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DNURS 836 Advanced Pharmacology for Anesthesia II > Anti-Hypertensives, Negative Inotropes & Chronotropes - Quiz 2 > Flashcards

Anti-Hypertensives, Negative Inotropes & Chronotropes - Quiz 2 Flashcards

1
Q

What factors might cause Peri-Operative HTN?

A

Increased Sympathetic Discharge

Light Anesthesia

Airway Manipulation

Hypercarbia

Hypoxia

Cross-Clamp

Hypothermia

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2
Q

What diseases might cause Peri-Operative HTN?

A

Pheochromocytoma

Hyperthyroid

MH

Intracranial HTN

Auto Hyperreflexia

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3
Q

What are complications r/t Peri-Operative HTN?

A

CVA

MI

LV & Cognitive Dysfunction

Pulm. Edema

Inc. Suture Tension

Hemorrhage

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4
Q

What can cause HTN Intra-Op?

A

Light Anesthesia

Pain

Thyroid Storm

MH

Hyperthermia

Hypercarbia

Distended Bladder

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5
Q

True or False

Calcium Channel Blockers, Alpha 1 Antagonists, Alpha 2 Agonists, ACE Inhbitors, and Beta-Blockers are ALL vasodilators?

A

False

Beta-Blockers are NOT Vasodilators

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6
Q

What are examples of Alpha-1 Antagonists?

A

Prazosin & Labetalol

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7
Q

Which medications are Alpha-2 Agonists?

A

Clonidine & Alpha-Methyldopa

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8
Q

How does direct smooth muscle dilation work?

A

Intracellular Nitric Oxide - SNP, Nitrates

&

Blockade of Calcium Channels

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9
Q

Captopril & Enalapril belong to which class of Vasodilators?

A

ACE Inhbitors

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10
Q

Dilating the Arteries reduces _______, while Dilating the Veins reduces ________

A

Dilating the Arteries reduces AFTERLOAD, while Dilating the Veins reduces PRELOAD

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11
Q

Why is Nitroglycerine NOT considered a Pure Venodilator?

A

NTG acts primarily on venous system, but ALSO affects arterials

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12
Q

Which medications is considered a Balanced vasodilator?

A

Sodiun Nitroprusside (SNP) - decreases BOTH Preload & Afterload

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13
Q

What are the Hemodynamic Effects of Vasodilators?

A

Reflex Tachycardia

&

Redistribution of Coronary Blood Flow

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14
Q

Why can the Redistribution of Coronary Blood Flow be good AND bad?

A

NTG can improve collateral circulation, but other meds can cause Coronary Steal

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15
Q

Why is maintaining distolic pressure important in the setting of Ischemic Heart Disease?

A

The collateral heart arteries are super dilated & depend on pressure for perfusion

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16
Q

Why is NTG preferred over SNP for Coronary Artery Disease?

A

SNP shunts blood away from Ischemic Zones, while NTG dilates only Conductance vessels and moves more blood to the Ischemic Zones

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17
Q

How does Hydralazine work?

A

Direct Arterial Vasodilator via an increase cGMP

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18
Q

How does Hydralazine affect the Heart?

A

↑HR

↑Contractility

↑SV

↑CO

↑Myocardial O2 Demand - avoid in CAD

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19
Q

How does Hydralazine affect the Kidneys?

A

↑Renin Actiivty

&

↑Fluid Retention

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20
Q

What does Hydralazine do to the Blood Pressure?

A

↓Diastolic BP > Systolic BP

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21
Q

What are complications related to Hydralazine?

A

↑ICP

&

Lupus

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22
Q

What are the CNS effects of Hydralazine?

A

Headache

Dizziness

Tremor

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23
Q

What are the CV side effects of Hydralazine?

A

Palpitations

Angina

Tachycardia

Flushing

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24
Q

What are the GI side effects of Hydralazine?

A

N/V

Anorexia

Abd. Pain

Ileus

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25
Q

How long does it take for Hydralazine to work?

A

30 minutes

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26
Q

How long do the effects of Hydralazine last?

A

PO: 4-6 hrs

IV: 2-6 hrs

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27
Q

The half-life of Hydralazine is ______

A

The half-life of Hydralazine is 3-7 hrs

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28
Q

How does Sodium Nitroprusside & Nitroglycerine work?

