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Top Drawer > Antihypertensives/Beta Blockers > Flashcards

Antihypertensives/Beta Blockers Flashcards

1
Q

In anesthesia, before treating hypertension, what should you do?

A

determine why the patient is hypertensive in the first place!!!! figure out what the cause is before giving an antihypertensive/BB

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2
Q

What could be some potential causes of hypertension in a patient receiving anesthesia?

A
  • pain (give opioids)
  • hypothermia (bair hugger)
  • anxiety (give anxiolytic)
  • increased ICP (give propofol)
  • bladder distension (cath)
  • poorly controlled HTN (CAREFULLY give antihypertensive/BB)
  • lack of anesthesia (turn your gas on!!)
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3
Q

T/F: hypertension under anesthesia should always be treated with an antihypertensive or beta blocker

A

FALSE
- many times you can treat the cause of HTN and BP will decrease
- use antihypertensives sparingly

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4
Q

What is the MOA of labetalol?

A
  • NONSELECTIVE beta antagonist
  • SELECTIVE alpha1 antagonist
  • blocking beta1: decrease HR and contractility
  • blocking beta2: vasodilation
  • blocking alpha1: arteriolar vasodilation
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5
Q

What is the ratio of alpha to beta blockade with labetalol?

A

1 (a) to 7 (b) blockade
1:7 ratio

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6
Q

What is labetalol used used for?

A
  • acute and chronic HTN in pregnant patients
  • treat increases in BP and HR from stimulation (like intubation)
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7
Q

When is labetalol contraindicated?

A
  • bronchospastic disease
  • impaired cardiac conduction
  • underlying resting bradycardia
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8
Q

How do we achieve BP reduction with labetalol use?

A
  • decreased PVR, which can depress cardiac contractility
  • essentially unchanged CO
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9
Q

T/F: Labetalol can significantly affect CO

A

false
- per Barash, CO is essentially unchanged

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10
Q

T/F: labetalol has profound affects in CBF and ICP

A

false
- only causes minimal affects in CBF and ICP

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11
Q

Labetalol Dosing

A

5-20 mg boluses IV
- less is more!!! use with caution

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12
Q

Labetalol onset and duration

A

Onset: 1-2 min
Duration: up to 6 hours

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13
Q

Why is labetalol contraindicated in bronchospastic disease?

A

a potential side effect of labetalol is bronchoconstriction

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14
Q

What is the MOA of esmolol?

A

SELECTIVE beta1 antagonist
- directly only works on the heart

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15
Q

Does esmolol have rapid or slow onset?

A

esmolol has rapid onset

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16
Q

Is esmolol short acting or long acting?

A

short acting

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17
Q

When would esmolol be used?

A
  • perioperative tachycardia
  • pretreatment during intubation/extubation
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18
Q

What cardiac effects do we see with esmolol?

A
  • decrease in HR, contractility, and CP
  • some decrease in BP with no rebound effects
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19
Q

When is esmolol contraindicated?

A
  • bradycardia
  • heart block
  • cardiogenic shock
  • heart failure
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20
Q

Esmolol Dosing

A
  • 10 mg boluses IV
  • 50 mcg/kg/min infusion after a 0.5 mg/kg bolus
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21
Q

Esmolol onset and duration

A

Onset: rapid
Duration: 10-15 min

22
Q

How is esmolol metabolized?

A

plasma esterases

23
Q

What is the reasoning behind esmolol’s short duration?

A

metabolism by plasma esterases

24
Q

An infusion of esmolol at __________ should be started after a _________ bolus is given

A
  • 50 mcg/kg/min infusion
  • 0.5 mg/kg bolus
25
Q

What is the MOA of propranolol?

A

NONSELECTIVE beta1 and beta2 antagonist

26
Q

Due to propranaolol’s beta2 antagonist effect, what should be our concern?

A
  • risk of bronchoconstriction
  • careful with use in bronchospastic disease
27
Q

when is propranolol contraindicated?

A
  • bronchospastic disease
  • AV block
  • bradycardia
28
Q

When would propranolol be used?

A
  • HTN
  • angina
  • acute MI
  • pheochromocytoma
  • anxiety/panic attacks
29
Q

How does propranolol achieve decreased BP?

A

decrease in contractility, HR, and CO, therefore causing decrease in myocardial oxygen demand

30
Q

Propranolol Dosing

A

1 - 3 mg IV
- no more than 1 mg/min
- titrated to effect

31
Q

Propranolol onset and duration

A

Onset: 2-3 min
Duration: up to 4-6 hours

32
Q

What is the MOA of metoprolol?

A
  • SELECTIVE beta1 adrenergic receptor antagonist
  • prevents inotropic and chonotropic responses to beta stimulation
33
Q

When would metoprolol be used?

A
  • rapid HR and contractility control
  • treatment for MI
34
Q

Metoprolol Dosing

A

1-5 mg IV; up to 15 mg
- best to give 1 mg at a time

35
Q

What is the half-life of metoprolol?

A

3-4 hours

36
Q

What is the action of vasopressin in the body?

A
  • antidiuretic hormone via increasing water reabsorption in the kidneys
  • released by the posterior pituitary
37
Q

When is vasopressin used?

A
  • cardiac arrest (but removed from ACLS algorithm)
  • sepsis
  • shock
  • hypotension secondary to ACE inhibitors refractory to catecholamines or sympathomimetics
38
Q

What are the sites of action of vasopressin and what are their effects?

A

V1: CV effects
V2: renal effects
V3: pituitary effects

39
Q

Vasopressin Dosing

A

1-2 unit bolus

40
Q

How is vasopressin diluted for safe administration?

A

10/20 units/1mL in a 10/20 mL syringe to get 1 unit/mL concentration

41
Q

Vasopressin is a potent _____________ in what two locations?

A
  • potent vasoconstrictor
  • arterial
  • mesenteric
42
Q

Knowing that vasopressin is a potent vasoconstrictor, what should we consider when giving this during/after a surgery?

A
  • vasoconstriction can potentially cause necrosis in the surgical site
43
Q

When would hydralazine be used?

A
  • HTN
  • heart failure
  • eclampsia
44
Q

What is the MOA of hydralazine?

A
  • direct systemic arterial vasodilator
  • blocks Ca++ release from sarcoplasmic reticulum
  • causes relaxation of arterial smooth muscle
45
Q

What are the cardiac effects seen with hydralazine administration?

A
  • decreased BP
  • increased HR, SV, CO
46
Q

When is hydralazine contraindicated?

A
  • coronary artery disease (CAD)
  • increased ICP
47
Q

What effect does hydralazine potentially have on ICP?

A

potentialy increased ICP

48
Q

Hydralazine Dosing

A

2.5-5 mg IV
- titrated q 20-30 min

49
Q

Hydralazine onset and duration

A

Onset: 15-30 min
Duration: 4-6 hours

50
Q

How often is hydralazine titrated?

A

every 20-30 minutes

51
Q

Nitroglycerine

A
52
Q

Nipride

A

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