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My Pharm II > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Perioperative HTN - Primary cause: Increased _________ discharge with systemic vasoconstriction

A

sympathetic

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2
Q

Perioperative Hypertension Complications:

A
  • CVA
  • MI
  • ischemia
  • LV dysfunction
  • arrhythmias
  • increased suture tension
  • hemorrhage
  • pulmonary edema
  • cognitive dysfunction
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3
Q

Hemodynamic Effects of vasodilators

A

Reflex increase in HR (Baroreceptors) pure

Redistribution of coronary blood flow

  • NTG may improve collateral circulation
  • Others may cause coronary steal
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4
Q

Hydralazine (apresoline)

A
  • Direct acting arterial vasodilator
  • Inc HR, contractility, renin activity, fluid retention, CO, SV
  • Dec BP (diastolic > systolic) and SVR
  • Has own receptor referred to as hydralazine receptor – cGMP pathway
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5
Q

Avoid hydralazine in patients with?

A
  • CAD
  • Increased ICP
  • Lupus

(Increases myocardial oxygen demand )

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6
Q

Hydralazine S/S

A
  • paralytic ileus
  • Anemia
  • aganulocytosis
  • muscle cramps
  • edema
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7
Q

Hydralazine onset

A

30 mins

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8
Q

Hydralazine advantages

A
  • Maintains/increases cerebral blood flow

- increased CO and SV

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9
Q

Nitroglycerine

A
  • Causes a release of nitric oxide for non-specific relaxation of the vascular smooth muscle
  • Dilates veins > arteries
  • Dec PVR, venous return, myocardial oxygen consumption
  • Relaxes coronary vessels and relieves spasms
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10
Q

Non-cardiac Effects of NTG

A
  • Dilates meningeal vessles (caution with inc ICP)
  • Dec renal blood flow with dec BP
  • Dilates pulmonary vessels
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11
Q

NTG onset

A

1 min

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12
Q

NTG Metabolism/Tolerance

A

Metabolized by glutathione nitrate reductase in the liver

Nitrite ion oxidizes Hgb to methemoglobin

Tolerance in arterial vessels can occur with chronic administration but not in the venous vessels

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13
Q

NTG S/S

A
  • Headache (most common)
  • Postural hypotension
  • Methemoglobinemia
  • anaphylaxis
  • oral and conjunctival edema
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14
Q

NTG Warnings/Contraindications

A
  • PDE5 inhibitors viagara, Cialis – profound hypoTN
  • Narrow angle glaucoma
  • Head trauma, cerebral hemorrhage
  • Severe anemia
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15
Q

Nitroprusside

A
  • Inc cerebral blood flow and ICP
  • Renal blood flow: maintained, slight reduction
  • Overall reduction in myocardial O2 demand
  • With abrupt discontinuation: reflex tachycardia and hypertension
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16
Q

odd about kinetics of Nitroprusside

A

Half-life can be as long as 7 days d/t compound build up

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17
Q

Nitroprusside S/S

A
  • retrosternal discomfort
  • thiocyanate/cyanide toxicity
  • Increased Cr
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18
Q

Nitroprusside Warnings/Contraindications

A
  • Congenital optic atrophy
  • Hypovolemia
  • Compensatory HTN (AV shunting, aortic coarctation)
  • Inc ICP
  • Severe renal/hepatic impairment
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19
Q

Thiocyanate/Cyanide Toxicity S/S

A
  • Hypotension
  • blurred vision
  • fatigue
  • metabolic acidosis
  • pink skin
  • absence of reflexes
  • faint heart sounds
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20
Q

Thiocyanate/Cyanide Toxicity Increased risk

A
  • doses over 4 mcg/kg/min

- > 2 days of therapy

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21
Q

Thiocyanate/Cyanide levels

A

Thiocyanate:

  • Therapeutic 6-29 mcg/mL
  • Fatal: >200 mcg/mL

Cyanide

  • Toxic: > 2 mcg/mL
  • Fatal: > 3 mcg/mL
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22
Q

Treatment of Cyanide Toxicity

A
  • Stop infusion
  • Administer 100% oxygen
  • Correct metabolic acidosis
  • Administer 3% sodium nitrite 4-6 mg/kg slowly IV
  • Administer sodium thiosulfate 150-200 mg/kg IV over 15 min breaks down cyanide
  • Consider Vitamin B12 25 mg/hr
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23
Q

Which nonselective alpha antagonist irreversibly binds to the receptor?

A

Phenoxybenzamine

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24
Q

Phenoxybenzamine use

A
  • Long-term preoperative treatment to control the effects of pheochromocytoma (“chemical sympathectomy”)
  • Relieve ischemia in PVD
  • BPH to improve flow
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25
Q

Phenoxybenzamine

A
  • Reduced PVR to reduced BP
  • Secondary increases in NE due to alpha 2 blockade can increase HR and CO
  • Crosses the BBB
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26
Q

Phentolamine uses

A
  • Hypertension secondary to pheochromocytoma
  • Clonidine withdrawal hypertension
  • Erectile dysfunction
  • Extravasation of catecholamines
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27
Q

Oral Alpha 1 Antagonists for BPH

A

“-osin’s”

Might not give effect you want from giving alpha agonists

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28
Q

Alpha 2 Agonists and Cardiac Complications

A

Reduce cardiac complications: Cochrane Review

  • Overall mortality
  • Cardiac mortality
  • MI

Vascular Surgery especially beneficial

29
Q

Clonidine

A
  • Decreases HR, BP, C.O., and SVR (Baroreceptors reflexes are preserved)
  • Abrupt cessation of drug may lead to rebound hypertension (at risk if using for at least 6 days)
30
Q

Why do you get rebound HTN after abrupt cessation of Clonidine? Treatment?

