A condition in which there is a less-than-normal amount of red blood cells and/or a less-than-normal amount of hemoglobin.
Anemia
What is the general action of the antianemic class of drugs?
Darbepoetin and epoetin stimulate production of red blood cells.
Nandrolone stimulates the production of erythropoetin.
True or false: Antianemics should be used cautiously in patients with peptic ulcers.
True.
What are the most frequent side effects of the antianemics?
nausea, vomitting, constipation, diarrhea, abdominal pain, hypertension, hypotension, red urine.
Liquid preparations of _____ may stain teeth: they are diluted in a full glass of water or fruit juice for adults, and a half glass for children. How should they drink the preparation?
Antianemics
Drink with a straw or place drops at the back of the throat.
Why must the hemoglobin level of patients on antianemics be monitored?
Hemoglobin levels > 12 g/dL increase the chance of arrhythmias, MI, stroke, and heart failure, as well as seizures, tumor growth, and death.
True or False: Patients on antianemics who begin passing stools that are dark green or black should seek immediate treatment due to a possible life-threatening side effect.
False. Stools of the patient taking antianemics may be dark green or black, and this is harmless.
Why do antianemics turn urine very yellow or very red?
Iron supplements in the antianemics turn urine intensely yellow.
Cyancobalamin and hydroxocobalamin will turn urine red.
Why is combination pharmacotherapy often used in the treatment of anemia?
Because of the infreqency of solitary vitamin deficiencies.
What should be avoided within 1 hour after administration of ferrous salts? Why?
Iron absorption is decreased by 33% if iron and calcium are given with meals.
If a patient needs both iron and calcium supplementation, how should the health care provider go about providing these?
Calcium carbonate does not absorb iron salts if supplements are given between meals.
What types of drugs are considered antianginals?
Nitrates
Calcium Channel Blockers
Beta Blockers
_____ dilate coronary arteries and cause systemic vasodilation. This _____ (increases/decreases) _______ (preload/ afterload).
Nitrates
decreases preload
_____ dilate coronary arteries, and some also slow heart rate.
Calcium channel blockers
_____ lower myocardial oxygen consumption via a decrease in heart rate.
Beta Blockers
True or False: Pharmacotherapy with antianginals may involve combinations of different drugs in order to minimize side effects or adverse reactions.
True
What antianginals are used to treat and prevent attacks of angina and may be used in the acute treatment of attacks of angina pectoris?
Nitrates
True or False: Only Beta Blockers and Calcium Channel Blockers are effective in treating acute attacks of angina.
False: Only nitrates are effective in an acute attack.
What antianginals are used prophylactically in the long term management of angina pectoris? How do they work?
Calcium Channel Blockers and Beta Blockers
They act on blood pressure and heart rate.
What are the common side effects of antianginal drugs?
Fatigue
Weakness
Peripheral Edema
What drinks should patients taking antianginals avoid?
Excessive amounts of coffee, tea, cola, and large amounts of grapefruit juice.
True or False: If a patient on an antianginal experiences a headache, the dose should be altered.
False. Headaches are a common side effect and should decrease in frequency with continuation of therapy. Asprin or acetaminophen may be ordered to treat Headaches.
Why should a patient on Antianginals have their intake and output monitored, along with daily weights?
Necessary in order to assess for evidence of fluid overload, heart failure.
A patient is on antianginal pharmacotherapy for chest pain and experiences trouble breathing, has wheezing, and is dizzy. What should the nurse do?
Notify health care provider.
What class of drugs is used to treat various forms of anxiety, including GAD?
Antianxiety agents
True or False: Antianxiety agents are only meant to be used in short term treatment of the condition.
False: The antianxiety agents include medications intended for both intermittent or short term use and long term use.
True or False: Benzodiazepines have no analgesic properties.
True
What is the general action of the antianxiety agents?
Most cause CNS depression
What therapeutic class of drugs are used for a variety of effects having to due with depression of the CNS: including treatment of muscle spasms and procedural sedation?
Antianxiety agents
What are the most common side effects of the antianxiety agents?
True or false: when administering medications that fall into the therapeutic category of "antianxiety agents" via IV, resuscitation equipment should always be available.
True
What may happen to a patient if you administer antianxiety agents too quickly IV?
apnea, hypotension, bradycardia, cardiac arrest.
