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Emily: Pharm 2 > Quiz 2: Antihypertensives, Negative Inotropes, Negative Chronotropes. > Flashcards

Quiz 2: Antihypertensives, Negative Inotropes, Negative Chronotropes. Flashcards

1
Q

Phenoxybenzamine (Dibenzyline) works on what receptor and is it an agonist or antagonist?

A
  • Alpha 1

- antagonist

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2
Q

Phenoxybenzamine (Dibenzyline) _________ binds to the receptor.

A

-irreversibly

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3
Q

What are the uses of Phenoxybenzamine?

A
  • Treat pheochromocytoma
  • Relieves ischemia for PVD
  • BPH to improve flow
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4
Q

T/F: Phenoxybenzamine does not cross the BBB.

A

FALSE

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5
Q

Phenoxybenzamine block serotoinin, _______, and cholinergic receptors.

A

-histamine

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6
Q

What are the side effects of phenoxybenzamine?

A

CNS: sedation, depression, tiredness, lethargy, headache
GI: N/V
CV: postural hypotension, tachycardia, arrhythmias

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7
Q

What is the half life of Phenoxybenzamine?

A

-24 hours

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8
Q

Phentolamine works at what recepotor and is it an antogonist or agonist?

A
  • Alpha

- Antagonist

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9
Q

What are the uses of Phentolamine?

A
  • HTN secondary to Pheochromocytoma
  • Clonidine withdrawal hypertension
  • Erectile dysfunction
  • EXTRAVASATION OF CATECHOLAMINES
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10
Q

Prazosin (Minipres) works at what receptor?

A
  • Alpha 1

- Antagonist

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11
Q

What are the uses of prazosin?

A
  • Vasodilates the arteries > veins
  • Increases HR
  • Increases urinary flow
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12
Q

What receptor does clonidine work on and is it an agonist or antagonist?

A
  • Alpha 2

- Agonist

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13
Q

What is the affinity of clonidine over the alpha 2 to alpha 1.

A
  • 220 to 1
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14
Q

Yes/No: Baroreceptors reflexes are preserved using clonidine.

A

Yes

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15
Q

What will happen with sudden discontinuation of clonidine?

A

-Excessive HTN, Tachy, Restlesness, insominia, headache, nausea

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16
Q

Half life of clonidine?

A
  • 9 to 12 hours
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17
Q

What will clonidine do for anesthesia?

A

-Reduce requirement of anesthesia drugs

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18
Q

What receptor does dexmedetomidine (precedex) use and is it an agonist or antagonist?

A
  • Alpha 2

- Agonist

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19
Q

What is the affinity of precedex over the alpha 2 receptor than the alpha 1 receptor?

A
  • 1620:1
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20
Q

Yes/No: Precedex can be used to inhibit post-op shivering

A

Yes

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21
Q

Precedex will cause N/V, fever, hypoxia in volunteer healthy adults, but a bolus will cause ______ and _______ as will an regular infusion will cause _____.

A
  • HTN
  • Bradycardia (Sinus arrest)
  • hypotension
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22
Q

What is the max amount of time to administer precedex IV.

A

24 hours

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23
Q

Methyldopa (Aldomet) is metabolized in the CNS to ___________.

A

methylepinephrine

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24
Q

Methylepinephrine acts on what receptor and is it a agonist or antagonist.

A
  • Alpha 2

- agonist

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25
Q

What is methyldopa (Aldomet) used for:

A

-treat hypertension during pregnancy

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26
Q

What are the side effects of methyldopa:

A
  • sedation
  • HA
  • dizzy
  • fluid retention
  • orthostasis
  • bradycardia
  • Dry mouth
  • positive Coombs test
  • impotence
  • bone marrow suppression
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27
Q

A.C.E. predominately ________ vasodilators.

A

arterial

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28
Q

What are A.C.E. inhibitors given to traet?

A
  • CHF
  • MR by afterload reduction
  • Increase CO without a decrease in preload
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29
Q

What is the only ACE inhibitor injection?

A

enalaprilat

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30
Q

What will an ACE inhibitor do for a patient with HTN renal blood flow?

A

-It will decrease vascular resistance and increase GFR and RBF.

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31
Q

What type of renal patient would you avoid ACE inhibitors.

A
  • decreased renal funcion

- renal artery stenosis

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32
Q

What are some side effects of an ACE inhibitor?

A
  • Cough
  • rhinorrhea
  • angioedema
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33
Q

T/F: ACE inhibitor is suddenly stopped and patient is going through withdrawal. The patient S/S would be CHF, bronchospasm, hypokalemia, hyponatremia, and rebound hypertension.

A

FALSE

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34
Q

If ARF and Hyper K+ is seen with an ACE inhibitor what would be the next step?

A

Discontinue the drugs

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35
Q

Is it okay to use and ACE inhibitor during pregnancy?

