vasoactive drugs Flashcards
1
Q
trade name of adenosine
A
Adenocard, Adenocor,
2
Q
dose of adenosine
A
6 mg over 1-2 seconds 12 mg second dose 20 mL flush
3
Q
onset of adenosine
A
rapid
4
Q
DOA adenosine
A
very breif
5
Q
uses of adenosine
A
Paroxysmal SVT including those associated with accessory bypass tracts (WPWS);
not effective for a.fib/flutter, vtach
6
Q
metabolism of adenosine
A
Blood and tissue to inosine\
then to AMP and hypoxanthine
7
Q
elimination of adenosine
A
Erythrocytes and vascular endothelial cells
8
Q
a/e adenosine
A
Arrhythmias,
hypotension,
bronchospasm in patients with asthma
9
Q
contraindications of adenosine
A
Second or third degree AV block, sick sinus syndrome, symptomatic bradycardia; known or suspected bronchoconstriction, asthma
10
Q
Atenolol category
A
beta blocker
beta 1 selective
Antianginal,
antihypertensive,
11
Q
atenolol b receptors
A
b 1 selective
12
Q
dose of atenolol
A
HTN PO 25-50 mg
May also be used for angina, a.fib, post-MI, thyrotoxicosis
13
Q
onset of atenolol
A
1 hour
14
Q
peak of atenolol
A
2-4 hours
15
Q
uses of atenolol
A
Tx HTN, angina, post-MI, acute ETOH withdrawal, SVT, a.fib, migraine h/a prophy
16
Q
metabolism of atenolol
A
hepatic
17
Q
elimination of atenolol
A
Feces 50%,
urine 40%
18
Q
major side effects of atenolol
A
Bradycardia, hypotension, 2nd degree AV block, bronchospasm, wheezing
19
Q
contraindications of atenolol
A
Sinus bradycardia, SAnode d/f, heart block greater than first degree, cardiogenic shock, uncompensated heart failure, pulmonary edema, pregnancy
20
Q
cation with atenolol certain conditions
A
Caution: diabetes, myasthenia gravis, PVD, raynauds, pheochromocytoma (use alpha blocker first), thyroid disease
21
Q
calcium chloride dosage acute symptomatic
A
Acute symptomatic 200-1000 mg Q1-3 days
Beta blocker OD 20mg/kg over 5-10min followed by infusion 20mg/kg
22
Q
calcium chloride dosage Cardiac arrest with hyperkalemia/magnesemia or hypocalcemia and how fast
A
Cardiac arrest with hyperkalemia/magnesemia or hypocalcemia 500-1000mg over 2-5 min
23
Q
calcium chloride with beta blocker overdose
A
Beta blocker OD 20mg/kg over 5-10min followed by infusion 20mg/kg
24
Q
onset of calcium chloride
A
immediate
25
uses of calcium chloride
```
Treat hypocalcemia,
emergent tx of severe hypermagnesemia,
beta blocker OD,
severe hyperkalemia,
malignant arrhythmias
```
26
elimination of calcium chloride
feces
27
AE with calcium chloride
```
Acidosis,
hyperphophatemia,
hypokalemia,
hypomagnesemia,
tissue necrosis,
hot flash,
vasodilation
```
28
absolute contraindication with calcium chloride
digoxin overdose
29
calcium chloride forms a precipitate with WHAT and do no give with it then?