True or False: Antianxiety agents may induce withdrawl effects if discontinued abruptly.
True. Therefore, when discontinuing the medication, the dose should be tapered to avoid withdrawl reactions.
What functional drug classes are considered antianxiety agents?
Antidepressants
Antiseizure drugs
Benzodiazepines
Beta Adrenergic Agonists
Nonbarbituate and Nonbenzodiazepine CNS depressants
True or False: Prolonged high dose therapy of antianxiety agents may result in physical or psychological dependance.
True
This therapeutic class of drugs suppresses cardiac arrythmias.
Antiarrhythmics
Arrhythmias arising from the ____ may cause symptoms but are not life threatening. In contrast, arrhythmias arising from the _____ can be fatal.
atria
ventricle
Folic Acid, Iron salts, and Vitamin B12 are all medications that may be used in the treatment of _____.
Anemia.
What classes of drugs are considered antiarrhymics?
Class 1a-c: Sodium Channel Blockers
Class 2: Beta Adrenergic Blockers
Class 3: Potassium Channel blockers
Class 4: Calcium Channel blockers
Misc:
The Cardiac Glycoside Digoxin
Adenosine
What are the PO instructions for administering an Antiarrhythmic?
1 hr before or 2 hours after meals. Administration with food, especially milk or milk products, reduces absorption by approximately 20%.
True or False: Its best to administer Antiarrhythmics with milk.
False. Antiarrhytmics should not be taken with milk or food because this reduces their absorption by 20%
What can happen if a patient abruptly stops taking antiarrhymic medication?
life threatening arrhythmias, hypertension, or MI.
True or false: Grapefruit juice should be avoided by patients on antiarrhythmic medications.
True.
Bluish discoloration of the face, neck and arms is likely to occur with prolonged pharmacotherapy involving ______. What action should the patient take? Is the color permanent?
Antiarrhythmics
Notify health-care provider
No; it is usually reversible and will fade over several months.
True or False: Side effects of antiarrhythmics may occur several days, weeks, or even years after the initiation of therapy and may persist for several months after withdrawl.
True
What effect do antiarrhymics have on temperature regulation?
They impair temperature regulation; therefore extremes of heat and cold should be avoided.
What male-specific side effect may warrant a decrease in the dose of antiarrhythmic medication prescribed?
Epididymitis (pain and swelling in scrotum)
What are the first signs of toxicity in infants and children that are taking antiarrhythmics?
changes in heart rate: especially bradycardia.
True or False: Patients taking antiarrhythmics should be monitored for signs of ARDS.
True
How does a health care provider go about choosing an antiarrhythmic agent for a patient?
The choice depends on etiology of the arrythmia and the individual patient characteristics.
____ are abnormalities of electrical conduction that may result in alterations in heart rate or cardiac rhythm.
Arrhythmias (Dysrhythmias)
Diagnosis of _____ is often difficult because patients often must be conncected to an electrocardiograph (ECG) and be experiencing symptoms in order to determine the exact type of ____ disorder.
Arrhythmia (Dysrhythmia)
rhythm
What are typical symptoms of a cardiac arrhythmia? What are typical patient reports of the way their heart feels?
dizziness, weakness, decreased exercise tolerance, shortness of breath, and fainting
Patients may report palpitations or a sensation that their heart has skipped a beat.
True or False: Severe arrhythmias may result in sudden death
True.
What is the simplest method for classifying dysrhythmias?
The type of rhythm abnormality and the location
Arrhythmias that originate in the atria
Supraventricular.
Name 9 diseases or health associations commonly associated with dysrhythmias.
HTN
Cardiac Valve Disease (ie mitral stenosis)
Coronary Artery Disease
Medications such as Digoxin
Low potassium levels in the blood
MI
Stroke
Diabetes Mellitus
Congestive Heart Failure
There are many types of arrhythmias, but all have in common a defect in what?
The generation or conduction of electrical impulses across the myocardium. These action potentials carry the signal for cardiac muscle cells to contract and are precisely coordinated for the chambers to beat in a synchronized manner.
What structure is known as the pacemaker of the heart and why?
The sinoatrial (SA) node. It has a property called automaticity, the ability of certain cells to spontaneously generate an action potential.
