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Anesthesia Pharm: Summer > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

Antihypertensives have 3 targets of therapy

A

heart

kidneys

arterioles/venules

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2
Q

What do Ca channel blockers do?

A
  • Block L-type channels
  • Reduce myocardial O2 demand
    • decrease afterload
    • coronary vasodilation
  • Decrease HR
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3
Q

Whatr are the types of Ca blockers?

A

PHENYLALKYLAMINES
Verapamil

DIHYDROPYRIDINES
Nicardipine, etc..

BENZOTHIAZEPINES
Diltiazem

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4
Q

These Ca blockers physically occlude channel after binding to receptor when in open state…AV Node.

A

Phenylalkylamines…verapamil

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5
Q

These Ca blockers prevent Ca entry into channel by altering channel structure…peripheral arterioles.

A

Dihydropyridines…”-pines”

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6
Q

These Ca blockers work like ”magic”…mechanism unknown…other effects include inhibition of Na-K pump and inhibition of calcium-calmodulin binding…AV Node selective

A

Benzothiazepines…Diltiazem

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7
Q

What are the pharmacologic effects of Ca blockers? (5)

A

↓ Contractility
↓ Heart Rate
↓ SA Node Activity
↓ AV Node Conduction
↓ Systemic BP –2º vascular smooth muscle relaxation

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8
Q

What are the clinical uses of Ca blockers? (4)

A

Coronary Artery Spasm

Stable Angina

Cerebral Vasospasm

HTN

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9
Q

What is the better treatment for coronary spasm?

A

nitrate with Ca blocker

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10
Q

Name the phenylalkamines.

A

Verapamil

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11
Q

Name the 1,4 dihydropyrimidines. (6)

A

Nifedipine
Nicardipine
Nimodipine
Isradipine
Felodipine
Amlodipine

Note: All end in -ipine

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12
Q

Name the benzothiazepines.

A

Diltiazem

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13
Q

What is verapamil? (3)

A

Derivative of papavarine
Phenylalkylamine
Also works on fast sodium channels–potentiates LA

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14
Q

How does verapamil work? (4)

A

AV Node depression
SA Node– (-) chronotrope
Negative Inotrope
Vasodilator–not as much as other Ca blockers

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15
Q

What are the clinical uses for verapamil?

A
  • SVT Treatment
  • Stable Angina
  • Essential HTN
  • Maternal and Fetal Tachydysrhythmias–may decrease uterine blood flow
  • Intra-arterial injection for cerebral vasospasm,
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16
Q

Will verapamil affect the placenta?

A

yes

17
Q

What is the concern with intra-arterial injection of verapamil for cerebral vasospasm?

A

Problem with decreased BP so may need to inject NE as well

18
Q

What does nifedipine do?

A

VASODILATOR
negligible SA/AV node–not good for arrhythmias
Tachycardia
Myocardial depression

19
Q

What drug should you NOT use for LV failure pts to treat HTN and is light-sensitive?

A

Nifedipine

20
Q

What HTN drug works mainly arterially with some venous effect?

A

Nifedipine

21
Q

What are the good effects of nifedipine?

A

Profound vasodilation

No myocardial depression

No conduction effects

22
Q

What are the clinical uses of nifedipine?

A

Angina–although better drugs exist

HTN EMERGENCIES

23
Q

What are the bad effects of nifedipine? (3)

A

No IV prep (light)

Severe hypotension

Peripheral edema

24
Q

What are the effects of nicardipine?

A

VASODILATION

No effect on SA/AV Node

No myocardial depression

25
Q

What are the uses of nicardipine? (3)

A

Perioperative hypertension
Improves LV function during ischemia
Coronary spasm

26
Q

What is the greatest drug of all Ca channel blockers at vasodilation especially coronary arteries?

A

Nicardipine

27
Q

Nicardipine

What is the intraop dose?

Half -life?

Infusion rate?

A

100 mcg

14 min

5 mg/hr

Note: This is the DOC!

28
Q

What HTN drug crosses the BBB and works on the large cerebral arteries?

A

Nimodipine–“o” for the noggin

Note: This drug is the lipid soluble analogue of nifedipine.

29
Q

What drug is used for cerebral vasospasm?

A

nimodipine

30
Q

For what is diltiazem the DOC? (2)

A

AV Node Function

Coronary vasodilation

31
Q

What are the clinical uses for diltiazem? (3)

A

SVT (including afib and flutter)

Essential HTN

Used similar to Verapamil

32
Q

What drugs interaction with Ca channel blockers? (7)

A

Anesthetic drugs

NMBs

Local anesthetics

Potassium containing solutions

Dantrolene

Platelet function

Digoxin

33
Q
A

Anesthesia Pharm: Summer (5 decks)

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