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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

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1
Q

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

A

Pheochromocytoma

By blocking the action of catecholamines

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2
Q

What are the side effects of alpha 2 receptor blockade?

A

Reflex tachycardia
Orthostatic hypotension

May have unrecognized volume depletion

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3
Q

The cholinomimetic side effects of alpha 2 blockade are?

A

Hyperperistalsis
Abdominal pain
Diarrhea

They can be treated by atropine/glyco

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4
Q

Unopposed stimulation of beta receptors may lead to

A

Hypotension

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5
Q

Side effects of nonselective beta antagonists are

A

Bronchospasm

CHF

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6
Q

What’s a nonselective beta antagonist?

A

Propranolol

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7
Q

Side effects of beta 1 selective anatgonists?

A

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

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8
Q

Beta antagonists are used to

A

Reduce myocardial O2 demand

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9
Q

Which drugs are beta 1 selective antagonists?

A

Metoprolol
Atenolol
Carvedilol
Esmolol

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10
Q

Short acting beta 1 selective antagonist?

A

Esmolol

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11
Q

What is the a:b ratio of labetalol?

A

1:7

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12
Q

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

A

Reflex tachycardia

Bradycardia

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13
Q

Alpha 1 antagonism decreases

A

Peripheral vascular resistance

Renin

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14
Q

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

A

Centrally acting alpha 2 agonist
Sympathetic output
Pre synaptic

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15
Q

Discontinuation of clonidine can lead to

A

Rebound hypertension

Treat with vasodilator

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16
Q

Other uses of clonidine

A

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

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17
Q

Hydralazine directly causes vascular

A 
Smooth muscle relaxation
Reflex tachycardia (May also have a direct effect on heart rate)
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18
Q

Hydralazine causes more relaxation of arterioles or veins?

A

Arterioles

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19
Q

Hydralazine decrease systolic pressure more or less than diastolic pressure?

