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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
Q

How does dopamine need to be administered?

A

As a CRI

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26
Q

What is a low dose of dopamine?

What is seen with a low dose?

A
  • 1-4 ug/kg/min

- Stimulates dopamine receptors

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27
Q

What are 4 results of dopamine receptor stimulation?

A
  • Splanchnic vasodilation
  • Natriuresis
  • Diuresis
  • Alterations in renal & GI blood flow
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28
Q

What is natriuresis?

A

Excretion of sodium in the urine

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29
Q

What is diuresis?

A

Increased discharge of urine

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30
Q

What is a medium dose of dopamine?

What are 2 things seen with a medium dose?

A
  • 5-10 ug/kg/min

- Increase HR/contractility, mild change in vascular resistance

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31
Q

What is a high dose of dopamine?

What are 2 things seen with a high dose?

A
  • Increase vascular resistance

- Increase contractility/HR

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32
Q

Mainly beta and only mild alpha effects are seen with which type of dopamine dose?

A

Medium dose

33
Q

Dopamine receptors are stimulated with which type of dopamine dose?

A

Low dose

34
Q

Significant beta and alpha effects are seen with which type of dopamine dose?

A

High dose

35
Q

What type of agonist is dobutamine?

A

Non-specific Beta agonist

36
Q

Which drug is a common choice for equine hypotension?

A

Dobutamine

37
Q

What is dobutamine used for?

A

Treatment for hypotension

38
Q

What are 2 things increased by dobutamine?

A
  • Contractility

- HR

39
Q

What are 4 side effects seen with dobutamine?

A
  • Tachycardia
  • Arrhythmias
  • Vasodilation
  • Seizures/tremors (cats at doses > 5ug/kg/min)
40
Q

What type of an agonist is isoproterenol?

A

Beta agonist

41
Q

What is the main clinical use of isoproterenol?

A

Treatment 3rd degree heart block

42
Q

What are 3 effects isoproterenol has?

A
  • Increase HR (can cause significant tachycardia)
  • Potent inotrope
  • Potent chronotrope
43
Q

Is isoproterenol still commonly used?

A

No

44
Q

What are 3 side effects seen with isoproterenol?

A
  • Arrhythmias
  • Tachycardia
  • Hypotension
45
Q

What type of agonist is phenylephrine?

A

Alpha 1 agonist

46
Q

What are 4 clinical uses of phenylephrine?

A
  • Significant vasoconstriction
  • Splenic contraction
  • Decrease epistaxis
  • Decrease nasal edema
47
Q

What are 2 side effects seen with phenylephrine?

A
  • Decreased blood flow

- Decreased cardiac output (increased afterload, reflex bradycardia)

48
Q

Caution should be used when using phenylephrine in what species?
Why?

A
  • Horses

- Decrease in blood flow to GIT

49
Q

High doses of phenylephrine have potential for what?

A

Some Beta effects

50
Q

How is phenylephrine administered?

A

As a CRI

51
Q

What are 2 clinical uses for ephedrine?

A
  • Treatment of hypotension

- Increase cardiac output

52
Q

What are 3 effects of ephedrine?

A
  • Increase HR
  • Increase vascular resistance
  • Increase contractility
53
Q

Which drugs are used routinely for the treatment mild of hypotension?

A
  • Ephedrine
  • Dopamine
  • Dobutamine
  • Phenylephrine
54
Q

Which drugs are used routinely for the treatment of moderate hypotension?

A
  • Phenylephrine

- Norepinephrine

55
Q

Which drugs are used for the treatment of severe hypotension?

A
  • Vasopressin

- Epinephrine

56
Q

Does ephedrine have a slow or fast onset?

A

Fast onset

57
Q

What can ephedrine cause?

A

CNS excitement

58
Q

Which cardiovascular drug is not given CRI?

A

Ephedrine

59
Q

Which 2 drugs are mainly or only non-selective beta agonists?

A
  • Mainly: dobutamine

- Only: isoproterenol

60
Q

What are 3 clinical uses for vasopressin?

A
  • Treatment during CPA (cardiopulmonary arrest)
  • Vasodilatory shock
  • Von Willebrand disease (stimulates platelets and bone marrow)
61
Q

Which is better for the treatment of CPA, epinephrine or vasopressin?

A

Vasopressin

62
Q

What are 4 side effects of vasopressin?

A
  • Decrease tissue perfusion
  • Contraction (bladder, gall bladder)
  • Local irritation at injection site
  • Skin necrosis (extravasation)
63
Q

What are the 3 steps in the treatment of hypotension in order?

A

1) Check anesthetic depth
2) Check volume status
3) Administer CV drugs

64
Q

What can cause hypotension in regards to anesthetic depth?

What should be done?

A
  • Too deep

- Decrease anesthetic

65
Q

What are 3 things that can be done if patient has a low volume status causing hypotension?

A
  • Administer fluid bolus
  • Increase fluid rate
  • Change to more appropriate fluid choice
66
Q

What can be given to treat an ephedrine overdose that has caused ventricular tachycardia?

A

1-2 mg/kg lidocaine

67
Q

What is used to treat ventricular tachyarrhythmias by reducing cellular excitation?

A

Lidocaine

68
Q

When treating a hypertensive emergency, the MAP should be reduced by no more than what?

A

25% within minutes to 1 hour

69
Q

Excessive falls in arterial blood pressure can lead to what?

A

Renal, cerebral and coronary ischemia

70
Q

Nitroprusside CRI causes what?

A

Arterial & venous dilation

71
Q

Nitroprusside CRI can’t be used longer than what time period?
Why?

A
  • 24 hours

- Cyanide can build up

72
Q

Hydralazine can cause what?

This can lead to what?

A
  • Arterial vasodilator

- Profound hypotension

73
Q

What is enalaprilat?

A

ACE inhibitor

74
Q

What is a class of drugs that will slow down heart rate?

A

Beta blockers

75
Q

What are 3 drugs that can be used to treat hypertension?

A
  • Nitroprusside CRI
  • Hydralazine
  • Enalaprilat
76
Q

What are 3 examples of negative dromotropic agents?

A
  • Diltiazem
  • Esmolol
  • Adenosine
77
Q

What does a dromotropic agent do?

A

Decreases conduction of electrical impulses to the heart.

78
Q

What are 2 indications for the use of temporary transvenous pacing?

A
  • Support HR & BP while under general anesthesia for permanent pacemaker
  • Refractory bradycardia stabilization prior to pacemaker implantation
79
Q

What type of cardiac disorder do we commonly apply transvenous pacing?

A

Severe 3rd degree AV block

Anesthesiology (19 decks)

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