Do not give with bicarb or phosphate containing solutions to avoid precipitation;
30
what electrolyte imbalance should you give hyperkalemia with
Preferred in hyperkalemia with circulatory compromise
31
how do CaCl and Calcium Gluconate compare
Amp of 10% CaCl contains three times (3x) more Ca than amp of 10% Ca gluconate
32
dose of calcium gluconate
Hypocalcemia ionized Ca 4-5 mg/dL or 1-1.2mmol/L
1000-2000 mg over 2 hrs
33
elimination calcium gluconate
feces
34
adverse effects of calcium gluconate
Risk for hyperphosphatemia,
hypokalemia,
hypomagnesemisa,
kidney stones
35
contraindications of calcium gluconate
v.fib,
hypercalcemia,
concomitant use of IV Ca gluconate and ceftriaxone; caution in pts on digitalis bc hypercalcemia promotes cardiotoxicity
36
what must you NOT give calcium gluconate with? and what would happen if you did
Do not give with bicarb or phosphate containing solutions to avoid precipitation
37
trade name of clonadine
catapres
38
category of clonadine
Alpha2 adrenergic agonist;
| antihypertensive
39
dose of clonadine PO
PO 0.1mg BID
| TD 0.1mg/24hr patch
40
dose of clonadine for pain epidural
Pain epidural: 30 mcg/hr titrate MAX >40mcg/
41
onset of PO clonidine
PO 0.5-1hr
| TD 2-3 days
42
peak of PO clonidine
6-10 hours
43
uses of clonidine
Tx HTN,
ADHD,
cancer pain,
neuropathic pain,
44
metabolism of clonidine
hepatic
45
elimination of clonidine
urine
46
major adverse effects of clonidine
Bradycardia/tachycardia,
| hypotension
47
contraindications with clonadine
```
Epidural administration:
infection at site;
concurrent anticoagulation,
bleeding diathesis,
administration above C4 dermatome;
caution with drugs with SA/AV nodal blocking properties
```
48
how do alpha 2:1
Alpha2:Alpha1
220:1
49
trade name of digoxin
digitalis
50
category of digoxin
Antiarrhythmic;
| cardiac glycoside
51
dose of digoxin with SVT
SVT: 0.5-1mg give ½ of total digitalizing dose as the initial dose than ¼ of the TDD in each of the 2 subsequent doses at 6-8 hr interval
52
onset of digoxin IV
5-60 min IV
53
onset of digoxin PO
PO 1-2 hrs
54
DOA digoxin
DOA 3-4 days
55
uses of digoxin
Sequential sugar hydrolysis in the stomach or
reduction of lactone ring by intestinal bacteria
A-fib with RVR
A-flutter
*NO LONGER THE FIRST CHOICE WITH these- BB or Ca channel blockers are best
56
metabolism of digoxin
urine
57
major adverse effects of digoxin
```
Junctional rhythm,
heart block,
PR prolongation,
Vtach/vfib,
Noncardiac side effects:
GI—anorexia, N/V, and abd pain: CNS—visual disturbances, headache, drowsiness, confusion vision changes (yellow/blurred vision),
```
58
contraindications of digoxin
Hypersensitivity; vfib
59
what can lead to cardiac toxicity?
```
Cardiac arrhythmia (toxicity) can be precipitated by hypokalemia,
hypomagnesemia,
hypoxia,
hypercalcemia,
hypernatremia,
renal failure
```
60
class of anti arrhythmic of diltiazem
Class IV
61
category of diltiazem
anti-arrythmic
| calcium channel blocker
62
dose of diltiazem and use
| if it is repeated what is the dose?
Afib/flutter: 0.25 mg/kg over 2 min bolus (~20mg); may repeat after 15 min at 0.35 mg/kg over 2 min (~25mg);
63
infusion dose of diltiazem
cont inf 10 mg/hr
| may increase rate in 5mg/hr increments up to 15mg/hr
64
onset of diltiazem
3 minutes
65
peak of diltiazem
2-5 minutes
66
DOA diltiazem
1-3 hours
67
use of diltiazem
control of rapid rate in a-fib a-flutter
68
metabolism of diltiazem
hepatic
69
elimination of diltiazem
urine
70
adverse effects of diltiazem
Hypotension,
av block,
elevated ast/alt,
stevens-johnson syndrome
71
contraindications with diltiazem
```
Sick sinus syndrome,
2nd or 3rd degree block,
severe hypotension,
cardiogenic shock,
concomitant administration with IV beta blocker,
WPWS,
vtach
```
72
trade name of esmolol
Brevibloc
73
