Cardiac Pharm test 1 Flashcards
1
Q
Also has indirect sympathomimetic effect eliciting the release of norepinephrine via Beta-1 stimulation
A
Dopamine
2
Q
Men benefit from beta blockers with ____
A
reduced MI
3
Q
Limited use since dobutamine and milrinone has emerged
A
Isoproternol
4
Q
Scopolamine Used as a patch with a total dose of ___and applied behind ear
A
1.5 mg
5
Q
Detrimental effects on the heart limiting isoproternol use
A
-Excessive tachy -Myocardial ischemia -Arrhythmia production
6
Q
Isoproternol’s positive ________and ________ effect results in a dramatic increase in myocardial oxygen consumption
A
inotropic , chronotropic
7
Q
Scopolamine Duration
A
3 days
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
9
Q
Dobutamine drug class
A
Synthetic sympathomimetic amine
10
Q
Not as potent as epi in stimulating alpha receptors in equal doses
A
Norepi
11
Q
Classified as non-selective beta blocker but is unique d/t its alpha blocking component
A
Labetalol (Normodyne, Trandate):
12
Q
Has little Beta 2 activity at low doses
A
Norepi
13
Q
Increase in CO compensates for decrease in SVR and the BP is ________ (or at low doses relatively unchanged)
A
increased
14
Q
May benefit vascular surgery patients at high risk for ____but not for stroke
A
MI
15
Q
UOP may fall due to renal vascular resistance is increased
A
Norepi
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
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
18
Q
Ephedrine onset/ duration
A
Immediate; 15 min to 1.5 hours depending on dose
19
Q
Milirione loading dose
A
50 mcg/kg slowly over 10 minutes
20
Q
Stimulates both alpha and beta receptors directly
A
EPHEDRINE
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
22
Q
Has for the most part unopposed alpha stimulation
A
Norepi
23
Q
Milrone has of an increase in HR probably contributes to an absence of myocardial oxygen consumption true or false
A
true
24
Q
Potent non-selective agonist of Beta 1 and Beta 2 receptors
A
Isoproternol
25
(epi)This is followed by a longer _______ as Beta 2 stimulation then forces potassium (that is extracellular) into red blood cells
hypokalemia
26
ANTICHOLINERGICS
Atropine, Glycopyrrolate, Scopolamine
27
Has strong alpha stimulating effect with virtually no beta stimulation
PHENYLEPHRINE
28
Women suffered from clinical significant increases in \_\_\_\_
CHF
29
Isoproternol Increase in CO is seen due to combination B1 and B2 inducing _______ and resultant drop in \_\_\_\_\_.
vasodilation , SVR
30
Coronary Artery perfusion may be increased b/c of the increase in DBP
Norepi
31
contraindicated beta blockers
asthma, Brady arrhythmias, acute heart failure, or advanced heart block
32
Recent evidence indicates significant adverse effects when used in cardiac surgery and clinicians have stopped using it for inotropic support
Dobutamine
33
PVR (peripheral) and preload/afterload are diminished
ALPHA RECEPTOR ANTAGONIST
34
Produces a positive inotropic action and vasodilation without producing tachycardia
Milrinone (Primacor)
35
Lack of alpha 2 blocking indicates that they have no effect on norepinephrine levels
ALPHA RECEPTOR ANTAGONIST
36
(epi)As doses increase, alpha effects predominates resulting in vasoconstriction and increase in SVR
SBP increases, DBP remains relatively unchanged, Pulse Pressure increases
37
Dobutamine has Primarily \_\_\_\_\_\_with some \_\_\_\_\_\_\_\_effects
Beta 1 agonist, Beta 2
38
Isoproternol has Profound \_\_\_\_\_\_\_\_stimulation results in both positive inotropic an chronotropic effects
Beta 1
39
Antisialagogue effects of anticholinergics greatest to least
Scopolamine, glycopyrrolate, atropine
40
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
clonidine
41
mydrorisis, cyclopegia effects of anticholinergics greatest to least
scopolamine, atropine, glyco 0.
42
Clinical result is a decrease in both \_\_\_\_\_and \_\_\_\_\_.
