HTN, Angina, HF

cdunbar4's version from 2017-10-10 17:40

Drugs for HTN (some used for Angina, MI as well)

Question Answer
1st line choice for HTN; mild-mod HTN, mod heart/liver/renal failurehydrocholorthiazide (thiazide diuretics)
Main NCs hydrocholorthiazideK loss (need supplements); ortho hypoTN
Anuria and people with gout shouldn't take which HTN drug?thiazides; could exacerbate gout; Also, mothers shouldn't breastfeed
spironolactone used forreducing edema r/t HF, nephrotic syndrome, or liver disease
K Sparing Diuretics less effective than others, modest diuresis, increased rf hyperK
K sparing diuretics are CI in renal failure; watch administration with other drugs that increase K
s/s hyperkalemia muscles weakness, parasthesia, diarrhea, dysrhythmia, colicky pain
furosemide (Lasix)most effective in getting BP down, but not good for maintenance
conditions furosemide is used for edema, HF, cirrhosis, CKD, acute pulmonary edema, HTN
All SE of furosemide are related to fluid loss and potential elyte imbalance: monitor BP and I/O!; monitor labs (esp. K); watch for hyperC6 in DM; can cause ototoxicity
CCB that act on arteriolesnifidepine
CCBs that act on arterioles and heartverapamil and dilitiazem
CCBs MOAblocks Ca channels in cardiac and arteriole smooth muscle → limits contractions which results in a ↓PR = ↓BP
NC CCBs: SE's r/t vasodilation: hypoTN, dizzy, h//a; GRAPEFRUIT helps enhance absorption
Herbal interactions CCBsmelatonin and nifedipine; hawthorne and verapamil
enalapril, lisinoprilACE inhibitors: 1st line choice for HTN & HF; & ↓RF MI/CVA, delays renal disease & retinopathy in DM
losartan, valsartanARBs; similar to ACE inhibitors
3 main SE of ACE/ARBsortho hypoTN (usu 1st dose); serious SE: angioedema (throat/tongue); annoying SE: dry cough (↓s adherence)
doxazosin and atenolol belong to which drug class?adrenergic antagonists for HTN, angina, dysrhythmias, MI prophylaxis, selective or nonselective
hydralazine & nitroprusside belong to which drug class?direct vasodilators
Serious SE of hydralazine or nitroprussidereflex tachycardia d/t hr compensating from lowered BP: h/a, palps, flushin, nausea, diarrhea
Hydralazine and nitroprusside CI in which conditionslupus, CVD, rheumatic HD, Monitor BP/HR closely during HTN crisis

Angina Pectoris & MI

Question Answer
organic nitratesnitroglycerin: dilate veins to decrease O2 demand
nitroglycerin usesdecrease pain of EXERTIONAL angina (short acting/acute attacks)
Nitro also is used to assist in the diagnosis of what? Other uses?Myocardial Infarction: it is given IV for 24 hours after onset for persistent pain, HF, or severe HTN to relieve myocardial O2 demand or coronary spasm
Most serious SE nitroHYPOTN, also reflex tachycardia. Hold if BP <90/60 or pulse >100
Common adverse effect nitro?tolerance and can be serious; develops with large doses or ongoing use; develops quickly, but also reverts quickly
Contraindications NITRO (think about condition in which vasodilation would be detrimentalIncreased ICP, Glaucoma; also CI in use with sildenafil (life-threatening hypoTN and CV collapse
Drug of choice for vasospastic anginaCalcium channel blockers, dilitizem
Thrombolytics: reteplase used DURING anacute MI via IV route
Heparin or warfarin for first 48 hours following an MI?heparin first then switched to warfarin OR LMWH. Aspirin is also given ASAP with an MI & afterwards for antiplatelet action
MONA acronym for interventions of MIMorphine, Oxygen, Nitro, Aspirin

Heart Failure

Question Answer
1st line choice drug class usedACE inhibitors as they slow progression of HF, dilate veins which decrease pulmonary congestion & peripheral edema
Other drug classes used for HFdiuretics (increase UO/reduce fluid overload, may exacerbate gout, monitor K loss)
B-adrenergic antagonists: reverse remodeling, CI with digoxin, insulin, CCBs. D/C slowly d/t thyroid storm
Vasodilatorshydralazine, nitroprusside: Can cause reflex tachycardia d/t direct dilation of vessels
vasodilators CI in which conditionslupus, CVD, rheumatic HD
Cardiac glycoside: DIGOXIN MOArelieves s/s, limited to patients unresponsive to ACE Inhibitors or HF pts with afib
ANTIDOTE Digoxindigibine
Dig toxicity symptomsanorexia, n/v diarrhea, visual disturbances, wt. gain over 2lbs in 2 days. Watch for fluid retention and edema


Question Answer
Class I Na Channel Blockersprocainmide: prolongs refractory period, suppresses opening of Na channels to slow apical pulse so ectopic areas are suppressed
Class II Beta Adrenergic Blockerspropranolol: delays refractory period/narrow therapeutic window
Class III K Channel Blockersamiodarone: delays refractory period, blocks K channels in myocardial cells
AE amiodaronepulmonary toxicity (can be fatal)
CI amiodaroneiodine sensitivity & other CV conditions