat rapid heart rhythms and high blood pressure.

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Negative Inotropic Effect

These drugs decrease the force of heart muscle contraction, which can be a concern in heart failure.

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How do Class IV drugs work?

They block calcium channels, delaying the electrical signals in the heart and slowing its rate.

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Class IV: Good for what?

They are effective against arrhythmias (irregular heartbeats) and angina (chest pain).

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Class IV: Not for everyone

These drugs are not suitable for people with severe heart failure, heart block, or pregnant women.

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Class IV: Interactions

They can interact with other medications, potentially increasing their effects or causing problems.

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Adverse Effects

Class IV drugs can cause dizziness, fatigue, low blood pressure, heart failure, and other side effects.

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Dosage Titration

Start with a small dose and increase gradually to find the best amount needed to control the arrhythmia.

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Nursing Considerations

Nurses should monitor patients closely for signs of complications, especially when starting or adjusting the dosage.

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Study Notes

NCMA 216: Pharmacology - Drugs Affecting the Cardiovascular System

  • The course covers drugs affecting the cardiovascular system, including the anatomy and physiology of the cardiovascular system, common cardiovascular disorders, and various medications for management and treatment.
  • Learning objectives include understanding the physiology of the cardiovascular system, identifying common disorders affecting the cardiovascular system, and determining appropriate pharmacological treatments and nursing responsibilities during drug therapy.
  • Students will learn to use various medications for cardiovascular disorders, and appropriate pharmacological treatment and nursing responsibilities during drug therapy for patients with problems in cardiovascular function.
  • The cardiovascular system delivers oxygen and nutrients to all body cells and removes waste products.
  • It consists of the heart, blood vessels, and blood.

Review of the Anatomy and Physiology of the Cardiovascular System

  • The heart is a hollow, muscular organ that pumps oxygenated blood to the body's cells and collects waste products from the tissues.
  • The heart is divided into four chambers: the atria (upper) and the ventricles (lower).
  • The right side of the heart receives deoxygenated blood from the body and sends it to the lungs.
  • The left side of the heart receives oxygenated blood from the lungs and pumps it to the body.
  • Blood vessels (arteries, veins, and capillaries) carry blood to and from the heart.
  • Arteries carry blood away from the heart, veins carry blood toward the heart, and capillaries facilitate exchange between blood and body tissues.
  • The heart has four valves: the mitral, tricuspid, aortic, and pulmonary valves, which regulate blood flow.

Cardiac Cycle

  • The cardiac cycle involves the contraction (systole) and relaxation (diastole) of the heart chambers.
  • Deoxygenated blood enters the right atrium, then flows through the tricuspid valve to the right ventricle, then through the pulmonary valve to the pulmonary arteries and to the lungs.
  • Oxygenated blood from the lungs goes to the left atrium, then flows through the mitral valve to the left ventricle, then through the aortic valve to the aorta and to the rest of the body.

Cardiac Conduction System

  • The cardiac conduction system is responsible for initiating and conducting the electrical impulses that control the heart's rhythmic contractions.
  • This system includes the sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, and Purkinje fibers.
  • The SA node is the heart's natural pacemaker, generating electrical impulses that initiate contractions in the atria.
  • The AV node slows the impulse transmission, allowing the atria to contract completely before the ventricles contract.
  • The bundle of His and Purkinje fibers rapidly conduct the impulse to the ventricles, causing them to contract.

Blood Pressure

  • Blood flow occurs from higher to lower pressure areas.
  • The left ventricle maintains high pressure, and the right atrium has low pressure.
  • The brain and hormones control the maintenance of blood pressure
  • Hypertension is high blood pressure, and hypotension is low blood pressure
  • Hypertensive crisis is severely high blood pressure, and shock is severely low blood pressure.
  • Elements of Mean Arterial Pressure (MAP) are heart rate, stroke volume, and total peripheral resistance (PVR).

Drugs Affecting Blood Pressure

  • Drugs affecting blood pressure can be categorized into ACE inhibitors, ARBs, calcium channel blockers, vasodilators, renin inhibitors, diuretics, and sympatholytics.
  • Specific examples of each class of drugs are listed in the document.

The Renin-Angiotensin-Aldosterone System (RAAS)

  • RAAS is a hormonal system that regulates blood pressure and fluid balance.
  • The system is activated when blood pressure decreases in the kidneys
  • The role of the kidneys is constant perfusion; to help ensure blood flow is maintained
  • Key medications in this system are mentioned in the notes.

Hypertension

  • Hypertension is diagnosed when blood pressure is consistently above the normal limits.
  • Risk factors include increased age, smoking, high salt diet, low physical activity, obesity, and chronic diseases.
  • Key classifications and categories of hypertension are noted in the notes.

Hypotension

  • Hypotension occurs when blood pressure becomes dangerously low.
  • Causes may include positional shifts, a high carb diet, standing for a long time, and emotional responses.
  • Remedies and treatments to address hypotension are in these notes.

Antihypertensive Drugs

  • A list of antihypertensive drugs is included in the document, categorized by class (ACE inhibitors, ARBs, etc.).

Blood Pressure - Sympathetic Nervous System

  • The sympathetic nervous system regulates blood pressure through stimulating the heart and blood vessels.
  • Parasympathetic branch has the opposite effect to lower blood pressure
  • Specific agents are included in the notes

Blood Pressure - Raising Agents

  • Include midodrine and droxidopa.

Drugs for Heart Failure

  • Heart failure is a condition where the heart cannot pump blood effectively around the body.
  • This can lead to congestion in the lungs or other areas of the body.
  • Various medications, general measures and device therapies can be used to treat heart failure are noted in the notes.
  • It includes Cardiac Glycosides, like Digoxin and Phosphodiesterase Inhibitors, like Milrinone.

Drugs affecting Arrhythmia

  • Arrhythmias are irregularities in the heart's rhythm.
  • Drugs categorized by classes (Class I - IV) and actions are described here.

Drugs for Angina

  • Angina is chest pain caused by reduced blood flow to the heart muscles.
  • The document provides details about the different types of angina, risk factors, mechanism, and treatment.

Drugs affecting Blood Coagulation

  • Details of blood coagulation, thromboembolic disorders, hemorrhagic disorders, and relevant drugs are included.
  • This section also covers mechanisms of blood coagulation, and nursing considerations.

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Drugs Affecting Cardiovascular System PDF

Description

This quiz focuses on the pharmacology of drugs affecting the cardiovascular system. It covers the anatomy and physiology of the cardiovascular system, common disorders, and pharmacological treatments along with nursing responsibilities. Students will deepen their understanding of managing cardiovascular conditions through medication.

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