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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
How long does it take for Hydralazine to work?
30 minutes
26
How long do the effects of Hydralazine last?
PO: 4-6 hrs IV: 2-6 hrs
27
The half-life of Hydralazine is \_\_\_\_\_\_
The half-life of Hydralazine is **3-7 hrs**
28
How does Sodium Nitroprusside & Nitroglycerine work?
**Via Nitric Oxide Pathway** NO --\> Guanalate Cyclase --\> GTP --\> cGMP --\> Relaxation
29
What are the Cardiac effects of Nitroglycerine?
↓Pulm. Vascular Resistance ↓Venous Return ↓Myocardial Oxygen Consumption Relaxes Coronary Vessels & Spasms
30
What are the Non-Cardiac effects of Nytroglycerine?
Meningeal Vessel Dilation & ↓Renal Blood FLow
31
What is the Onset, Duration, and Half-Life of NTG?
**Onset**: 1 min **Duration**: 3-5 min **Half-Life**: 1-4 min
32
What are the complications associated w/ Long-Term use of Nitroglycerine?
Methemoglobinemia d/t being metabolized by Glutathione NItrate & Arterial Tolerance, but NOT Venous
33
What are the CNS side effects of Nitroglycerine?
**Headache** Apprehension Blurred Vision Vertigo
34
What are the CV side effects of Nitroglycerine?
Postural Hypotension & Syncope Palpitations ↑HR
35
When should Nitroglycerine NOT be given?
PDE5 Inhibitors Glaucoma Head Trauma Severe Anemia Hypotension
36
What are the Disadvantages of using Nitroglycerine?
↓DBP Tachyphylaxis Intrapulmonary Shunting Prolonged Bleeding Time Reflex Tachycardia Variable Efficacy Methemoglobinemia
37
How does Sodium Nitroprusside work?
Direct Artery AND Vein Dilator w/ a slight ↑HR
38
How does Sodium Nitroprusside afffect Cerebral Blood Flow?
↑Flow & ↑ICP
39
How does Sodium Nitroprusside affect the Kidneys?
Slight Decrease or No Effect
40
What happens if Sodium Nitroprusside is abruptly discontinued?
Reflex Tachycardia & HTN
41
What does SNP do to Myocardial O2 Demand?
Decreases Demand
42
How long does it take from administration does SNP has its max effect?
2-3 min
43
What is the Onset & Duration of Sodium Nitroprusside?
**Onset**: \< 1 min **Duration**: 5-10 min
44
What conditions would make Sodium Nitroprusside contraindicated?
Optic Atrophy Hypovolemia Compensatory HTN (AV Shunt; Aortic Coarctation) Increased ICP Severe Liver/Kidney Impairment
45
Which medication has the side effects of Nasal Stuffiness & Increased Creatinine?
SNP
46
What is the big adverse effect from giving \> 4mg/kg/min of SNP for more than 2 days?
Thiocyanate/Cyanide Toxicity
47
What does Thiocyanate / Cyanide Toxicity look like?
Hypotension Blurred Vision Fatigue Metabolic Acidosis Pink Skin Absent Reflexes Distant Heart Sounds
48
What are normal Thiocyanate Levels?
6 -29 mcg/mL
49
At what levels of Thiocyanate does it become Toxic and Fatal?
**Toxic**: 35 - 100 mcg/mL **Fatal**: \> 200 mcg/mL
50
What are normal Cyanide Levels?
\< 0.2 mcg/mL & \< 0.4 mcg/mL for smokers
51
At what levels are Cyanide Levels Toxic and Fatal?
**Toxic**: \> 2 mcg/mL **Fatal**: \> 3 mcg/mL
52
How is Cyanide Toxicity treated?
100% Oxygen Correct Acidosis 3% Sodium Nitrite Sodium Thiosulfate Hydroxocobalamin (B12)
53
What are the advantages to using Sodium Nitroprusside?
