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Pharm 2 > Cardiac Pharm test 1 > Flashcards

Cardiac Pharm test 1 Flashcards

1
Q

Also has indirect sympathomimetic effect eliciting the release of norepinephrine via Beta-1 stimulation

A

Dopamine

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2
Q

Men benefit from beta blockers with ____

A

reduced MI

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3
Q

Limited use since dobutamine and milrinone has emerged

A

Isoproternol

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4
Q

Scopolamine Used as a patch with a total dose of ___and applied behind ear

A

1.5 mg

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5
Q

Detrimental effects on the heart limiting isoproternol use

A

-Excessive tachy -Myocardial ischemia -Arrhythmia production

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6
Q

Isoproternol’s positive ________and ________ effect results in a dramatic increase in myocardial oxygen consumption

A

inotropic , chronotropic

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7
Q

Scopolamine Duration

A

3 days

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8
Q

Dobutamine Is an option in Cardiogenic and Septic shock and in select patient with mild heart failure because:

A

Positive inotropic effects Lack of chronotropy Maintenance of normal BP

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9
Q

Dobutamine drug class

A

Synthetic sympathomimetic amine

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10
Q

Not as potent as epi in stimulating alpha receptors in equal doses

A

Norepi

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11
Q

Classified as non-selective beta blocker but is unique d/t its alpha blocking component

A

Labetalol (Normodyne, Trandate):

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12
Q

Has little Beta 2 activity at low doses

A

Norepi

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13
Q

Increase in CO compensates for decrease in SVR and the BP is ________ (or at low doses relatively unchanged)

A

increased

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14
Q

May benefit vascular surgery patients at high risk for ____but not for stroke

A

MI

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15
Q

UOP may fall due to renal vascular resistance is increased

A

Norepi

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16
Q

DROPERIDOL Black Box: associated with ______interval in certain patients increasing probability of development of ___________leading to serious morbidity and death

A

prolonged QT, torsades de points

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17
Q

Ephedrine Use cautiously in patients with questionable ______________ d/t myocardial oxygen consumption may be more dramatically increased as a result of positive inotropic effect

A

coronary perfusion

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18
Q

Ephedrine onset/ duration

A

Immediate; 15 min to 1.5 hours depending on dose

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19
Q

Milirione loading dose

A

50 mcg/kg slowly over 10 minutes

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20
Q

Stimulates both alpha and beta receptors directly

A

EPHEDRINE

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21
Q

Dopamine doses: 2 mcg/kg/min 2-5 mcg/kg/min 10 mcg/kg/min and above

A

Dopamine receptors: 2 mcg/kg/min Beta: 2-5 mcg/kg/min Alpha: 10 mcg/kg/min and above

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22
Q

Has for the most part unopposed alpha stimulation

A

Norepi

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23
Q

Milrone has of an increase in HR probably contributes to an absence of myocardial oxygen consumption true or false

A

true

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24
Q

Potent non-selective agonist of Beta 1 and Beta 2 receptors

A

Isoproternol

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25
Q

(epi)This is followed by a longer _______ as Beta 2 stimulation then forces potassium (that is extracellular) into red blood cells

A

hypokalemia

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26
Q

ANTICHOLINERGICS

A

Atropine, Glycopyrrolate, Scopolamine

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27
Q

Has strong alpha stimulating effect with virtually no beta stimulation

A

PHENYLEPHRINE

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28
Q

Women suffered from clinical significant increases in ____

A

CHF

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29
Q

Isoproternol Increase in CO is seen due to combination B1 and B2 inducing _______ and resultant drop in _____.

