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Principles III > CV Pharmacology PPT > Flashcards

CV Pharmacology PPT Flashcards

Josh's guide to kicking ass in CV pharm!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

1
Q

Name __ sympathomimetics

A 
Epinephrine
Norepinephrine
Dobutamine
Dopamine
Milrinone
Phenylephrine
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2
Q

Epinephrine is what type of catecholamine

A

Endogenous

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3
Q

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

A

B1 and B2

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4
Q

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

A

periphery
DECREASES afterload
bronchodilation

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5
Q

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

A

Heart
increases inotropy/chronotropy/dromotropy
== increased CO

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6
Q

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

A

minimal

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7
Q

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

A

Alpha 1

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8
Q

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

A

skin, mesenteric, hepatarenal constriction

=increased afterload

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9
Q

2 main SE of Epinephrine

A
  • glycogenolysis and gluconeogenesis= hyperglycemia

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

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10
Q

Norepinephrine is what type of catecholamine?

A

endogenous

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11
Q

Norepinephrine effects what receptors? and causes what reactions?

A

(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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12
Q

Starting dose for Norepinephrine

A

same as epinephrine 0.01-0.02 mcg/kg/min

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13
Q

Norepinephrine is 1st line agent for what?

A

Low CO post CPB vasodilation

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14
Q

Dobutamine is what type of Catecholamine?

A

Synthetic

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15
Q

Dobutamine works on what receptors

A

partially selective B1 agonist, some B2 effects

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16
Q

What does the isomer of Dobutamine do?

A

opposing effects on alpha 1 receptors

  • Dextro- blocks alpha 1
  • Levo- stimulates Alpha 1
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17
Q

Dobutamine doses and receptors stimulated

A

< 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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18
Q

Dopamine is what type of Catecholamine

A

endogenous

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19
Q

Dopamine is a precursor to what drug (catecholamine)

A

Noreponephrine

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20
Q

Dopamine stimulates what receptors

A

D1, D2, B1, B2, and Alpha 1

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21
Q

Dopamine doses? receptors stimulated and effects?

Low dose?

A

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

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22
Q

Dopamine doses? receptors stimulated and effects?

Moderate dose?

A

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

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23
Q

Dopamine doses? receptors stimulated and effects?

High doses?

A

> 10 mcg/kg/min
A1
increased afterload

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24
Q

Milrinone is what drug class?

A

Phosphodiasterase inhibitor

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25
Q

Milrinone is what type of catecholamine

A

Non-catecholamine inotrope

you dummy remember it is a phosphodiasterase inhibitor

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26
Q

Milrinone MOA

A

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

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27
Q

Milrinone does what to inotropy?

A

increases it

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28
Q

Milrinone does what to vascular smooth muscle?

A

dilates it

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29
Q

Milrinone may selectively dilate _______ vasculature > systemic

A

pulmonary

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30
Q

will Milrinone work in the presence of B blockade?

A

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

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31
Q

caution dosing Milrinone in what pt’s and why?

A

Renal failure b/c 80% eliminated unchanged by kidneys

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32
Q

WHat type of catecholamine is Phenylephrine?

A

synthetic non-catecholamine

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33
Q

Phenylephrine effects what receptor

A

direct Alpha 1

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34
Q

Phenylephrine effects of alpha 1 stimulation

A

venous and arterial constriction
increase afterload
increase venous tone

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35
Q

Name 3 vasodilators

A

Nitroglycerine
sodium nitroprusside
nicardipine

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36
Q

Nitro is an organic nitrate that acts on what?

A

venous capacitance vessels

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37
Q

nitroglycerine works by generating what?

A

Endothelial nitric oxide

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38
Q

nitroglycerine causes peripheral venous _______?

A

pooling

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39
Q

nitroglycerine causes decreased LV wall tension which equals what?

A

decreased preload

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40
Q

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

A

> 2 mcg/kg/min

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41
Q

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

A

Sodium Nitroprusside

42
Q

Sodium Nitroprusside inhibits what natural body response

A

HPV

43
Q

the Sodium Nitroprusside molecule is 44% _____ by weight

A

cyanide

44
Q

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

A

cyanide

NO

45
Q

NO MOA

A

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

46
Q

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

A

> 2 mcg/kg/min

47
Q

2 SE of cyanide toxicity

A

1) tissue hypoxia, anearobic metabolism (lactic acid)

2) Mixed venous PO2 and SpO2 increased

48
Q

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

A

methemoglobinemia

49
Q

what is a rare SE of SNP infusion

A

Thiocyanate toxicity

50
Q

s/s of Thiocyanate toxicity

A
  • slow clearance by kidneys= fatigue, tinnitus, N/V

- Inhibits uptake of iodine by the thyroid = hypothyroidism

51
Q

Nicardipine class

A

1,4 DHP CCB

52
Q

does Nicardipine have SA or AV node blockade?