(milrinone)
preload and afterload
43
Used as first line therapy (along with dopamine) for shock
Norepi
44
Esmolol is metabolized by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
nonspecific plasma esterases found in the cytosol of RBC
45
Ephedrine As with any indirect-acting agent, _________ may develop with subsequent dosing b/c catecholamine stores become depleted.
tachyphylaxis
46
Is also a potent bronchial dilator and pulmonary vasodilator
Isoproterenol
47
Clonidine drug class
Presynaptic Alpha-2 Agonist
48
Effects similar to epi but to a lesser degree and not accompanied with dramatic increase in serum glucose
EPHEDRINE
49
Milirinone infusion
0.5 mcg/kg as needed
50
Modified isoproterenol but is used widespread
Dobutamine
51
Metoprolol dose
5 mg doses IV q 5 minutes to max of 15 mg is recommended
52
\_\_\_\_\_\_\_\_\_ 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
Tamsulosin
53
Pulmonary artery pressure _______ and an _______ in LV stroke work index is observed
decreases and increase
54
Used for heart stimulation for cardiac stress testing
Dobutamine
55
Esmolol IV loading dose: _____ Followed by infusion of \_\_\_\_\_\_\_
500 mcg/Kg, 100-300 mcg/kg/min
56
Produces both dopamine ad alpha adrenergic blockade and thus small reductions in blood pressure may occur especially in volume depleted patients
DROPERIDOL
57
Relax smooth muscle effect of anticholinergics greatest to least
atropine=glycopyrrolate, scopolamine
58
Clonidine: ________ \_\_\_\_\_\_\_ happens with abrupt stopping of the drug. The resultant increase in catecholamine levels manifests as Tachy and Hptn
Rebound hypertension
59
prevention of motion induced nausea
scopolamine, atropine, 0 glyco.
60
ESMOLOL onset
Onset of 2 minutes
61
Acts centrally and peripherally
EPHEDRINE
62
Stimulation of peripheral presynaptic alpha 2 receptor causes inhibition of catecholamine release with subsequent vasodilation
Clonidine
63
Avoid starting beta blockers immediately before surgery, in \_\_\_\_\_\_\_\_\_\_, or in patient with prior ____________ or \_\_\_\_\_\_\_\_\_\_\_\_.
emergency surgery, cerebrovascular disease or sepsis
64
Milinone Acts to enhance diastolic function, \_\_\_\_\_\_\_cardiac output and \_\_\_\_\_\_\_\_pulmonary wedge pressure
increases, decrease
65
(EPI) If coronary arteries are not obstructed
autoregulation increases O2 delivery to meet the increase in demand
66
TRIOTROPIUM use
Used as a bronchodilator for patients with COPD
67
Labetalol: Beta to alpha blockade is
7:1
68
(epi) Insulin secretion is inhibited by an overriding\_\_\_\_\_\_\_\_.
Beta 2 stimulation
69
has CNS effects that are much more pronounced at lower doses Does not substantially increase HR
Scoplamine
70
A __________ is required by FDA prior to use of droperidol
12-lead EKG
71
There are concerns anemia might complicated periop beta blockers by further limiting \_\_\_\_\_\_\_\_
O2 delivery
72
Ephedrine Duration is ______ than epi due to lack of basic catechol structure so it’s resistant to metabolism by monoamine oxidase
longer
73
Beta blockers is associated with worse outcomes when Hgb levels are decreased by \_\_\_\_\_
\> 35%
74
Topical doses should not exceed _________ and\_\_\_\_\_\_\_\_ in children in order to prevent severe hypertension
0.5 mg (4 drops of 0.25% in adults, 20 mcg/kg
75
ANTICHOLINERGICS moa
Competitive antagonists of acetylcholine at muscarinic receptors
76
4 thing epi increases that causes in increase in 02 consumption.
HR, LV Stroke volume, and CO increase.
77
(EPI) The peripheral vasculature promotes the redistribution of blood flow to skeletal muscle, thus producing a decrease in SVR
Low Doses 10 mcg/min:
78
(epi) Beta stimulation leads to activation of the renin-angiotensin system and also: to an increase in:
lipolysis Glycogenolysis Gluconeogenesis Ketone production Lactate release by skeletal muscle
79
(epi) If coronary arteries are obstructed
O2 delivery may be insufficient to meet demand resulting in myocardial ischemia
80
Prevents bradycardia without inducing significant levels of tachycardia
GLYCOPYRROLATE
81
ESMOLOL Elimination half-life
Elimination half-life of ~ 9 minutes
82
Elimination half life of atropine is approximately \_\_\_\_\_\_\_\_
4 hours
83
Selective alpha 1 antagonist used for chronic tx of hptn
Prazosin (Minipress), doxazosin (Cardura), an terazosin (Hytrin)
84
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
norepi
85
\_\_\_\_\_\_\_\_ replaced propranolol in anesthesia because of its rapid onset and short duration
Esmolol
86
Scopolamine Can be used as a preop medication with _____ and ______ being a desirable effect
sedation, amnesia
87
Continuing medication throughout the perioperative period is essential. Tapering dose and dc may occasionally be indicated prior to surgery
CLONIDINE
88
\_\_\_\_\_\_ induces vasodilation in both arterioles and veins
Prazosin
89
Improves weaning of high risk patients from cardiopulmonary bypass
Milrinone
90
Ephedrine dose
5-25 mg
91
Isoproterenol drug class
Synthetic catecholamine
92
Can be seen used in: Brady with heart block Torsades de points VT After heart transplant for chronotropic support (Beta 2 receptor stimulation)
Isoproternol
93
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 _______ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_.