A

NO

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36
Q

What are perioperative issues with ACE inhibitors.

A
  • Hypotension

- Decrease in Glomerular perfusion pressure

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37
Q

What would you treat a hypotensive episode with a patient on an ACE inhibitor?

A

FLUID

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38
Q

What is the difference with Angiotensin 2 receptor antagonists than an ACE inhibitor?

A
  • Less cough/angioedema

- no IV meds available

39
Q

What drugs are Angiotensin 2 receptor antagonist?

A
  • Losartan (Cozaar)

- Irbesartan (Avapro)

40
Q

What is the function of calcium?

A
  • Signal transduction (heart, CNS)
  • Muscle contraction
  • bone health
  • clotting cascade
41
Q

What is the primary action of a calcium channel blocker?

A
  • Negative inotropic effect
  • negative dromotropic effect (AV conduction block)
  • Vasodilation of systemic, splanchnic, coronary and pulmonary beds
42
Q

What is phenylalkylamines. What drugs belong to this class and what are the indications?

A
  • Calcium Channel blocker
  • Verapamil
  • Conversion of supraventricular (atrial) tachycardia and or coronary artery spasm
43
Q

What is bensothiazines. What drugs belong to this class and what are the indications?

A
  • Calcium Channel blocker
  • Diltiazem
  • Rate control of tachycardia, tachyarrhythmias, renal protection
44
Q

What is dihydropyridines. What drugs belong to this class and what are the indications?

A
  • Calcium Channel Blocker
  • Nifedipine, nicardipine, Nimodipine,Nitrendipine, Isradipine.
  • HTN, Afterload reduction, Cerebral vasospasm, ischemia, renal protection
45
Q

What are some the qualities about dihydropyridines?

A
  • Pure arterial vasodilator with minimal reflex tachycardia
  • minimal negative inotropic and dromotropic effects
  • used as an antihypertensive
46
Q

Nicardipine (Class: Dihydropyridines) good qualities are:

A
  • without negative inotropic or dromotropic effect
  • arteriole specific vasodilator
  • NO CORONARY STEAL SYNDROME
  • no rebound HTN with withdrawal
  • reflex tachycardia < 10 bpm
47
Q

What are disadvantages of Nicardipine (Class: Dihydropyridines)?

A
  • slow on/off onset
  • may accumulate
  • variable duration of action
  • hypotension
  • VENOUS IRRITATION MAY CAUSE TACYCARDIA
48
Q

Clevidipine is a _____ ___ _____.

A

Calcium Channel Blocker (NEWEST OUT)

49
Q

What are the advantages of clevidipine?

A
  • Rapid on/off onset
  • no dose adjustment for renal/hepatic disease
  • no effect on preload
  • low potential for drug interaction
50
Q

What is the disadvantage of clevidipine?

A
  • Lipid emulsion
  • Continuous monitoring
  • contraindicated for egg and soy bean allergy, pancreatitis, and HLD
51
Q

Verapamil is a negative ________, _________, and ________.

A
  • inotrope
  • dromotrope
  • vasodilator (little effect)
52
Q

What is verapamil used for?

A
  • Aortic stenosis
  • IHSS
  • Conversion of atrial reentry tachyarrhythmias
  • Coronary artery vasospasm (Prinzmetal angina)
53
Q

Where does Diltiazem (Cardizem) fit in the calcium channel blockers? And what is its used?

A
  • Between Phenylalkylamine and dihydropyridines class.

- Rate control for ATRIAL Fib. and atrial tachycardia versus the conversion agent like verapamil.

54
Q

What are the myocardial oxygen effects of verapamil and diltiazem?

A

Enhance myocardial oxygen balance by:

  • Decreasing afterload just a bit and negative inotropic effects
  • increase coronary O2 delivery through vasodiliation
55
Q

Dihydropyridine vasodilator may worsen MvO2 by causing ________ hypotension and ______tachycardia (except ________).

A
  • diastolic
  • reflex
  • nicardipine
56
Q

Calcium channel blockers can be reversed if they cause ______, reflex _________ release and _________ activation leading to decreases in RBF and GFR.

A
  • hypotension
  • catecholamine
  • angiotensin
57
Q

T/F: Clevidipine reduces gastric emptying.

A

TRUE

58
Q

T/F: Diltiazem decreases sedative effects of midazolam.

A

FALSE

59
Q

Beta blocker actions decrease ____ (HR and contractility), decrease _______ release, and do ___ __________.

A
  • C.O.
  • Renin
  • not vasodilate
60
Q

What are the advantages of beta blockers over vasodilators?

A
  • No reflex tachycardia
  • No widening of pulse pressure
  • Improved MvO2
  • Intrinsic antiarrhythmic activity
61
Q

What medications are beta 1 selevtive?

A
  • Metoprolol
  • atenolol
  • acebutolol
  • bisoprolol
  • esmolol
62
Q

What medication are non selective beta?