classification of esmolol
B-1 selective beta blocker
74
intubation dose of esmolol
Intubation 1-2mg/kg
75
HTN dose of esmolol w/tachycardia
| bolus (mg/kg)
HTN/tachycardia 80mg initial bolus (1mg/kg) over 30 sec
76
infusion dose of esmolol
& infusion
| followed by 150 mcg/kg/min infusion max 300 mcg/kg/min
77
onset of esmolol
2-10 minutes
78
peak of esmolol
10-30 minutes
79
DOA esmolol
unknown
80
metabolism of esmolol
In RBCs by blood cell esterases
81
excretion of esmolol
urine
82
uses of esmolol
Treatment of SVT and Afib/flutter;
| tx of intraoperative and postoperative tachycardia and or HTN
83
major adverse effects of esmolol
```
Hypotension,
bradycardia,
bronchospasm,
CHF,
pulmonary edema
```
84
contraindications with esmolol
Sinus bradycardia,
heart block greater than 1st degree,
cardiogenic shock,
uncompensated cardiac
85
fenlodopam categoty
dopamine 1 agonist
| arteriol vasodilation
86
fanlodopam trade name
corlopam
87
fenlodopam dose
0.03-0.1mcg/kg/min may increase by 0.05-0.1mcg/kg/min Q15min
88
max dose of fenlodopam
max 1.6 mcg/kg/min
89
onset of fenlodopam
10 minutes
90
duration of action of fenlodopam
1 hour
91
metabolism of fenlodopam
hepatic
92
excretion of fenlodopam
Urine 90%. 10% feces
93
uses of fenlodopam
Severe HTN
94
A/E fenlodopam
```
Hypotension,
flushing,
dizziness,
h/a,
nausea,
hypokalemia,
increases HR
```
95
caution with fenlodopam
Use with caution in patients with glaucoma as it increases IOP
96
trade name of hydralazine
apresoline
97
category of hydralazine
Direct vasodilator;
| phenothalazine derivative
98
dose of hydralazine
10-20 mg Q 4-5 hrs PRN
99
onset of hydralazine
5-10 minutes
100
peak of hydralazine
1-4 hours
101
DOA hydralazine
15-30 minutes
102
metabolism of hydralazine
hepatic
103
elimination of hydralazine
urine
104
use of hydralazine
HTN
105
adverse effects of hydralazine
```
Tachycardia,
increased ICP,
lupus like syndrome,
pancytopenia,
peripheral neuropathy,
skin
```
106
contraindications of hydralazine
Mitral valve rheumatic heart disease
107
Amrinone trade name
Inocor
108
Amrinone category
Phosphodiesterase enzyme inhibitor
109
dose amrinon
0.75 mg/kg IV bolus over 2-3 min
followed by maintenance of 5-10 mcg/kg/min
110
maintenance dose of amrinon
IV bolus
followed by maintenance of 5-10 mcg/kg/min
111
onset of amrinon
2-5 minutes
112
peak of amrinon
30 min to 2 hrs
113
DOA amrinon
10 min
114
metabolism of amrinon
hepatic
115
elimination of amrinon
urine
116
use of amrinon
Short term therapy in pts with intractable heart failure
117
major adverse effects of amrinon
```
Arrhythmias,
hypotension,
n/v,
thrombocytopenia,
hepatotoxicity
```
118
amrinon contraindications
Hypersensitivity, patients with severe aortic or pulmonic valvular disease
119
category of labetalol
Blocks alpha,
beta1,
beta 2
120
labetalol receptors PO B1:B2
1:3
121
labetalol recepotrs IV B1: B2
1:17
122
dose of labetalol
20 mg IV over 2 min; may administer 40-80 mg at 10 min
123
max dose of labetalol
300 mg
124
infusion dose of labetalol
2 mg/min
125
onset of labetalol
2-5 minutes
126
peak of labetalol
5-15 min
127
DOA of labetalol
2-18 hours
128
metabolism of labetalol
hepatic
129
elimination of labetalol
urine
130
major adverse effects of labetalol
```
Hypotension,
bronchospasm,
ventricular arrhythmias,
hyperkalemia,
hepatotoxicity
```
131
contraindications of labetalol
```
Severe bradycardia,
heart block,
asthma,
non compensated heart failure,
cardiogenic shock
```
132
trade name of labetalol
Normodyne
133
category of lisinopril
Inhibitor of ACE
134
dose of lisinopril
CHF 2.5-5mg PO initially up to 20-40 mg
HTN PO 10 mg to 40 mg
135
onset of lisinopril
1 hour
136
peak of lisinopril
6 hours
137
DOA of lisinopril
24 hours
138
elimination of lispinopril
urine
139
uses of lisinopril
Acute MI, CHF, HTN
