First Aid 245-268 Flashcards
Atropine is aka
bella donna
jimson weed
Muscarinic antagonist
can reverse lethal bradyarrythmias
Muscarinic antagonists used in eye check ups to dilate
Atropine
Homatropine
Tropicamide
“Park my Benz”
Parkinsons - use Benztropine (M1) to improve tremor/rigidity
Hyoscamine
Dicyclomine
Uses
Antispasmodics for IBS
Antimuscarinics
Tiotroprium is preferred over Ipratroprium for treatment of COPD and asthma because
Tiotroprium dissociates from M3 more slowly, provides longer bronchial relaxation;
Antimuscarinic
M2 antagonist used to treat overactive bladder
Oxybutinin
Solifenacin
Tolterodine
Hot as a hare (M3) Mad as a Hatter Dry as a Bone Blind as a Bat Red as a Beet
Antimuscarinic toxidrome ie atropine overdose
Can cause acute angle glaucoma
Pralidoxime
reverses DUMBBELSS
no CNS penetration
What receptors does Dobutamine act on?
B1> B2, alpha
direct sympathomimetic
What receptors does dopamine act on?
D1 = D2 > beta > alpha
direct sympathomimetic
What receptors does epinephrine act on?
Beta > alpha
direct sympathomimetic
What receptor does Fenoldopam act on?
D1
post-op HTN (vasodilates)
direct sympathomimetic
What receptors does isoproterenol act on?
beta 1 = beta 2
evaluation of tachyarrythmias
direct sympathomimetic
What receptor does midodrine act on?
Alpha 1
tx of postural hypotension
direct sympathomimetic
What receptors does norepinephrine act on?
alpha 1 > alpha 2 > beta 1
direct sympathomimetic
What receptors does phenylephrine act on?
alpha 1 > alpha 2
tx hypotension, rhinitis, in ocular procedures to produce mydriasis
direct sympathomimetic
Never give what if cocaine intoxication is suspected and why?
Beta blockers
Cocaine is a general (indirect) sympathomimetic agonist - blocking beta would cause unopposed alpha-1 activation and extreme HTN
Amphetamine
Cocaine
Ephedrine
are all:
Indirect sympathomimetics
Clonidine
Guanfacine
Uses
Alpha-2 sympatholytics - reduce sympathetic outflow - treat hypertensive emergency, ADHD, Tourette syndrome
Name the non-selective alpha blockers and their applications
Phenoxybenzamine (irreversible) - Pheochromocytoma
Phentolamine - give to patients on MAO inhibitos who eat tyramine-rich foods
Prazosin, Terazosin, Doxazosin, Tamsulosin - all used for unrinary symptoms of BPH. How do they work?
alpha-1-selective blocker - DECREASE vascular smooth muscle contraction and sphincter contraction
What alpha blocker used in treatment of PTSD?
Prazosin
MOA Mirtazapine
alpha-2 blocker
What beta blockers are class II antiarrythmics indicated for SVT?
Metoprolol, Esmolol
reduce AV conduction velocity
What beta blockers reduce mortality in patients with HF?
Bisoprolol
Carvedilol (**nonselective alpha and beta antagonist)
Metoprolol
What beta blocker is used in the treatment of glaucoma by reducing secretion of aqueous humor?
Timolol
Name the beta-1 selective agonists
Acebutolol (partial agonist) Metoprolol Atenolol Betaxolol Esmolol (Selective agonists are mostly A through M)
What poisoning is frequently misdiagnosed as a fish allergy?
Scombroid - bacteria in spoiled fish convert histadine to histamine
Toxin: AChE inhibitors, organophosphates
Tx?
Atropine ? pralidoxime
Toxin: Amphetamines (basic)
Tx?
Nh4Cl - acidify the urine
Toxin: Antimuscarinic/anticholinergic agents
tx?
Physostigmine and control hyperthermia
Toxin: Arsenic
Tx?
Dimercaprol, succimer
Toxin: Benzodiazepines
Tx?
Flumazenil
Toxin: Beta-blockers
Tx?
Saline, atropine, glucagon
Toxin: Cyanide
Tx?
Nitrite + thiosulfate, hydroxycobalamin
Toxin: Digitalis (digoxin)
Tx?
Anti-digitalis Fab fragments
Toxin: Gold
Tx?
Penicillamine
Dimercaprol
succimer
Toxin: Heparin
Tx?
Protamine sulfate
Toxin: Iron
Tx?
Deferoxamine
Deferasirox
Deferiprone
Toxin: Lead
Tx:
EDTA
Dimercaprol
Succimer
Penicillamine
Toxin: Mercury
Tx?
Dimercaprol
Succimer
Toxin: Methanol, ethylene glycol
Tx?
Fomepizole
Toxin: Methemoglobin
Tx?
Methylene blue, vitamin C
Toxin: Salicylates
Tx?
NaHCO3 (alkalinize urine), dialysis
Toxin: TCAs
Tx?
NaHCO3
Toxin: Warfarin
Tx?
Vitamin K (delayed effect), FFP (immediate)
Ergonovine, an ergot alkaloid, is used to diagnose Prinzmetal’s angine because it does what?
Causes coronary vasospasm
VANCE - what drugs cause cutaneous flushing?
Vancomycin Adenosine Niacin Calcium channel blockers Echinocandins
What drug can be given with Doxorubicin or Daunorubicin to prevent the development of dilated cardiomyopathy?
Dexrazoxane
ABCDE - drugs that cause torsades de pointes
AntiArrhthmics - class IA, III AntiBiotics (macrolides) AntiCychotics ie haloperidol AntiDepressants ie TCAs AntiEmetics ie ondansetron
Embryonic structure: Truncus arteriosis
Gives rise to:
Ascending aorta and pulmonary trunk
Embryonic structure: Bulbis cordis
Gives rise to:
Smooth parts of L and R ventricles
Embryonic structure: Endocardial cushion
Gives rise to:
Atrial septum, membranous interventricular septum, AV and semilunar valves
Embryonic structure: Primitive atrium
Gives rise to:
Trabeculated part of L and R atria
Embryonic structure: Primitive ventricle
Gives rise to:
Trabeculated part of L and R ventricles
Embryonic structure: Primitive pulmonary vein
Gives rise to:
Smooth part of LA
Embryonic structure: Left horn of sinus venosus
Gives rise to:
Coronary sinus
Embryonic structure: Right horn of sinus venosus
Gives rise to:
Smooth part of RA (sinus venarum)
Embryonic structure: Right common cardinal vein and right anterior cardinal vein
Gives rise to:
SVC
Where does erythropoesis occur in the fetus?
Yolk sac
Liver
Spleen
Bone marrow
Where does erythropoesis occur on the adult?
Vertebrae Sternum Pelvis Ribs Cranial bones Tibia and femur
What divides the left and right atria in the developing fetus?
Septum primum and septum secondum
Foramen ovale and ostium secundum: fx?
R to L shunting of blood to bypass pulmonary circulation (atrial development)
VSD most commonly occurs in the
membranous septum
How does fetal blood bypass the hepatic circulation?
Ductus venosus - goes umbilical vein –> IVC
Closure of ductus arteriosus at birth from
increase in O2 –> decrease in prostaglandins
Closure of foramen ovale at birth from
increase in LA pressure, decrease in pulmonary resistance
Prostaglandins E1 and E2 keep what open?
PDA (pulmonary artery –> aorta)
MediaN umbilical ligament used to be in the fetus:
AllaNtois –> urachus
The nucleus pulposus used to be in the fetus
Notochord
UmbiLical arteries become
MediaL umbilical ligaments
Umbilican vein becomes
Ligamentum teres
Why could a RCA infarct result in bradycardia or heart block?
Nodal dysfunction due to SA and AV nodes not being supplied by RCA
What is right dominant circulation?
85% of the population
The Posterior descending artery arises from the RCA
Coronary blood flow peaks in
early diastole
MAP =
MAP = CO x TPR = 2/3DP + 1/3SP
PP =
PP = SP - DP
PP is inversely proportional to
arterial compliance
Decreased afterload has what effect on SV?
Increases SV
Nitroglycerin decreases
preload (venodilator)
Hydralazine decreases
afterload (vasodilator)
EF =
SV/EDV = EDV-ESV/EDV
Ejection fraction is decreased in
systolic HF
Ejection fraction is normal in what kind of HF?
Diastolic HF