Class 5 Deck 1 Flashcards
What are CCB 3 primary actions?
- Negative inotropic
- Negative domotropic (AV conduction block)
- Vasodilation (systemic, splanchnic, coronary, pulmonary)
Name the 3 classes of CCB.
- Phenylalkylamine (Verapamil)
- Benzothiazine (Diltiazem)
- Dihydropyridine (Ni - )
Name the 4 uses for verapamil.
- Aortic stenosis
- Atrial re-entry Tach
- Coronary artery vasospasm (prinzmetal angina)
- MILD VASODILATOR
5 Nicardipine advantages.
- PURE VASODILATOR
- Minimal contractility / conduction effects
- Mild natriuetic effect
- No coronary steal
- Coronary and cerebral vasodilation
5 reasons nicardipine is useful for IV hypertension control in an ICU.
- Slower onset/offset than SNP
- Less BP swings
- No rebound HTN w/ discontinuation
- Reflex tach <10 bpm
- Prolonged duration good for post op
What type of drug is clevidpine and what does it do?
- Ultra short acting CCB (Dihydropyridine)
- Vasodilation reduces PVR
What are the 7 advantages associated with clevidipine?
- Rapid on/off
- Reliable control
- Ready to use vial
- No adjustments for renal/hepatic disease
- No myocardial depression
- No preload effect
- Minimal drug interaction
What are the 4 disadvantages with Clevidpine?
- Lipid emulsion
- Continuous monitoring
- Contraindicated w/ Egg and soy allergy, pancreatitis, and HLD
- Reduce gastric emptying
How does diltiazem compare to verapimil?
-Diltiazem will control rate in Afib and Atrial Tach, while verapamil will convert.
In terms of negative inotropy/dromotropy, place the CCB in order of most potent to least potent.
-Verapmil > Diltiazem > Nicardipine (Dihydropidines)
In terms of vasodilation, place the CCB in order of most potent to least potent.
Nicardipine > Verapamil/Diltiazem
How does verapamil and diltiazem enhance myocardial O2 balance?
- Afterload reduction and negative inotropic effect
- Coronary vasodilation
How does Dihydropyridine worsen myocardial oxygen balance?
-Diastolic hypotension and reflex tach
How do CCBs effect renal function?
- Increase RBF and GFR
- Induce naturesis
- Can protect against nephrotoxic drugs
Anesthetic considerations of CCBs
- Potentiate effects of NMB
- Enhance Hypotension, CV depressant, and vasodilation of anesthetics and analgesics
- Use adequate hydration
What 3 drugs can cause vasodilitation by acting at the Alpha-1 or DA-1 receptors
- Droperidol
- Haloperidol
- Phenothiazines
What are the limitations with all vasodilators?
- Diminish venous return and CO w/ hypovolemia
- Volume overload
- Coronary and cerebral hypoperfusion in patients w/ obstructed arteries
SNP can cause what 2 things?
- Cyannide toxicity
- Intrapulmonary shunting
What 2 drugs are used to treat reflex tach that is associated with vasodilators?
- Beta blocker
- trimethaphan
What are the actions of Beta Blockers?
- Decrease CO
- Decrease Renin release
- NO vasodilation
What are the advantages of Beta Blockers over Vasodilators?
- No reflex tach
- No widening pulse pressure
- Improved myocardial O2 consumption
- Intrinsic antiarrhythmia activity
- No effect on hypoxic pulmonary vasoconstriction
Beta 1 causes a decrease in what 5 things?
- Decrease AV conduction velocity
- Decrease HR
- Decrease Contractility
- Decrease Renin release
- Decrease lipolysis
Name 3 Beta-1 selective beta blockers medications
- Metoprolol
- Atenolol
- Esmolol
Name the classic non-selective beta blocker
-Propanolol
Name 2 combined Alpha 1 and non-selective beta medications.
- Carvedilol
- Labetalol
Beta blockers are also classified by elimination half life. Name the 3.
- Long (Hepatic biotransformation) Atenelol
- Intermediate (Hydroxalated by liver, and 1st pass) Propanolol, Metoprolol
- Short (red cell esterases) Esmolol
4 main beta blocker adverse effects
- Non selective blockade of beta 2 (vasoconstriction, PVD, bronchospasms)
- Myocardial depression
- Bradycardia
- Hyperkalemia
Beta blockers can have a drug interaction with what 2 drugs?
- Verapamil
- Digoxin
How do you treat Beta blocker overdose?
- Atropine
- Isoproterenol, dobutamine (if atropine fails to ↑ HR)
- glucagon (antidote)
- Pacing
What are the 5 indications for beta blocker use?
- Intra/postop HTN and tachycardia
- Rate control / conversion SVT, Afib/Flut
- Myocardial protection in ischemic heart disease
- Sympathetic response to ECT
- Hyperthyroidism
When are beta blocker contraindicated?
- Bradycardia
- > 1st degree block
- Cardiogenic shock
- Raynauds
Caution should be used with Beta Blockers and what type of patients
- Asthma/COPD
- Diabetes
- Heart Failure
3 things to know about propanolol
- Prototype non-selective beta blocker
- Lipid soluble can cross CNS
- 1st pass metabolism (70% metabolized in liver)
What 4 things is esmolol used for?
- Blunt CV response to intubation
- Control SVT and Afib
- More likely to convert Afib than verapamil
- Intra/postop HTN and Tachycardia
Metoprolol has a _______ duration of action and is used to treat what 3 things?
- Longer
- Angina
- Acute MI
- HTN
Labetalol combines what 2 things?
- Weak alpha blockade
- Weak NON-SELECTIVE beta blockade (7:1 ratio)
How does labetalol treat Vasoconstricted and Hyperdynamic HTN?
-Vaso = vasodilation w/o reflex tach Hyper = Beta blocker w/o reflex vasoconstriction
What are the 5 indications for Labetalol?
- Hyperdyanmic HTN (blunts CV response of intubation)
- Aortic dissection
- SNP tachyphlyaxis
- Intracranial HTN (No ICP increase)
- Toxemia in pregnancy (no 1st trimester, UBF preserved)
What are the 5 adverse effects of labetalol?
- Negative inotropy
- Bronchospasms
- Prolong duration w/ elevated doses
- Hyperkalemia
- Rewarming hypotension
How does carvedilol work?
- Combines alpha blockade and non-selective beta blockade
- Decreases myocardial O2 demand and cardiac work
When is carvedilol used?
- Angina, CHF, dysrhythmias
- 3-5 times more potent than labetelol in ↓ BP.
Beta Blockers may mask _________ and _________
- Hypoglycemia
- Hyperthyroidism
Why are beta blockers continued on the day of surgery?
-GA can potentiate negative inotropic and conduction delays.
Order of operations for intraop HTN
-Beta blockers - Vasodilators - CCB - Diuretics - Alpha 2 agonists - ACE
What is the drug of choice in BP management during pregnancy?
- Alpha-Methyldopa
- Labetalol (2nd & 3rd trimester only)
