Term
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Definition
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Term
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Definition
| Systemic vascular resistance |
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Term
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Definition
| The force of ventricular contraction is proportional to muscle fiber length. As fiber length increases, there is a corresponding increase in contractile force |
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Term
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Definition
insufficient blood supply (ischemia) to the heart
-Ischemic Heart Disease is the number 1 killer in the United States
-Coronary Artery Disease
-Brought upon by hypertension and atherosclerosis (our last lecture!)
-Can result in myocardial infarction
-Potential permanant damage or ultimately death |
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Term
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Definition
medical emergency:
Acute Coronary Syndrome (ACS)
-Unstable Angina
-NSTEMI (elevated troponin)
-STEMI (elevated troponin, ST elevated MI) |
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Term
| Angina drug therapy goals |
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Definition
1) prevent a myocardial infarction
2) prevent myocardial ischemia and anginal pain |
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Term
| nitroglycerin/isosorbide mononitrate |
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Definition
nitrates
MOA: relax vascular smooth muscle; reduces cardiac oxygen demand
Pharmacokinetics: Highly lipid soluble; Oral, sublingual, transdermal, translingual spray, IV,; ointment; Nitroglycerin- extensive first pass effect; Extensive hepatic metabolism
Indications: acute spasm; management of unstable angina; prophylaxis for chronic stable/variant angina
Adverse: Headache!; hypotension (orthostatic hypotension); Reflex tachycardia (counteract with a ßblocker?); Tolerance!
Drug/Drug: PDE-5 inhibitors; Hypertension meds; EtOH
Contraindications: Severe head trauma- Can increase intracranial pressure; PDE-5 Inhibitors; Anemia?- Can worsen oxygenation of tissue |
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Term
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Definition
propranolol (non-selective)/atenolol (selective)
beta-blocker
MOA: Decrease HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart
Indications: Chronic Stable Angina ; NOT for Variant/Prinzmetal Angina; Post M.I.; Hypertension ; Heart failure (only 3 are FDA approved); Dysrhythmias; Less common; Migraines, anxiety
Adverse: Weakness, Diarrhea; Sexual dysfunction (erectile difficulties); Bradycardia; Rebound hypertension (sudden stoppage); Heart failure/pulmonary edema; hyperglycemia*; depression
Contraindications:Asthma/COPD?; severe bradycardia; uncompensated heart failure; Diabetes? |
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Term
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Definition
non-DHP calcium channel blockers
MOA: prevents Ca influx into vascular smooth muscle; Dilates peripheral and cardiac vessels; prevent Ca influx into cardiac tissue
Indications: Hypertension; arrhythmias; angina
Adverse: Headache, dizziness, flushed skin ; peripheral edema; Constipation (verapamil); Bradycardia; Ventricular Arrhythmias |
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Term
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Definition
DHP calcium channel blocker
MOA: prevents Ca influx into vascular smooth muscle; Dilates peripheral and cardiac vessels
Indications: Hypertension; Angina; Delay premature Labor; off label Raynauds Disease; off label Migraine prevention
Adverse: Headache, dizziness, flushed skin; profound hypotension-reflex tachycardia (baroreceptor reflex); peripheral edema
Contra: Heart block; heart failure; hypotension
Drug/drug: the Non-DHPs are CYP3A4 inhibitors, adn the DHPs are simply substrates |
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Term
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Definition
antianginal agents
MOA: Unkown!
Pharm: CYP3A4 substrate
Indications: chronic stable angina
Adverse: Hypertension; QT prolongation; Constipation, Headache, Dizziness, Nausea
Drug/drug: CYP3A4 inhibitors; QT prolongation drugs (ex.