A

vasodilation , SVR

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30
Q

Coronary Artery perfusion may be increased b/c of the increase in DBP

A

Norepi

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31
Q

contraindicated beta blockers

A

asthma, Brady arrhythmias, acute heart failure, or advanced heart block

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32
Q

Recent evidence indicates significant adverse effects when used in cardiac surgery and clinicians have stopped using it for inotropic support

A

Dobutamine

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33
Q

PVR (peripheral) and preload/afterload are diminished

A

ALPHA RECEPTOR ANTAGONIST

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34
Q

Produces a positive inotropic action and vasodilation without producing tachycardia

A

Milrinone (Primacor)

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35
Q

Lack of alpha 2 blocking indicates that they have no effect on norepinephrine levels

A

ALPHA RECEPTOR ANTAGONIST

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36
Q

(epi)As doses increase, alpha effects predominates resulting in vasoconstriction and increase in SVR

A

SBP increases, DBP remains relatively unchanged, Pulse Pressure increases

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37
Q

Dobutamine has Primarily ______with some ________effects

A

Beta 1 agonist, Beta 2

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38
Q

Isoproternol has Profound ________stimulation results in both positive inotropic an chronotropic effects

A

Beta 1

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39
Q

Antisialagogue effects of anticholinergics greatest to least

A

Scopolamine, glycopyrrolate, atropine

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40
Q

In situations where beta blockers are contraindicated, such as asthma, Brady arrhythmias, acute heart failure, or advanced heart block, an adrenergic agonist such as ______ may have some benefit

A

clonidine

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41
Q

mydrorisis, cyclopegia effects of anticholinergics greatest to least

A

scopolamine, atropine, glyco 0.

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42
Q

Clinical result is a decrease in both _____and _____.

(milrinone)

A

preload and afterload

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43
Q

Used as first line therapy (along with dopamine) for shock

A

Norepi

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44
Q

Esmolol is metabolized by _______________.

A

nonspecific plasma esterases found in the cytosol of RBC

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45
Q

Ephedrine As with any indirect-acting agent, _________ may develop with subsequent dosing b/c catecholamine stores become depleted.

A

tachyphylaxis

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46
Q

Is also a potent bronchial dilator and pulmonary vasodilator

A

Isoproterenol

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47
Q

Clonidine drug class

A

Presynaptic Alpha-2 Agonist

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48
Q

Effects similar to epi but to a lesser degree and not accompanied with dramatic increase in serum glucose

A

EPHEDRINE

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49
Q

Milirinone infusion

A

0.5 mcg/kg as needed

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50
Q

Modified isoproterenol but is used widespread

A

Dobutamine

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51
Q

Metoprolol dose

A

5 mg doses IV q 5 minutes to max of 15 mg is recommended

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52
Q

_________ have been known to cause “floppy iris” syndrome which may complicate cataract surgery D/c prior to surgery is not required as long as the ophthalmologist is aware

A

Tamsulosin

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53
Q

Pulmonary artery pressure _______ and an _______ in LV stroke work index is observed

A

decreases and increase

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54
Q

Used for heart stimulation for cardiac stress testing

A

Dobutamine

55
Q

Esmolol IV loading dose: _____ Followed by infusion of _______

A

500 mcg/Kg, 100-300 mcg/kg/min

56
Q

Produces both dopamine ad alpha adrenergic blockade and thus small reductions in blood pressure may occur especially in volume depleted patients

A

DROPERIDOL

57
Q

Relax smooth muscle effect of anticholinergics greatest to least

A

atropine=glycopyrrolate, scopolamine

58
Q

Clonidine: ________ _______ happens with abrupt stopping of the drug. The resultant increase in catecholamine levels manifests as Tachy and Hptn

A

Rebound hypertension

59
Q

prevention of motion induced nausea

A

scopolamine, atropine, 0 glyco.

60
Q

ESMOLOL onset

A

Onset of 2 minutes

61
Q

Acts centrally and peripherally

62
Q

Stimulation of peripheral presynaptic alpha 2 receptor causes inhibition of catecholamine release with subsequent vasodilation

63
Q

Avoid starting beta blockers immediately before surgery, in __________, or in patient with prior ____________ or ____________.

A

emergency surgery, cerebrovascular disease or sepsis

64
Q

Milinone Acts to enhance diastolic function, _______cardiac output and ________pulmonary wedge pressure

A

increases, decrease

65
Q

(EPI) If coronary arteries are not obstructed

A

autoregulation increases O2 delivery to meet the increase in demand

66
Q

TRIOTROPIUM use

A

Used as a bronchodilator for patients with COPD

67
Q

Labetalol: Beta to alpha blockade is

68
Q

(epi) Insulin secretion is inhibited by an overriding________.