A

Due to NE upregulation of receptors

Need combined alpha/beta blocker (labetalol/coreg)

31
Q

How long does clonidine patch take?

A

2 days to reach full potential

32
Q

Clonidine: effects on anesthesia

A
  • Reduces propofol and thiopental requirements
  • Alternative to N2O for shortening induction time and attenuating the adrenergic response to intubation during inhaled anesthesia
  • Supplement of regional blocks
33
Q

Which has a higher affinity for Alpha 2 receptors, clonidine or Precidex?

A

Precidex (1620:1 vs 220:1)

34
Q

Dexmedetomidine S/S

A

-Nausea/vomiting, Fever, Hypoxia

Bolus:
-Hypertension.*
-Bradycardia.
(Clinically significant bradycardia and sinus arrest in young, healthy volunteers with high vagal tone.*)

Infusion:
-Hypotension

35
Q

Look at slide 58

A

.

36
Q

Methyldopa use

A

HTN in 3rd trimester

37
Q

Methyldopa S/S

A
  • Fluid retention
  • Positive Coombs test
  • hemolytic anemia
  • bone marrow suppression
  • impotence
38
Q

A.C.E. Inhibitors

A
  • Predominantly arterial vasodilators
  • Treat CHF and MR by afterload reduction
  • Increase CO without excessive decrease in preload
39
Q

ACEs best in _______ pt due to renal protection

A

diabetic

40
Q

Look at slide 65

A

.

41
Q

Most end in “-pril”

A

ACE inhibitors

42
Q

ACE Inhibitors S/S

A
  • Cough, congestion, and rhinorrhea most common side effects
  • Angioedema serious side effect
  • Safe to DC w/o taper
43
Q

Cough due to increased ________ in the lungs, does not go away unless changing med to ARB or similar

A

bradykinin

44
Q

A.C.E. Inhibitors caution with

A
  • ARF and hyper K+

- Do NOT use at all during pregnancy

45
Q

“-sartans”

A

ARBs (less cough/angioedema than ACEIs)

46
Q

Calcium Channel Blockers effects

A
  • Negative Inotropic effect
  • Negative dromotropic effect (AV conduction block)
  • Vasodilation of systemic, splanchnic, coronary and pulmonary beds
47
Q

phenylalkylamines

A

verapamil

48
Q

benzothiazines

A

diltiazem

49
Q

Dihydropyridines

A

“-dipines” (pure atrial dilators)

50
Q

verapamil, used for

A

Potent negative inotrope, dromotrope and vasodilator

Used for:

  • Aortic Stenosis and IHSS
  • Conversion of atrial re-entry tachyarrhythmias
  • Coronary artery vasospasm (Prinzmetal angina
51
Q

Verapamil S/S

A
  • Constipation

- lower extremity edema

52
Q

Look at slide 89

A

.

53
Q

CCBs S/S

A

Arthralgias/joint stiffness, itching

54
Q

Which CCBs better at reducing workload on heart

A

Verapamil and Diltiazem

55
Q

May potentiate the effects of neuromuscular blocking agents

A

CCBs

56
Q

_________ reduces gastric emptying

A

Clevidipine

57
Q

_______ increases sedative effects of midazolam

A

Diltiazem - increased DOA

58
Q

Beta Blockers actions

A
  • Decrease C.O. (HR and contractility)

- Decrease renin release

59
Q

Beta blockers advantages over vasodilators

A
  • No reflex tachycardia or widening of pulse pressure
  • Improved MvO2 (decrease HR and decrease contractility)
  • Intrinsic antiarrhythmic activity
60
Q

Non-selective Beta blockers

A

Propranolol, Nadolol, Timolol, Pindolol, Carteolol

61
Q

Look at slide 102-103

A

.

62
Q

BBlockers S/S

A

Non-selective blockade of Beta-2 receptors

  • Vasoconstriction and worsening PVD
  • Bronchospasm

Myocardial depression
-Decreased contractility could precipitate CHF

Life-threatening bradycardia or asystole

Hyperkalemia in renal failure*

63
Q

Caution when using with Verapamil, Digoxin. Why?

A
  • Verapamil (decrease HR and contractility)

- Digoxin (decrease HR and conduction)

64
Q

BBlocker O/D treatment

A
  • Treat with atropine
  • May need Isoproterenol, dobutamine and/or glucagon infusion
  • Could ultimately need pacing
65
Q

BBlockers contraindications

A
  • Severe bradycardia
  • > 1st degree heart block
  • Cardiogenic shock
  • Raynaud’s disease

Caution

  • Asthma/COPD
  • Diabetes can cause hyperglycemia or mask hypoglycemia
  • Heart failure
66
Q

Labetalol

A

Combines weak Alpha blockade with weak non-selective Beta blockade

67
Q

BBlocker caution

A

Do not stop abruptly due to rebound hypertension and tachycardia

Anticholinesterases may increase bradycardia

68
Q

Look at slide 120

A

.

69
Q

Look at slide 123

A

.

My Pharm II (8 decks)

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