Contra: patients with QT prolongation |
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Term
| Two main types of heart failure |
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Definition
SYSTOLIC- Left Ventricular (LV) systolic dysfunction
DIASTOLIC- Diastolic Heart Failure (preserved LV ejection fraction)
Less common
Combination |
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Term
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Definition
Hypertension
Coronary Artery Disease
Myocardial Infarction
Congenital Heart Disease
Dysrhythmias
Diabetes
Lot more causes |
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Term
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Definition
ACE inhibitors
-enalapril, captopril
Angiotensin II receptor blockers
-losartan
Beta blockers
-carvedilol, metoprolol succinate
Aldosterone antagonists
-eplerenone, spironolactone
B-type natriuretic peptides
-nesiritide
Phosphodiesterase inhibitors
-milrinone
Cardiac glycosides
-digoxin |
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Term
| eplerenone/spironolactone |
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Definition
aldosterone antagonists
MOA: block aldosterone receptors in the heart , kidney and blood vessels
Indications: Eplerenone-Heart failure and hypertension; Spironolactone-Edema , Ascites, Hypokalemia, Hirsutism in women
Adverse: Gynecomastia (spironolactone); Hyperkalemia (muscle cramps, arrhythmias); Frequent urination!; Dizziness,lightheadedness, weakness |
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Term
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Definition
B-type natriuretic peptide
MOA: synthetic B-type natriuretic peptide; diuresis; natriuresis; vasodilation in arteries and veins
Pharm: IV route only
Indications: IV only; acute; last ditch effort; trial found no benefit
Adverse: Hypotension; ventricular tachycardia; Unproven, but suggested renal damage; Dizziness,lightheadedness, weakness |
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Term
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Definition
phosphodiesterase 3 inhibitor
MOA: inhibit PDE breakdown of cAMP, PDE3 found more in heart and vascular smooth muscle; Inodilator-
Indications; severe HF; only for 48 hrs!
Adverse: ventricular dysrhythmias; headache |
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Term
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Definition
Cardiac glycosides
MOA: Positive inotropic drug by inhibiting Na/K ATPase (pump); Negative chronotrope- reduced HR; Negative dromotrope-SA, AV node conduction
Pharm: Positive inotropic drug by inhibiting Na/K ATPase (pump); Negative chronotrope- reduced HR; Negative dromotrope-SA, AV node conduction
Indications: Heart Failure (symptomatic), not found to prolong life, not used as first line therapy!; Dysrhythmias (atrial fibrillation, A.fib)
Adverse: Dysrhthmias!; Anorexia, Nausea, Vomiting; Fatigue; Vision disturbances- yellow tint, "Halos" (Very important adverse***)
Drug/drug: diuretics (increase risk of digoxin dysrhythmias); ACEIs/ARBs (increase K and decrease digoxin response); Sympathomimetics; verapamil; cholestyramine (reduces amount of digoxin absorption). |
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Term
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Definition
unfractionated heparin
MOA: Binds to antithrombin III; indirectly inhibibit thrombin(IIa); Indirectly Inhibits factor Xa; Prevents conversion of fibrinogen to fibrin
Pharm: Large molecule weight and highly polar; Variable tissue and protein binding; IV and subcutaneous routes
Indications: DVT prophylaxis (SC); DVT treatment (therapeutic) (IV); Used as anticoagulant in dialysis, open heart surgery; Disseminated intravascular coagulation; ACS, unstable angina, MI, stroke, lots more
Adverse: Bleeding; Hematoma; Local site injection reaction; Anemia; thrombocytopenia
Monitoring: For IV treatment we measure aPTT or anti-Xa; Spinal/Epidural Hematoma risk
Contra: History of HIT (heparin induced thrombocytopenia); Low platelet count; Recent neurosurgery; Pork allergy- from intestinal mucosa from pigs
Reversal: protamine |
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Term
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Definition
low molecular weight heparin
MOA: Binds to antithrombin III; minimally- indirectly inhibit thrombin(IIa); More selectivity to inhibit Xa compared to heparin
Pharm: Smaller molecular weight; Long half life; Renally eliminated; Subcutaneously route only
Indications: DVT prophylaxis; DVT treatment (therapeutic); ACS, unstable angina, MI, stroke, lots more; Hip/Knee surgery Post op DVT prevention
Adverse: Bleeding; Hematoma; Local site injection reaction; Anemia; thrombocytopenia
Boxed warning: spinal/epidural hematoma
Monitoring: None needed due to its higher selectivity for Xa; Spinal/Epidural Hematoma risk