Works Immediately Short Acting Reduces Cardiac O2 Demand
54
What are the Disadvantages to using Sodium Nitroprusside?
Reflex Tachycardia Intrapulmonary Shunts Hypotension Methemoglobinemia Coronary Steal Bleeding Cerebral Vasodilator
55
How does Phenoxybenzamine work?
Irreversible Alpha Antagonist - PO Med
56
When is Phenoxybenzamine normally used?
Pheochromocytoma Relieve PVD Ischemia Improve BPH Flow
57
How can Phenoxybenzamine also Increase HR & CO?
Secondary Increase in Norepi
58
Does Phenoxybenzamine cross the Blood Brain Barrier?
Yes
59
What is the Half-Life of Phenoxybenzamine?
24 Hours w/ a 4 Day Duration of Action - can Upregulate Alpha Receptors
60
How does Phentolamine work?
Same as Phenoxybenzamine - Alpha 1 & 2 Antagonist
61
When is Phentolamine used?
HTN d/t Pheochromocytoma HTN d/t Clondine withdrawal Erectile Dysfunction Extravasation
62
The class of medications that end in "-osin" are \_\_\_\_\_\_
The class of medications that end in "-osin" are **ALPHA 1 ANTAGONISTS**
63
How does Clonidine work?
Alpha 2 Agonists that blocks Sympathetic Outflow & Renin Release
64
What is the main consequence of abruptly stopping Clonidine if it's been taken for the last 6 days?
Rebound HTN
65
What does Clonidine do?
↓HR ↓BP ↓CO
66
How does Clonidine affect Anesthesia?
Reduces Propofol Requirements & Shortens Induction Time
67
How does Methyldopa work?
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
What are the side effects of Methyldopa?
Sedation Fluid Retention Bradycardia Positve Coombs Hemolytic Anemia
69
How do ACE Inhibitors work?
Arterial Vasodilation - Can be stopped abruptly w/o rebound effects
70
When are ACE Inhibitors used?
CHF Mitral Regurgiation Post MI Diabetic Nephroprotection
71
What are the Renal effects of ACE Inhibitors in a **Hypertensive** patient?
↓Renal Vascular Resistance & Improves GFR
72
What are the Renal effects of ACE Inhibitors in a **Hypotensive** patient?
↓Renal Function ↓GFR Hyperkalemia
73
In what setting should ACE Inhibitors be avoided?
Severe Kidney Dysfunction Renal Artery Stenosis **Pregnancy** - Fetal death
74
What are side effects of ACE Inhibitors?
Cough Congestion Rhinorrhea Angioedema Hyperkalemia
75
How should ACE Inhibitors & ARBS be managed Peri-Operatively?
Hold on day of surgery for Cardiac Cases, but may take for other cases
76
How do NSAIDs affect ACE Inhibitors?
↓Anti-Hypertensive Effect ↑Hyperkalemia ↑ARF
77
How do ARBS compare to ACE Inhibitors?
Same effects, but w/ less Cough & Angioedema & No IV Form
78
How does Aliskiren (Tekturna) work?
Direct Renin Inhibitor
79
How does Sacubitril/Valsartan (Entresto) work?
Reduces Blood Volume & Vasodilation
80
What are the functions of Calcium?
Muscle Contraction Signal Transudction Bone Health Clotting Cascade
81
What are the Primary Effects of Calcium Channel Blockers?
Negative Inotrope & Dromotrope & Vasodilation
82
Which drugs are Dihydropyridine Calcium Channel Blockers and how do they work?
Drugs ending in "-pine" Pure Arterial Vasodilators w/ minimal Reflex Tachy & Minimal Negative Inotropic & Dromotropic effects
83
Why is Nicardipine (Cardene) favorable for Cardiac O2 Supply/Demand?
No Coronary Steal
84
What is the Onset & Duration of Nicardipine (Cardene)?
**Onset**: \< 1 min **Duration**: 15-20 min
85
What makes Nicardipine (Cardene) useful?
