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RUSVM Anesthesiology 2016 > CV Drugs > Flashcards

CV Drugs Flashcards

1
Q

What are the classes of drugs that have effects on the heart?

A

Anticholinergics
Antiarrhythmics
Vasopressors/Iontropes

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2
Q

What are two types of Vasopressors/Iontropes?

A

Adrenergic agonists

Vasopressin

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3
Q

What is the ultimate goal of CV drugs?

A

Oxygen delivery to the tissues

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4
Q

DO2

A

Oxygen Delivery to Tissues

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5
Q

What is DO2 dependent on?

A

Cardiac Output

Blood O2 content (CaO2)

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6
Q

CaO2

A

Blood O2 content

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7
Q

What is the equation for DO2?

A

CO x CaO2

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8
Q

What is the equation for CO?

A

Heart Rate X Stroke Volume

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9
Q

What are the targets for CV drugs?

A

Heart Rate
Contractility
Afterload/Preload

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10
Q

What drugs affect Heart rate?

A

Anticholinergics

Antiarrhythmics

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11
Q

What are drugs that effect Contractility?

A

Inotropes

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12
Q

What are drugs that effect Afterload/Preload?

A

Pressors

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13
Q

What is the definition of Anticholinergics?

A

Competitive antagonists at the muscarinic Ach receptors

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14
Q

What drugs antagonize Nicotinic Ach receptors?

A

Neuromuscular Blockers

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15
Q

What kind of drugs decrease parasympathetic tone?

A

parasympatholytics

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16
Q

What is the effect of Anticholinergics?

A

Decreases Parasympathetic tone

Increased firing of the SA node (chronotropy) and conduction speed through the AV node (dromotopy)

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17
Q

Where are M1 receptors located?

A

CNS

Stomach

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18
Q

Where are M2 receptors located?

A

Heart
CNS
airway smooth muscle

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19
Q

What do M2 receptors cause?

A

bradycardia

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20
Q

Where are M3 receptors located?

A

CNS
salivary glands
airway smooth muscle

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21
Q

Where are M4 receptors located?

A

CNS

Heart

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22
Q

Where are M5 receptors located?

A

CNS

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23
Q

What do M3 receptors cause?

A

Salivation
bronchodilation
vasodilation

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24
Q

When are anticholinergics indicated?

A

Bradycardia secondary to increased vagal tone

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25
Q

What increases vagal tone?

A 
Intubation 
vomiting 
manipulation of ophthalmic
GI
Hepatobiliary structures
Opioids
Brachycephalic conformation
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26
Q

What are the side effects of anticholinergics?

A 
Increased viscosity of saliva
Ileus and colic 
decreased LES pressure 
sedation 
bronchodilation 
mydriasis
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27
Q

When is atropine contraindicated?

A

glaucoma

28
Q

What species are the used of anticholinergics cause for concern?

A

Horses

Ruminants

29
Q

What are the CNS side effects of anticholinergics?

A

Sedation

30
Q

What are the respiratory side effects of anticholinergics?

A

bronchodilation

31
Q

What are the Ophthalmic side effects of anticholinergics?

A

mydriasis

32
Q

Paradoxical Bradycardia

A

due to blockade of presynaptic inhibitory M1 receptors on vagus
inhibition of inhibitory receptors leads to increased Ach release

33
Q

What is a Class 1B Anti arrhythmic?

A

Lidocaine

34
Q

What are Class II Anti-arrhythmics?

A

Beta Blockers

35
Q

When are beta blockers used?

A

severe sinus or supraventricular tachycardia

36
Q

When do you use Beta Blockers in anesthesia?

A

tachycardia associated with pheochromocytoma

37
Q

What is the most common beta blocker used?

A

Esmolol

38
Q

What happens when alpha 1 and alpha 2 receptors are activated?

A

vasoconstriction

39
Q

What does Beta 1 on the heart cause?

A

Increased Inotropy and chronotropy

40
Q

What does beta 2 on the blood vessels and bronchi cause?

A

Vasodilation and bronchodilation

41
Q

What does alpha overstimulation cause?

A

Vasoconstriction
Decreased perfusion
increased cardiac workload

42
Q

What does beta 1 overstimulation cause?

A

tachyarrhythmia

increased myocardial O2 demand

43
Q

What does beta 2 overstimulation cause?

A

vasodilation

decreased pre load

44
Q

What drugs act on mixed receptors?

A

Dopamine
Ephedrine
Norepinephrine
Epinephrine

45
Q

What drug acts primarily on alpha receptors?

A

Phenylephrine

46
Q

What drugs act primarily on beta receptors?

A

Dobutamine

Isoproterenol

47
Q

What drug acts on non-adrenergic receptors?

A

Vasopressin

48
Q

What receptors does Dopamine act on with low doses?

A

Dopamine receptors

49
Q

What receptors does Dopamine act on with medium doses?

A

Beta receptors

50
Q

What receptors does Dopamine act on with high doses?

A

Beta and alpha receptors

51
Q

What can ephedrine cause?

A

Reflex bradycardia

CNS stimulation

52
Q

What is norepinephrine indicated in?

A

refractory shock or non-responsive hypotension

53
Q

What is epinephrine indicated in?

A

CPR

Anaphylactic shock

54
Q

What kind of agonist is Phenylephrine?

A

Alpha 1

55
Q

What does phenylephrine cause?

A

Splenic contraction

56
Q

What is phenylephrine used to treat?

A

nephrosplenic entrapment

57
Q

What receptor does Dobutamine act on?

A

Beta 1

58
Q

What does Dobutamine cause?

A

Increased inotropy

minimal effects on chronotropy

59
Q

What receptor does Isoproterenol act on?

A

Beta 1 and B2

60
Q

What is Isoproterenol used for?

A

treatment of 3rd degree AV block and bronchodilation

61
Q

Vasopressin

A

Antidiuretic hormone

62
Q

When is Vasopressin indicated?

A

Refractory shock

non-responsive hypotension

63
Q

What does Vasopressin cause?

A

Vasoconstriction

Tissue Ischemia

64
Q

What is the first thing to do for hypotension?

A

evaluate patient and turn down the vaporizer if the patient is too deep
If the patient is too light ass mac-sparing drug then turn down the vaporizer

65
Q

What are other strategies for hypotension?

A

Give crystalloid fluid bolus
Treat the suspected underlying cause
consider CV drug therapy

66
Q

How do you treat Vasodilation?

A

Give Vasopressor

67
Q

How do you treat decreased contractility?

A

Give Inotrope

RUSVM Anesthesiology 2016 (38 decks)

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