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Pharm II, Exam 2 > Cardiac Meds > Flashcards

Cardiac Meds Flashcards

0
Q

Epinephrine

Bronchodilator dose

A

0.1-0.5 mg IM/SQ q10-15 m repeat PRN

8-15 gtts in nebulizer reservoir 4-6x/day onset 1min

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1
Q

Epinephrine

Cardiac arrest dose

A 
1mg IV q3-5m =standard
2-5mg IV q3-5 = intermediate
1,3,5 MG IV q3m = escalating 
0.1 mg/kg IV q3-5 min high
ETT 2-2.5x higher dose in 10 ml NS/distilled water
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2
Q

Epinephrine

Anaphylaxis dose

A
  1. 3-0.5 mg IM/SQ q15-20 min repeat PRN

0. 1 mg IV over 5-10 min if hypotension, f/u with 1-10mcq/min gtts

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3
Q

Epinephrine

Refractory hypotension & bradycardia DOSE

A

1-10 mcq/min IV titrated to effect

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4
Q

Epinephrine what receptors?

A

Alpha & beta agonist

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5
Q

What are alpha effects of epinephrine

A 
Alpha 1: 
-peripheral vasoconstriction, inc PVR
-sphincter contraction bladder
Alpha 2:
-Decrease insulin secretion, inc BS
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6
Q

What are beta effects on epinephrine

A

B1: inc HR, contractility, conductivity- inc BP
B2: dilation of skeletal m, bronchodilator, detrussor relaxation, incr glycogenolysis
B3: increase lypolysis

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7
Q

What are the toxic effects of epinephrine

A
  • stress related: fear, anxiety, restlessness
  • cardiac arrhythmias esp when used w/halothane
  • pressor effect: lg doses extreme HTN—-MI, stroke, etc
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8
Q

Norepinephrine (levophed)

What receptors

A

Alpha and Beta1 not B2

Increase in SVR
Vasoconstriction in all vascular beds

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9
Q

Cardiac effects of norepinephrine

A

Baroreceptor mediated reflex BRADYCARDIA

Inc SVR- dec venous return- dec CO

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10
Q

Effects of levophed on blood vessels

A

A1: vasoconstriction in all vascular beds incr in SVR- dec venous return- dec CO

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11
Q

Toxic effects of norepinephrine

A

Similar to epinephrine, but less severe

Don’t use with halothane - dysrythmias

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12
Q

Norepinephrine dose

A

0.5-1mcq/min titrated to desired response
8-30 mcq/min is usual dose
ACLS dose range is 0.5-30mcq/min
O: 1-2 min D: limited.
Elimination: urine 84-96% as inactive metabolite

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13
Q

Dopamine doses, onset, peak, DOA

A 
1-20 mcq/kg/min
Renal 1-3 mcq/kg/min
Beta    2-10
Alpha   >10 increase PVR, decrease RBF
O: 2-4 min.      P: 2-10 min.         DOA<10 min
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14
Q

What receptors does dobutamine works on

A

Beta 1 agonist, minimal if any B2 & A agonist effects
Positive inotropic, less chronotropic effects
Direct acting synthetic catecholamine

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15
Q

Dobutamine problematic

A

Pregnant pt: increases uterine vascular resistance thereby decreasing uterine blood flow

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16
Q

Why we use dobutamine

A
  • increase CO for CHF pt, esp if HR & SVR are increased
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17
Q

Dobutamine dose

A

2-20 mcq/kg/min
>10mcq/kg/min predisposes to tachycardia & dysrythmias
>20 increases HR>10%, may lead to MI

O: <10

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18
Q

Toxic effects of dobutamine

A
  • Caution in A-fib pt r/t increased conduction velocity may cause RVR
  • Increases risk of SVT & ventricular arrhythmias with VAs
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19
Q

Which med increases risk for SVT/arrhythmias due to VA?

A

Dobutamine

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20
Q

How to use dobutamine if SVR is high?

A

Use with vasodilators to decrease afterload to optimize CO

No vasoconstrictor activities and no effect on SVR

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21
Q

Contraindications for Isoproterenol

A

V-tach, vfib, hypotension, idioventricular rhythm, ischemic heart, cardiac arrest, CAD pt

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22
Q

The most potent sympathomimetic at B1 & 2 receptors

A

Isoproterenol

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23
Q

Isoproterenol

receptors & Effects

A
  • B1: Increases HR, contractility, automacitity=inc CO/MRO2 consumption
  • B2: Decreased SVR/MAP due to vasodilation in skeletal muscle
  • B1 & B2 agonist
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24
Q

How is Isoproterenol metabolized

A

Liver by COMT

Rapidly metabolized- needs continuous infusion

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25
Q

Dobutamine doses

A

-2-20 mcq/kg/min

> 10 predispose pt to tachycardia/dysrhythmias

> 20 incr HR>10% may lead to MI

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26
Q

Which drug can cause tachyphylaxis?

