CV Pharmacology PPT Flashcards by Study Study

Name __ sympathomimetics

Epinephrine
Norepinephrine
Dobutamine
Dopamine
Milrinone
Phenylephrine

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Epinephrine is what type of catecholamine

Endogenous

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Epinephrine stimulates what receptors with low doses (0.01-0.04 mcg/kg/min)

B1 and B2

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Epinephrine’s B2 stimulation occurs where in the body? and causes what reactions?

periphery
DECREASES afterload
bronchodilation

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Epinephrine’s B1 stimulation occurs where in the body? and cause what reaction?

Heart
increases inotropy/chronotropy/dromotropy
== increased CO

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with low doses of Epinephrine the is a _______ change in systemic BP!!

minimal

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with higher doses of Epinephrine there is stimulation of what receptor?

Alpha 1

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Epinephrine’s alpha-1 stimulation occurs where in the body? and causes what reaction?

skin, mesenteric, hepatarenal constriction

=increased afterload

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2 main SE of Epinephrine

glycogenolysis and gluconeogenesis= hyperglycemia

- Increase Na+/K+ pump activity= mild HypoK+

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Norepinephrine is what type of catecholamine?

endogenous

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Norepinephrine effects what receptors? and causes what reactions?

(same B1 as epinephrine)

B1 increases inotropy/chronotropy/dromotropy == increased CO
minimal B2 stimulation
POTENT Alpha a effects- more vasoconstriction
–hepatorenal, mesenteric, skin, and skeletal muscle constriction

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Starting dose for Norepinephrine

same as epinephrine 0.01-0.02 mcg/kg/min

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Norepinephrine is 1st line agent for what?

Low CO post CPB vasodilation

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Dobutamine is what type of Catecholamine?

Synthetic

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Dobutamine works on what receptors

partially selective B1 agonist, some B2 effects

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What does the isomer of Dobutamine do?

opposing effects on alpha 1 receptors

Dextro- blocks alpha 1
Levo- stimulates Alpha 1

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Dobutamine doses and receptors stimulated

< 5 mcg/kg/min = predominant B1-B2 agonism= increased CO, Decreased afterload

> 5mcg/kg/min= B1 stim and Alpha 1 stim= increased CO, stable afterload

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Dopamine is what type of Catecholamine

endogenous

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Dopamine is a precursor to what drug (catecholamine)

Noreponephrine

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Dopamine stimulates what receptors

D1, D2, B1, B2, and Alpha 1

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Dopamine doses? receptors stimulated and effects?

Low dose?

0.5-3 mcg/kg/min
D1
renal vascular dilation

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Dopamine doses? receptors stimulated and effects?

Moderate dose?

3-10 mcg/kg/min
B1
inotrope and chronotrope

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Dopamine doses? receptors stimulated and effects?

High doses?

> 10 mcg/kg/min
A1
increased afterload

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Milrinone is what drug class?

Phosphodiasterase inhibitor

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Milrinone is what type of catecholamine

Non-catecholamine inotrope | you dummy remember it is a phosphodiasterase inhibitor

Milrinone MOA

inhibits PDE II = decrease hydrolysis of cAMP = INCR intracellular cAP = INCR intracellular Ca++ movement

Milrinone does what to inotropy?

increases it

Milrinone does what to vascular smooth muscle?

dilates it

Milrinone may selectively dilate _______ vasculature > systemic

pulmonary

will Milrinone work in the presence of B blockade?

fuck yeah!!! you beat you ass!!!

caution dosing Milrinone in what pt's and why?

Renal failure b/c 80% eliminated unchanged by kidneys

WHat type of catecholamine is Phenylephrine?

synthetic non-catecholamine

Phenylephrine effects what receptor

direct Alpha 1

Phenylephrine effects of alpha 1 stimulation

venous and arterial constriction increase afterload increase venous tone

Name 3 vasodilators

Nitroglycerine sodium nitroprusside nicardipine

Nitro is an organic nitrate that acts on what?

venous capacitance vessels

nitroglycerine works by generating what?

Endothelial nitric oxide

nitroglycerine causes peripheral venous _______?

pooling

nitroglycerine causes decreased LV wall tension which equals what?

decreased preload

with nitroglycerine higher doses will dilate ARTERIAL vascular smooth muscle! at what dose does this occur??

>2 mcg/kg/min

what vasodilator is a non-selective arterial and venous vascular smooth muscle dilator

Sodium Nitroprusside

Sodium Nitroprusside inhibits what natural body response

HPV

the Sodium Nitroprusside molecule is 44% _____ by weight

cyanide

Sodium Nitroprusside interacts with oxyhemoglobin forms methemoglobin and releases _________ and ______

cyanide | NO

NO MOA

NO activates guanylate cyclase = increase intracellular cGMP (inhibints Ca++ entry) =vascular dilation

Be cautious of cyanide toxicity with SNP dose greater than what?