The SA node generates a new action potential approximately 75 times per minute under resting conditions, with a normal range of 60 to 100 bears per minute. This is referred to as the normal ___________.
Sinus Rhythm.
On leaving the SA node, where does the action potential that produces heart beats go?
The atrioventricular (AV) node
True or False: If the SA node malfunctions, the AV node gan generate action potentials and continue the hearts contraction at a rate of 40 to 60 beats per minute.
True
Why is impulse conduction through the AV node slow compared with other areas in the heart?
In order to allow atrial contraction enough time to completely empty blood in the the ventricles, thereby optimizing cardiac output.
How does the heart generate contractions if the SA and AV nodes both fail?
The AV bundle (bundle of His) and Purkinjie fibers will generate myocardial contractions at about 30 beats per minute.
When areas of the heart other than the SA node begin to generate action potentials, these areas are known as what? Why can they be problematic?
ectopic foci or ectopic pacemakers.
Their impulses may compete with those from the normal conduction pathway.
Define Tachycardia (Atrial or Ventricular). Which type is more serious?
Rapid heartbeat greater than 100 bpm in adults.
Ventricular tachycardia is more serious.
Define flutter (Atrial or Ventricular) and the clinical action taken for both types of flutter.
Rapid, regular heartbeats; may range between 200-300 bpm.
Atrial may require treatment but is not usually fatal.
Ventricular requires immediate treatment
What is Heart Block?
Area of nonconduction in the myocardium; may be partial or complete; classified as first, second, or third degree.
Atrial or Ventricular Fibrillation
Very rapid, uncoordinated beats; complete disorganization of rhythm resulting in a lack of adequate cardiac contraction; requires immediate treatment.
Premature atrial or premature ventricular contractions (PVCs)?
An extra beat often originating from a source other than the SA node; not normally serious unless it occurs in high frequency.
Sinus bradycardia
Slow heartbeat, less than 60 beats per minute; may require a pacemaker.
At what point do patients suffering from dysrythmias need to start pharmacotherapy for the problem?
Only when the condition cannot be controlled by other means; these drugs can cause serious adverse effects.
The waves of electrical activity across the myocardium can be measured using the _______.
electrocardiograph.
What three distinct waves are produced by a normal EKG? What do they record?
True or False: Most antidysrrhythmic drugs act by interfering with myocardial action potentials.
True.
Under resting conditions, what two ions are found in higher concentrations outside of the myocardial cells?
Na+ and Ca2+
Under resting conditions, what ion is found in higher concentration inside the myocardial cells?
K+
In regards to the heart: On the cellular level, when does an action potential begin? What happens to the charge of the cell? Describe the roles of both Na+ and Ca+
An action potential begins when sodium ion channels locted in the plasma membrane open and Na+ rushes into the cell.
This produces a rapid depolarization. Ca2+ enters the cell through calcium ion channels during this time, and this is the signal for the release of additional intracellular calcium.
What ion is directly responsible for the contraction of the cardiac muscle? Describe why.
Ca2+. During depolarization, Ca2+ enters the cell through calcium ion channels and signals a release in intracellular calcium that causes the contraction of the cardiac muscle.
During depolarization, the inside of the plasma membrane temporarily reverses its charge, become _______.
positive.
In general, After depolarization, how does a cell return to its polarized state?
The removal of Na+ from the cells via the sodium pump and the movement of K+ back into the cell through potassium ion channels`
How is the process of depolarization different for the SA and AV nodes of the heart?
In cells located in the SA and AV nodes, it is the influx of Ca2+ rather than Na+ that generates the rapid depolarization of the membrane.
What is the primary pharmacologic strategy used to prevent or terminate arrhythmias?
Blocking sodium, potassium or calcium channels.
Explain how class I antidysrhythmics work. (Where in the process of contraction do they act?)
Class I: Sodium channel blockers
They act to prevent sodium influx to the cell, thus preventing depolarization. The spread of the action potential across the membrane will slow, and areas of ectopic pacemaker activity will be suppressed.
What two classes of antidysrythmics act to prevent muscle contraction after depolarization has already started?
Class II: Beta Adrenergic Blockers
Class IV: Calcium Channel Blockers
Depolarization has already started because these two drugs do not affect sodium influx.
Class III antiarrythmics affect which part of the process of contraction?
