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Anesthesiology > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

What are 2 things a positive inotrope does?

A
  • Increase cardiac output

- Increase atrial filling pressure

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2
Q

Adrenergic agonists help to maintain what?

Prevent what?

A
  • Maintain arterial blood pressure

- Prevent tissue ischemia

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3
Q

When vasopressors are administered what occurs to heart rate?

A

Slows heart rate

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4
Q

Adrenergic agonists are not recommended in the face of what?

A

Hypovolemia

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5
Q

What are 2 examples of adrenergic agonists?

A
  • Bronchospasm (asthma)

- Life threatening allergic reactions

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6
Q

What are 3 possible routes of administration for adrenergic agonists?
What is not an effective route?

A
  • SQ, IV, Intra-tracheal

- Oral

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7
Q

What is are 3 examples of a drug that is an A1, A2, B1, B2 agonist?

A
  • Epinephrine
  • Norepinephrine
  • Ephedrine
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8
Q

What effect does epinephrine have on heart rate?

On vascular tone?

A
  • Increases HR

- Increases vascular tone (vasoconstriction)

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9
Q

What is the strongest vasopressor that can be administered during cardiopulmonary arrest?

A

Epinephrine

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10
Q

Is epinephrine the go to drug for hypotension?

Why?

A
  • No

- Can be potent tachyogenic drug. Also potent vasoconstrictor which decreases organ profusion

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11
Q

What are 2 indications for epinephrine?

A
  • Treat life-threatening allergic reactions

- CRI in non-responsive hypotension

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12
Q

Epinephrine decreases what?

A

Renal blood flow

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13
Q

Epinephrine increases what 6 things?

A
  • Blood pressure
  • Peripheral vascular resistance
  • Myocardial contractile force
  • Heart rate
  • Cardiac output
  • Bronchodilator
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14
Q

What are 4 disadvantages of epinephrine?

A
  • Severe vasoconstriction can lead to decrease perfusion of tissues
  • Increase in oxygen consumption (increased cardiac work)
  • Can induce ventricular fibrillation (tachyarrhythmias)
  • Increase sensitivity to tissue hypoxia
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15
Q

Epinephrine should be left for what?

A

Resistant hypotension or CPA

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16
Q

Does norepinephrine produce more or less severe tachycardia than epinephrine?

A

Less severe tachycardia

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17
Q

What is norepinephrine used for?

A

Significant non-responsive hypotension

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18
Q

Do you usually use norepinephrine with cardiac arrest?

A

No

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19
Q

What does norepinephrine decrease?

A

Renal blood flow

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20
Q

What are 4 things increased by norepinephrine?

A
  • Blood pressure
  • Peripheral vascular resistance
  • Myocardial contractile force
  • Heart rate
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21
Q

What is an example of an A1, B1, B2 agonist?

A

Dopamine

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22
Q

What are 2 indications for dopamine?

A
  • Treatment of hypotension

- Increase urine output

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23
Q

What does dopamine decrease?

A

Partial pressure of oxygen in blood (interferes with ventilatory response)

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24
Q

What are 4 things dopamine increases?

