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Anesthesiology > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

What are the primary effects of inhalant anesthetics on the CV system?

A

Vasodilation and inotropy at higher doses

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2
Q

What are the primary effects of propofol/alfaxalone/thiopenal on the CV system?

A

Negative inotropy and vasodilation especially at higher doses

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3
Q

What are the primary effects of opioids on the CV system?

A

Bradycardia; can be profound

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4
Q

What are the synthetic agonist of adrenergic receptors?

A

Isoproteronol, ephedrine, dobutamine, and phenylephrine

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5
Q

What are the endogenous agonist of adrenergic receptors?

A

Epinephrine, norepinephrine, and dopamine

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6
Q

What are the post-synaptic effects of alpha-1/2 receptors?

A 
Vasoconstriction
Minimal Inotropy (alpha-1)
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7
Q

What are the effects of beta-1 receptors?

A

Inotropy, chronotropy, lusitropy, dromotropy

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8
Q

What is lusitropy and dromotropy?

A

Lusitropy- relaxation

Dromotropy- conduction velocity of the AV node

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9
Q

What are the effects of beta-2 receptors?

A

Some inotropy, vasodilation

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10
Q

What is the endogenous agonist of cholinergic receptors?

A

Acetylcholine

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11
Q

What are the effects of muscarinic receptors?

A

M1- increased gut motility
M2- increased cardiac parasympathetic tone
M3- salivation/vasodilation

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12
Q

What are synthetic cholinergic agonists?

A

Bethanechol and pilocarpine

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13
Q

What is the first drug that is usually used for surgical bradycardia?

A

Atropine

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14
Q

What are some other things you can do to correct bradycardia before giving atropine?

A

Stop or reduce any bradycardia inducing drugs.

Inhalants, opioids, etc

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15
Q

What are most bradycardias due to?

A

Excessive vagal tone

Brachiocephalics, visceral manipulation, ocular pressure, drugs

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16
Q

What is sometimes induced when atropine is given and will it resolve?

A

2nd degree AV block, typically will resolve fairly quickly

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17
Q

What can be given if a bradycardia isn’t due to vagal tone?

A

Give a beta-agonist

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18
Q

What is isoproterenol good for?

A

Increasing HR while decreasing BP with an non-vagal bradycardia

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19
Q

What are causes of low BP?

A

Low HR/SV/CO
Low blood volume
Vasodilation with no reflex tachycardia

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20
Q

What are some ways to increase SVR?

A

Alpha agonists

Phenylephrine, norepi, or ephedrine

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21
Q

What are some ways to increase SV and CO?

A

Beta agonists

Dopamine, dobutamine, ephedrine

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22
Q

What are effects of alpha agonists?

A

Alpha-1/2: vasoconstriction, decrease CO/SV at high doses

Alpha-1: mild inotropy

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23
Q

What is phenylephrine used for in horses?

A

As a nasal spray to reduce nasal edema

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24
Q

What are some effects of ephedrine?

A

Bronchodilation, promotion of release of NE from terminals

25
Q

Should ephedrine be used in “sick” animals?

A

No, more appropriate of elevating BP in healthy animals

26
Q

What is an indication for using dopamine?

A

Increase BP and HR

27
Q

Does dopamine case vasoconstriction or dilation?

A

Vasodilation- esp in kidneys, mesentary, and coronary vessels

28
Q

Is dobutamine or dopamine more appropriate for horses, dogs, and cats?

A

Horses- dobutamine

29
Q

What are the effects of dobutamine?

A

Intropy>chronotropy

Low doses produce desired effect in horses

30
Q

Are the BP effects of dopamine dose dependent in small animals?

A

Yes

31
Q

Are the BP effects of dopamine dose dependent in horses?

A

No, no change in BP until very high doses

32
Q

What are the effects of dobutamine in small animals?

A

Dose dependent increase in CO but no increase in BP except at high doses

33
Q

What are the effects of phenylephrine in small animals?

A

Dose dependent increases in BP, no change in CO, increased SVR in high doses

34
Q

What are the effects of dobutamine in horses?

A

Rapid increase of BP at low doses with increased CO

35
Q

What is a major issue with using norepinephrine?

A

Profound vasoconstriction- must maintain organ perfusion

36
Q

When is norepinephrine usually used?

A

Serious hypotension esp with sepsis and shock

37
Q

What is the pathophysiology of hypotension in septic patients?

A

Circulating vasodilatory mediators

38
Q

What is norepiephrine sometimes combined with?

A

Dobutamine

39
Q

When should epinephrine be used over norepinephrine?

A

Cardiac arrest, acute anaphylaxis, tachycardia, or bronchoconstricion

40
Q

What receptors are more affected by epinephrine at low doses?

A

Beta adrenergic

41
Q

What receptors are more affected by epinephrine at high doses?

A

Alpha adrenergic

42
Q

What is vasopressin?

A

Antiduretic hormone (ADH)

43
Q

When is vasopressin used?

A

In catecholamine resistant hypotension with shock/sepsis

44
Q

What is a major concern with vasopressin?

A

Potent vasoconstriction- must maintain organ perfusion

45
Q

What is a side effect of atropine/glycopyrrolate that contraindicates its use in cardiac patients?

A

Increased myocardial O2 consumption

46
Q

What can beta agonists lead to?

A

Tachycardias with ventricular arrhythmias

47
Q

What can alpha agonists lead to?

A

Hypertension- can be profound

48
Q

What can vasoconstrictors lead to?

A

Tissue necrosis esp if injected outside of the vein

49
Q

When are ventricular arrhythmias most common?

A

During the peri-anesthetic period and are usually not due to cardiac pathology

50
Q

When should ventricular arrhythmias be treated

A

If they result in poor CO/BP- typically will be sustained and rapid

51
Q

What drug is used to treat ventricular arrhythmias?

A

Lidocaine IV

52
Q

What is the MOA of lidocaine?

A

Na channel blocker- stabilization of neuronal membranes

NOT a negative inotrope

53
Q

What are some good side effects of lidocaine?

A
  • Reduction of MAC and anesthetic requriements
  • Improves bowel motility
  • Useful for pain neuropathies
  • Some free radical scavenging
54
Q

T/F: Lidocaine is neurotoxic especially at excessive doses

A

True

It can also cause cardiovascular collapse at 3x toxic dose

55
Q

What condition may cause primary hypertension?

A

Renal disease or catecholamine producing tumors

Typically managed with Ca channel blockers or ACE inhibitors

56
Q

What drugs are used to manage the cardiac effects of hyperthyroidism?

A

Beta blockers

57
Q

What are drugs used to treat hypertension?

A

Arterial dilators- hydralazine

Venous (capacitence) dilators- nitroprusside

Mixed dilators- alpha antagonists, prazosin, ACE inhibitors

58
Q

When is nitropursside used?

A

Acute hypertensive emergencies (short acting infusion)

Anesthesiology (27 decks)

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