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CPR Exam 1 > Drugs to Treat Acute Aortic Dissection > Flashcards

Drugs to Treat Acute Aortic Dissection Flashcards

1
Q

How do beta blockers work in treating aortic dissection?

A
  • Blocking effects of Epi
  • Cause heart to beat slower and with less force (lowers BP)
  • Opens veins and arteries up to help improve blood flow
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2
Q

What is the MOA of LabetaloL?

A
  • Blocks both alpha and beta receptors

- Decreases peripheral vascular resistance

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3
Q

What are some contraindications of labetalol?

A
  • Overt cardiac failure
  • Greater than first degree heart block
  • Severe bradycardia
  • Cardiogenic shock
  • Severe hypotension
  • Anyone with history of obstructive airway disease including asthma
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4
Q

What are some adverse effects of labetalol?

A
  • Dizziness
  • Tingling scalp or skin
  • Lightheadedness
  • Excessive tiredness
  • Headache
  • Upset stomach
  • Stuffy nose
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5
Q

What are some precautions to take when prescribing labetalol?

A
  • Hepatic injury
  • Cardiac failure
  • Exacerbation of ischemic heart disease following abrupt withdrawal
  • Non-allergic bronchospasm
  • Pheochromocytoma
  • DM and hypoglycemia
  • Major surgery
  • Impaired hepatic function
  • Jaundice or hepatic dysfunction
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6
Q

What are the drug interactions with labetalol ?

A
  • TCAs: tremor
  • Beta receptor agonist
  • Drugs in patients with bronchospasm
  • Cimetidine
  • Halothane anesthesia
  • Nitroglycerin
  • Calcium antagonists
  • DIgitalis glycosides (increase risk of bradycardia)
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7
Q

What is a specific population you have to be careful about when giving labetalol?

A
  • Nursing mothers due to a small amount being able to be excreted in breast milk
  • Pediatric patients: safety and effectiveness have not been identified yet
  • Geriatric patients: orthostatic symptoms could arise
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8
Q

When are peak plasma levels of labetalol reached?

A
  • 1 to 2 hours after oral administration
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9
Q

What can increase the bioavailability of labetalol?

A
  • Taking with food
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10
Q

Where is labetalol found in the body?

A
  • Plasma protein binding (50%)
  • Breast milk
  • Crosses placenta
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11
Q

How is labetalol metabolize?

A
  • Mainly through conjugation to glucuronide metabolites
  • Excreted in urine (55-60% appear in urine)
  • Excreted via bile into the feces
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12
Q

How do you advise patients when taking labetalol?

A
  • Take exactly as prescribed
  • Do not interrupt or discontinue without physician’s advice
  • Consult a physician at any signs or symptoms of impending cardiac failure or hepatic dysfunction
  • Transient scalp tingling may occur
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13
Q

What does esmolol do in the heart?

A
  • Affects the response to nerve impulses in heart

- Heart beats slower means there is a lower BP

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14
Q

What is the MOA of esmolol?

A
  • Class II antiarrhythmic

- Competitively blocks response to B1 adrenergic stimulation

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15
Q

What is esmolol used for?

A
  • To control rapid heart beats or abnormal heart rhythms

- Also used to treat fast heartbeat and tachycardia during surgery, after surgery, or during other medical procedures

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16
Q

What are some contraindications of esmolol?

A
  • Bronchial asthma
  • Overt cardiac failure
  • Cardiogenic shock
  • Severe sinus bradycardia
  • Other conditions associated with severe and prolonged hypotension
  • Hypersensitivity to product
  • History of obstructive airway disease
  • Heart block greater than first degree
  • Decompensated heart failure
  • IV administration of CCBs near giving esmolol
  • Pulmonary hypertension
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17
Q

What are pregnancy considerations with esmolol?

A
  • Could cause fetal bradycardia
  • Monitor during pregnancy if beta blocker is given to mom
  • Newborns should be monitored for 48 hours after birth
18
Q

Is a mom allowed to breastfeed while taking esmolol?