Contra: History of HIT (heparin induced thrombocytopenia); Low platelet count; Recent neurosurgery; Pork allergy- from intestinal mucosa from pigs
Reversal: protamine |
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Term
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Definition
Vit K antagonist
MOA: Inhibits factors II,VII, IX, X and proteins C&S; Actually inhibits the VKORC1 enzyme
Pharm: Each factor/protein inhibited has a different half life; Oral route only; Highly protein bound
Indications: DVT/PE prophylaxis; DVT/PE treatment ; A.fib stroke prevention; ACS, unstable angina, MI, stroke, lots more
Adverse: Bleeding; S/Sx of bleeding-reduce blood pressure, increased HR, bruises, petechiae, hematoma, black tarry stools, discolored urine, pelvic pain, headache, lumbar pain
Monitoring: Prothrombin time, International Normalized Ratio (PT/INR); INR goal is generally 2-3 (2.5-3.5 heart valve); Genetic testing? VKORC1, CYP enzymes
Contra: Pregnancy (X); lactation
Reversal: Vit K; Kcentra/Feiba (4 factor Prohtrombin Complex Concentrate) |
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Term
| Warfarin drug/drug interactions |
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Definition
Vitamin K containing foods- green leafy vegetables
Most herbals that start with the letter : Ginko,Ginger, Garlic
Lots of antibiotics will increase the anticoagulant effects
Amiodarone, cimetidine, acetaminophen, cholestyramine
LOTS OF DRUG-DRUG INTERACTIONS
1) Drugs that increase anticoagulant effects
2) Drugs that promote bleeding
3) Drugs that decrease anticoagulant effects
To further split up the drug drug interactions
1) Drugs that displace warfarin for protein binding sites
2) Decrease platelet activity
3) Enzyme induction
4) Enzyme inhibition
***Bridging therapy at time of induction.*** |
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Term
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Definition
IV
Direct thrombin inhibitors
MOA: directly inhibit thrombin that is both free and bound
Pharm: argatroban-short half life; extensive liver metabolism; dabigatran-large molecule; pro-drug; renally eliminated
Indications: patients who have developed HIT; Hx of HIT with active PE/DVT; Percutaneous Coronary Intervention (PCI)
Adverse: bleeding; hematuria |
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Term
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Definition
PO
Direct thrombin inhibitors
MOA: directly inhibit thrombin that is both free and bound
Pharm: argatroban-short half life; extensive liver metabolism; dabigatran-large molecule; pro-drug; renally eliminated
Indications: nonvalvular atrial fibrillation (stroke, thrombus prevention); DVT/PE; Canadian labeling: Post Op Hip/Knee thromboembolus prophylaxis
Adverse: Bleeding; GI issues-dyspepsia (abdominal pain, bloating, N/V); GI Ulcer, GERD, esophagitis; Can take with food or a PPI
Box warnings: Sudden stoppage can increase risk for thromboembolic events; Spinal/Epidural Hematoma
Drug/drug: P-glycoprotein inhibitors; P-glycoprotein is a transporter protein in the small intestine
Monitoring: NONE!
Reversal: Praxbind; dialysis can remove 60% of the drug over 3 hours |
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Term
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Definition
Factor Xa inhibitors
MOA: inhibit factor Xa;
Pharm: both are renally eliminated; rivaroxaban- hepatic metabolism via CYP3A4
Indications: Active DVT/PE; DVT prophylaxis; Can be used in history of HIT; ***Not pork-derived***
Adverse: Bleeding; Can still cause thrombocytopenia
Box warning: spinal/epidural hematome
Monitoring: NONE!
Reversal: NONE! |
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Term
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Definition
Factor Xa inhibitors
MOA: inhibit factor Xa;
Pharm: both are renally eliminated; rivaroxaban- hepatic metabolism via CYP3A4
Indications: nonvalvular atrial fibrillation (stroke, thrombus prevention); DVT/PE and future prevention of; Postoperative DVT thromboprophylaxis
Adverse: bleeding
Box warnings: Sudden stoppage can increase risk for thromboembolic events; Spinal/Epidural Hematoma
Drug/drug: P-glycoprotein inhibitors/inducers; CYP3A4 inhibitors/inducers
Monitoring: NONE!
Reversal: NONE! |
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Term
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Definition
platelet antagonist
MOA: Irreversible inactivation of cyclooxygenase; (COX1 > COX2); Inhibits synthesis of thromboxane A2; Inhibits platelet aggregation
Indications: Ischemic Stroke; TIAS; Chronic Stable Angina/Unstable Angina; Coronary Stenting; Acute MI, primary prevention or secondary prevention; Analgesic/Anti-inflammatory; Antipyretic
Adverse: Bleeding (GI Bleed, hemorrhagic stroke); risk vs benefit; tinnitus; Renal; Reyes Syndrome- avoid in children (age<12, esp with viral symptoms |
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