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Pharm Fall 2019 > Ex3 Vasodilators > Flashcards

Ex3 Vasodilators Flashcards

1
Q

BP =

A

COxSVR

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2
Q

CO=

A

HRxSV

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3
Q

increased BP is a result of

A

either increase in CO or increase in SVR

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4
Q

Increased CO occurs d/t

A

SNS: Beta-1 activation in heart

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5
Q

Increased SVR d/t

A

SNS: Alpha-2 activation
RAAS: increased aldosterone=H2O retention, AngiotensinII activation=vasoconstriction

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6
Q

Goal SBP

A

BASELINE - if baseline = 180, aim for that

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7
Q

secondary causes of HTN

A

OSA, pheochromocytoma, hyperparathyroidism

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8
Q

Essential HTN

A

primary HTN

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9
Q

B1 Blockers will result in

A

Decreased: HR, CO

Negative chronotropic effects

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10
Q

B1 Blockers = increased CO in which patients?

A

Rapid Afib

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11
Q

B2 agonist

A

Bronchodilation

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12
Q

Atenolol

A

+ B1-selective

NO a1 blockade

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13
Q

Carvedilol

A

NO B1 selective

+ a1 blockade

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14
Q

Esmolol

A

+ B1 Selective

NO a1 blockade

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15
Q

Labetalol

A

NO B1 selective

+ a1 blockade

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16
Q

Metoprolol

A

+ B1 selective

NO a1 blockade

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17
Q

Propranolol

A

No B1 selective/a1 blockade

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18
Q

Selective Beta-1 beta blockers

A

Atenolol
Esmolol
Metoprolol

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19
Q

Non-selective beta blockers

A

(+a1 blockade)
Carvedilol
Labetalol
Propranolol (-)a1 blockade

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20
Q

Which beta blockers are not beta selective or alpha1 blockers?

A

Propranolol

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21
Q

Metoprolol PO 2.5mg = ? IV

A

1mg

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22
Q

Labetolol Beta:Alpha PO

A

3:1

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23
Q

Labetolol Beta:Alpha IV

A

7:1

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24
Q

Main reason to use beta blockers

A

tachyarrhythmias

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25
Q

Beta blockers are condraindicated in

A

NOT in COPD/asthma - preferable to use B1 selective, but if not just have albuterol on standby

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26
Q

Beta Blocker benefit in periop

A

decreased risk of post-op MI

prophylaxis for Afib

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27
Q

Beta blockers common adverse effects

A 
hypotension
bronchospasm
bradycardia/heart block
worsening CHF
angina pectoris/MI upon abrupt d/c
rebound HTN
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28
Q

Selective Alpha1 blockers

A

prazosin
terazosin
doxazosin
tamsulosin

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29
Q

Non-selective Alpha1 blockers

A

phenoxybenzamine

phentolamine

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30
Q

Tx pheochromocytoma

A

non-selective alpha1 blockers
phenoxybenzamine
phentolamine

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31
Q

effect of selective alpha1 blockers

A

systemic vasodilation

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32
Q

effect of non-selective alpha blockers

A

decrease both HR/BP

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33
Q

adverse effects of alpha receptor blockers

A

hypotension

exaggeration of hypotension during epidural anesthesia

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34
Q

Tx of alpha blocker hypotension

A

phenyl or norepi

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35
Q

Poor mans Dex

A

clonidine

36
Q

MOA clonidine

A

selective partial alpha2 agonist

37
Q

Adverse effects of Alpha2 agonists

A 
(clonidine) 
sedation
hypotension
bradycardia
*rebound HTN
38
Q

ACE-Inhibitors with + active metabolites

A

Enalapril

Ramipril

39
Q

Caution with ACEI in OR

A

Renally eliminated

+ active metabolites in some

40
Q

Adverse effects - ACEI, ARB

A 
hypotension
angioedema
ARF
hyperK
**cough (only ACEI)
41
Q

Rx intxn -ACEI, ARB

A

potassium supplements
potassium sparing diuretics
** cautious w/ other hypotensive agents

42
Q

Contraindicated ACEI, ARB

A

pregnancy

43
Q

dihydropyridine CCB

A

nifedipine
amlodipine
nicardipine
clevidipine

44
Q

non-dihydropyridine CCB

A

verapamil

diltiazem

45
Q

CCB that decreases HR

A

diltiazem
verapamil
(nondhp)