A

Via Nitric Oxide Pathway

NO –> Guanalate Cyclase –> GTP –> cGMP –> Relaxation

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29
Q

What are the Cardiac effects of Nitroglycerine?

A

↓Pulm. Vascular Resistance

↓Venous Return

↓Myocardial Oxygen Consumption

Relaxes Coronary Vessels & Spasms

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30
Q

What are the Non-Cardiac effects of Nytroglycerine?

A

Meningeal Vessel Dilation

&

↓Renal Blood FLow

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31
Q

What is the Onset, Duration, and Half-Life of NTG?

A

Onset: 1 min

Duration: 3-5 min

Half-Life: 1-4 min

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32
Q

What are the complications associated w/ Long-Term use of Nitroglycerine?

A

Methemoglobinemia d/t being metabolized by Glutathione NItrate

&

Arterial Tolerance, but NOT Venous

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33
Q

What are the CNS side effects of Nitroglycerine?

A

Headache

Apprehension

Blurred Vision

Vertigo

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34
Q

What are the CV side effects of Nitroglycerine?

A

Postural Hypotension & Syncope

Palpitations

↑HR

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35
Q

When should Nitroglycerine NOT be given?

A

PDE5 Inhibitors

Glaucoma

Head Trauma

Severe Anemia

Hypotension

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36
Q

What are the Disadvantages of using Nitroglycerine?

A

↓DBP

Tachyphylaxis

Intrapulmonary Shunting

Prolonged Bleeding Time

Reflex Tachycardia

Variable Efficacy

Methemoglobinemia

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37
Q

How does Sodium Nitroprusside work?

A

Direct Artery AND Vein Dilator w/ a slight ↑HR

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38
Q

How does Sodium Nitroprusside afffect Cerebral Blood Flow?

A

↑Flow & ↑ICP

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39
Q

How does Sodium Nitroprusside affect the Kidneys?

A

Slight Decrease or No Effect

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40
Q

What happens if Sodium Nitroprusside is abruptly discontinued?

A

Reflex Tachycardia

&

HTN

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41
Q

What does SNP do to Myocardial O2 Demand?

A

Decreases Demand

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42
Q

How long does it take from administration does SNP has its max effect?

A

2-3 min

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43
Q

What is the Onset & Duration of Sodium Nitroprusside?

A

Onset: < 1 min

Duration: 5-10 min

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44
Q

What conditions would make Sodium Nitroprusside contraindicated?

A

Optic Atrophy

Hypovolemia

Compensatory HTN
(AV Shunt; Aortic Coarctation)

Increased ICP

Severe Liver/Kidney Impairment

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45
Q

Which medication has the side effects of Nasal Stuffiness & Increased Creatinine?

A

SNP

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46
Q

What is the big adverse effect from giving > 4mg/kg/min of SNP for more than 2 days?

A

Thiocyanate/Cyanide Toxicity

47
Q

What does Thiocyanate / Cyanide Toxicity look like?

A

Hypotension

Blurred Vision

Fatigue

Metabolic Acidosis

Pink Skin

Absent Reflexes

Distant Heart Sounds

48
Q

What are normal Thiocyanate Levels?

A

6 -29 mcg/mL

49
Q

At what levels of Thiocyanate does it become Toxic and Fatal?

A

Toxic: 35 - 100 mcg/mL

Fatal: > 200 mcg/mL

50
Q

What are normal Cyanide Levels?

A

< 0.2 mcg/mL

&

< 0.4 mcg/mL for smokers

51
Q

At what levels are Cyanide Levels Toxic and Fatal?

A

Toxic: > 2 mcg/mL

Fatal: > 3 mcg/mL

52
Q

How is Cyanide Toxicity treated?

A

100% Oxygen

Correct Acidosis

3% Sodium Nitrite

Sodium Thiosulfate

Hydroxocobalamin (B12)

53
Q

What are the advantages to using Sodium Nitroprusside?

A

Works Immediately

Short Acting

Reduces Cardiac O2 Demand

54
Q

What are the Disadvantages to using Sodium Nitroprusside?

A

Reflex Tachycardia

Intrapulmonary Shunts

Hypotension

Methemoglobinemia

Coronary Steal

Bleeding

Cerebral Vasodilator

55
Q

How does Phenoxybenzamine work?

A

Irreversible Alpha Antagonist - PO Med

56
Q

When is Phenoxybenzamine normally used?