Quick & Easy to Titrate Slower On & Off than SNP Less BP Swings No Rebound HTN Minimal Reflex Tachy
86
What is Clevidipine?
IV Dihydropyridine Calcium Channel Blocker that causes Arterioel Vasodilation
87
What are the advantages to using Clevidipine?
Clears quicker More reliable control No Renal/Hepatic Dose Adjustments No Myocardial Depression No Preload Effects
88
When should Clevidipine be avoided?
Egg & Soybean Allergies Pancreatitis HLD (Due to Lipid Emulsion - needs continous monitoring)
89
What kind of Calcium Channel Blocker is Verapamil and what are its effects?
Phenylalkylamine CCB - Mild Vasodilator, Potent Neg. Inotrope & Dromotrope
90
What conditions would Verapamil be a good choice for treatment?
Aortic Stenosis Tacchyarrythmias Arterial Vasospams
91
How does Diltiazem (Cardizem), a Benzothiazine, compare to Dihydropyridines & Verapamil?
Falls in b/t the two classes w/ less of a neg. intrope effect than verapamil
92
What is the risks of using Diltiazem (Cardizem)?
Drug Interactions d/t being a moderate CYP3A4 Inhibitors and a weak CYP2D6 & PGP Inhibitor.
93
Which type of Calcium Channel Blockers Improve Myocardial O2 Balance and which Worsens it?
**Improves** - Verapamil & Diltiazem **Worsens** - Dihydropyridines, except Nicardipine
94
How do Calcium Channel Blockers affect Renal Function?
No significant benefit or detriment
95
How should Calcium Channel Blockers be managed peri-operatively?
Continue taking up to time of surgery
96
How do Calcium Channel Blockers affect Neuromuscular Blockers?
Can Potentiate NDNMB effects
97
Which Calcium Channel Blocker reduces gastric emptying?
Clevidipine
98
What do Beta Blockers do?
↓CO ↓Renin Do NOT Vasodilate
99
Which meds are the Beta-1 Selective Blockers?
Metoprolol Atenolol Acebutolol Bisoprolol Esmolol
100
Which meds are the Non-Selective Beta Blockers?
Propranolol Nadolol Timolol Pindolol Carteolol
101
Which meds are combined Alpha-1 & Non-Selective Beta Blockers?
Carvedilol & Labetalol
102
Which commonly used Beta Blockers are Long Acting?
Nadolol & Atenolol
103
Which commonly used Beta Blockers are Intermediate Acting?
Propranolol & Metoprolol
104
Which commonly used Beta Blockers are Short Acting?
Esmolol
105
Which Beta Blockers have High Lipophylicity & is more likely to cross BBB?
Propranolol & Penbutolol
106
Which Beta Blockers have Moderate Lipophylicity?
Metoprolol Coreg Labetelol Pindolol
107
What are the Adverse Effects of using Non-Selective Beta Blockers?
Vasoconstriction Worsening PVD Bronchospasm
108
What are the Adverse Effects of all Beta Blockers?
Myocardial Depression Bradycardia Asystole Hyperkalemia in RF
109
What are Beta-Blockers useful for Peri-Operatively?
HTN Tachycardia Anxiety SVT A-Fib/Flutter Myocardial Protection
110
When are Beta-Blockers Contraindicated?
Bradycardia \> 1st Degree Block Cardiogenic Shock Raynaud's
111
What are the indications for Labetalol?
Hyperdynamic HTN Aortic Dissection SNP Tachyphylaxis Intracranial HTN Used for Test Dosing
112
What are the treatments for Beta-Blocker Overdose?
Glucagon Atropine Beta-1 Agonist Euglycemic Insulin IV Lipids
113
When can Labetolol be used for HTN in pregnancy?
2nd & 3rd Trimesters - Beta-Blockers during 1st trimester can cause growth retardation
114
How does Labetalol work?
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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