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Final Review > Cardiac Pharmacology > Flashcards

Cardiac Pharmacology Flashcards

1
Q

Epinephrine

A

Classification: Alpha and beta adrenergic agent. Vasopressor, intotropic, chronotropic, and dromoatropic

Mechanism of Action: Will increase HR and in turn affect CO and SVR

Indications: Cardiac arrest (will be given as a bolus), pulseless arrythmia, Hypotension, Anaphylaxsis

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2
Q

Norepinephrine

A

Class of Drug: Inotrope, vasoactive agent. Alpha and beta 1 agonist

Mechanism of Action: Will affect CO and SVR. Is an powerful alpha and beta1 which results in an increase in myocardial contractility

Indications: Hypotension, distributive shock

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3
Q

Dopamine

A

Class of Drug: Inotrope, vasoactive agent

Mechanism of Action: Precurser to norepinphrine. Stimaultes alpha, beta, and dopmerginic recpetors. Only administered via IV

Indications:

Low Dose (1-5 mg/kg/min): Renal Dose (dilate renal arteries)

Medium Dose (5-10 mg/kg/min): Cardiac Dose (treat bradycardia by increase CO)

High Dose (1-5 mg/kg/min): Vasopressor Dose (treat hypothermia with alpha effects of decreaseing SVR and constrction)

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4
Q

Phenylephrine

A

Class of Drug: Alpha agonist

Mechanism of Action: Last 20 min (last longer the epinephrine and no disturbances of heart rhythm)

Indications: Hypotension and used in RSI for hypotension

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5
Q

Vasopressin

A

Class of Drug: Inotrope, vasoactive agent

Generic: Vasopressin

Trade: ADH

Mechanism of Action: Non adrenergic peripheral vasoconstrictor

Indications: PEA, Hypotension,

NO BETA STIMULATION

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6
Q

Dubutamine

A

Class of Drug: Inotrope, vasoactive agent

Generic: Dubutamine

Mechanism of Action: Syntheteic catecholamine taht produces predominately beta effects (iontrope) and change BP

Indications: Patients with heart pumping problems and a systolic BP of >70mmHg

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7
Q

Isoproterenol

A

Class of Drug: Inotrope, vasoactive agent

Generic: Isoproterenol

Mechanism of Action: Nearly a pure beta agonists, patent iontrop and chronotrope, will decrease BP and increase SVR

Indications: Rarely used to treat bradycardia or b blocker overdose

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8
Q

Imamrione and Mitrinone

A

Class of Drug: Inotrope, vasoactive agent

Generic: Imamrione and Mitrinone

Mechanism of Action: Causes iontropic effects in the heart, peripheral vasodilation (does not affect sympathetic NS)

Indications: Severe CHF, Refractory cardiogenic shock

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9
Q

Atropine

A

Class of Drug: Chronotrope

Generic: Atropine

Mechanism of Action: Parasympathetic (enhance autonomacay of SA node which will increase rate through av conduction)

Indications: Symptomatic bradyarrhythmia but may not work in heart blocks

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10
Q

Lidocaine

A

Class of Drug: Class I Anti-Arrthymias (Na Channel Blockers)

Generic: Lidocaine

Mechanism of Action: Suppress ventricle arrthymias and decrease myocardial conduction and increase VF threshold

Indications: Refractory Shock, VF (pulseless), and VT management. Manage PVC irritability

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11
Q

Class II Anti-Arrhythmias (B-Blockers)

A

Names: Mteoprolol, propranolol, labetalol, atenalol, esmalol

Mechanism of Action: Beta Blocker Adrenergic Receptor

Decrease the effect of catecholamines, decrease HR and BP, decrease myocardial contraction and O2 consumption

Avoid in diseases with bronchospasms

Indications: Acute Coronary syndrome, hypertension, actute tachycardia (SVT)

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12
Q

Amiadarone

A

Category: Class III Anti-Arrhythmias (K Channel Blockers)

Generic Name: Amiarone

Mechanism of Action: Second line in ACLS

Indications: Refractory shock, pulsleless VF, VT, tachycardia,

Can cause amidarone lung or smurf lung

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13
Q

Adenosine

A

Category: Class IV Anti-Arrhythmias (Ca Channel Blockers)

Generic Name: Adenosine

Trade Name: Adenocard

Mechanism of Action: Endogenous compound that depresses both the SA and AV node

Indications: Treat SVT, warn patients of sensations of heat, chest pain, and flushing

Do not give to asthmatic patients

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14
Q

Digoxin

A

Category: Class IV Anti-Arrhythmias (Ca Channel Blockers)

