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Pharmacology > Chap 21 > Flashcards

Chap 21 Flashcards

1
Q

Vasopressers

A
  • Used to treat hypotension via vasoconstriction,

- Catecholamines (epinephrine

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2
Q

Inotropes

A

-Control stregnth
-treatment of decompensated heart failure secondary to depressed contractility
-May have chronotropic effect also
cause- Digoxin (digatalis)

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3
Q

Digoxin

A

With inotrope and chronotropic effects= increase heart contractility

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4
Q

Chronotropic control

A

heart rate

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5
Q

Inotropes control

A

Control strength

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6
Q

Hypotension caused by

A

shock/ cold

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7
Q

Antiarrhythmic agents

A

Classified according to their mechanism of action

  • Class IA
  • Class IB
  • Class II
  • Class IV
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8
Q

Class IA

A

Blocks fast sodium channels in the myocardium, particularly in the atrium (procainamide)

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9
Q

Class IB

A

Used for ventricular arrhythmias (lidocaine)

  • BVC’s
  • Beta I specific= heart, can affect beta 2= bronchospasms
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10
Q

Beta I

A

heart

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11
Q

Beta 2

A

bronchospasms

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12
Q

Class II

A

beta blockers, used in management of hypertension, post MI, or prevent arrhythmias (SVT) (Metoprolol)

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13
Q

Class IV

A

Calcium channel blockers: used in the management of SVT and ventricular rate control with atrial fib.
Not front line agent for chronic heart failure, but good alternative to Beta Blockers in the presence of airway disease.
-SUBSITUTE FOR DIGOXIN

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14
Q

Calcium channel blockers used in the management of

A

SVT and ventricular rate control with atrial fib

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15
Q

Antihypertensives

A
  • Angiotensin-Converting Enzyme (ACE inhibitors)
  • Angiotensin II
  • Calcium channel blockers
  • Beta blockers
  • Diuretics
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16
Q

Angiotensin I converted to

A

Antiotensin II in the pulmonary vasculature

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17
Q

Antiotensin-converting enzyme (ace inhibitors)

A

suppression of the renin-angiotesin- aldosterone system

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18
Q

Angiotensin II is a

A

vascoconstrictor

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19
Q

Aldosterone contributes to

A

sodium and water retention

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20
Q

ACE’s usually end in

A

“pril” (monopril, lisinopril, etc)

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21
Q

Calcium channel blockers

A

Causes relaxation of smooth muscle

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22
Q

Beta blockers

A

Decrease Angiotesin II concentration in the kidney and reduce myocardial contractility

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23
Q

Diuretics

A

five classes, essentially reduce vascular volume by diuresis of H2O and electrolytes (reduce volume)

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24
Q

Anti angina

A

Chest Pain

  • Nitrates
  • Beta Blockers
  • Calcium Antagonists
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25
Q

Nitrates

A

Smooth muscle dilation, Nitroglycerin

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26
Q

Antithrombotic agents

A
  • Anticoagulants
  • Antiplatelets
  • Thrombolytics
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27
Q

Anticoagulants

A

Heparin

Coumadin

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28
Q

Antiplatelets

A

Aspirin, Plavix

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29
Q

Thrombolytics

A

Clot busters

-used in acute M.I. or P.E.

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30
Q

ACL’s

A

Advanced Cardiac Life Support

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31
Q

Sudden Cardiac Death ACLs

A
  • Ventricular Fibrillation (VF) = heart quiver
  • Pulseless tachycardia (VT) = no p wavse, fast =CPR!
  • Pulseless electrical activity (PEA)= no BP, no pef, looks norm= CPR and Drugs
  • Asystole= flat line
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32
Q

A patient wtih VF, survival decreases by ___ for every minute that passes from the time of symptoms onset to defibrillation

A

7-10%,

-If CPR is initiated, this is reduced to 3-4% until defibrillation

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33
Q

Intervention of sudden cardiac death

A
  1. CPR
  2. Defibrillation
  3. IV access
  4. Medication therapy
  5. Advanced airway
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34
Q

VF and VT should be initially managed with

A

CPR

Defibrillation

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35
Q

PEA and Asystole are managed with

A

CPR

Drug therapy

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36
Q

Ventricular Fibrillation (VF)