A

Beta 2 stimulation

69
Q

has CNS effects that are much more pronounced at lower doses Does not substantially increase HR

A

Scoplamine

70
Q

A __________ is required by FDA prior to use of droperidol

A

12-lead EKG

71
Q

There are concerns anemia might complicated periop beta blockers by further limiting ________

A

O2 delivery

72
Q

Ephedrine Duration is ______ than epi due to lack of basic catechol structure so it’s resistant to metabolism by monoamine oxidase

73
Q

Beta blockers is associated with worse outcomes when Hgb levels are decreased by _____

74
Q

Topical doses should not exceed _________ and________ in children in order to prevent severe hypertension

A

0.5 mg (4 drops of 0.25% in adults, 20 mcg/kg

75
Q

ANTICHOLINERGICS moa

A

Competitive antagonists of acetylcholine at muscarinic receptors

76
Q

4 thing epi increases that causes in increase in 02 consumption.

A

HR, LV Stroke volume, and CO increase.

77
Q

(EPI) The peripheral vasculature promotes the redistribution of blood flow to skeletal muscle, thus producing a decrease in SVR

A

Low Doses 10 mcg/min:

78
Q

(epi) Beta stimulation leads to activation of the renin-angiotensin system and also: to an increase in:

A

lipolysis Glycogenolysis Gluconeogenesis Ketone production Lactate release by skeletal muscle

79
Q

(epi) If coronary arteries are obstructed

A

O2 delivery may be insufficient to meet demand resulting in myocardial ischemia

80
Q

Prevents bradycardia without inducing significant levels of tachycardia

A

GLYCOPYRROLATE

81
Q

ESMOLOL Elimination half-life

A

Elimination half-life of ~ 9 minutes

82
Q

Elimination half life of atropine is approximately ________

83
Q

Selective alpha 1 antagonist used for chronic tx of hptn

A

Prazosin (Minipress), doxazosin (Cardura), an terazosin (Hytrin)

84
Q

Generally used in patients with adequate cardiac output but low systemic vascular resistance: Keep in mind may exacerbate tissue perfusion oxygenation issues (by intense peripheral vasoconstriction) even though BP is adequate

85
Q

________ replaced propranolol in anesthesia because of its rapid onset and short duration

86
Q

Scopolamine Can be used as a preop medication with _____ and ______ being a desirable effect

A

sedation, amnesia

87
Q

Continuing medication throughout the perioperative period is essential. Tapering dose and dc may occasionally be indicated prior to surgery

88
Q

______ induces vasodilation in both arterioles and veins

89
Q

Improves weaning of high risk patients from cardiopulmonary bypass

90
Q

Ephedrine dose

91
Q

Isoproterenol drug class

A

Synthetic catecholamine

92
Q

Can be seen used in: Brady with heart block Torsades de points VT After heart transplant for chronotropic support (Beta 2 receptor stimulation)

A

Isoproternol

93
Q

Isoproternol: This is in addition to a probable already existing compromise due to the Beta 2 induced peripheral vasodilation causing a decrease in DBP and ultimately a ________ in _______ ______ ________.

A

decrease, coronary artery perfusion

94
Q

Scopolamine Patch onset ______

95
Q

Indirectly causes release of endogenous catecholamines, leading to a multiple mechanisms of action

96
Q

Produces dose related increase in ___, ___, ___, and ____.

(Ephedrine)

A

BP, CO, HR and SVR

97
Q

TRIOTROPIUM class

A

Long acting inhaled muscarinic antagonist

98
Q

phenylephrine Sharp rise in BP is produced as a result of a significant increase in ________ secondary to alpha 1 stimulation

A

peripheral resistance

99
Q

Endogenous central and peripheral neurotransmitter that is derived from dopa in the chain of catecholamine synthesis

100
Q

Dobutamine Produces slight drop in SVR b/c of ________

A

peripheral vasodilation

101
Q

Increase HR effect of anticholinergics greatest to least

A

Atropine, Glycopyrrolate, scopolamine

102
Q

Increase in_________ may be seen due to norepi vasoconstriction properties

103
Q

Belladonna alkaloid and is the PROTOTYPE anticholinergic

104
Q

Adult increasing HR dose of atropine:

A

0.4 – 0.6 mg

105
Q

Milrinone side effects

A

Arrhythmias

106
Q

The adrenergic stimulation results in a decrease in vital organ flow

107
Q

Frequently used after MI or in some types of angina and Hptn once pt is stable

A

Metoprolol

108
Q

Has no agonistic activity at alpha or dopamine receptors

A

Isoproternol

109
Q

Labetalol -IV dose ______ and can be repeated every few minutes PRN -If indicated, an infusion of _____can be started -Clinical practice a bolus dose is ______ titrated and repeated on basis of patient response

A

0.25 mg/kg, 2 mg/min, 5-10 mg

110
Q

ALPHA RECEPTOR ANTAGONISTS common side effects

A

-Orthostatic hypotension -Baroreceptor mediated reflex tachy

111
Q

Tamsulosin (Flomax) alfuzosin (Uroxatral) silodosin (Rapaflo) are ________ selective antagonists that produce relaxation of bladder neck and prostate

112
Q

Pharmacogenetic variation in metabolism suggest that _______ may not be the best choice of beta blocker in the periop period

A

metoprolol

113
Q

Usually first sympathomimetic chose for alleviation of hypotension due to cardiac depressant effects of anesthetic agents or vasodilation resulting from spinal anesthesia

114
Q

Avoid in patients with narrow-angle glaucoma because it increases intraocular pressure

115
Q

Premedicant sedative Analgesic combined with opiates for epidural treatment of severe pain Suppression of alcohol withdrawal symptoms Used as a catecholamine suppression test in diagnosis of pheochromocytoma

116
Q

Onset of atropine

A

Onset 1-2 minutes

117
Q

Dobutamine Strong _______ response with minimal ________.

A

inotropic, chronotropy

118
Q

Labetalol duration of action

A

2-6 hrs depending on dose

119
Q

Used in the past periop for “renal dose” dopaminergic effects to increase UOP however has been abandoned by some d/t long-term morbidity and mortality are not improved. It also inhibits aldosterone resulting in an increase in sodium excretion and UOP

120
Q

Often first chosen for patients in shock

121
Q

(epi) Increases in alpha effect also causes:

A

Splanchnic vasoconstriction Renal vasoconstriction: Renal vascular resistance and ultimately renal blood flow are decreased

122
Q

Metabolism or atropine

A

½ Liver with remainder unchanged in the urine

123
Q

Agent of choice (Anti-chorinergic) in obstetrics because it does not pass the placental barrier

A

GLYCOPYRROLATE

124
Q

Can cause large changes in increasing BP and decreasing HR

A

PHENYLEPHRINE

125
Q

May have poor response in cases of gram-negative sepsis b/c of a down regulation in which the sensitivity of beta receptors is diminished

126
Q

Dopamine has been implicated in limb ischemia in:

A

Pediatric patients Vascular diseases such as: Diabetes Atherosclerosis Raynaud’s Presence of an artline in the affected limb also increases incidence of limb ischemia with concurrent dopamine administration

127
Q

sedate effect of anticholinergics greatest to least

A

scopolamine, atropine, and glycopyrrolate has none (no bbb)

128
Q

Milrinone Substantially improves ___________ in association with acceleration of calcium uptake by the sarcoplasmic reticulum

A

LV function

129
Q

ESMOLOL Duration of action

A

10-15 minutes

130
Q

Milirone elimination

131
Q

Atropine overdose symtoms

A

Red as a beet (flushing) Blind as a bat (extreme mydriasis) Dry as a bone (lack of secretions and dry mouth) Mad as a hatter (Confusion) Hot as a hare (hyperthermia)

132
Q

Chronotropic activity seen with Beta 1 stimulation is generally absent in low doses

A

Norepi This is because of increase in SVR which includes reflex vagal activity

133
Q

Epinephrine induced Beta 2 stimulation also can cause a ___________as potassium follows glucose out of the hepatic cells

A

transient hyperkalemia

Pharm 2 (13 decks)

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