A

Ephedrine

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27
Q

Ephedrine

Dose, onset, duration, metabolism, excretion, receptors

A 
5-10 mg prn max=60 mg
Onset=<1 mon
Duration 5-15 min
Metabolism: liver
Renal up to 40% unchanged 
Direct B1 & B2, indirect A1 via NE relase
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28
Q

Which med is safe for pregnancy

A

Ephedrine

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29
Q

What is the drug of choice for CAD pt, to increase BP

A

Phenylepherine: Neo-synephrine

Direct A1 agonist

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30
Q

What is neosynephrine use for

A

Increase BP

Drug of choice for CAD r/t minimal chronotropic effects

Prolongs LA effects

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31
Q

Phenylepherine
dosing
Receptors

A 
Supplied as 1% solution = 10mg
Dilute .1ml=1mg in 10ml 
for 100mcq/ml
Dose:  50-100 mcq IV bolus 
            2-5 mg IM/SQ

Drip 30mg/500ml = 60 mcq/ml
Rate 10-200 mcq/min titrated

Direct A1 agonist

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32
Q

Phentolamine
Receptor
Use

A

A1 & A2 blocker

Use: HTN crisis, prevent sloughing after inadvertent extravasation of sympathomimetic drugs

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33
Q

What r the effects of Phenolamine on cardiac & blood vessels

A

Cardiac: increased HR via baroreceptor reflex (also blocked A2=increased NE release)

Blood vessels: anti A1= vasodilator, decreases systemic BP

34
Q

Phenoxybenzamine
Receptor
Use
Causes

A

A1 & A2 blocker
Use: control BP for pheochromocytoma, reynaud’s ???

Blood vessels: vasodilation, ortho hypotension

Slow onset

35
Q

alpha 2 function
Pre
Post

A

Pre- inhibition of NE release: negative feedback loop

Post- hyper polarization of CNS cells (dec Mac) platelet aggregation

36
Q

Alpha 1 function
Med agonist -
Med antagonist -

A

Vasoconstriction, mydriasis, GI relaxation, GI sphincter contraction

Agonist: Phenylephrine
Antagonist: Prazosin

37
Q

Beta 1
Function
Meds: agonist and antagonist

A

Post: cardiac= increased conduction, automaticity, contractility

Dobutamine
Metoprolol

38
Q

Beta 2

Presynaptic
Postsynaptic
Medications

A

Pre- NE release
Post-vasodilation, bronchodilator, GI/uterine/bladder relaxation, glycogenolysis, lipolysis

Terbutaline

39
Q

Norepinephrine should not be used….

A

Pregnancy, alpha 1-causes contractions

40
Q

What receptors - neosynephrine

A

Direct A1 agonist

A2 @ High Doses

40
Q

What Alpha antagonists do?

A

Bind selectively to Alpha receptors interfering w/ability of catecholamines & sympathomimetic agents to elicit alpha responses.

40
Q

What do Beta antagonist exhibit?

A

Selective affinity for receptors where they competitively inhibit stimulation

41
Q

What activates receptors?

A

NE, Epi, Dopa or agonist drugs

42
Q

Alpha 1 POST

A

Vasoconstriction, mydriasis, GI relaxation, contraction of GI/bladder sphincters

43
Q

Alpha 2 POST

A

Hyper polarization of the CNS cells, decreased MAC, platelet aggregation

44
Q

Alpha 2 PRE

A

Inhibition of NE release

Negative feedback loop

45
Q

Beta 1 POST

A

Cardiac-increased conduction, automaticity & contractility

46
Q

Beta 2 POsT

A

Vasodilation, bronchodilation, GI uterine & bladder relaxation, glycogenolysis, lipolysis

47
Q

Beta 2 PRE

A

Norepinephrine release

48
Q

Yohimbine

A

Alpha 2 pre blocker

More NE, erectile dysfunction, veterinary medicine to reverse certain sedatives

49
Q

Propranolol
Dose
Contraindicated
Receptors

A

.5-3 mg IV
20-80 mg PO for migraines

Not for asthma pt
B1 & B2 Blocker

50
Q

Esmolol = brevibloc

Use

A

Prevent HTN from ECT, response to laryngoscopy

51
Q

How is brevibloc hydrolyzed?

