Cardiac drugs

Question 1

nitroprusside: indication

Answer 1

-HTN, CHF without ischemia

Question 2

nitroprusside: side effects

Answer 2

hypotension, reflex tachy, cyanide tox, methemoglobinemia

Question 3

SNP: action

Answer 3

• direct smooth muscle relaxation

- decreases preload and afterload

Question 4

SNP titration

Answer 4

• up to 10 ug/kg/min
• don’t give over 1 mg/kg in 2.5 hrs
• toxic levels of 100 ug/kl occur if more than 1 mg/kg given over 3 hours

Question 5

cyanide tox

Answer 5

• unexplained metabolic acidosis

- treat with sodium nitrate and thiosulfate

Question 6

Nitroglycerine: indication

Answer 6

Myocardial ischemia, pulmonary HTN, systemic HTN

Question 7

NG: side effects

Answer 7

hypotension, arrhythmia, myocardial ieschemia

Question 8

NG: action

Answer 8

• direct smooth muscle relaxation
• reduces preload
  0. 25-5 ug/kg/min,

Question 9

epinephrine: indications

Answer 9

hypotension, LV failure, bronchospasm

Question 10

epi: side effects

Answer 10

HTN, arrhythmias, myocardial ischemia

Question 11

Dosage effects

Answer 11

• 1-2 ug/min-b2-bronchodilation (0.01-0.05 ug/kg/min)
• 4 ug/min-stim b1 receptors, LV improves
• 10-20 ug/min–both and alpha and beta receptors activated
• renal blood flow decreases, CO and HR increase

Question 12

Dopamine: indications

Answer 12

-hypotension, oliguria

Question 13

dopamine: side effects

Answer 13

HTN, tachycardia, arrhythmia, myocardial ischemia

Question 14

dopamine: effects

Answer 14

-increase contractility, renal blood flow, GFR
1-30 ug/kg/min-dopaminergic
2-10 beta
>10-alpha
-less arrhythmogenic than epi
-modiest inc in HR

Question 15

dobutamine: indications

Answer 15

-Heart failure

Question 16

dobutamine: side effects

Answer 16

hyper and hypotension, tachycardia, arrhythmia, myocardial ischemia

Question 17

dobutamine action

Answer 17

• selective b1 agonist
• dose-dependent increases in CO without marked increases in HR and BP
• acts directly to increase contractility

Question 18

Amrinone: indication

Answer 18

-short term CHF

Question 19

amrinone: side effects

Answer 19

thrombocytopenia, tachyphylaxis, hypokalemia, GI effects–marked hypotension in hypovolemic pts

Question 20

PDEI

Answer 20

• PDE breaks down cAMP

- PDEI–inc cAMP, improves uptake, storage and release of ca from SR during excitation-contraction coupling

Question 21

-amrinone: action

Answer 21

• inc CI, dec SVR and cardiac filling pressures
• HR usu unchanged to slightly inc
• in pts with CHF, does not significantly inc myocardial O2 consumption
• enhances AV conduction–pts with atrial arrhythmias should be pretreated w/ digitalis

Question 22

milrinone

Answer 22

• bypyridine derivative
• positive inotropy, vasodilation
• greater decrease in LV pressure and BP compared to amrinone b/c has enhanced vasodilatory properites

Question 23

chronotropes

Answer 23

atropine, isoproternol

Question 24

isoproterenol

Answer 24

• b1 and b2 agonist
• 3rd degree HB and EMD
• may decrease SVR and MAP at same time it’s increasing HR, contractility and myocardial O2 consumption

Question 25

SVT rx

Answer 25

- adenosine--6 mg, then 12mg, then 12mg | - verapamil-can be lethal in VT

Question 26

amiodarone

Answer 26

- antidysrhythmic - recurrent or refractory V-tach or V-fib - inc refractory period, reduce membrane excitability of heart - use prior to 3rd or 4th counter shock in cardiac arrest

Question 27

LIdcoaine

Answer 27

- suppresses ventricular arrythmias-PVC, Vtach, Vfib - decreases automaticity without causing myocardial depression - can block chronotropy and dec sympathetic NS outflow

Question 28

LIdo and defibrillation

Answer 28

- disrupts subsequent defib and cardioversion by increasing current and energy requirements, a process worsened by acidosis - asystole has been associated with prophylactic use of lido for rx of cardiac arrest\

Question 29

LIdo dosing

Answer 29

- 1.5-6ug/cc is therapeutic level - 1mg/kg bolus, 15-60 ug/kg/min infusion - rate of metabolism is dependent on hepatic blood flow and hepatic function

Question 30

Procainamide

Answer 30

-suppresses ventircular ectopy when lido is ineffective