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Nonanesthesia Pharm > Cardiac & Bronchodialators > Flashcards

Cardiac & Bronchodialators Flashcards

1
Q

Digitalis MOA

A

-inhibits Na/K ATPase in myocardium = ↑Na = ↑activity of Na/Ca exchanger = ↑Ca
-Leads to: ↑ino, ↑EF, ↓preload, ↓AV node conduction, ↓SA node automaticity

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2
Q

Digitalis therapeutic index

A

0.8-2 ng/ml
toxic > 2.4

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3
Q

Digitalis SE

A

-arrhythmias (Vfib, AV block)
-↓QT
-cardiotoxic (↑risk w/ ↓K)

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4
Q

Digitalis drug interactions

A

-quinidine
-CCB
-NSAIDS
-amiodarone
-BB
-diuretics

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5
Q

Digitalis and electrolytes

A

-↓K = ↑dig binding to Na/K ATPase = ↑therapeutic & toxic effects
-↑Ca = ↑digitalis-induced ↑Ca = Ca overload & digitalis-induced arrhythmias
-↓Mg = sensitizes heart to digitalis-induced arrhythmias

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6
Q

Digitalis Contraindications

A

-↓K
-WPW
-AV block
-renal dysfx
-harmful in pt w/HSS

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7
Q

What sympathomimetics are not metabolized by reuptake and MAO & COMT

A

-isoproterenol & dobutamine (COMT only)
-ephedrine (liver, mostly excreted renal unchanged)

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8
Q

Epinephrine receptor & dosing

A

B1>B2, a1
0.01-0.2 mcg/kg/min
1-20 mcg/min

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9
Q

NE receptor & dosing

A

a1, B1 > B2
0.01-0.2 mcg/kg/min
4-16 mcg/min

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10
Q

Dopamine receptor & dosing

A

B1>B2, a1
2-20 mcg/kg/min

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11
Q

Isoproterenol receptor & dosing

A

B1 > B2
0.015-0.15 mcg/kg/min
1-5 mcg/min

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12
Q

Dobutamine receptor & dosing

A

B1>B2>a1
2-20 mcg/kg/min

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13
Q

Ephedrine receptor & dosing

A

a, B indirect
bolus 5-25 mg IV
up to 50 mg IM

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14
Q

Isoproterenol clinical effect

A

Pure beta agonist
- ↑ HR, contractility, CO
-↓ PVR, DBP
-↑MVO2 demand while ↓ O2 supply

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15
Q

Dobutamine clinical effect

A

Selective B1 agonist
-↑ contractility, CO, cAMP, Ca in SR
-↓ PVR (B2)
-↓ LV filling pressure –> ↑coronary BF
-stimulates SA, AV nodal automaticity

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16
Q

PDE inhibitor MOA

A

↑cAMP & ↑cGMP

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17
Q

Clinical indication for PDE 3 vs 4 vs 5

A

-PDE3 = ↑ cAMP & ↑ cGMP (milrinone, cilostazol, amrinone) = inodilators
-PDE4 = ↑ cAMP (roflumilast, apremilast, ibudilast) = help w/ inflammatory states
-PDE5 = ↑ cGMP (sildenafil, tadalafil, vardenafil) = pulm vasodilation

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18
Q

PDE inhibitor SE

A

-block plt aggregation
-ventricular arrhythmias
-HA
-HoTN
-flushing

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19
Q

Inhaled beta-agonist MOA

A

b2 agonist = ↑cAMP = ↓Ca; stabilizes mast cell

20
Q

Inhaled beta-agonist SE

A

-tremor
-↑HR
-hyperglycemia
-↓K
-↓Mg
-dysrhythmias

21
Q

Inhaled muscarinic antagonist MOA

A

M3 antagonist = ↓IP3 = ↓Ca

22
Q

Inhaled muscarinic antagonist short vs long acting

A

-ipratropium (short)
-tiotropium (long)

23
Q

Methylxanthines (theophylline, aminophylline) MOA

A

PDEi = ↑cAMP & ↑cGMP; inhibit leukotriene; adenosine receptor antagonist

24
Q

Dose based SE for Methylxanthines

A

> 20 mcg/ml: N/V/D, HA, insomnia
30 mcg/ml: sz, arrhythmias, CHF

25
Q

Nonselective vs selective alpha antagonist

A

Non: phenoxybenzamine, phentolamine
a1: -zosin
a2: yohimbine

26
Q

Phentolamine dose

A

bolus: 1-5 mg
infusion: 0.1-0.2 mg/min

27
Q

Beta antagonist SE

A

-heart block
-HF
-AV block
-sinus arrest
-HoTN
-bronchospasm (asthma)

28
Q

What beta antagonist are not metabolized by the liver

A

Esmolol (hydrolysis of RBCe)
Atenolol (renal)

29
Q

Labetalol

A

-a1, B1, B2 (1a:7B)
-mixed blockade↓ PVR, ABP w/o reflex tachy
-IV peak 5 min
-Dose: 0.1-0.25 mg/kg q 10 min

30
Q

Class I antidysrhythmic SE

A

-cinchonism
-cardiotoxicity
-arterial embolism
-hypersensitivity rxn

31
Q

Class I antidysrhythmic MOA

A

-depresses phase 0
-mixed effects on phase 3 repolarization

32
Q

Class IA antidysrhythmic

A

-Quinidine
-procainamine
-disopyraminde
-moricizine

33
Q

Class IB antidysrhythmic

A

-Lidocaine
-Tocainide
-Mexiletine

34
Q

Class IC antidysrhythmic

A

-Flecanide
-Propafenone

35
Q

Class II antidysrhythmic

A

Beta blockers

36
Q

Class II antidysrhythmic MOA

A

-slows phase 4 depolarization in SA node

37
Q

Class III antidysrhythmic MOA

A

-prolongs phase 3 repolarization (↑QT)
-↑effective refractory period

38
Q

Class III antidysrhythmic SE

A

-pulmonary/thyroid/CV/dErm toxic
-optic neuropathy
-corneal microdeposits

39
Q

Class III antidysrhythmic

A

↓K
-amiodarone
-sotalol
ibutilide
-dofetilide
-bretylium

40
Q

Class IV antidysrhythmic

A

CCB:
-Verapamil
-Diltiazem

41
Q

Class IV antidysrhythmic MOA

A

↓conduction velocity through AV node

42
Q

Adenosine MOA

A

↓AV node conduction d/t K efflux (hyperpolarizes); 6 > 12 mg

43
Q

Non-dihydropyridines vs Dihydropyridines

A

Non-dihydropyridines
-verapamil, diltazem
- Target myocardium = ↓coronary vascular resistance, ↓ino, ↓dromo, ↓chrono
Dihydropyridine
- -dipine
-Targets vascular smooth muscle = ↓SVR

44
Q

CCB SE

A

-inhibit inflow of Ca into cells of cardiac & vascular smooth muscle

45
Q

CCB Drug Interactions

A

-potentiate NMB & LA
-vasoplegic synd
-may ↑dig levels
-BB
-HoTN, CHF, asystole, high-degree AV block w/ BB and dig

Nonanesthesia Pharm (11 decks)

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