A

In the blood by plasma esterase

52
Q

Brevibloc
Receptors
Doses

A

Beta 1, in high doses beta 2

100-200 mg IV 2 min prior to intubation
.5-1mg/kg load + 50-300 mcq/kg/min —–HTN
.5 mg/kg load + 50-200 mcq/kg/min——–SVT

53
Q

Labetalol

Receptor

A

B1 & B2 > A1 blocker
Beta > Alpha = 3:1 PO, 7:1 IV,
not A2= negative feedback is intact: NE stimulation intact

54
Q

Labetalol

Dose

A

-5-20mg IV initially, increased to 40-80 mg q10 min up to 300 mg

Infusion .5-2 mg/min —- not common

55
Q

What meds r used for pheochromocytoma

A

Prazosin A1 blocker

Phenoxybenzamine A1 & A2 blocker

56
Q

What is the MOA for Ace inhibitors

A

Block conversion of angiotensin I to angiotensin II via competitive inhibition of Ace

57
Q

When would you use ACE inhibitors

A

1st line therapy for HTN, CHF, mitral regurg

58
Q

How is renin secreted

A

Juxtaglomerular apparatus of the kidney in response to
glomerular hypo perfusion or a
reduced salt intake
Or release in response to stimulation from the SNS

59
Q

Conversions renin to

A

Angiotensin I— rapidly in converted to Angiotensin II in lungs by ACE

60
Q

What is Angiotensin II?

A

Potent vasoconstrictor and thus causes rise in BP

Stimulates release of aldosterone from the adrenal gland— inc BP

61
Q

What is HTN related to

A

Interection between ANS & renin angiotensin system

Na, circulating volume, & some hormones

62
Q

What local vasoactive agents do endothelial cells have?

A

Vasodilator ———nitric oxide

Vasoconstrictor —-peptide endothelin

63
Q

What is atrial natriuretic peptide

A

-Hormone secreted from atria of the heartiness response to increased volume
-acts like natural diuretic,
Defect may cause fluid retention & HTN

64
Q

What is Ouabian?

A

Steroid like substance

Interfere with cell Na & Ca transport—vasocontstriction

65
Q

When is elevated SBP and DBP more important

A

SBP after age >50 years old

DBP before <50 years old

66
Q

Secondary HTN

A

55 y.o. Artherosclerosis renal artery stenosis, sudden onset: TIA MI
Episodic: high thyroid, obesity,

67
Q

Grade 2 secondary HTN

A

Unresponsive to meds

68
Q

What diuretic has a high ceiling effect

MOA

A

Lasix
Act on ascending loop of Henley
Inhibits Na, K, Cl reabsorption, all 3 go out with urine

Most effective diuretic drugs

69
Q

S/s of lasix

A

Hypokalemia
Ototoxicity reversible: tinnitus, ear pain, vertigo, hearing impairment
Dehydration
Hypotension

ASA has irreversible ototoxicity

70
Q

Lasix drug interaction

A

Digoxin- ventricular dysrythmias low K
Ototoxic drugs: Aminoglycosides
Lithium not metabolized element,

71
Q

What drugs work in the distal convoluted tubule

A

Thiazide & related diuretics

72
Q

Function of thiazide
Ceiling effect
Contra

A

Increase renal excretion of Na, Cl, K, and H20
Low ceiling diuretic
Caution in sulfa allergy

73
Q

Which drug causes hyperuricemia

A

Thiazide

Hypokalemia
Hyperlipidemia
Conta: Sulfa allergy

74
Q

What drug/diuretic can be used for DI

A 
Thiazide 
Clinical use:
Essential HTN
Edema
DI
75
Q

Where in the kidney do K sparing diuretics work

A

Distal tubule where Na is normally reabsorbed in exchange for K

76
Q

What r two types of K sparing diuretics?

A

Epithelial Na channel blockers

Aldosterone receptor antagonist: blocks action of aldosterone

77
Q

Adverse effects of potassium sparing diuretics

A

Hyperkalemia

Endocrine effects: male boobs, menstrual irregularities

78
Q

Which drug has NO receptors?

A

Osmotic diuretics

79
Q

What diuretic - glaucoma

A

Carbonic anhydrase inhibitor

80
Q

What drugs can cause ototixicity

A

Lasix & mannitol

81
Q

What drugs increases lithium level

A

Thiazides & Ace inhibitors

Pharm II, Exam 2 (1 decks)

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