A

Heart quiver

treated with CPR and defibrillation

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37
Q

Pulseless tachycardia (VT)

A

No P waves, Fast= CPR!!

treated with CPR and Defibrillation

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38
Q

Asystole

A

Flat line
Check patient and check another lead
Managed with- CPR and Drug therapy

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39
Q

Pulseless Electrical Activity (PEA)

A

No BP, no perfusion, looks normal.

treated with CPR and drug therapy

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40
Q

Epinephrine Stimulates

A

Alpha 1, Beta 1, and beta 2 receptors

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41
Q

Epinephrine dose

A

Administered in 1 mg dose in 10 ml solution, given push

-Can be given multiple times, over 3-5 minute intervals

42
Q

Epinephrine has poor

A

receptor affinity with metabolic acidosis that is generally associated with hypoxia and anaerobic respiration

43
Q

Epinephrine is thought to make

A

myocardial muscle more responsive to defibrillation

44
Q

Vasopressin acts similar to

A

epinephrine

45
Q

Vasopressin dose

A

40U

46
Q

Vasopressin is a

A

non adrenergic vasoconstrictor, works in a metabolic acidosis environment

47
Q

Atropine used for

A

Asystole or PEA

48
Q

Atropine dose

A

1mg doses, IV push

49
Q

Atropine blocks/ exerts

A

blocks acetylcholine,

Exerts a chronotropic effect and increases HR

50
Q

Max recommended dose for atropine

A

during resuscitation is 0.4mg/kg

51
Q

Sodium bicarbonate (NaHCO3) used to manage

A

Metabolic Acidosis

52
Q

Sodium bicarbonate dose

A

give IV push 0.5 to 1 mEg/Kg

53
Q

Sodium bicarbonate goal is to

A

normalize pH to 7.2 or >

54
Q

Sodium bicarbonate facilitates

A

response to other drugs used

55
Q

Magnesium Sulfate used in

A

management of Torsades

56
Q

Torsades

A

EKG that gets smaller to larger waves

57
Q

ACL drugs

A
  • Epinephrine
  • Vasopressin
  • Atropine
  • Sodium bicarbonate
  • Magnesium Sulfate
58
Q

Cardiac drugs

A
  • Vasopressers
  • Inotropes
  • Chronotrops
  • Antiarrhythmic agents
  • Antihypertensives
  • Antiangina
  • Antithrombotic agents
59
Q

Alternative routs of med administration

A
  1. Intraosseous Route- needle access into the bone marrow

2. Enotracheal Route

60
Q

Bone marrow

A

highly vascularized and drug are circulated to systemic system quickly

61
Q

Drugs that can be given down an ET tube

A
  1. Narcan
  2. Atropine
  3. Vasopressin (once)
  4. Epinephrine
  5. Lidocaine
62
Q

In code - endotracheal route

A

Medication is injected down the ET tube and should be diluted with approximately 10ml of normal saline

  • Pt should be give 5-10 deep, rapid ventilations with an ambu bag
  • most meds dose stregnth should be doubled, with the exception of vasopressin
63
Q

Ventricular Fibrillation Pulseless Ventricular Tachycardia Attempts

A
  1. Defibrillation x1 attempt
  2. Epinephrine 1mg q 3-5 min,
    or vasopressin 40units x 1 dose
    (may replace first or second dose of epi)
    —-resume CPR for 5 cycles
  3. Check rhythm, if indicated defibrillation x1 attempt
  4. Epinephrine 1 mg q 3-5 min
    —resume CPR for 5 cycles
  5. Check rhythm, if indicated
    Defibrillation x1 attempt
    consider antiarrythmic, given before or after shock:
    Amiodarone or lidocaine
64
Q

Asystole and pulseless electrical activity attemtps

A 
1. Epinephrine 1mg IV q 3-5 min
or vasopressin 40 units + 1 dose
May replace first or second dose of epi
-----resume CPR
2. Atropine 1 mg IV for asystole or slow PEA rate;
(max 0.04 mg/kg)
65
Q

Torsades de pointes attempts

A
  1. If hemodynamically unstable; defibrillation
    Discontinue meds with QT-prolonged potential
    Correct any electrolyte abnormalities
  2. Magnesium 1-2g (diluted in 10mL of D5W) IV push
    OR
    Isoproterenol 2-10mcg/min infusion
    OR
    Lidocaine 1-1.5 mg/kg IV
66
Q

Cardiac output

A

Amount of blood that is pumped out of the heart per unit of time

67
Q

Chronotropic

A

agent affecting the rate of contraction of the heart

68
Q

Diastolic blood pressure (DBP)

A

Lowest pressure reached before ventricular ejection

69
Q

An agent taht influences the conduction of electrical impulses. a positive dromotropic agent enhances the conduction of electrical impulses to the heart

A

Dromotropic

70
Q

Inotropic

A

agent affecting the strength of muscular contraction

71
Q

AV Node

A

link between atrial depolarization and ventricular depolarization

72
Q

Presence of carbon dioxide aids in the release and delivery of o2 from hemoglobin

A

Bohr Effect

73
Q

MAP

A

pressure that dives blood into the tissues averaged over the entire cardiac cycle

74
Q

Episode of ventricular fibrillation , pulseless ventricular tachycardia, pulseless electrical activity, or asystole leading to loss of life

A

SCD sudden cardiac death

75
Q

Systolic Blood pressure

A

peak pressure reached during ventricular ejection

76
Q

Tachycardia defined as

A

overly rapid heartbeat, usually defined as greater than 100 beats/min in adults

77
Q

Vasodilators

A

agent causing dilation of blood vessels

78
Q

Vasopressors

A

agent causing contraction of capillaries and arteries

79
Q

Ventricular fibrillation defined as

A

cardiac condition in which normal ventricular contractions are replaced by coarse or fine, rapid movements of the ventricular muscle

80
Q

Cardiac drugs are used to

A

influence cardiac function and include agents that increase myocardial contractility , regulate arrhythmias, and treat cardiac arrest

81
Q

CO=

A

HR x SV

82
Q

MAP=

A

HR x SV x SVR or

CO x SVR

83
Q

Antibacterial/ Antivirals

A

Isoniazid (treats TB),
Relenza (Zanamivir)(treats influenza),
Tobramycin (treat CF),
Cephalosporins

84
Q

NMBs

A

Succinylcholine,
Vecuronium,
Rocuronium,
Atracurium,

85
Q

Xanthines

A

Aminophylline,

Theodur,

86
Q

Antileukotrienes

A

Montelukast (singular),
Zafirlukast,
Zileuton (zyflo)

87
Q

Sedatives

A 
Propofol,
Ambien (zolpidem),
Versad (Midazolam),
Alcohol,
Ativan (lorazepam),
88
Q

Corticosteroids

A 
Fluticasone (flovent),
Symbicort (Budesonide and formeterol),
Advair,
Budesonide (pulmocort)
Prednisone
89
Q

Mucolytic/ Expectorant

A

Acetylcysteine (mycomyst),
Guaifenesin,
Dornase Alfa

90
Q

Analgesics

A 
Tylenol (Acetaminophen),
Morphine,
Fentanyl (Sublimaze),
Aspirin (Salicylates),
Advil (ibuprofen),
Dilaudid (hydromorphine),
91
Q

Long Acting Anticholinergics

A

Tiotropium (spiriva),

92
Q

Short Acting Anticholinergics

A

Ipratropium (atrovent),

Levalbuterol

93
Q

Long Acting Beta Agonist

A

Umeclindinium,
Brovana,
Foradil (formoterol),
Advair,

94
Q

Short Acting Beta Agonist

A

Albuterol,

Duoneb

95
Q

Vasopressors treat

A

hypotension via vasocontriction (=Increase afterload = increase BP)

96
Q

Vasopressors are

A

Catecholamines such as epinephrine = given to increase BP

97
Q

Inotropes treat

A

treatment of decompensated heart failure secondary to depressed contractility

98
Q

Inotropes may have what effect also

A

Chronotropic= control hear rate

99
Q

Digoxin

A

INOTROPE
helps make the heart beat stronger and with a more regular rhythm.
-Digoxin is also used to treat atrial fibrillation, a heart rhythm disorder of the atria

100
Q

Beta blockers end in

A

olol

101
Q

Ace inhibitors end in

A

pril

Pharmacology (10 decks)

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