Sympatholytics- "Drugs to Read"

Question 1

if you discover intraoperative MI by the EKG or looking at wall motion abnormalities on the transesophageal echo what will the patient benefit form

Answer 1

beta blocker

Question 2

prior to giving the beta blocker for MI you would ensure the patient doesn’t have the following contraindication

Answer 2

reactive airway disease
shock
left ventricular failure

Question 3

prior to giving the beta blocker what do you ensure about your anesthetic

Answer 3

adequate concentrations of inhaled anesthetics

Question 4

what HR is the goal for beta blocker during intraop MI

Answer 4

60bpm

Question 5

name the drugs and dosages for intraop MI

Answer 5

esmolol 1-1.5mg/kg bolus 
esmolol 50-300mcg/kg/min
metoprolol 5mg iv
atenolol 5-10mg iv
propanolol 1-10mg iv

NITRO IS OFTEN ADDED

Question 6

beta blockers are approved for treatment of cardiac dysrhythmias as a result of enhanced sympathetic nervous system stimulation. such as

Answer 6

throtoxicosis
pheochromocytoma
perioperative stress

Question 7

carvedilol has been shown to decrease mortality associated with congestive heart failure due to its abilities to do what two things

Answer 7

vasodilator and antioxidant properties

Question 8

thyrotoxic patients can be prepared for surgery by administering what medications

Answer 8

propanolol or esmolol

Question 9

how do we treat excessive sympathetic nervous system activity

Answer 9

beta blockers

Question 10

what is the result of a patient being treated with dantrolene and CCB

Answer 10

hyperkalemia myocardial depression

Question 11

what is the result of cimetidine and ranitidine on drug plasma concentrations

Answer 11

increase concentration of calcium channel blockers

Question 12

state the long explanations for cardio protective effects produced by perioperative b blockers

Answer 12

decrease myocardial oxygen consumption and demand

less stress on potentially ischemic myocardium owing to decreased heart rate and myocardial contractility

attention of effects of endogenous catecholamines

redistribution of coronary blood flow to ischemic area

increased coronary blood flow owing to increased diastolic time

plaque stabilization owing to decrease in shear forces

cardiac antidysrhythmic effects

anti-inflammatory effects (?)

Question 13

amlodipine dose

Answer 13

oral 5-10mg

Question 14

what is the greater benefit of amlodipine and beta blockers

Answer 14

more effective treatment of myocardial ischemia than either drug alone

Question 15

nimodipine and cerebral protection

Answer 15

cerebral protection after global ischemia due to the blocking of calcium ion gradient across the cell membrane

Question 16

nimodipine and cerebral vasospasm

Answer 16

dilates cerebral arteries and prevents or attenuates cerebral vasospasm

*could increase intracranial pressure particularly in patients with preexisting decreases in intracranial compliacne

Question 17

nifedipine uses

Answer 17

angina pectoris