A

Neither dummy

53
Q

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

A

true

54
Q

Nicardipine is a venous or arterial dilator?

A

arterial ( blocks intracellular Ca++)

55
Q

Nicardipine is a predominate _________ dilator

A

coronary

56
Q

Name 2 antidysrhythmics

A

Amiodarone

Lidocaine

57
Q

Amiodarone Actions

A
  • Blocks inhibitory K+ channels

- prolongs action potentials. repolarization and refractory period

58
Q

Amiodarone treats what?

A

reentry and enhanced automaticity

ex: SVT, VT and A-fib

59
Q

Amiodarone MOA

A
  • depresses conduction in the AV node and the accessory bypass tracts
  • prolongs the refractory period in all cardiac tissues
60
Q

Amiodarone is 37% what?

A

iodine

61
Q

Amiodarone’s antiadrenergic effects are blockade of what?

A

blockade of A and Beta

62
Q

Amiodarone has ___ and _____ channel blocking effects

A

K+

Ca++

63
Q

Amiodarone has minor _____ inotropic and potent ________ properties

A

negative

vasodilating

64
Q

Amiodarone t 1/2 is how long?

A

29 days

65
Q

Amiodarone is metabolized by what?

A

hepatic

66
Q

SE of Amiodarone

A

pulmonary alveolitis
prolonged QT
skin/corneal/thyroid effects

67
Q

Lidocaine is for the tx of what?

A

re-entry dysrhythmias

ex: PVCs V-tach

68
Q

Lidocaine decreases phase ____ causing decreased K+ ion permeability

A

4

69
Q

Lidocaine causes decreased __ node and ____ ____ conduction

A

AV

his bundle

70
Q

Lidocaine is metabolized by what?

A

Hepatic

with active metabolites

71
Q

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

A

Toxic plasma conc- vasodilation and myocardial depression

plasma level > 5 mcg/ml- SZ

plasma level > 10 mcg/ml- CNS depression/ apnea/ arrest

72
Q

Name 3 commonly used adjuncts

A

inhaled NO
Prostacyclin (PGI2)
IABP

73
Q

Inhaled NO is at what concentration levels?

A

2-40 ppm (blended into FGF)

74
Q

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

A

Hemoglobin

75
Q

Inhaled NO relaxes what?

A

Pulmonary vascular smooth muscle

76
Q

Inhaled NO desired effects

A

decreased PAP

reduced afterload

77
Q

Inhaled NO is for tx of what?

A

low CO in cor pulmonale

improves V/Q matching in ARDS (does not improve mortality)

78
Q

Prostacyclin (PGI2) is administered how

A

inhaled or IV

79
Q

what is Prostacyclin (PGI2)

A

potent vasodilator!

80
Q

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

A

reduce PAP often causes systemic hypotension

81
Q

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

A

nope

rapid inactivation

82
Q

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

A

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

83
Q

what is the IABP?

A

Aortic balloon counterpulsation

84
Q

IABP inflates with what?

A

helium!! 9like all balloons silly)

85
Q

IABP inflates when? and why?

A

diastole

increased coronary perfusion

86
Q

the IABP deflates when? and why?

A

just before AV opening

decreased LV afterload

87
Q

what are the ONLY 2 functions of the IABP

A

1) increased Myocardial O2 supply (diastolic augmentation)

2) decreased myocardial oxygen demand (reduced afterload)

88
Q

3 anticoagulants Boyd cares about!!!

A

Heparin
Bivalirudin (angiomax)
Argatroban

89
Q

Heparin sodium is what? and made from what?

A

unfractionated heparin

made of porcine or bovine

90
Q

Heparin sodium increases antithrombin III activity by how much?

A

1000x’s

91
Q

Does Heparin sodium cross the placenta???

A

no way

92
Q

what is teh CPB minimum dose for Heparin sodium

A

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

93
Q

with Heparin sodium 100 units = _____mg

A

1 mg

94
Q

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

A

direct thrombin inhibitor

95
Q

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

A

25 min

96
Q

Bivalirudin (angiomax) is eliminated how????

A

non-organ

by proteolysis

97
Q

what is a huge disadvantage of Bivalirudin (angiomax)

A

difficult to monitor

98
Q

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

A

direct thrombin inhibitor

99
Q

Argatroban is LESS or MORE potent than Bivalirudin?

A

less

100
Q

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

A

pump- 0.05 mg/kg

IV- 0.1 mg/kg

101
Q

what is a disadvantage of Argatroban

A

difficult to monitor

Principles III (24 decks)

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