A
  • It isn’t known for sure if esmolol is present but due to short half life, one would have to decide after monitoring baby
19
Q

What does esmolol do in the geriatric patient?

A
  • Bradycardia which may require dosage reductions
20
Q

What are some adverse effects of esmolol?

A
  • Anaphylactic reactions
  • Extravasation
  • Hyperkalemia
  • Hypotension (can occur during surgery)
21
Q

What is the MOA of nitroprusside?

A
  • Increases intracellular production of cGMP which causes vascular smooth muscle relaxation (dilation)
22
Q

What happens to nitroprusside in the blood?

A
  • Sodium nitroprusside breaks down and binds to oxyhemoglobin
23
Q

What does oxyhemoglobin release after sodium nitroprusside is bound?

A
  • NO
  • Cyanide (toxic)
  • Methaemoglboin
24
Q

What are the indications of nitroprusside?

A
  • Lowers BP immediately
  • Reduces bleeding during surgery
  • Treats acute CHF
25
Q

What are some contraindications of nitroprusside?

A
  • Not to be used for compensatory HTN
  • Not in patients with inadequate cerebral circulation
  • Not in patients who are near death
  • NOt in patients with B12 deficiency, anemia, severe renal disease, and hypovalemia
26
Q

What is worrisome about the use of nitroprusside?

A
  • Cyanide being released

- Watch for conditions that have high cyanide ratios (Leber’s optic atrophy or tobacco amblyopia)

27
Q

What are some common adverse effects of nitroprusside?

A
  • Bradyarrhythmias
  • Hypotension
  • Palpitations
  • Tachyarrhythmias
  • Apprehension
  • Restlessness
  • Confusion
  • Dizziness
  • Cyanide poisoning
  • Thiocyanate toxicity
28
Q

What can be administered in order to reduce the chance of cyanide toxicity?

A
  • Sodium thiosulfate

- Increases the rate of cyanide processing but may be toxic at high doses

29
Q

What are some precautions to take with nitroprusside?

A
  • Cyanide toxicity
  • Check thiocyanate levels
  • Monitor pulse oximeter
  • Consideration of methemoglobinemia and thiocyanate toxicity
30
Q

What is the black box warning on nitroprusside?

A
  • Not suitable for direct injection
  • Hypotension may occur leading to irreversible ischemic injury or death
  • Cyanide toxicity
31
Q

How many cyanide ions are made from metabolism of nitroprusside?

A
  • One molecule of sodium nitroprusside makes four (4) CN- ions
32
Q

How is cyanide excreted?

A
  • Reacts with thiosulfate to produce thiocyanate and then excreted in urine
33
Q

What is the MOA of nicardipine?

A
  • Calcium entry blocker

- Inhibits the influx of calcium ions into cardiac and smooth muscle

34
Q

What are the indications of nicardipine?

A
  • Short term treatment of HTN

- Prolonged control of BP

35
Q

What is a contraindication of nicardipine?

A
  • Not to be used in those with advanced aortic stenosis
36
Q

What are some adverse effects of nicardipine?

A
  • Headache
  • Hypotension
  • Tachycardia
  • Nausea/vomiting
37
Q

What are some warnings associated with nicardipine?

A
  • Monitor BP and HR
  • Can increase frequency, duration, or severity of angina
  • Use in patients with heart failure: Possible negative inotropic effects
  • Use in patients with impaired hepatic function
  • Use in patients with impaired renal function
38
Q

What should you do with nicardipine in geriatric patients?

A
  • Use low initial doses due to decreased hepatic and renal function
39
Q

What are some drug interactions with nicardipine?

A
  • beta blockers
  • Cimetidine
  • Cyclosporine
  • Tacrolimus
40
Q

How is nicardipine metabolized?

A
  • CYP450 enzymes (CYP3A4)

- Transporters (P-GP substrate)

CPR Exam 1 (21 decks)

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