Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology II for Anesthesia > 01 Vasodilators and Antihypertensives > Flashcards

01 Vasodilators and Antihypertensives Flashcards

0
Q

Alpha 2 receptor blockade enhances ___ release, increasing HR

A

NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Alpha antagonists (phentolamine, phenoxybenzamine, prazosin) are sympatholytics used almost exclusively for the treatment of

A

Pheochromocytoma

By blocking the action of catecholamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the side effects of alpha 2 receptor blockade?

A

Reflex tachycardia
Orthostatic hypotension

May have unrecognized volume depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The cholinomimetic side effects of alpha 2 blockade are?

A

Hyperperistalsis
Abdominal pain
Diarrhea

They can be treated by atropine/glyco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Unopposed stimulation of beta receptors may lead to

A

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Side effects of nonselective beta antagonists are

A

Bronchospasm

CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What’s a nonselective beta antagonist?

A

Propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Side effects of beta 1 selective anatgonists?

A

Bradycardia
AV heart block
Hypotension (due to decreased myocardial contractility, HR, renin release)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Beta antagonists are used to

A

Reduce myocardial O2 demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which drugs are beta 1 selective antagonists?

A

Metoprolol
Atenolol
Carvedilol
Esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Short acting beta 1 selective antagonist?

A

Esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the a:b ratio of labetalol?

A

1:7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Labetelol has no _____ but less _______ than with pure beta antagonists

A

Reflex tachycardia

Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Alpha 1 antagonism decreases

A

Peripheral vascular resistance

Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clonidine is a ____ that decreases CNS _____ at _____ alpha 2 receptors

A

Centrally acting alpha 2 agonist
Sympathetic output
Pre synaptic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Discontinuation of clonidine can lead to

A

Rebound hypertension

Treat with vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other uses of clonidine

A

Pre anesthetic medication
Regional anesthesia
Treatment of opioid withdrawal
Post operative shivering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hydralazine directly causes vascular

A 
Smooth muscle relaxation
Reflex tachycardia (May also have a direct effect on heart rate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hydralazine causes more relaxation of arterioles or veins?

A

Arterioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hydralazine decrease systolic pressure more or less than diastolic pressure?

A

Less than

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The effects of hydralazine start in

A

10-20 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The duration of hydralazine is unpredictable and lasts

A

3-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dose of hydralazine

A

2.5-10 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hydralazine is metabolized in the ____ and excreted

A

Liver

Renally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Minoxidil is an _____ medication with action like hydralazine that is used for the most severe forms of

A

Oral

Hypertenstion (causes reflex tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Other side effects of minoxidil are

A

Fluid retention
Edema
Pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is hypertrichosis and what can cause it?

A

Abnormal amount of hair growth on the body

Minoxidil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nitrates deliver ___ vascular smooth muscle to cause

A

Nitric oxide

Vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

NO release is part of normal endothelial function and aids in

A

Auto regulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What drug increases the local availability of endogenous NO?

A

Sildenafil (Viagra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do nitrates affect platelet function?

A

Inhibit activation/aggregation/adhesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a possible explanation for vasospasm after subarachnoid hemorrhage?

A

Nitrates are rapidly inactivated by hemoglobin

32
Q

Inhaled NO is a ___________ that bronchodilates and improves

A

Selective pulmonary vasodilator

V/Q matching

33
Q

Inhaled nitric oxide is used to treat

A

Pulm HTN, persistent HTN of newborn, adult respiratory distress syndrome / acute lung injury

34
Q

NO combines with Hgb to form

A

Met-Hgb

35
Q

Commonly used oral nitrate for prevention of angina pectoris

A 
Isosorbide mononitrate (Imdur)
Dinitrate
36
Q

What is a side effect of isosorbide mononitrate or dinitrate?

A

Orthostatic hypotension

37
Q

Nitroglycerin releases NO through _______. It causes mainly

A

Glutathione-dependent pathway

Venous dilation

38
Q

What are some uses of nitroglycerin?

A

Controlled hypotension (less potent than SNP)
Cerebral vasodilation
Uterine relaxation

39
Q

What are side effects of cerebral vasodilation?

A

Increased ICP and CBP

Headache

40
Q

What dose of nitroglycerin can be used for uterine relaxation?

A

50-100 mcg IV bolus

41
Q

How likely is the risk of methemoglobinemia with nitroglycerin? How is it treated?

A

Rare because of rapid hepatic metabolism

Methylene blue

42
Q

How is nitroglycerin administered?

A

Sublingually/transmucosally (first pass effect)
Transdermally

Increases coronary perfusion to ischemic subendocardium

43
Q

What is given for angina pectoris?

A

0.3 mg SL nitroglycerin or

2% ointment

44
Q

IV dose of NTG? How fast does tolerance develop?

A

0.5-2 mcg/kg/min

Within 24 hrs of sustained treatment

45
Q

What is one concern of dosing NTG by IV?