140
major adverse effects of lisinopril
Hypotension,
dizziness,
increased BUN/creatinine,
angioedema
141
contraindications of lisinopril
```
cardiogenic shock
Lisinopril
Inhibitor of ACE
CHF 2.5-5mg PO initially up to 20-40 mg
HTN PO 10 mg to 40 mg
1hr
6hrs
24hrs
Urine
Acute MI, CHF, HTN
Hypotension, dizziness, increased BUN/creatinine, angioedema
Hypersensitivity, angioedema; concomitant use with aliskiren in pts with DM
```
142
trade name of metoprolol
lopressor
143
category of metoprolol
beta 1 selective
144
dose of metoprolol for afib
A.fib IV 2.5-5mg Q2-5min;
145
dose of metoprolol HTN
HTN 1.25-5mg A6-12 hrs IV
| MI 5mg Q5min up to 3 doses
146
peak of metoprolol
20 minutes
147
DOA of metoprolol
5-8 hours
148
metabolism of metoprolol
hepatic
149
excretion of metoprolol
urine
150
uses of metoprolol
angina
HTN
MI
151
major adverse effects of metoprolol
Bradycardia, heart block, hypotension, pulmonary edema, bronchospasm
152
contraindications of metoprolol
```
Hypersensitivity,
sinus brady,
heart block,
cardiogenic shock,
overt heart failure,
sick sinus syndrome,
PAD
```
153
category of milrinone
Selective phosphodiesterase inhibitor
154
milrinone trade name
milrinone lactate
155
dose of milrinone
Loading 50 mcg/kg over 10 min
| follow by maint inf 0.375-0.75mcg/kg/min
156
maintenance dose of milrinone
follow by maint inf 0.375-0.75mcg/kg/min
157
onset of milrinone
5-15 minutes
158
metabolism of milrinone
hepatic
159
excretion of milrinone
urine
160
treatment uses of milrinone
Tx heart failure; inotropic therapy
161
adverse effects of milrinone
```
Ventricular arrhythmia,
thrombocytopenia,
angina,
hypotension,
h/a,
hyperthermia
```
162
contraindications of milrinone
Hypersensitivity;
| caution in pts w/ renal insufficiency and aortic/pulmonic valvular disease
163
category of nicardipine
calcium channel blocker
164
trade name of nicardipine
cardene
165
dose of nicardipine
IV 5mg/hr initially;
166
max of nicardipine
max 15mg/hr
167
onset of nicardipine
10 minutes
168
DOA of nicardipine
8 hours
169
metabolism of nicardipine
hepatic
170
excretion of nicardipine
urine
171
uses of nicardipine
Chronic stable angina, HTN
172
major adverse side effects of nicardpine
Flushing,
hypotension
, edema,
exacerbation angina pectoris
173
contraindications with nicardipine
Hypersensitivity;
advanced aortic stenosis
caution- may increase angina or MI, use with beta blockers may worsen HF
174
category of nitroglycerine
Nitrate/antianginalVenodilator
175
how does nitroglycerine affect vessels?
Nitroglycerine forms free nitric oxide which activates guanylate cyclase to increase cGMP smooth muscle relaxant
176
dose of nitroglycerine
IV 5mcg/min up to 400mcg/min
177
max dose of nitroglycerine
400 mcg/min
178
onset of nitroglycerine
immediate
179
peak of nitroglycerine
immediate
180
use of nitroglycerine
Tx or prevention angina pectoris,
acute decompensated heart failure,
perioperative HTN
181
metabolism of nitroglycerine
Hepatic;
| nonhepatic via RBC and vascular walls
182
elimination of nitroglycerine
urine
183
major adverse side effects of nitroglycerine
hypotension
tachycardia
flushing
dizziness
184
what conditions can you not give nitroglycerine with?
, constrictive pericarditis,
pericardial tamponade,
restrictive cardiomyopathy,
SUBLINGUAL- early MI, increased ICP, severe anemia
185
hypersensitivity to certain things are contraindicated with nitro
Hypersensitivity to organic nitrates or components,
| hypersensitivity to corn,
186
what medications can you not give nitroglycerine with?
concurrent use of phosphodiesterase inhibitors,
| concurrent use with riociguat
187
trade name of nitroprusside
nipride
| nitropress
188
category of nitroprusside
direct acting ventilator and arteriol dilator
189
how does nitroprusside work?
Direct acting venous and arteriolar smooth muscle relaxer; releases NO spontaneously
190
dose of nitroprusside
0.3-0.5 mcg/kg/min
191
max dose of nitroprusside
max 10 mcg/kg/min
192
onset of nitroprusside
less than 2 minutes
193
DOA nitroprusside
1-10 minutes
194
uses of nitroprusside
HTN, acute decompensated HR
195
metabolism of nitroprusside
Combines with hgb to form
| cyanide and cyanmethemoglobin
196
excretion of nitroprusside
urine
197
major adverse effects of nitroprusside
Hypotension,
flushing,
cyanide toxicity when max dose is used for long periods (even >10 min), increased ICP
198
contraindications with nitroprusside
Compensatory HTN (aortic coarctation, av shunt),
controlled hypotension in pts with inadequate cerebral circulation/moribund pts ,
high output HF with reduced SVR,
congenital optic atrophy or tobacco amblyopia
199
phenoxybenzamine trade name
dibenzyline
200
MOA/category of phenoxybenzamine
alpha 1 blocker
201
dose of phenoxybenzamine
PO 10 mg up to 20-40 mg BID or TID
202
oset phenoxybenzamine
several hours
203
DOA phenoxybenzamine
3 days
204
excretion of phenoxybenzamine
urine/bile
205
uses of phenoxybenzamine
Symptomatic pheochromocytoma, (tx sweating)
micturition problems associated with neurogenic bladder, outlet obstruction,
treatment of hypertensive crisis caused by sympathomimetic amines
206
major adverse side effects phenoxybenzamine
hypotension
| tachycardia
207
contraindications of phenoxybenzamine
hypersensitivity
| shock
208
phentolamine category
nonselective alpha blocker
209
dose of phentolamine extravasation NE
5-10 mg in 10-15 mL NS
210
HTN w/pheo dose of phentolamine
5mg 1-2 hrs before surgery; 5mg during surgery;
211
HTN crisis with phentolamine dose
HTN crisis 1-5 mg bolus up to 15 mg max
212
max dose of phentolamine
1-5 mg
213
onset of phentolamine
1-2 min
214
DOA phentolamine
10-30 minutes
215
metabolism of phentolamine
hepatic
216
excretion of phentolamine
urine
217
uses of phentolamine
Diagnosis of pheo;
management of extravasation of sympathomimetic vasopressors,
tx hypertensive crisis
218
adverse effects of phentolamine
```
Tachycardia,
bradycardia,
HTN,
h/a,
pain at injection site
```
219
contraindications of phentolamine
hypersensitivity
220
prazosin category/moa
Competitive inhibitor of postsynaptic alpha receptors leading to vasodilation of veins and arterioles and decrease in total peripheral resistance and BP
221
dose of prazosin
HTN PO 1mg 2-3x/day; max 20 mg
222
onset of prazosin
2 hours
223
peak of prazosin
2-4 hours
224
DOA prazosin
10-24 hours
225
metabolism of prazosin
hepatic
226
elimination of prazosin
feces
| urine
227
major adverse s/e prazosin
```
Palpitation,
dizziness,
h/a, weakness,
nausea,
angina,
floppy iris syndrome,
orthostatic hypotension
```
228
contraindications of prazosin
hypersensitivity
229
propranolol category
Nonselective beta blocker B1&2
230
dose of propranolol
20-80 mg PO
| IV 1-3 mg/dose
231
onset of propranolol
1-2 hours
232
peak of propranolol
1-4 hours
233
DOA propranolol
6-12 hours
234
metabolism propranolol
hepatic
235
excretion propranolol
urine
236
uses of propranolol
```
Management HTN,
angina,
pheo,
tremor,
supraventricular arrhythmias
```
237
major adverse effects of propranolol
```
Bradycardia,
CHF,
hypotension,
fatigue,
hyperglycemia,
hyperkalemia,
bronchospasm
```
238
contraindications propranolol
```
Hypersensitivity,
uncompensated HF,
sick sinus syndrome,
bradycardia,
cardiogenic shock,
asthma
```
239
trade name of propranolol
propranolol
240
moa/ category propranolol
beta 1 & 2 blocker
241
dose of timolol
10 mg BID
242
onset of timolol
15-45 minutes
243
peak of timolol
0.5- 2.5 hours
244
DOA timolol
4 hours
245
metabolism timolol
hepatic
246
excretion timolol
urine
247
uses of timolol
Tx HTN angina, prophy migraine
248
adverse effects of timolol
```
Bradycardia,
fatigue,
bronchospasm,
hyperglycemia,
hyperkalemia,
pulm edema,
CHF
```
249
contraindications with timolol
```
Hypersensitivity,
sinus brady,
sinus node d/f,
heart block,
cardiogenic shock,
uncompensated cardiac failure,
bronchospastic disease
```
250
category of verapamil
calcium channel blocker
251
dose of verapamil po
80-120 mg PO
252
dose of verapamil IV
IV 0.075-0.15mg/kg over 2 min and then 0.005mg/kg/min continuous infusion
253
po onset verapamil
PO 1-2 hrs
254
IV onset verapamil
IV 1-5 min
255
peak of verapamil
Immediate release 1-2 hrs
256
DOA verapamil PO
PO 6-8 hrs
257
DOA verapamil IV
IV 10-20 min
258
metabolism verapamil
hepatic
259
excretion verapamil
urine
260
uses verapamil
SVT, afib/flutter, HTN, angina
261
major A/E verapamil
```
Gingival hyperplasia,
hypotension,
conduction block,
increased hepatic enzymes,
arrhythmia,
decreased neuromuscular transmission
```
262
contraindications verapamil
```
Hypersensitivity,
severe LV D/Hypotension,
cardiogenic,
sick sinus syndrome,
heart block,
afib/flutter,
WPWs,
concurrent sue IV beta blocker
```