A

Pheochromocytoma

Relieve PVD Ischemia

Improve BPH Flow

57
Q

How can Phenoxybenzamine also Increase HR & CO?

A

Secondary Increase in Norepi

58
Q

Does Phenoxybenzamine cross the Blood Brain Barrier?

59
Q

What is the Half-Life of Phenoxybenzamine?

A

24 Hours w/ a 4 Day Duration of Action - can Upregulate Alpha Receptors

60
Q

How does Phentolamine work?

A

Same as Phenoxybenzamine - Alpha 1 & 2 Antagonist

61
Q

When is Phentolamine used?

A

HTN d/t Pheochromocytoma

HTN d/t Clondine withdrawal

Erectile Dysfunction

Extravasation

62
Q

The class of medications that end in “-osin” are ______

A

The class of medications that end in “-osin” are ALPHA 1 ANTAGONISTS

63
Q

How does Clonidine work?

A

Alpha 2 Agonists that blocks Sympathetic Outflow & Renin Release

64
Q

What is the main consequence of abruptly stopping Clonidine if it’s been taken for the last 6 days?

A

Rebound HTN

65
Q

What does Clonidine do?

A

↓HR

↓BP

↓CO

66
Q

How does Clonidine affect Anesthesia?

A

Reduces Propofol Requirements

&

Shortens Induction Time

67
Q

How does Methyldopa work?

A

Acts as False Transmitter at Alpha 2 Receptors to create a Negative Feedback Loop - so kind of like a Alpha 2 Agonist to reduce Sympathetic Outflow

(Normally used in Pregnancy to treat HTN)

68
Q

What are the side effects of Methyldopa?

A

Sedation

Fluid Retention

Bradycardia

Positve Coombs

Hemolytic Anemia

69
Q

How do ACE Inhibitors work?

A

Arterial Vasodilation - Can be stopped abruptly w/o rebound effects

70
Q

When are ACE Inhibitors used?

A

CHF

Mitral Regurgiation

Post MI

Diabetic Nephroprotection

71
Q

What are the Renal effects of ACE Inhibitors in a Hypertensive patient?

A

↓Renal Vascular Resistance

&

Improves GFR

72
Q

What are the Renal effects of ACE Inhibitors in a Hypotensive patient?

A

↓Renal Function

↓GFR

Hyperkalemia

73
Q

In what setting should ACE Inhibitors be avoided?

A

Severe Kidney Dysfunction

Renal Artery Stenosis

Pregnancy - Fetal death

74
Q

What are side effects of ACE Inhibitors?

A

Cough

Congestion

Rhinorrhea

Angioedema

Hyperkalemia

75
Q

How should ACE Inhibitors & ARBS be managed Peri-Operatively?

A

Hold on day of surgery for Cardiac Cases, but may take for other cases

76
Q

How do NSAIDs affect ACE Inhibitors?

A

↓Anti-Hypertensive Effect

↑Hyperkalemia

↑ARF

77
Q

How do ARBS compare to ACE Inhibitors?

A

Same effects, but w/ less Cough & Angioedema

&

No IV Form

78
Q

How does Aliskiren (Tekturna) work?

A

Direct Renin Inhibitor

79
Q

How does Sacubitril/Valsartan (Entresto) work?

A

Reduces Blood Volume & Vasodilation

80
Q

What are the functions of Calcium?

A

Muscle Contraction

Signal Transudction

Bone Health

Clotting Cascade

81
Q

What are the Primary Effects of Calcium Channel Blockers?

A

Negative Inotrope & Dromotrope

&

Vasodilation

82
Q

Which drugs are Dihydropyridine Calcium Channel Blockers and how do they work?

A

Drugs ending in “-pine”

Pure Arterial Vasodilators w/ minimal Reflex Tachy & Minimal Negative Inotropic & Dromotropic effects

83
Q

Why is Nicardipine (Cardene) favorable for Cardiac O2 Supply/Demand?

A

No Coronary Steal

84
Q

What is the Onset & Duration of Nicardipine (Cardene)?

A

Onset: < 1 min

Duration: 15-20 min

85
Q

What makes Nicardipine (Cardene) useful?

A

Quick & Easy to Titrate

Slower On & Off than SNP

Less BP Swings

No Rebound HTN

Minimal Reflex Tachy

86
Q

What is Clevidipine?