Generic Name: Digoxin

Trade Name: Lanoxin

Mechanism of Action: Cardiac glycoside, derivities of digitalis, anti-arrhythmia and inotropic

Indications: Decreased ventricular repsonpe in atrial fibirllation or atrial flutter

Narrow Therapeutic Range

May cause arrhythmias and precitate cardiac arrest

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15
Q

Nitroglycerin

Nitroprusside

A

Category: Nitric Vasodilator

Generic Name: Nitroglycerin, Nitroprusside

Mechanism of Action: Breaks down nitric oxide to produce vasodilation

Indications: Angina, AMI, CHF, hypertensive crisis

Can result in hypotension

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16
Q

ACE Inhibitors

A

Category: ACE Inhibitors

Generic Name: Captropril

Mechanism of Action: Prevent sysnthesis of angotensin which will result in vasodilation

Indications: Hypertension, Myocardial infarction

17
Q

What are drugs with Positive Chronotropic Effects

A

A positive chronotrope will increase HR and this will be anything that stimulates B1

Ex. Epi, Norepi, Dopamine, Dobutamine, Atropine

18
Q

What is a drug that is a powerful alpha agent

A

Levophed, Phenylephrine and dopamine (high/pressor dose).

19
Q

What are the effects of beta 2 stimulation

A

Bronchodilation (for receptors in the lungs) and vasodilation (due to the receptors in the periphery)

20
Q

Cautions with beta 1 stimulation

A

The increased HR and contractility cause an increase in myocardial demand/oxygen consumption and myocardial irritability. Also decreased time in diastole…may impact filling time at high rates.

21
Q

Effects of Dopamine

A

Low Dose (1-5 mcg/kg/min) results in renal and splanchnic vasodilation (due to dopaminergic receptor stimulation)

Moderate Dose (5-10 mcg/kg/min) results in increased HR, contractility and rate of conduction due to B1 stimulation

High Dose (10-20 mcg/kg/min) results in increased SVR and increased BP due to a1 stimulation

22
Q

When is a bolus of Epinephrine given

A

In pulsesless states! VT, VFib, PEA and asystole

Vasopressin is also an alternative that can be given and it will have the advantage that there is no B1 stimulation thus doesn’t further stress the heart (beyond the increased afterload it results) with the increased HR and increased irritability

23
Q

How do “Iondilators” work and Why are they helpful in patients with CHF

A

Inhibit phosphodiesterase III (an enzyme that breaks down cAMP. Increased levels of cAMP in the heart results in increased inotropism and increased cAMP in peripheral smooth muscles causes vasodilation

24
Q

Heparin

Coumadin

A

Category: Anti-Thrombolytic/Coagulation

Generic Name: Heparin, Coumadin

Mechanism of Action: Heparin inhibits clotting pathway, Caumadin will use used post heparin

Indications: Treat thromboemobulism, PE, atrial fib, intravascular coagulation

CAUTION: Bleeding, bruising, hemorrhage

25
Q

ASA

Abciximab

Clopidagrel

A

Category: Anti-Thrombolytic/Platlet

Generic Name: ASA, Abciximab, Clopidagrel

Trade Name: Aspirin, Repro, Plavix

Mechanism of Action: prevent thromboxone fomation

Indications: Thrombolus embolism, myocardial infarction

Cation Increased risk of bleeding, relative contraindications when thrombolytics are used

26
Q

Alteplase

Retephase

Streptokinase

Tenecteplase

A

Category: Anti-Thrombolytic

Mechanism of Action: Lyse formed thrombi be degrading fibrin

Indications: Acute myocardial infarction, PE,

27
Q

Inotrope

A

Affects myocardial contractility

28
Q

Dromotrope

A

Affect rate of conduction

29
Q

Catecholamine

A

Sympathomimetic Action

30
Q

Alpha Adrenergic Receptors

A

Located in peripheral vasculature where they will regulate smooth vascular tone

Agonist Action: Vasoconstriction

Alpha 1- Peripheral blood vessels

Alpha 2- Presynaptic sympathetic neurons and CNS

31
Q

Beta 1 Receptors

A

Located in the heart

Agonist: Increase HR, Contraction, and conduction

32
Q

Dopaminergic Receptors

A

Located in the smooth muscle in the cerebral, coronary, renal, and splanchnic vascular beds

Agonist stimulation will results in vasodilation and therefore increased blood flow to these areas

33
Q

Adenosin

A

Depress both SA and AV node to treat SVT

34
Q

Anticoagulants

A

Will prevent the formation of a fibrin clot and prevent further clot formation

Used to preven PE and in DIC

35
Q

Antiplatletes

A

Inhibits the stickiness of platlets in the clotting process

36
Q

Thrombolytics

A

Final Review (27 decks)

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