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Pharmacology > Cardio: Drugs for Aortic Dissection > Flashcards

Cardio: Drugs for Aortic Dissection Flashcards

1
Q

What four drugs are first line for aortic dissection?

A

Labetalol, esmolol, nitroprusside, nicardipine

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2
Q

MOA of labetalol

A

Blocks both a1 and non-selective B

-decreases PVR

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3
Q

Indications for labetalol

A 
Arterial HTN (emergencies to stable HTN)
-also used in combo with other HTN drugs
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4
Q

Contraindications of labetalol/esmolol?

A

HF, 2nd-3rd degree AV block, bradycardia, cardiogenic shock, severe hypotension

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5
Q

What are some precautions when prescribing labetalol?

A 
Hepatic injury (monitor LFTs)
Cardiac failure
Withdrawl syndrome
Bronchospasm and DM (decreases B2 activity)
Pheochromocytoma
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6
Q

What are some drugs to look out for when prescribing labetalol?

A 
Tricyclic antidepressants (tremor)
B-blockers
Cimetidine*
Halothane
Nitroglycerin (hypotension)
CCBs (verapamil)
Digitalis
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7
Q

What special population (2) may require an adjusted dose when prescribing labetalol?

A

Geriatric patients
-elimination is reduced, so may have to decrease dose

Pregnancy
-clearance increases, so may have to increase dose

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8
Q

MOA of Esmolol?

A

B1 specific B-blocker

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9
Q

Indications for Esmolol?

A

Control of rapid heart beats, especially indicated around surgery

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10
Q

Should you prescribe esmolol during pregnancy?

A

It can be used, but it can cause fetal bradycardia

-have to monitor pts closely, or switch drugs

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11
Q

Does esmolol interact with other drugs?

A

yes, many interactions

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12
Q

What special population may require a lower dose when prescribing esmolol?

A

The elderly

-clearance decreases, so may have to reduce

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13
Q

Main adverse effects of esmolol?

A

Hyperkalemia
-especially in renal failure pts

Hypotension
-must monitor them closely within 30min of dosage

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14
Q

Which B-blocker is very short acting?

A

Esmolol

-half life 9 mins

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15
Q

Nitroprusside MOA

A

Releases NO when broken down

  • NO activates guanylate cyclase, which increase cGMP
  • cGMP increases PKG=inactivation of myosin light chains (phosphorylation)
  • -decreases contraction=vasodilation
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16
Q

Should you prescribe nitroprusside with PDE-5 inhibitors?

A

No way, Jose

-both work to vasodilate, and can cause massive drops in BP

17
Q

Indications for nitroprusside

A

Hypertensive emergencies!

-can also use it during surgeries and HF

18
Q

Adverse effects of nitroprusside

A

Bradyarrythmias
Hypotension
Palpitations
Tachyarrhythmias (reflex)

and many more, dude lists like 50

19
Q

What is the major toxicity of nitroprusside?

A

Nitroprusside is broken down into Cyanide

-so look out for seizures and lactic acidosis

20
Q

What hematological issue can nitroprusside cause?

A

Methemoglobinemia

-sequesters hemoglobin, so patients may develop blue skin and “chocolate brown” blood

21
Q

When would nitroprusside cause thyiocyante toxicity?

A

Pts w renal impairment
-CN- binds to thiosulfate, which is normally excreted in urine

Renal failure means less is excreted

22
Q

MOA of Nicardipine

A

dihyropyridine CCB

-causes vasodilation

23
Q

Indications for Nicardipine

A

IV: short-term tx of hypertension, but switch to oral ASAP

Oral: long term BP control

24
Q

Contraindications for Nicardipine?

A

Pts w advanced aortic stenosis

25
Q

Adverse effects of nicardipine?

A

Headache, hypotension, tachycardia (reflexive), N/V

26
Q

What are some precautions to think about when prescribing nicardipine?

A

Can cause hypotension

Can worsen angina

Can worsen HF (due to negative inotropic effects)

27
Q

In someone with hepatic or renal impairment, what should you think about when giving nicardipine?

A

Hepatic impairment: Lower doses and monitor blood flow

Renal: Can significantly lower clearance and increase AUC curve (?)

28
Q

Where should you administer nicardipine?

A

In large peripheral/central veins rather than smaller ones of wrist/hand
-minimizes risk of thrombophlebitis, local irritation

29
Q

Is nicardipine safe in kids?

A

No, safety has not been established yet

30
Q

What should you do w doses of nicardipine in elderly?

A

Lower the doses!

31
Q

What drugs do nicardipine interact with?

A

Those that inhibit CYP3A4: Cimitidine, cyclosporines, tacrolimus
-increases concentration

32
Q

Is nicardipine safe to give w B-blockers?

A

yes, but need to monitor in those with HF

Pharmacology (50 decks)

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