> 2 mcg/kg/min

2 SE of cyanide toxicity

1) tissue hypoxia, anearobic metabolism (lactic acid) | 2) Mixed venous PO2 and SpO2 increased

Increased SvO2 and poor tissue oxygenation is S/S of what disorder

methemoglobinemia

what is a rare SE of SNP infusion

Thiocyanate toxicity

s/s of Thiocyanate toxicity

- slow clearance by kidneys= fatigue, tinnitus, N/V | - Inhibits uptake of iodine by the thyroid = hypothyroidism

Nicardipine class

1,4 DHP CCB

does Nicardipine have SA or AV node blockade?

Neither dummy

Nicardipine has minimal myocardial depression!!!! true or false???

true

Nicardipine is a venous or arterial dilator?

arterial ( blocks intracellular Ca++)

Nicardipine is a predominate _________ dilator

coronary

Name 2 antidysrhythmics

Amiodarone | Lidocaine

Amiodarone Actions

- Blocks inhibitory K+ channels | - prolongs action potentials. repolarization and refractory period

Amiodarone treats what?

reentry and enhanced automaticity | ex: SVT, VT and A-fib

Amiodarone MOA

- depresses conduction in the AV node and the accessory bypass tracts - prolongs the refractory period in all cardiac tissues

Amiodarone is 37% what?

iodine

Amiodarone's antiadrenergic effects are blockade of what?

blockade of A and Beta

Amiodarone has ___ and _____ channel blocking effects

K+ | Ca++

Amiodarone has minor _____ inotropic and potent ________ properties

negative | vasodilating

Amiodarone t 1/2 is how long?

29 days

Amiodarone is metabolized by what?

hepatic

SE of Amiodarone

pulmonary alveolitis prolonged QT skin/corneal/thyroid effects

Lidocaine is for the tx of what?

re-entry dysrhythmias | ex: PVCs V-tach

Lidocaine decreases phase ____ causing decreased K+ ion permeability

Lidocaine causes decreased __ node and ____ ____ conduction

AV | his bundle

Lidocaine is metabolized by what?

Hepatic | with active metabolites

Lidocaine what occurs with the following levels? Toxic plasma conc- plasma level > 5 mcg/ml plasma level > 10 mcg/ml

Toxic plasma conc- vasodilation and myocardial depression plasma level > 5 mcg/ml- SZ plasma level > 10 mcg/ml- CNS depression/ apnea/ arrest

Name 3 commonly used adjuncts

inhaled NO Prostacyclin (PGI2) IABP

Inhaled NO is at what concentration levels?

2-40 ppm (blended into FGF)

Inhaled NO is rapidly inactivated by what???? this is why there are no systemic effects!

Hemoglobin

Inhaled NO relaxes what?

Pulmonary vascular smooth muscle

Inhaled NO desired effects

decreased PAP | reduced afterload

Inhaled NO is for tx of what?

low CO in cor pulmonale | improves V/Q matching in ARDS (does not improve mortality)

Prostacyclin (PGI2) is administered how

inhaled or IV

what is Prostacyclin (PGI2)

potent vasodilator!

IV doses of Prostacyclin (PGI2) is used to do what?

reduce PAP often causes systemic hypotension

does Prostacyclin (PGI2) have systemic effects when inhaled?? why or why not?

nope | rapid inactivation

what is teh advantage of Prostacyclin (PGI2) over inhaled NO

much cheaper (so we should use it of the no insurance ones)

what is the IABP?

Aortic balloon counterpulsation

IABP inflates with what?

helium!! 9like all balloons silly)

IABP inflates when? and why?

diastole | increased coronary perfusion

the IABP deflates when? and why?

just before AV opening | decreased LV afterload

what are the ONLY 2 functions of the IABP

1) increased Myocardial O2 supply (diastolic augmentation) | 2) decreased myocardial oxygen demand (reduced afterload)

3 anticoagulants Boyd cares about!!!

Heparin Bivalirudin (angiomax) Argatroban

Heparin sodium is what? and made from what?

unfractionated heparin | made of porcine or bovine

Heparin sodium increases antithrombin III activity by how much?

1000x's

Does Heparin sodium cross the placenta???

no way

what is teh CPB minimum dose for Heparin sodium

300 U/kg ( min ACT 400s-nl is 90-120s)

with Heparin sodium 100 units = _____mg

1 mg

Bivalirudin (angiomax) is what type of drug??? dont say anticoagulant!!

direct thrombin inhibitor

Bivalirudin (angiomax) has a short half life of how long?

25 min

Bivalirudin (angiomax) is eliminated how????

non-organ | by proteolysis

what is a huge disadvantage of Bivalirudin (angiomax)

difficult to monitor

Argatroban is what type of drug???? don't say anticoagulant dumbass!!

direct thrombin inhibitor

Argatroban is LESS or MORE potent than Bivalirudin?

less

Argatroban pump load (dose) and IV load (dose)

pump- 0.05 mg/kg | IV- 0.1 mg/kg

what is a disadvantage of Argatroban

difficult to monitor

CV Pharmacology PPT Flashcards

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