decrease, coronary artery perfusion
94
Scopolamine Patch onset \_\_\_\_\_\_
4 hours
95
Indirectly causes release of endogenous catecholamines, leading to a multiple mechanisms of action
EPHEDRINE
96
Produces dose related increase in \_\_\_, \_\_\_, \_\_\_, and \_\_\_\_.
(Ephedrine)
BP, CO, HR and SVR
97
TRIOTROPIUM class
Long acting inhaled muscarinic antagonist
98
phenylephrine Sharp rise in BP is produced as a result of a significant increase in ________ secondary to alpha 1 stimulation
peripheral resistance
99
Endogenous central and peripheral neurotransmitter that is derived from dopa in the chain of catecholamine synthesis
Dopamine
100
Dobutamine Produces slight drop in SVR b/c of \_\_\_\_\_\_\_\_
peripheral vasodilation
101
Increase HR effect of anticholinergics greatest to least
Atropine, Glycopyrrolate, scopolamine
102
Increase in\_\_\_\_\_\_\_\_\_ may be seen due to norepi vasoconstriction properties
preload
103
Belladonna alkaloid and is the PROTOTYPE anticholinergic
Atropine
104
Adult increasing HR dose of atropine:
0.4 – 0.6 mg
105
Milrinone side effects
Arrhythmias
106
The adrenergic stimulation results in a decrease in vital organ flow
Norepi
107
Frequently used after MI or in some types of angina and Hptn once pt is stable
Metoprolol
108
Has no agonistic activity at alpha or dopamine receptors
Isoproternol
109
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
0.25 mg/kg, 2 mg/min, 5-10 mg
110
ALPHA RECEPTOR ANTAGONISTS common side effects
-Orthostatic hypotension -Baroreceptor mediated reflex tachy
111
Tamsulosin (Flomax) alfuzosin (Uroxatral) silodosin (Rapaflo) are ________ selective antagonists that produce relaxation of bladder neck and prostate
alpha 1
112
Pharmacogenetic variation in metabolism suggest that _______ may not be the best choice of beta blocker in the periop period
metoprolol
113
Usually first sympathomimetic chose for alleviation of hypotension due to cardiac depressant effects of anesthetic agents or vasodilation resulting from spinal anesthesia
Ephedrine
114
Avoid in patients with narrow-angle glaucoma because it increases intraocular pressure
Atropine
115
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
CLONIDINE
116
Onset of atropine
Onset 1-2 minutes
117
Dobutamine Strong _______ response with minimal \_\_\_\_\_\_\_\_.
inotropic, chronotropy
118
Labetalol duration of action
2-6 hrs depending on dose
119
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
Dopamine
120
Often first chosen for patients in shock
Dopamine
121
(epi) Increases in alpha effect also causes:
Splanchnic vasoconstriction Renal vasoconstriction: Renal vascular resistance and ultimately renal blood flow are decreased
122
Metabolism or atropine
½ Liver with remainder unchanged in the urine
123
Agent of choice (Anti-chorinergic) in obstetrics because it does not pass the placental barrier
GLYCOPYRROLATE
124
Can cause large changes in increasing BP and decreasing HR
PHENYLEPHRINE
125
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
Dopamine
126
Dopamine has been implicated in limb ischemia in:
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
sedate effect of anticholinergics greatest to least
scopolamine, atropine, and glycopyrrolate has none (no bbb)
128
Milrinone Substantially improves ___________ in association with acceleration of calcium uptake by the sarcoplasmic reticulum
LV function
129
ESMOLOL Duration of action
10-15 minutes
130
Milirone elimination
kidneys
131
Atropine overdose symtoms
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
Chronotropic activity seen with Beta 1 stimulation is generally absent in low doses
Norepi This is because of increase in SVR which includes reflex vagal activity
133
Epinephrine induced Beta 2 stimulation also can cause a \_\_\_\_\_\_\_\_\_\_\_as potassium follows glucose out of the hepatic cells
transient hyperkalemia