Class III: Potassium Channel Blockers
They delay repolarization of the myocardial cells and lengthen the refractory period, which tends to stabilize dysrhythmias.
Antiarrythmics act by altering specific electrophysiological properties of the heart. They do this by what two basic mechanisms?
Blocking flow through ion channels (Conduction)
Altering autonomic activity (Automaticity)
True or False: Research studies have shown that the use of antidysrythmic medication for prophylaxis can actually increase patient mortality.
Explain why this is True or False
True
There is a narrow margin between a therapeutic effect and a toxic affect with drugs that affect cardiac rhythm. They have the ability not only to correct dysrythmias but also to woesen or even create new ones.
Prodysrythmic effects of Class I antiarrythmics has resulted in increased use of what two classes of drugs? What drug specifically is used most often?
Class II (Beta-Adrenergic Blockers) and Class III (Potassium Channel Blockers)
Amiodarone (Potassium Channel Blocker)
Why are Class I antiarrythmics divided into 3 subgroups? What does each subgroup signify?
They are divided into three subgroups based on subtle differences in their mechanisms of action.
Class 1A: Delays repolarizaion, slows conduction velocity, increases duration of action potential
Class 1B: Accelerates repolarization, slows conduction velocity, decreases duration of action potential.
Class 1C: Slows conduction velocity
Which class of Antiarrythmics are similar in structs and action to local anesthetics?
Sodium channel Blockers -- Class I.
In fact, lidocaine is a sodium channel blocker that is used as a local anesthetic.
An EKG indicating sodium blocker toxicity would display what?
Increases in PR and QT intervals and widening of QRS complex.
True or False: No sodium channel blockers have the potential to create new arrythmias or worsen existing ones. That is why they are frequently used.
False
All the sodium channel blockers can cause new dysrythmias or worsen existing ones. For that reason, they are rarely used.
Class I antiarrythmics tend to have anticholinergic side effects, like what?
dry mouth, constipation, urinary retention.
____ are Class II antidysrhythmics and are widely used for other cardiovascular disorders as well , including hypertension, MI, heart failure.
Beta-Adrenergic Antagonists, aka Beta Blockers
What cardiovascular disorders might beta blockers be used to treat?
hypertension
MI
heart failure
dysrythmia
____ slow the heart rate and and decrease conduction velocity through the AV node. Myocardial automaticity is reduced, and many types of dysrythmias are stabilized.
Beta Blockers
How do Beta Blockers exert their effects?
Primarily by blockade of calcium ion channels in the SA and AV nodes, although these drugs also block sodium ion channels in the atria and ventricles
What is the main value of beta blockers as antiarrythmic agents?
To treat atrial dysrythmias associated with heart failure.
In post-MI patients, ______ decrease the likelihood of sudden death due to their antidysrhythmic effects.
Beta blockers
Blockade of beta receptors in the heart may cause what adverse effects?
Bradycardia
Hypotension
Dizziness
Abrupt discontinuation of beta blockers can lead to _____ and _______.
Arrythmias and hypertension
These Class III antidysrhythmic drugs prolong the duration of the action potential and reduce automaticity.
Potassium Channel blockers.
True or False: Amiodarone can produce pulmonary toxicity in a significant number of patients.
True
Like the beta blockers, the antidysrhythmic _______ are prescribed for various cardiovascular disorders.
Calcium Channel Blockers
True or False: A few CCBs (calcium channel blockers) block calcium channels in both the heart and arterioles while the remainder are specific to calcium channels in the vascular smooth muscle.
True
Calcium channel blockers exert effects on the heart similar to what other antiarrythmic?
Beta Blockers
Calcium channel blockers are only affective against what kind of dysrhythmia?
Supraventricular (Atrial) dysrhythmias
Digoxin is primarily used to treat_____ but may be used to treat certain types of ______ arrythmias.
heart failure
Atrial
How does digoxin exert its effects on arrhythmias?
Decreases automaticity of the SA node and slows conduction through the AV node.
Digoxin falls into the functional class of _______.
Cardiac glycosides
Why should patients on digoxin be monitored closely?
Excessive levels of digoxin can produce dysrhythmias
Interactions with other medications are common
The process of red blood cell formation is called _______.
Hematopoiesis
Hematopoeisis occurs primarily where? What does it require?