A

Potential for absorption if drug into plastic tubing

46
Q

How does sodium nitroprusside lower BP?

A

Direct venous and arterial vasodilation

Used for controlled hypotension, hypertensive emergencies, cardiac disease

47
Q

T or F. SNP does not cause reflex tachycardia.

A

False

48
Q

Which nitrate attenuated hypoxic pulmonary vasoconstriction?

A

SNP

But has potential for coronary steal syndrome

49
Q

Concentration and dose of SNP?

A

50 mg/250 mL = 200 mg/mL = same as NTG

0.3-0.5 mcg/kg/min = ~10 mL/hr (good rule of thumb)

50
Q

The onset of SNP is almost _____ and its duration is

A

Instant

1-10 min

51
Q

Why should SNP be wrapped in foil or black plastic?

A

Breaks down in light

52
Q

When using SNP, what should be used concurrently?

A

Continuous arterial BP monitoring

53
Q

What is the max dose of SNP for short term compared to long term use?

A

10 mcg/kg/min under ten min

2 mcg/kg/min long term

54
Q

The use of SNP can cause

A

CN toxicity

The CN needs to be sequestered

55
Q

Normally, ___ of Hb is met-Hb. CN can bind Hb to form ____, which dissociates to form more

A

1%
Cyanmet-Hb
Met-Hb

56
Q

The liver and kidneys convert CN to ________ by _______. This process requires a sulfur donor, usually

A

Thiocyanate
By rhodanese enzyme
Thiosulfate

57
Q

An adverse effect of using SNP is ______, especially with hepatic dysfunction

A

Cyanide toxicity

58
Q

T or F. If you have suspicion of cyanide toxicity, wait for lab results before treating.

A

False, treat early

59
Q

An early sign of cyanide toxicity is ___ due to the inactivation of _____. The uncoupling of ______ inhibits cellular respiration which leads to ______ and lactate formation.

A

Acidosis (may need NaHCO3 to treat)
Cytochrome oxidase
Mitochondrial oxidative phosphorylation
Anaerobic metabolism

60
Q

CN can reduce the affinity of

A

O2 to Hb

61
Q

What are the other signs of cyanide toxicity?

A

Tachycardia
Change in mental status
Seizures
HTN (tachyphylaxis)

62
Q

How would you treat CN tox?

A

STOP nitroprusside
Cyanide buffers: sodium nitrate IV or inhaled amyl nitrate
THEN sodium thiosulfate IV
Vitamin B12a (hydroxocobalamin)

63
Q

How does sodium nitrate or amyl nitrate work? What indicates that there is no further need for nitrate therapy?

A

Converts around 10% of Hb to met-Hb which sequesters CN

More than 10% met-Hb indicates no further need

64
Q

What is the role of sodium thiosulfate in CN toxicity treatment?

A

Allows rhodanese to continue converting CN to thiocyanate, which is then excreted renally

65
Q

VitB12a chelates CN to form _____, which is excreted

A

Vit B12

Renally

66
Q

The first line therapy for systemic hypertension or CHF which can reverse ____ and improve outcomes in

A

Angiotensin Converting Enzyme Inhibitors (ACEIs)
LV hypertrophy
Diabetics

67
Q

How do ACEIs reduce Na and water retention?

A

Decrease plasma aldosterone

Refer to the renin-angiotension-aldosterone pathway

68
Q

ACEIs are free from many common side effects of other hypertensive agents such as

A

Depression
Insomnia
Sexual dysfunction
Electrolyte imbalances

69
Q

Examples of ACEIs

A

Enalapril (vasotec)
Quinapril (accupril)
Lisinopril (zestril)
Ramipril (altace)

70
Q

ACEIs can cause bradykinin accumulation which produces what side effects?

A

Cough

Allergic like symptoms

71
Q

Decrease in aldosterone can cause what effects?

A

HYPERKALEMIA

Reduced Na and water retention

72
Q

An allergy to ACEIs presents as

A

Angiodema

73
Q

Prolonged hypotension observed under GA with ACEIs may require ____ if unresponsive to fluid bolus or sympathomimetic

A

Vasopressin

Consider holding medication for 24+ hrs before surgery

74
Q

Angiotensin II receptor blockers (ARBS) act _____ in the renin-angiotensin-aldosterone pathway to inhibit the hypertensive effect of angiotensin II. Example?

A

Later

Losartan (cozaar)

75
Q

ARBs can cause _____ especially of used together with K-sparing

A

Hyperkalemia

Diuretics

76
Q

ARBs are similar to ACEIs but with less incidence of _____. They should be _____ prior to major surgery

A

Cough

Discontinued

77
Q

Losartan and its active metabolites are metabolized by the

A

Liver

78
Q

Which antihypertensives or vasodilators can cause reflex tachycardia?

A

Alpha antagonists
SNP
Hydralazine

Pharmacology II for Anesthesia (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions