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Pharm 2 > Class 5 Deck 1 > Flashcards

Class 5 Deck 1 Flashcards

1
Q

What are CCB 3 primary actions?

A
  • Negative inotropic
  • Negative domotropic (AV conduction block)
  • Vasodilation (systemic, splanchnic, coronary, pulmonary)
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2
Q

Name the 3 classes of CCB.

A
  • Phenylalkylamine (Verapamil)
  • Benzothiazine (Diltiazem)
  • Dihydropyridine (Ni - )
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3
Q

Name the 4 uses for verapamil.

A
  • Aortic stenosis
  • Atrial re-entry Tach
  • Coronary artery vasospasm (prinzmetal angina)
  • MILD VASODILATOR
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4
Q

5 Nicardipine advantages.

A
  • PURE VASODILATOR
  • Minimal contractility / conduction effects
  • Mild natriuetic effect
  • No coronary steal
  • Coronary and cerebral vasodilation
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5
Q

5 reasons nicardipine is useful for IV hypertension control in an ICU.

A
  • Slower onset/offset than SNP
  • Less BP swings
  • No rebound HTN w/ discontinuation
  • Reflex tach <10 bpm
  • Prolonged duration good for post op
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6
Q

What type of drug is clevidpine and what does it do?

A
  • Ultra short acting CCB (Dihydropyridine)

- Vasodilation reduces PVR

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7
Q

What are the 7 advantages associated with clevidipine?

A
  • Rapid on/off
  • Reliable control
  • Ready to use vial
  • No adjustments for renal/hepatic disease
  • No myocardial depression
  • No preload effect
  • Minimal drug interaction
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8
Q

What are the 4 disadvantages with Clevidpine?

A
  • Lipid emulsion
  • Continuous monitoring
  • Contraindicated w/ Egg and soy allergy, pancreatitis, and HLD
  • Reduce gastric emptying
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9
Q

How does diltiazem compare to verapimil?

A

-Diltiazem will control rate in Afib and Atrial Tach, while verapamil will convert.

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10
Q

In terms of negative inotropy/dromotropy, place the CCB in order of most potent to least potent.

A

-Verapmil > Diltiazem > Nicardipine (Dihydropidines)

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11
Q

In terms of vasodilation, place the CCB in order of most potent to least potent.

A

Nicardipine > Verapamil/Diltiazem

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12
Q

How does verapamil and diltiazem enhance myocardial O2 balance?

A
  • Afterload reduction and negative inotropic effect

- Coronary vasodilation

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13
Q

How does Dihydropyridine worsen myocardial oxygen balance?

A

-Diastolic hypotension and reflex tach

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14
Q

How do CCBs effect renal function?

A
  • Increase RBF and GFR
  • Induce naturesis
  • Can protect against nephrotoxic drugs
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15
Q

Anesthetic considerations of CCBs

A
  • Potentiate effects of NMB
  • Enhance Hypotension, CV depressant, and vasodilation of anesthetics and analgesics
  • Use adequate hydration
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16
Q

What 3 drugs can cause vasodilitation by acting at the Alpha-1 or DA-1 receptors

A
  • Droperidol
  • Haloperidol
  • Phenothiazines
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17
Q

What are the limitations with all vasodilators?

A
  • Diminish venous return and CO w/ hypovolemia
  • Volume overload
  • Coronary and cerebral hypoperfusion in patients w/ obstructed arteries
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18
Q

SNP can cause what 2 things?

A
  • Cyannide toxicity

- Intrapulmonary shunting

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19
Q

What 2 drugs are used to treat reflex tach that is associated with vasodilators?

A
  • Beta blocker

- trimethaphan

20
Q

What are the actions of Beta Blockers?

A
  • Decrease CO
  • Decrease Renin release
  • NO vasodilation
21
Q

What are the advantages of Beta Blockers over Vasodilators?

A
  • No reflex tach
  • No widening pulse pressure
  • Improved myocardial O2 consumption
  • Intrinsic antiarrhythmia activity
  • No effect on hypoxic pulmonary vasoconstriction
22
Q

Beta 1 causes a decrease in what 5 things?

A
  • Decrease AV conduction velocity
  • Decrease HR
  • Decrease Contractility
  • Decrease Renin release
  • Decrease lipolysis
23
Q

Name 3 Beta-1 selective beta blockers medications

A
  • Metoprolol
  • Atenolol
  • Esmolol
24
Q

Name the classic non-selective beta blocker

A

-Propanolol

25
Q

Name 2 combined Alpha 1 and non-selective beta medications.

A
  • Carvedilol

- Labetalol

26
Q

Beta blockers are also classified by elimination half life. Name the 3.

A
  • Long (Hepatic biotransformation) Atenelol
  • Intermediate (Hydroxalated by liver, and 1st pass) Propanolol, Metoprolol
  • Short (red cell esterases) Esmolol
27
Q

4 main beta blocker adverse effects

A
  • Non selective blockade of beta 2 (vasoconstriction, PVD, bronchospasms)
  • Myocardial depression
  • Bradycardia
  • Hyperkalemia
28
Q

Beta blockers can have a drug interaction with what 2 drugs?

A
  • Verapamil

- Digoxin

29
Q

How do you treat Beta blocker overdose?

A
  • Atropine
  • Isoproterenol, dobutamine (if atropine fails to ↑ HR)
  • glucagon (antidote)
  • Pacing
30
Q

What are the 5 indications for beta blocker use?

A
  • Intra/postop HTN and tachycardia
  • Rate control / conversion SVT, Afib/Flut
  • Myocardial protection in ischemic heart disease
  • Sympathetic response to ECT
  • Hyperthyroidism
31
Q

When are beta blocker contraindicated?

A
  • Bradycardia
  • > 1st degree block
  • Cardiogenic shock
  • Raynauds
32
Q

Caution should be used with Beta Blockers and what type of patients

A
  • Asthma/COPD
  • Diabetes
  • Heart Failure
33
Q

3 things to know about propanolol

A
  • Prototype non-selective beta blocker
  • Lipid soluble can cross CNS
  • 1st pass metabolism (70% metabolized in liver)
34
Q

What 4 things is esmolol used for?

A
  • Blunt CV response to intubation
  • Control SVT and Afib
  • More likely to convert Afib than verapamil
  • Intra/postop HTN and Tachycardia
35
Q

Metoprolol has a _______ duration of action and is used to treat what 3 things?

A
  • Longer
  • Angina
  • Acute MI
  • HTN
36
Q

Labetalol combines what 2 things?

A
  • Weak alpha blockade

- Weak NON-SELECTIVE beta blockade (7:1 ratio)

37
Q

How does labetalol treat Vasoconstricted and Hyperdynamic HTN?

A 
-Vaso = vasodilation w/o reflex tach
Hyper = Beta blocker w/o reflex vasoconstriction
38
Q

What are the 5 indications for Labetalol?

A
  • Hyperdyanmic HTN (blunts CV response of intubation)
  • Aortic dissection
  • SNP tachyphlyaxis
  • Intracranial HTN (No ICP increase)
  • Toxemia in pregnancy (no 1st trimester, UBF preserved)
39
Q

What are the 5 adverse effects of labetalol?

A
  • Negative inotropy
  • Bronchospasms
  • Prolong duration w/ elevated doses
  • Hyperkalemia
  • Rewarming hypotension
40
Q

How does carvedilol work?

A
  • Combines alpha blockade and non-selective beta blockade

- Decreases myocardial O2 demand and cardiac work

41
Q

When is carvedilol used?

A
  • Angina, CHF, dysrhythmias

- 3-5 times more potent than labetelol in ↓ BP.

42
Q

Beta Blockers may mask _________ and _________

A
  • Hypoglycemia

- Hyperthyroidism

43
Q

Why are beta blockers continued on the day of surgery?

A

-GA can potentiate negative inotropic and conduction delays.

44
Q

Order of operations for intraop HTN

A

-Beta blockers - Vasodilators - CCB - Diuretics - Alpha 2 agonists - ACE

45
Q

What is the drug of choice in BP management during pregnancy?

A
  • Alpha-Methyldopa

- Labetalol (2nd & 3rd trimester only)

Pharm 2 (23 decks)

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