Red bone marrow; B vitamins, Vitamin C, copper and iron
Hematopoeisis is responsive to the demands of the body:
white blood cells can increase to ____ times normal in response to _____ and red blood cells can increase as much as _____ times normal in response to _______.
10; infection
5; hypoxia
The process of red blood cell formation and hemoglobin production is regulated primarily by the hormone ______. What organ secretes this hormone?
Erythropoietin
Kidney
Pharmacologically, what are the most important substances controlling leukopoeisis? What do they do?
Colony stimulating factors (CSFs)
Stimulate the growth and differentiation of one or more types of leukocytes.
What is the goal of pharmacotherapy with colony stimulating factors (CSFs)
To produce a rapid increase in the number of neutrophils in patients who have suppressed immune systems.
CSF therapy shortens the length of time that patients are susceptible to _____ due to low numbers of neutrophils.
life-threatening infection
What is the name for the condition of having low numbers of neutrophils? How is this condition treated?
Neutropenia
With colony-stimulating factors
What application do CSFs have in relation to drug therapy for cancer patients?
By raising neutrophil counts, CSFs can assist in keeping antineoplastic dosing regiments on schedule (and more effective).
The production of platelets, called _____, begins with what cell in the bone marrow?
Thrombocytopoiesis
The megakaryocyte, which starts shedding membrane pound packets that enter the blood stream and become platelets.
Megakaryocyte activity is controlled by _____, which is secreted by what organ?
Thrombopoietin
Liver
What 3 biological conditions cause anemia?
Erythrocyte loss due to hemorrhage
Increased Erythrocyte destruction
Impaired Erythrocyte production
True or False: Only plants can synthesize vitamin B12.
False: Only bacteria can synthesize vitamin B12.
The most profound consequence of Vitamin B12 deficiency is _____ anemia.
Pernicious; also called megaloblastic.
What is the most common cause of Vitamin B12 deficiency?
Absence of intrinsic factor, which is secreted by the stomach and required for Vitamin B12 to be absorbed.
True or False: Vitamin B12 is absorbed in the intestine.
True. Although intrinsic factor, which is required for the absorption of Vitamin B12, is secreted in the stomach, Vitamin B12 is absorbed in the intestine.
Inflammatory diseases of the stomach or surgical removal of the stomach may result in deficiency of________.
Intrinsic factor
What is the characteristic appearance of the erythrocytes of a person suffering from pernicious anemia?
They are abnormally large and they do not fully mature
What drug is used in the pharmacotherapy of pernicious anemia?
Cyancobalamin, a form of vitamin B12.
What vitamin deficiency is linked to B12 deficiency?
Folic acid (Folate)
Because free iron is toxic to the body, what protein complexes exist biologically to bind iron?
Ferritin
Hemosiderin
Transferrin
What is the most common nutritional cause of anemia?
Iron deficiency
More than 50% of patients diagnosed with iron deficiency anemia have _____. This is characteristic of what disease processes?
GI bleeding
GI malignancies or chronic peptic ulcer disease.
Mild iron deficiency anemia may be corrected how?
By increasing the intake of iron-rich foods, such as fish, red meat, fortified cereal, and whole grain breads.
What foods are rich in iron?
Fish
Red meat
Fortified Cereal
Whole Grain Breads
How is more severe iron deficiency anemia treated?
Iron supplements, including:
Ferrous sulfate
Ferrous gluconate
Ferrousd fumarate
Why do many iron supplements contain vitamin C?
Iron oxidizes vitamin C
Vitamin C is believed to enhance Iron absorption
What drug is commonly prescribed to treat thrombocytopenia?
oprelvekin (Neumega)
What is oprelvekin (Neumega)? What does it do?
Platelet enhancer
It enhances platelet production
oprelvekin (Neumega) is functionally equivalent to _____. What does this substance do in the body?
interleukin-11
It is secreted by monocytes and lymphocytes and signals the cells in the immune system to respond to an infection.
What is the hardest working organ in the body?
The heart
True or False: Coronary Artery Disease (CAD) is one of the leading causes of mortality in the United States.
True
The primary defining characteristic of ______ is narrowing or occlusion (obstruction) of a coronary artery.