A
  • Myocardial contractility
  • Renal blood flow
  • Glomerular filtration rate
  • Systemic vascular resistance (only seen with high dose)
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25
How does dopamine need to be administered?
As a CRI
26
What is a low dose of dopamine? | What is seen with a low dose?
- 1-4 ug/kg/min | - Stimulates dopamine receptors
27
What are 4 results of dopamine receptor stimulation?
- Splanchnic vasodilation - Natriuresis - Diuresis - Alterations in renal & GI blood flow
28
What is natriuresis?
Excretion of sodium in the urine
29
What is diuresis?
Increased discharge of urine
30
What is a medium dose of dopamine? | What are 2 things seen with a medium dose?
- 5-10 ug/kg/min | - Increase HR/contractility, mild change in vascular resistance
31
What is a high dose of dopamine? | What are 2 things seen with a high dose?
- Increase vascular resistance | - Increase contractility/HR
32
Mainly beta and only mild alpha effects are seen with which type of dopamine dose?
Medium dose
33
Dopamine receptors are stimulated with which type of dopamine dose?
Low dose
34
Significant beta and alpha effects are seen with which type of dopamine dose?
High dose
35
What type of agonist is dobutamine?
Non-specific Beta agonist
36
Which drug is a common choice for equine hypotension?
Dobutamine
37
What is dobutamine used for?
Treatment for hypotension
38
What are 2 things increased by dobutamine?
- Contractility | - HR
39
What are 4 side effects seen with dobutamine?
- Tachycardia - Arrhythmias - Vasodilation - Seizures/tremors (cats at doses > 5ug/kg/min)
40
What type of an agonist is isoproterenol?
Beta agonist
41
What is the main clinical use of isoproterenol?
Treatment 3rd degree heart block
42
What are 3 effects isoproterenol has?
- Increase HR (can cause significant tachycardia) - Potent inotrope - Potent chronotrope
43
Is isoproterenol still commonly used?
No
44
What are 3 side effects seen with isoproterenol?
- Arrhythmias - Tachycardia - Hypotension
45
What type of agonist is phenylephrine?
Alpha 1 agonist
46
What are 4 clinical uses of phenylephrine?
- Significant vasoconstriction - Splenic contraction - Decrease epistaxis - Decrease nasal edema
47
What are 2 side effects seen with phenylephrine?
- Decreased blood flow | - Decreased cardiac output (increased afterload, reflex bradycardia)
48
Caution should be used when using phenylephrine in what species? Why?
- Horses | - Decrease in blood flow to GIT
49
High doses of phenylephrine have potential for what?
Some Beta effects
50
How is phenylephrine administered?
As a CRI
51
What are 2 clinical uses for ephedrine?
- Treatment of hypotension | - Increase cardiac output
52
What are 3 effects of ephedrine?
- Increase HR - Increase vascular resistance - Increase contractility
53
Which drugs are used routinely for the treatment mild of hypotension?
- Ephedrine - Dopamine - Dobutamine - Phenylephrine
54
Which drugs are used routinely for the treatment of moderate hypotension?
- Phenylephrine | - Norepinephrine
55
Which drugs are used for the treatment of severe hypotension?
- Vasopressin | - Epinephrine
56
Does ephedrine have a slow or fast onset?
Fast onset
57
What can ephedrine cause?
CNS excitement
58
Which cardiovascular drug is not given CRI?
Ephedrine
59
Which 2 drugs are mainly or only non-selective beta agonists?
- Mainly: dobutamine | - Only: isoproterenol
60
What are 3 clinical uses for vasopressin?
- Treatment during CPA (cardiopulmonary arrest) - Vasodilatory shock - Von Willebrand disease (stimulates platelets and bone marrow)
61
Which is better for the treatment of CPA, epinephrine or vasopressin?
Vasopressin
62
What are 4 side effects of vasopressin?
- Decrease tissue perfusion - Contraction (bladder, gall bladder) - Local irritation at injection site - Skin necrosis (extravasation)
63
What are the 3 steps in the treatment of hypotension in order?
1) Check anesthetic depth 2) Check volume status 3) Administer CV drugs
64
What can cause hypotension in regards to anesthetic depth? | What should be done?
- Too deep | - Decrease anesthetic
65
What are 3 things that can be done if patient has a low volume status causing hypotension?
- Administer fluid bolus - Increase fluid rate - Change to more appropriate fluid choice
66
What can be given to treat an ephedrine overdose that has caused ventricular tachycardia?
1-2 mg/kg lidocaine
67
What is used to treat ventricular tachyarrhythmias by reducing cellular excitation?
Lidocaine
68
When treating a hypertensive emergency, the MAP should be reduced by no more than what?
25% within minutes to 1 hour
69
Excessive falls in arterial blood pressure can lead to what?
Renal, cerebral and coronary ischemia
70
Nitroprusside CRI causes what?
Arterial & venous dilation
71
Nitroprusside CRI can't be used longer than what time period? Why?
- 24 hours | - Cyanide can build up
72
Hydralazine can cause what? | This can lead to what?
- Arterial vasodilator | - Profound hypotension
73
What is enalaprilat?
ACE inhibitor
74
What is a class of drugs that will slow down heart rate?
Beta blockers
75
What are 3 drugs that can be used to treat hypertension?
- Nitroprusside CRI - Hydralazine - Enalaprilat
76
What are 3 examples of negative dromotropic agents?
- Diltiazem - Esmolol - Adenosine
77
What does a dromotropic agent do?
Decreases conduction of electrical impulses to the heart.
78
What are 2 indications for the use of temporary transvenous pacing?
- Support HR & BP while under general anesthesia for permanent pacemaker - Refractory bradycardia stabilization prior to pacemaker implantation
79
What type of cardiac disorder do we commonly apply transvenous pacing?
Severe 3rd degree AV block

Anesthesiology (19 decks)

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