A

Less than

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20
Q

The effects of hydralazine start in

A

10-20 min

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21
Q

The duration of hydralazine is unpredictable and lasts

A

3-6 hours

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22
Q

Dose of hydralazine

A

2.5-10 mg/kg

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23
Q

Hydralazine is metabolized in the ____ and excreted

A

Liver

Renally

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24
Minoxidil is an _____ medication with action like hydralazine that is used for the most severe forms of
Oral | Hypertenstion (causes reflex tachycardia)
25
Other side effects of minoxidil are
Fluid retention Edema Pericardial effusion
26
What is hypertrichosis and what can cause it?
Abnormal amount of hair growth on the body | Minoxidil
27
Nitrates deliver ___ vascular smooth muscle to cause
Nitric oxide | Vasodilation
28
NO release is part of normal endothelial function and aids in
Auto regulation
29
What drug increases the local availability of endogenous NO?
Sildenafil (Viagra)
30
How do nitrates affect platelet function?
Inhibit activation/aggregation/adhesion
31
What is a possible explanation for vasospasm after subarachnoid hemorrhage?
Nitrates are rapidly inactivated by hemoglobin
32
Inhaled NO is a ___________ that bronchodilates and improves
Selective pulmonary vasodilator | V/Q matching
33
Inhaled nitric oxide is used to treat
Pulm HTN, persistent HTN of newborn, adult respiratory distress syndrome / acute lung injury
34
NO combines with Hgb to form
Met-Hgb
35
Commonly used oral nitrate for prevention of angina pectoris
``` Isosorbide mononitrate (Imdur) Dinitrate ```
36
What is a side effect of isosorbide mononitrate or dinitrate?
Orthostatic hypotension
37
Nitroglycerin releases NO through _______. It causes mainly
Glutathione-dependent pathway | Venous dilation
38
What are some uses of nitroglycerin?
Controlled hypotension (less potent than SNP) Cerebral vasodilation Uterine relaxation
39
What are side effects of cerebral vasodilation?
Increased ICP and CBP | Headache
40
What dose of nitroglycerin can be used for uterine relaxation?
50-100 mcg IV bolus
41
How likely is the risk of methemoglobinemia with nitroglycerin? How is it treated?
Rare because of rapid hepatic metabolism | Methylene blue
42
How is nitroglycerin administered?
Sublingually/transmucosally (first pass effect) Transdermally Increases coronary perfusion to ischemic subendocardium
43
What is given for angina pectoris?
0.3 mg SL nitroglycerin or | 2% ointment
44
IV dose of NTG? How fast does tolerance develop?
0.5-2 mcg/kg/min | Within 24 hrs of sustained treatment
45
What is one concern of dosing NTG by IV?
Potential for absorption if drug into plastic tubing
46
How does sodium nitroprusside lower BP?
Direct venous and arterial vasodilation Used for controlled hypotension, hypertensive emergencies, cardiac disease
47
T or F. SNP does not cause reflex tachycardia.
False
48
Which nitrate attenuated hypoxic pulmonary vasoconstriction?
SNP But has potential for coronary steal syndrome
49
Concentration and dose of SNP?
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
The onset of SNP is almost _____ and its duration is
Instant | 1-10 min
51
Why should SNP be wrapped in foil or black plastic?
Breaks down in light
52
When using SNP, what should be used concurrently?
Continuous arterial BP monitoring
53
What is the max dose of SNP for short term compared to long term use?
10 mcg/kg/min under ten min | 2 mcg/kg/min long term
54
The use of SNP can cause
CN toxicity The CN needs to be sequestered
55
Normally, ___ of Hb is met-Hb. CN can bind Hb to form ____, which dissociates to form more
1% Cyanmet-Hb Met-Hb
56
The liver and kidneys convert CN to ________ by _______. This process requires a sulfur donor, usually
Thiocyanate By rhodanese enzyme Thiosulfate
57
An adverse effect of using SNP is ______, especially with hepatic dysfunction
Cyanide toxicity
58
T or F. If you have suspicion of cyanide toxicity, wait for lab results before treating.
False, treat early
59
An early sign of cyanide toxicity is ___ due to the inactivation of _____. The uncoupling of ______ inhibits cellular respiration which leads to ______ and lactate formation.
Acidosis (may need NaHCO3 to treat) Cytochrome oxidase Mitochondrial oxidative phosphorylation Anaerobic metabolism
60
CN can reduce the affinity of
O2 to Hb
61
What are the other signs of cyanide toxicity?
Tachycardia Change in mental status Seizures HTN (tachyphylaxis)
62
How would you treat CN tox?
STOP nitroprusside Cyanide buffers: sodium nitrate IV or inhaled amyl nitrate THEN sodium thiosulfate IV Vitamin B12a (hydroxocobalamin)
63
How does sodium nitrate or amyl nitrate work? What indicates that there is no further need for nitrate therapy?
Converts around 10% of Hb to met-Hb which sequesters CN | More than 10% met-Hb indicates no further need
64
What is the role of sodium thiosulfate in CN toxicity treatment?
Allows rhodanese to continue converting CN to thiocyanate, which is then excreted renally
65
VitB12a chelates CN to form _____, which is excreted
Vit B12 | Renally
66
The first line therapy for systemic hypertension or CHF which can reverse ____ and improve outcomes in
Angiotensin Converting Enzyme Inhibitors (ACEIs) LV hypertrophy Diabetics
67
How do ACEIs reduce Na and water retention?
Decrease plasma aldosterone Refer to the renin-angiotension-aldosterone pathway
68
ACEIs are free from many common side effects of other hypertensive agents such as
Depression Insomnia Sexual dysfunction Electrolyte imbalances
69
Examples of ACEIs
Enalapril (vasotec) Quinapril (accupril) Lisinopril (zestril) Ramipril (altace)
70
ACEIs can cause bradykinin accumulation which produces what side effects?
Cough | Allergic like symptoms
71
Decrease in aldosterone can cause what effects?
HYPERKALEMIA | Reduced Na and water retention
72
An allergy to ACEIs presents as
Angiodema
73
Prolonged hypotension observed under GA with ACEIs may require ____ if unresponsive to fluid bolus or sympathomimetic
Vasopressin Consider holding medication for 24+ hrs before surgery
74
Angiotensin II receptor blockers (ARBS) act _____ in the renin-angiotensin-aldosterone pathway to inhibit the hypertensive effect of angiotensin II. Example?
Later | Losartan (cozaar)
75
ARBs can cause _____ especially of used together with K-sparing
Hyperkalemia | Diuretics
76
ARBs are similar to ACEIs but with less incidence of _____. They should be _____ prior to major surgery
Cough | Discontinued
77
Losartan and its active metabolites are metabolized by the
Liver
78
Which antihypertensives or vasodilators can cause reflex tachycardia?
Alpha antagonists SNP Hydralazine

Pharmacology II for Anesthesia (7 decks)

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