Coronary Artery Disease
The narrowing of coronary arteries characteristic of CAD deprives cells of needed oxygen and nutrients, resulting in a condition called ______.
Myocardial Ischemia
As long as the coronary occlusion or narrowing occurs over time, as much as ______ of more of the coronary artery may be occluded and cause no symptoms. Why?
50%
The heard may compensate for its inadequate blood supply
As chronic CAD progresses, the myocardium does not receive enough oxygen to meet the metabolic demands of the heart, and symptoms of __a___ begin to appear. Further more, persistent myocardial ischemia, as has just been described, may lead to __b___.
a. Angina
b. MI
What is the most common cause of CAD in adults?
Atherosclerosis: the presence of plaque-- a fatty, fibrous material within the walls of the coronary arteries.
What affect to arterial placques characteristic of Atherosclerosis have on normal vessel elasticity? What can result from this change?
Impairs normal vessel elasticity
The coronary vessel is unable to dilate properly when the myocardium needs additional blood or oxygen, such as during periods of exercise.
____ is acute chest pain caused by insufficient oxygen to a portion of the myocardium.
Angina Pectoris
True or False: Angina Pectoris is more prevalent in those under 55 years of age.
False
It is more prevalent in those over 55 years of age.
What is the classic presentation of angina pectoris?
A steady, intense pain in the anterior chest, sometimes accompanied by a crushing or constricting sensation.
True or False: The pain of angina is experienced only in the chest area.
False: the discomfort may radiate to the left shoulder and proceed down the left arm and it may extend posterior to the thoracic spine or move upward to the jaw. In some patients, the pain is experienced in the abdominal area.
True or False: Woman tend to experience different symptoms from men during Angina Pectoris.
True: Women may present with gastric distress, nausea, vomitting, a burning sensation in the chest or chest wall, overwhelming fatigue, and sweating.
What precipitates angina pain?
Physical exertion or emotional excitement
Events associated with increased myocardial oxygen demand.
Angina pectoris episodes are usually of _____ duration. What can help the pain subside?
short (5-10 minute)
physical rest
stress reduction
Angina pain often parallels the symptomology of a _____. Why is it important to be able to differentiate between the two?
Myocardial infarction
The pharmacologic interventions for the two differ considerably
MI is fatal while Angina is not
True or False: Gallstones and biliary diease may present with symptoms mimicking Angina.
True.
Many diseases can cause chest pain characteristic of angina pectoris. Others include peptic ulcers, GERD, pneumonia and musculoskeletal injuries.
Various drug classes are used to treat angina pectoris, but they may be placed in what two basic, practical categories?
What general mechanism of action do antianginals assert their effects?
Those that terminate an acute angina episode in progress
Those that decrease the frequency of angina episodes
Reducing the myocardial need for oxygen
What are the four ways in which antianginals may reduce myocardial demand for oxygen?
Slowing the heart rate
Dilating veins so the heart received less blood (reduced preload)
Causing the heart to contract with less force (reduced contractility)
Lowering blood pressure, thus offering the heart less resistance when ejecting blood from its chambers (reduced afterload)
The pharmacotherapy of angina uses what three classes of drugs?
Beta blockers (Beta-adrenergic antagonists)
Calcium Channel Blockers
Organic Nitrates
What are the drugs of choice for relieving an acute angina episode?
Rapid-acting organic nitrates
What are the drugs of choice for preventing angina pain?
Beta blockers, although calcium channel blockers are used when beta blockers are not well tolerated by the patient.
What is the mechanism of nitrates in relation to relieving angina pain?
Nitrates dilate the veins, reducing the amount of blood returning to the heart (preload_
They also dilate the coronary arteries, bringing more blood to the myocardium.
The primary therapeutic action of the ____ is the ability to relax both arterial and venous smooth muscle.
Organic nitrates
True or False: Tolerance may develop with short acting nitrates, but is not a problem with long-acting nitrates.
False: Tolerance is a common and potentially serious problem with the long-acting nitrates, not the short acting nitrates.
In addition to being used for the treatment of angina, long-acting organic nitrates may also be used in the treatment of what disease?
Heart Failure
How rapidly can tolerance to long-acting nitrates develop?
As quickly as 24 hours after beginning of pharmacotherapy.
True or False: Tolerance to Nitrates disappears when the medication is withheld.