A

IV Dihydropyridine Calcium Channel Blocker that causes Arterioel Vasodilation

87
Q

What are the advantages to using Clevidipine?

A

Clears quicker

More reliable control

No Renal/Hepatic Dose Adjustments

No Myocardial Depression

No Preload Effects

88
Q

When should Clevidipine be avoided?

A

Egg & Soybean Allergies

Pancreatitis

HLD

(Due to Lipid Emulsion - needs continous monitoring)

89
Q

What kind of Calcium Channel Blocker is Verapamil and what are its effects?

A

Phenylalkylamine CCB - Mild Vasodilator, Potent Neg. Inotrope & Dromotrope

90
Q

What conditions would Verapamil be a good choice for treatment?

A

Aortic Stenosis

Tacchyarrythmias

Arterial Vasospams

91
Q

How does Diltiazem (Cardizem), a Benzothiazine, compare to Dihydropyridines & Verapamil?

A

Falls in b/t the two classes w/ less of a neg. intrope effect than verapamil

92
Q

What is the risks of using Diltiazem (Cardizem)?

A

Drug Interactions d/t being a moderate CYP3A4 Inhibitors and a weak CYP2D6 & PGP Inhibitor.

93
Q

Which type of Calcium Channel Blockers Improve Myocardial O2 Balance and which Worsens it?

A

Improves - Verapamil & Diltiazem

Worsens - Dihydropyridines, except Nicardipine

94
Q

How do Calcium Channel Blockers affect Renal Function?

A

No significant benefit or detriment

95
Q

How should Calcium Channel Blockers be managed peri-operatively?

A

Continue taking up to time of surgery

96
Q

How do Calcium Channel Blockers affect Neuromuscular Blockers?

A

Can Potentiate NDNMB effects

97
Q

Which Calcium Channel Blocker reduces gastric emptying?

A

Clevidipine

98
Q

What do Beta Blockers do?

A

↓CO

↓Renin

Do NOT Vasodilate

99
Q

Which meds are the Beta-1 Selective Blockers?

A

Metoprolol

Atenolol

Acebutolol

Bisoprolol

Esmolol

100
Q

Which meds are the Non-Selective Beta Blockers?

A

Propranolol

Nadolol

Timolol

Pindolol

Carteolol

101
Q

Which meds are combined Alpha-1 & Non-Selective Beta Blockers?

A

Carvedilol

&

Labetalol

102
Q

Which commonly used Beta Blockers are Long Acting?

A

Nadolol

&

Atenolol

103
Q

Which commonly used Beta Blockers are Intermediate Acting?

A

Propranolol

&

Metoprolol

104
Q

Which commonly used Beta Blockers are Short Acting?

105
Q

Which Beta Blockers have High Lipophylicity & is more likely to cross BBB?

A

Propranolol

&

Penbutolol

106
Q

Which Beta Blockers have Moderate Lipophylicity?

A

Metoprolol

Coreg

Labetelol

Pindolol

107
Q

What are the Adverse Effects of using Non-Selective Beta Blockers?

A

Vasoconstriction

Worsening PVD

Bronchospasm

108
Q

What are the Adverse Effects of all Beta Blockers?

A

Myocardial Depression

Bradycardia

Asystole

Hyperkalemia in RF

109
Q

What are Beta-Blockers useful for Peri-Operatively?

A

HTN

Tachycardia

Anxiety

SVT

A-Fib/Flutter

Myocardial Protection

110
Q

When are Beta-Blockers Contraindicated?

A

Bradycardia

> 1st Degree Block

Cardiogenic Shock

Raynaud’s

111
Q

What are the indications for Labetalol?

A

Hyperdynamic HTN

Aortic Dissection

SNP Tachyphylaxis

Intracranial HTN

Used for Test Dosing

112
Q

What are the treatments for Beta-Blocker Overdose?

A

Glucagon

Atropine

Beta-1 Agonist

Euglycemic Insulin

IV Lipids

113
Q

When can Labetolol be used for HTN in pregnancy?

A

2nd & 3rd Trimesters - Beta-Blockers during 1st trimester can cause growth retardation

114
Q

How does Labetalol work?

A

Weak Alpha Blocker w/ Weak Non-Selective Beta Block

Negative Inotrope & Chronotrope w/ vasodilation

DNURS 836 Advanced Pharmacology for Anesthesia II (12 decks)

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