46
Q

CCB that increases/doesn’t effect HR

A

nifedipine
nicardipine
clevidipine

47
Q

CCB that decreases will HR will also

A

decrease SA/AV node conduction

48
Q

CCB that causes coronary artery dilation most

A

nifedipine
nicardipine
clevidipine

49
Q

CCB that causes peripheral artery dilation most

A

nifedipine
nicardipine
clevidipine

50
Q

Uses for diltiazem/verapamil in OR

A

IV -
supraventricular tachydysrhythmias
HTN

51
Q

Use for nifedipine, nicardipine, clevidipine in OR

A

HTN

52
Q

Use for nimodipine in OR

A

cerebral artery vasospasm prophylaxis

53
Q

CCB anesthetic Rx intxn

A

additive negative inotropy/peripheral vasodilation

54
Q

CCB Rx intxn

A

Dig, BB, amio

increased risk for AV block

55
Q

Adverse effects DHP CCB

A

reflex tachycardia

56
Q

Adverse effects non-DHP CCB

A

bradycardia–> cardiac arrest

57
Q

HTN urgency

A

SBP >/= 180
and/or
DBP >/= 110
w/o evidence of target organ damage

58
Q

HTN emergency

A

SBP > 200
and/or
DBP > 120
w/ concurrent target organ dysfunction

59
Q

HTN emergency organ damage

A

AKI, liver injury, retinopathy, seizures

60
Q

High risk HTN emergency

A

CAD, DM, PVD, impaired renal fxn, smoking, elevated LDL

61
Q

Overall Tx of HTN emergency

A

Gradual decrease in BP

62
Q

HTN emergency in acute aortic dissection

A

Goal HR <60 BPM
Goal SBP <100-120 mmHg
ASAP (<5-10min)

63
Q

HTN emergency in ischemic stroke pt

A

HTN after stroke is bodys way of maintainin CPP

-increased risk for hemorrhagic conversion if given thrombolytics

64
Q

Goal BP in intracerebral hemorrhage

A

SBP 140-160

65
Q

HTN urgency vs HTN emergency treatment

A

emergency: must come down quicker than urgency
Urgency: discharge onto PO Rx

66
Q

Nitroprusside effect on preload, afterload, CO

A

(-)preload
(–)afterload
(+)CO
Fast on/off

67
Q

Hydralazine effect on preload, afterload, CO

A

Avoid in OR, unpredictable
(n/a)preload
(-)afterload
(+)CO

68
Q

Nicardipine effect on preload, afterload, CO

A 
(n/a)preload
(-)afterload
(+)CO
Fast on
Slow off
69
Q

Clevididipine effect on preload, afterload, CO

A

*same as nicardipine, except fast on AND OFF
(n/a)preload
(-)afterload
(+)CO

70
Q

Nitroglycerin effect on preload, afterload, CO

A

(–)preload
(-, n/a)afterload
(+,n/a)CO
Fast on/off

71
Q

Esmolol effect on preload, afterload, CO

A

(n/a)preload
(n/a)afterload
(-)CO
Fast on/off

72
Q

Metoprolol effect on preload, afterload, CO

A

*same as esmolol –> except longer duration
(n/a)preload
(n/a)afterload
(-)CO

73
Q

Enalaprilat

A

discouraged in OR d/t prolonged duration

74
Q

Phentolamine

A

quick on/off, DOC pheo, catecholamine induced HTN emergency

75
Q

Nitroprusside characteristics

A
  • Toxic metabolites w/ renal/liver failure (>72h or >3mcg/kg/min)=avoid
  • avoid in neuro d/t increased ICP
76
Q

Hydralazine characteristics

A
  • OK for pregnant pts
  • Lupus like syndrome (w/ long term use)
  • avoid in OR d/t prolonged duration
77
Q

Nicardipine characteristics

A
  • Reflex tachycardia
78
Q

Clevidipine characteristics

A
  • Lipid (calories/infxn risk)
  • caution: egg/soy allergy
  • metabolized by plasma esterases (off quick)
79
Q

Nitroglycerin characteristics

A
  • tachyphylaxis
  • flushing, erythema
  • dilates veins > arteries
  • “vasospasm prophylaxis” after CABG
80
Q

Esmolol characteristics

A
  • C/I in heart failure
  • metabolism via plasma esterases
  • aortic dissection = need arterial vasodilator for tachy (i.e. nitroprusside)
81
Q

Metoprolol, Labetolol characteristics

A

Contraindicated in heart failure

82
Q

Avoid which drugs in HF?

A

Beta Blocker

83
Q

Preferred Rx in HTN pregnant patient

A

DOC: Labetolol
2nd: hydralazine

84
Q

Enalaprilat characteristics

A
  • too long acting for OR

- do not use in pregnant

85
Q

Fenoldopam characteristics

A
  • pure dopamine agonist
  • pure vasodilator =reflex tachy
  • hypokalemia (from diuresis)
  • avoid in neuro (ICP)
86
Q

Drugs to avoid in neuro patients

A

Nitroprusside

Fenoldopam

Pharm Fall 2019 (33 decks)

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