True
How do beta blockers help in the treatment of angina?
They reduce the cardiac workload by slowing the heart rate and reducing contractility.
What antianginals are ideal for patients with both HTN and CAD?
beta blockers; they have antihypertensive action
True or False: Beta blockers have efficacy equal to organic nitrates when it comes to decreasing the severity and frequency of angina episodes caused by exertion.
True
How do CCBs (Calcium Channel Blockers) help to relieve angina?
They relax arteriolar smooth muscle, thus lowing blood pressure and reducing the afterload of the heart. Some also slow the conduction velocity through the heart, decreasing the heart rate and contributing to the reduced cardiac workload.
What is the primary cause of MI?
Coronary Artery Disease (CAD)
Explain how CAD due to atherosclerosis can cause an MI.
Pieces of unstable plaque in the arteries can break off and lodge in a small vessel serving a portion of the myocardium. Exposed plaque activates the coagulation cascade, resulting in platelet aggrevation and adherence. A new clot quickly forms on the existing plaque, making obstruction of the vessel imminent.
What are the pharmacologic goals for treating a patient with an MI (5)? What agents are used for each goal?
Restore blood supply to damaged myocardium (thrombolytics)
Control or prevent MI associated arrhythmias with beta blockers or other dysrhythmics
Reduce post MI mortality with aspirin, beta blockers, and ACE inhibitors
Manage severe MI pain and associated anxiety with narcotic analgesis.
Quick restoration of cardiac circulation with _____ medications reduces mortality casued by acute MI.
Thrombolytics.
In the treatment of an acute MI: after the clot is successfully dissolved using ______, what therapy is initiated to prevent the formation of additional clots?
Thrombolytics
Anticoagulants
Thrombolytics are most effective in the treatment of acute MI when administered in what time frame? At what point do they become ineffective?
20 minutes to 12 hours.
After 24 hours.
True or False: Thrombolytics have a wide margin of safety between dissolving clots and producing serious adverse effects.
False: they have a narrow margin of safety
The primary risk of thrombolytics is what?
excessive bleeding due to interference with the normal clotting process.
True or False: During the administration of Thrombolytic agents, vital signs must be monitored continuously: any signs of bleeding call for discontinuation of therapy. Stopping the infusion will rapidly terminate adverse effects.
True
What are the most immediate needs of the MI patient?
To ensure the heart continues functioning
To ensure permanent damage from the infarction is minimized.
Unless contraindicated, how much aspirin is given as soon as an MI is suspected?
160 -325 mg
Why is aspirin given to patients experiencing an MI?
It dramatically reduces the mortality, probably due to its antiplatelet action (helps prevent blood clots).
On diagnosis of MI in the emergency room, patients are immediatly placed on what drug to prevent additional thrombi from forming?
Heparin (an anticoagulant)
How long is heparin therapy continued for someone who has just had an MI? What medication are they then switched to?
48 hours
warfarin (Coumadin) or low molecular weight heparin (Lovenox)
What drug class is administered to the patient suffering from chest pain to assist in differentiating MI and angina? How is this done?
Organic nitrates
At the initial onset of chest pain, sublingual nitroglycerin is administered to assist in the diagnosis. Three doses may be taken 5 minutes apart. Pain that persists 5 to 10 minutes after initial dose may indicate MI.
True or False: Beta blockers can reduce the mortality associated with MI if taken within 8 hours of the onset of symptoms.
True.
Beta blockers reduce myocardial oxygen demand, which is crirical for patients experiencing a recent MI.
True or False: Patients who have suffered an MI will likely be on beta blocker therapy for the rest of their lives.
True.
What is the most common type of anxiety?
Generalized Anxiety Disorder (GAD)
_____ is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity.
Panic disorder
_____ are fearful feelings attached to situations or objects.
Phobias
common ones include: snakes, spiders, crowds, and heights
A fear of crowds
Social anxiety
Recurrent, intrusive thoughts or repetitive behaviors that interfere with normal activities or relationships.
Obsessive compulsive disorder
A type of situational anxiety that develops in response to re-experiencing a previous life event.
PTSD: Post traumatic stress disorder
War, physical or sexual abuse, natural disaster, murder
What part of the brain is responsible for both anxiety and wakefulness?
