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ICU Liz > Cardiovascular Medications > Flashcards

Cardiovascular Medications Flashcards

1
Q

Define an Inotrope

A

agents that increase myocardial contractility e.g dobutamine, adrenaline

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2
Q

define a vasopressor

A

agents that cause vasoconstriction leading to increased SVR (systemic vascular resistance) - + BP e.g. Noradrenaline, metaraminol

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3
Q

define chronotrope

A

agents that alters the HR. Can be positive (e.g. atropine) or negative (e.g. beta blockers)

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4
Q

define vasodilator

A

agents that cause dilation of the blood vessels by promoting the relaxation of vascular smooth muscle e.g. GTN

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5
Q

what do Alpha 1 receptors do and give a drug example.

A
  • increase CO
  • increase peripheral resistance
  • cause vasoconstriction
  • noradrenaline, dopamine, adrenaline
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6
Q

what do Alpha 2 receptors do?

A
  • ## inhibits the release of endogenous norepinephrine leading to vasodilation
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7
Q

what do beta 1 receptors do?

A

-increase myocardial contractility, HR and CO.

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8
Q

what do Beta 2 Alpha 1 receptors do?

A
  • cause vasodilation of bronchioles, peripheral and renal circulations
  • decreases peripheral vascular resistance
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9
Q

what does dopaminergic receptors do?

A

-causes vasodilation - increases blood flow to renal and mesentery

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10
Q

what does Noradrenaline do?

A

Works on both Alpha 1 and Beta 1 receptors ​
Mechanism of action:​
-Causes vasoconstriction of peripheral vessels​
-↑ SVR​
-Improves Blood pressure and organ perfusion ​
-Increases contractility and Heart rate​

​

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11
Q

what are the indications of Noradrenaline?

A

Indications:​

  • Restore BP in acute hypotensive states, such as sepsis​
  • Target a mean arterial pressure (MAP) of 70mmHg to ensure adequate organ perfusion​

​

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12
Q

what is the concentrations that noradrenaline come, what is the onset and duration time?

A

Concentration: 8mg/16mg/32mg in 100mls N/Saline​
Onset 1-2 mins
Duration 1-2mins

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13
Q

what does Adrenaline do?

A

Mechanism of action:​
-Acts on both the heart and lungs​
-In the lungs causes bronchodilation ​
-Low doses act on B1 & B2 receptors = ^ HR & contractility - CO​
-In high doses will further ^ Hr & contractility.
Also has Alpha 1 effects - causing vasoconstriction​

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14
Q

what are the indications for Adrenaline?

A

Indications​
-Cardiac arrest, bronchospasm, anaphylaxis, arrhythmias - VF, VT ​
First-line treatment in ALS​

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15
Q

what is the standard dose of Adrenaline?

A

Standard dose 1mg/ml, make with NS 6mg (SS)
12mg (DS)/100ml
24mg (QS)/100ml

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16
Q

what does Metaraminol do?

A

Mechanism of action​

  • Vasoconstrictor - stimulates alpha effects – peripheral vasoconstriction - +BP & +SVR (afterload)​
  • Indirect effects on sympathetic nerve endings causing the release of endogenous noradrenaline
17
Q

what are the indications for Metaraminol?

A

Indications​

-Short term management of acute hypotension (can be administered peripherally)​

18
Q

what is the standard doses that metaraminol can come in?

A

Standard dose: 10mg/20mls or 20mg/40mls NaCl ​

(0.5mg/ml)​

19
Q

explain what a low dose of dopamine can do?

A

Low doses - dopaminergic effects (0.5-3mcg/kg/min)​

Effects: Dilation of renal, mesenteric, cerebral & coronary blood vessels –renal perfusion & diuresis​

20
Q

explain what moderate doses of dopamine can do?

A

Moderate doses – Beta1 effect (4-8mcg/kg/min)​

Effects: increase contractility – improved CO​

21
Q

explain what high doses of Dopamine can do?

A

High doses – Alpha effects (>10mcg/kg/min)​

Effects: vasoconstriction​

22
Q

explain what Vasopressin drugs can do?