A
  • Propranolol
  • Nadolol
  • Timolol
  • Pindolol
  • Carteolol
63
Q

What drugs are alpha 1 and nonselective beta?

A
  • Carvedilol

- Labetalol

64
Q

Beta 1 blocker do what?

A
  • decrease velocity of AV conduction
  • HR
  • contractility,
  • renin release
  • lipolysis
65
Q

Non-selective beta blockers do what?

A
  • bronchoconstriction
  • peripheral vasoconstriction
  • decrease glycogenolysis
66
Q

What are the drug names, beta selectivity, and elimination route of a long acting beta blocker?

A

NAME

  • nadolol (nonselective)
  • atenolol (selective)

ELIMINATION ROUTE
Kidney

67
Q

What are the drug names, beta selectivity, and elimination route of a intermediate acting beta blocker?

A

NAME

  • Propranolol (nonselective)
  • Metoprolol (selective)

ELIMINATION ROUTE
-Liver

68
Q

What are the drug names, beta selectivity, and elimination route or a ultra short acting beta blocker:

A

NAME

  • Flestolol (Nonselective)
  • Esmolol (Selective)

ELIMINATION ROUTE
-Red Cell esterase

69
Q

The lipophylicity of beta blockers are:

A

LOW:
Acebutolol, Atenolol, Bisoprolol, Carteolol, Nadolol

MODERATE:
Metoprolol, Pindolol, Coreg, Labetalol

HIGH:
Penbutolol, Propranolol

70
Q

Overdose of Beta Blockers would be treated with:

A
  • Atropine
  • Isoproterenol, dobutamine, and/or glucagon infusion
  • Pacing
71
Q

Verapamil will decrease heart rate and _______.

A

contractility

72
Q

Digoxin will decrease heart rate and _______.

A

conduction

73
Q

What are the contraindication of beta blockers?

A
  • Sever bradycardia
  • > 1st degree heart block
  • cardiogenic shock
  • Raynaud’s disease

CAUTION

  • astma/copd
  • diabetes
  • heart failure
74
Q

T/F: Propranolol is or is not a lipid soluble and can or cannot penetrate the BBB?

A
  • Lipid soluble

- Does penetrate BBB

75
Q

If you wanted to blunt the cardiovascular response to intubation what beta blocker would you use?

A

Esmolol (Brevibloc)

76
Q

T/F: Esmolol is more likely to convert A. Fib. to NSR than verapamil.

A

TRUE

77
Q

Esmolol can be used in intraop and postop ____ and _________.

A
  • HTN

- Tachycardia

78
Q

What is Metoprolol (Lopressor,Toprol) approved to treat?

A
  • angina

- acute MI

79
Q

Labetalol combines weak ____ blockade with a weak ____________ beta blockade.

A
  • alpha

- non-selective (Beta:Alpha = 7:1)

80
Q

Labetalol provides an effective antihypertensive action by doing a _______ inotrope and chronotrope with ______________.

A
  • negative

- vasodilitation

81
Q

T/F: Labetalol increases ICP.

A

FALSE

82
Q

What are the indications for labetalol?

A
  • hyperdynamic HTN
  • Aortic dissection
  • tachyphylaxis with SNP
83
Q

What would be adverse effects of Labetalol?

A
  • unwanted negative inotropy
  • prolonged duration with high dose
  • Bronchospasm in high dose
  • Acute hyperkalemmia in renal failure
  • Rewarming a post op hypothermic patient
84
Q

T/F: Beta blockers may mask hypoglycemia and hyperthyroidism.

A

TRUE

85
Q

T/F: Anticholinesterases will not increase bradycardia.

A

FALSE

86
Q

What is the line of therapy for patient with intraop HTN:

A
  1. Beta blocker
  2. vasodilation
  3. Calcium channel blockers.
  4. Diuretics
  5. Alpha 2 agonist
  6. ACE inhibitor
87
Q

When can beta blockers be used in pregnancy?

A
  • 2nd and 3rd trimester

- if used in 1st trimester can cause growth retardation

88
Q

What is the most favorable antihypertensive in pregnancy?

A

alpha-methyldopa

89
Q

When can you use ACE inhibitor in pregnancy?

A

NEVER

90
Q

When can hydralazine be used during pregnancy?

A

ONLY during delivery

91
Q

How should nifedipine be used in pregnancy?

A

P.O. route only.

92
Q

How fast should you drop HTN crisis in a patient?

A

No more than 25% within the first few hours

93
Q

What is a emergency HTN:

A
  • SBP > 180

- DBP > 120

94
Q

What would be examples hypertensive urgencies and emergencies of target organ damage?

A
  • Encephalopathy
  • ICH
  • Unstable angina
  • acute MI
  • Acute LV failure with pulmonary edema
  • Dissecting aortic aneurysm
  • Eclampsia

Emily: Pharm 2 (11 decks)

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