Reticular formation
When is pharmacotherapy indicated for patients suffering from anxiety?
When anxiety becomes severe enough to significantly interfere with daily activities of life.
Anxiolytics include drugs from which therapeutic categories (6) ?
____ is a condition characterized by a patient's inability to fall asleep or remain asleep.
Insomnia
CNS depressants are known as ____; at higher doses, they are called _____.
sedatives; hypnotics
True or False: The term tranquilizer is used to describe a drug with the ability to produce a calming effect at lower doses and the ability to induce sleep at higher doses.
False:
This described a sedative-hypnotic.
Tranquilizer is an older term, sometimes used to describe a drug that produces a calm or tranquil feeling.
Antidepressants are sometimes used to treat anxiety. What pharmacological classes are included in this category of drugs?
Tricyclic antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Monoamine Oxidase Inhibitors (MAOIs)
Atypical Antidepressants (including SNRIs)
What Antidepressants are considered first line in the treatment of depression? What anxiety disorders do they effectively treat?
SSRIs
OCD and phobias
What antidepressant should be avoided in patients with a history of heart attack, heart block, or arrhythmia?
TCAs
What antidepressant has common, anticholinergic effects such as dry mouth, blurred vision, and urine retention?
TCAs
What class of antidepressants is the safest? What kind of side effects do they have?
SSRIs.
Although less common than other classes, they have some sympathomimetic side effects (increased heart rate and HTN) and some anticholinergic effects.
True or False: SSRIs can cause weight gain and sexual dysfunction.
True
The ____ are drugs of choice for various anxiety disorders and for insomnia.
Benzodiazepines
Why are barbituates rarely prescribed to treat insomnia (4)?
Significant adverse effects
The availability of more effective medications
The risk for physical and psychological dependance is high (schedule II drugs)
Withdrawl syndrome is severe and can be fatal
In regards to barbituates:
low doses do what?
Moderate doses have what effects?
Higher doses do what?
Low doses: reduce anxiety and cause drowsines
Moderate doses: inhibit seizure activity and promote sleep (inhibit brain impulses traveling through limbic and RLS)
High doses: induce anesthesia
True or False: Barbiturates stimulate microsomal enzymes in the liver that metabolize medications, thus stimulating their own metabolism as well as other drugs that use these enzymes for their breakdown.
True
True or False: When taking barbiturates for an extended period of time, cross tolerance to other CNS depressants, such as the opoids, can develop.
True
What schedule are benzodiazepines in? How do they compare to barbituates in terms of risk for dependance and tolerance?
They are schedule IV drugs
They are considerably less likely to produce physical dependance and tolerance than barbiturates
How do benzodiazepines act?
By binding to the GABA receptor chloride channel molecule, thus enhancing the effect of GABA, a naturally inhibitory neurotransmitter found throughout the brain.
True or False: Benzodiazepines can produce life threatening respiratory depression or coma if taken in excessive amounts, and death is likely.
False: Benzodiazepines do not produce these effects, and death is unlikely inless they are taken in large quanitites in combination with other CNS depressants, OR if patient suffers from sleep apnea.
Although benzodiazepines increase total sleep time, some reduce stage ___ sleep and some effect ___ sleep.
IV
REM
Aside from the treatment of anxiety and insomnia, what other uses have made benzodiazepines one of the most widely prescribed drug classes?
Treatment of alcohol withdrawl symptoms
Central muscle relaxation
Induction agents in general anesthesia
Treatment of Seizure disorders
A hypertensive crisis can result from an interaction between MAOIs and foods containing ______. Why?
Tyramine.
Tyramine is usually degraded by MAO in the intestines; if a patient takes MAOIs, however, tyramine enters the blood stream in high concentrations and replaces norepinephrine within presynaptic terminals: the result is a sudden release of norepinephrine, which causes acute HTN.
What common foods do patients taking MAOIs need to avoid (10)?Why?
Cheese,
chocolate
beer
yogurt
bananas
soy sauce
pepperoni
hot dogs
raisins
avocados.
All of these foods contain Tyramine
Author
Anonymous
ID
152198
Card Set
Pharmacology: characteristics of drug classes, Part 1
Description
Characteristics of drug classes
Antianemics (28)
Antianginals (25)
Antianxiety agents (14)
Antiarrhythmics (26)
