Note Cards Flashcards
Meds that cause reflex bradycardia
Phenylephrine
Dopamine
Drugs that are Racemix Mixtures
Dobutamine Verapamil Sotalol Mepivacaine Bupivacaine
+/- isotomiers of Dobutamine
(-) potent alpha agonist; weak beta agonist
(+) competative agonist at alpha; potent Beta agonist
+/- isotomiers of Verapamil
(-) reason CCB classification
(+) Na-channels –> LA effect
+/- isotomiers of Sotalol
(-) beta blocker (+) class III
(+) S of bupivacaine
less toxic than that of mepivacaine?
Drugs to avoid with LHF
“CBL”
- CCB (verapamil)
- Beta blockers
- left sided HF
Drugs to avoid in RHF
“DNR”
- Dopamine
- Norepi
- right sided HF
Drugs that have Tachyphylaxis
- Dobutamine (beta)
- Ephedrine ( alpha inhibition p first dose)
- NTG – more of a tolerance
Drugs it’s important to HYDRATE before administering :
- Phenoxybenzamine
- CCB’s
- BB’s
Drugs known to cause ORTHOSTATIC hypotension
- Phenoxybenzamine
- Prazosin
- Labetalol
Prodrugs:
- SNP
- Enalipril
- Lovastatin
- Simvastatin
- ASA
- Clopidegrel (Plavix)
- Parsurgrel (effient)
- T4 to T3
- Fenofibrate?
Drugs to decrease w/Liver dx
- cardizem
- Labetalol
Interactions with volitiles:
Yohimbine (alpha 2)
Interactions with NMBD:
CCB - decrease AcH at presynaptic cleft
Interactions with LA:
Verapamil
Diltaizem
Increase IOP:
Dopamine
Versed?
Fenoldopam
Succ
DUMBELLS
For Cholinergics – “Wet”
what increases ACh but is breaking on the heart?
cholinergics
Anti-Cholinergics (antimuscarinics) are:
- atropine
- Scopolamine
- glycopyrrolate
- Ipartropium
- Oxybutinin
Protein binding Greatest to least - Beta Blockers:
“-PENAMA”
- Propranolol
- Esmolol
- Nadolol
- Acebutolol
- Metoprolol
- Atenolol
Vd of Opioids greatest to least:
“FMMSRA”
- Fentanyl
- Meperidine
- Morphine
- Sufentanil
- Remifentanil
- Alfentanil
Protein binding (greatest to least) - LA:
“LBRMTLPPC”
- Levo
- Bupivacaine
- Ropivacaine
- Mepivacaine
- Tetracaine
- Lidocaine
- Prilocaine
- Chloroprocaine (zero)
LA Metabolism fastest to slowest (esters)
“PLEB”
- Prilocaine
- Lidocaine/Mepivacaine
- Etiocaine
- Bupivacaine/Ropivacaine
RPM - “start slow and speed up”
Ropiviacaine, Prilocaine = Metabolism
Protein binding of antiarrhymics (greatest to least)
- Amiodarone
- Propranolol
- Verapamil
- Quinidine
- Lidocaine
- Procainanide
- Sotalol (zero)
Gases - hepatic effects greatest to least:
“HEIDes”
H > E> I > Des
NMB’s in order of R/O anaphylaxis (greatest to least)
-Succ> Atracurium >Cis > Roc > Vec
Gases that potentiate NMB (most to least)
Des > Sevo > Halo > N2O
Order of NMD’s Sugammadex works on (best to least):
Roc > Vanc»_space; Panc
CO equation =
CO = SV x HR
Ficks Principle Equation
CO = [ O2 consumption / (O2 pulm vein) - (O2 pulm artery) ]
SV =
EDV - ESV
SV alternative (CO and HR)
SV = CO/HR
EF =
SV/EDV
SVR =
[ (MAP - CVP) / CO] x 80
MAP = (with SVR)
MAP = [ (CO x SVR) / 80 ] + CVP
MAP (with TPR)
MAP = CO x TPR
MAP (pulse pressure)
MAP = Diastolic Pressure + 1/3 Pulse Pressure
pulse pressure =
Systolic - Diastolic
*** aprox. = SV
Factors that Increase VENOUS Return (Increase CO):
- Venoconstriction by smpathetic stimulation
- muscle pump
- body posture (trend; raised legs)
- Respiratory (Decreased intrathoracic pressure)
Factors that Decrease VENOUS return (decrease CO):
- Standing
- PEEP (increases intrathoracic pressure)
- Pneumothorax
- Acure/severe asthma
Preload is directly proportional to
SV
Increased Preload = Increased SV and vis versa
SV is indirectly proportionate to:
Afterload
Decrease afterload = increase SV
SV is directly proportionate to:
Contractility
If your PCWP is high (normal is 8-14) what is harmful:
FLUIDS
Normal CVP
5-8 mmHG
L II, III, aVF indicate
inferior MI / RCA
V1-V4 indicate
anterior
anterior septal MI
LAD
V5 - V6, I and aVL indicate
Lateral Left circumflex
LAD?
ST depression in V1, V2
Posterior
Left Circ or RCA
RCA seen in
Leads II, III, aVF
sees RA and ventricle
LCA supplies LAB and circumflex — then feeds?
septal anterior and lateral
LAD in leads
V1-V4
small box on ekg paper measures:
1mm x 1mm = .45
Big box on ekg paper measures;
5mm x 5mm = .20 sec
vertical small box on ekg measures:
0.1mV
vertical large box on ekg paper measures:
0.5 mV
R Prime indicates
RBBB
T wave
asymmetrical and upright
T wave in hypokalemia
low amplitude
T wave in yperkalemia
tall and peaked
leads on the upper body are
negative
leads on the lower body are
positive
a = augmented V= voltage R= right arm L= left arm F =
left foot
aVR does not view any
cardiac wall
aVF views
Left Leg - inferior LV
R axis normal in
abnormal in?
normal in young
abn change inspiration - COPD, WPW, RVH
L axis normal in?
normal in old or obese
P Wave is known as
P-Pulmonale
lung disease Right Atrial strain
Poor R wave poor progression
anteroseptal infart
young women
Q wave indicated
old MI
-not permanent
u wave
hypokalemia
ST elevation all leads but aVR may indicate
Pericarditis
inferior MI
RCA is seen in
ST elevation in L II, III, aVF
anterior septal MI
LAD is seen in leads?
LV1-V4
ST Depression in leads V1 and V2 indicate
posterior MI
LCA or RCA
systolic murmur heard b/w what heart sounds
S1 and S2
what sound is heard with closure of tricuspid and mitral valves?
S1
what sound is heard with the closure of the aortic and pulmonic valves?
S2
S3 heart sound is normal in? abn?
normal in children <30 yrs old
heard with **Bell at Left sternal border
S4 Heart sound indicates:
abn Stiff non-compliant ventricle
PMI is heard at:
5th Intercostal Space
Left midclavicular line
Diastolic Murmur
Mitral stenosis
-low open snamp after S2 before Murmur
Aortic stenosis
loud harsh enection click; at 2nd intercostal space, diminished S2, CRACKLES
Bell used to hear
LOW sounds
S3
Mitral stenosis
Diaphragm used to hear
HIGH
S1, S2 & S4
+ Thrill in grades
4-6
Order of Nerve Blockade for Spinal or Epidural Anesthesia
The order in which nerves are blocked following epidural administration of a local anesthetic are:
- B fibers (preganglionic sympathetic efferents)
2. C and A-delta (A