A

Also known as anti-diuretic hormone – regulate body’s retention of H2O​

  • Acts on V1, V2, V3 receptors​
  • At high doses it acts on smooth muscle receptors to cause peripheral vasoconstriction and increase SVR and BP​
  • Less potently acts on kidneys to promote water reabsorption​

​

23
Q

what are the indications for vasopressin drugs?

A

Indications​:

-To increase BP in vasodilatory shock when low SVR persists despite fluid resuscitation and first-line vasopressor​

24
Q

what are some side effect that could be caused by using a vasopressor drug?

A

Side Effects​:

  • Myocardial, mesenteric or peripheral ischemia​
  • Hyponatraemia (due to water retention)​
25
Q

how does dobutamine work?

A

Mechanism of action:​

  • Binds to Beta 1 receptors - improves CO by increasing contractility & Stroke volume with minimal ^ HR ​
  • Some B2 effect - with peripheral vasodilation (depends on dose). This augments the increase in CO​
26
Q

what are the indications of dobutamine?

A

Indication:​

  • Heart failure​
  • Cardiogenic shock​
27
Q

how does GTN work?

A

Mechanism of action​

​

A nitrate vasodilating agent​

  • Low doses causes vasodilation, thus off loading the heart and reducing preload.​
  • At higher doses it acts as an arterial dilator, reducing afterload.​
  • reduces cardiac oxygen demand.​
  • It also causes relaxation of the coronary arteries (useful in angina)​

​

28
Q

How does Amiodarone work and what is it used for?

A

Treatment of arrhythmias (AF, Flutter, VT, VF) (class III antiarrhythmic)​

  • Long half life​
  • Amiodarone blocks sodium channels and myocardial potassium channels. Results in slowing of conduction & prolongation of refractoriness in AV node. ​
29
Q

how does Atropine work?

A

Mechanism of Action​:

-Blocks action of vagus nerve on heart & increases HR​

30
Q

what are the indications for Atropine?

A

Indications:​

-Bradyarrhythmias with hemodynamic instability​

31
Q

what are some side effects that Atropine can cause?

A

Side effects​

  • Dry mouth,
  • blurred vision,
  • dizziness​
32
Q

how does Propofol work and what is it used for?

A
  • Short acting anaesthetic agent​
  • Acts on GABBA receptors​
  • Neat lipid suspension​

-Used for induction and maintenance of anesthesia, and sedation in mechanically ventilated pts​

33
Q

how often should a Propofol line be changed?

A

Change line every 12hrs!!​

34
Q

what is Fentanyl​? what side effect can it cause and what reversal drug can we give?

A
  • Synthetic opioid analgesia​
  • Acts on opioid receptors​
  • Accumulative effect​

-Can depress respiratory drive​

Reversal: Naloxone​-500mcg/50ml (10mcgs/ml)​

​Titrate according to CPOT, usual starting rate 2ml/hr​

35
Q

explain Ketamine, what it can be used for and what side effect it can cause.

A

Ketamine ​

  • Rapid acting, NMDA receptor agonist​
  • Can be used as general anaesthesia, analgesia and bronchodilator​
  • Also a powerful bronchial relaxant, relieves bronchospasm and improves pulmonary compliance​
  • Causes an increase in myocardial O2 consumption ​
  • 200mg/200m
36
Q

explain Precedex (Dexmedetomidine)​, its indication and what side effects to watch for.

A
  • alpha2 Adrenoceptor agonist​
  • Decreases CNS activity, therefore can decrease HR and BP​

-Used for agitation and tube tolerance when trying to desedate​

  • Watch for profound bradycardia, notify MO if SBP<90mmhg and/or HR<60bpm​
  • Use with caution pts with impaired hepatic function and >65years of age, metabolised by liver​
  • DO NOT BOLUS​
  • Needs own lumen on CVC line, must centrally​
37
Q

explain Midazolam​ and what it is used for

A
  • Short acting muscle relaxant​
  • -CNS depressant inducing sedation, hypnosis, amnesia and anaesthesia​

Used for agitation, sedation, intubation and short procedures​

38
Q

what is the reversal drug for Midazolam?

A

Reversal: Flumazenil

39
Q

can vasoactive infusions be bolused?

A

only certain drugs ie Metarminol

ICU Liz (16 decks)

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