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Anesthesia Pharmacology > Vasodilators > Flashcards

Vasodilators Flashcards

1
Q

Sodium Nitroprusside (Nipride)
MOA
&
Receptors

Nitric Oxide Donors

A

Exogenous NO donor:
NO stimulates conversion of
GMP to cGMP by guanylate cyclase;
↑ cGMP levels cause ↓ intracellular Ca++,
causing vascular smooth muscle relaxation

Arterial & venous dilator

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2
Q

Sodium Nitroprusside (Nipride)
Indications
&
Effects

Nitric Oxide Donors

A

HTN: Controlled ↓BP is needed
Pulmonary venous congestion: ↓ PVR

Pheochromocytoma, Spinal Surgeries, HTN Emergencies & Carotid Surgeries

Arterial vasodilators counteract effects of vasoconstriction; ↓ SVR

Venous vasodilators alleviate pulmonary/systemic congestion;
↓ venous return

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3
Q

Sodium Nitroprusside (Nipride)
Dosing

Nitric Oxide Donors

A

Infusion:
0.3-2 mcg/kg/min

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4
Q

Sodium Nitroprusside (Nipride)
Onset
Duration

Nitric Oxide Donors

A

Onset
Immediate
Duration
Transient

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5
Q

Sodium Nitroprusside (Nipride)
Side Effects
&
Considerations

Nitric Oxide Donors

A

↓BP: Potent vasodilator
can significantly drop BP

Dissociates immediately into CN & NO to produce methemoglobin &
CYANIDE poisoning

Methemoglobinemia Tx:
Methylene Blue;
IV: 1-2 mg/kg over 5 min
MAX: 7-8 mg/kg

Maintenance of hemodynamics
during surgical cases

Requires continuous administration

Requires arterial line monitoring

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6
Q

Nitroglycerin (Nitrostat)
MOA
&
Receptors

Nitric Oxide Donors

A

Exogenous NO donor:
NO stimulates conversion of
GMP to cGMP by guanylate cyclase;
↑ cGMP levels cause ↓ intracellular Ca++, causing vascular smooth muscle relaxation

Primarily venous dilator;
Dilates the large coronary arteries

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7
Q

Nitroglycerin (Nitrostat)
Indications
&
Effects

Nitric Oxide Donors

A

Acute MI;
HTN & Pulmonary venous congestion;

Relaxes Sphincter of Oddi Spasm;

Relaxes uterus to release retained placenta post-delivery

Venous vasodilators; ↓ venous return

High doses can cause arterial vasodilation; ↓ SVR

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8
Q

Nitroglycerin (Nitrostat)
Dosing

Nitric Oxide Donors

A

Infusion
Initial dose: 5-10 mcg/min
Titrate to desired MAP/SBP

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9
Q

Nitroglycerin (Nitrostat)
Onset
Duration
1/2 Time

Nitric Oxide Donors

A

Onset
Rapid
Duration
3-5 min
1/2 Time
1-4 min

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10
Q

Nitroglycerin (Nitrostat)
Side Effects
&
Considerations

Nitric Oxide Donors

A

↓BP: Potent venodilator
HA related to profound venodilation

Tachyphylaxis: w/in 24 hrs;
12-15 hrs drug-free interval may be needed to reverse tolerance

Maintenance of hemodynamics
during surgical cases

Requires continuous administration

Requires arterial line monitoring

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11
Q

Hydralazine (Apresoline)
MOA
&
Receptors

Direct Vasodilator

A

Direct-acting smooth muscle relaxant
& acts as a vasodilator primarily
in resistance arterioles

Inhibition of inositol trisphosphate (IP3) induced Ca++ release from the sarcoplasmic reticulum in arterial smooth muscle cells

Selective for resistance arterioles

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12
Q

Hydralazine (Apresoline)
Indications
&
Effects

Direct Vasodilator

A

HTN

Arterial vasodilation; ↓ SVR

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13
Q

Hydralazine (Apresoline)
Dosing

Direct Vasodilator

A

IV: 2.5 mg

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14
Q

Hydralazine (Apresoline)
Onset
Duration
1/2 Time

Direct Vasodilator

A

Onset
Slow; peaks 1 hr
Duration
~12 hrs
1/2 Time
3-7 hrs

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15
Q

Hydralazine (Apresoline)
Side Effects
&
Considerations

Direct Vasodilator

A

Extreme/profound ↓BP; rebound ↑HR
Caution: use w/ elderly pts

Maintenance of hemodynamics
during surgical cases

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16
Q

Nicardipine (Cardene)
MOA
&
Receptors

Calcium Channel Blocker

A

Dihydropyridine

Binds to receptors on voltage-gated
(L-type) Ca++ channels
↓ Ca++ influx inhibits
excitation-contraction coupling

** Selective for arteriolar beds**

17
Q

Nicardipine (Cardene)
Indications
&
Effects

Calcium Channel Blocker

A

Short term control of HTN

Arterial vasodilation;
↓ SVR & ↓ BP

No significant change in HR d/t
no effect on SA/AV node

Slight myocardial depression

Greatest coronary artery dilation

Moderate peripheral artery dilation

18
Q

Nicardipine (Cardene)
Dosing

Calcium Channel Blocker

A

Infusion
Initial: 5 mg/hr
Titrated: 2.5 mg/hr
Q5 min to MAX 15 mg/hr

19
Q

Nicardipine (Cardene)
Onset
Duration
1/2 Life

Calcium Channel Blocker

A

Onset
IV: 1-3 min
Duration
IV: ≤8 hrs
1/2 Life
3-5 hrs

20
Q

Nicardipine (Cardene)
Side Effects
&
Considerations

Calcium Channel Blocker

A

Dose-dependentt ↓BP;
requires continuous
hemodynamic monitoring

Maintenance of hemodynamics
during surgical cases

21
Q

Verapamil (Calan)
MOA
&
Receptors

Calcium Channel Blocker

A

Phenylalkylamines

Cardiac selective inhibition of voltage-gated Ca++ channels is frequency-dependent;
↓ Ca++ influx inhibits
excitation-contraction coupling

Selective for AV node

22
Q

Verapamil (Calan)
Indications
&
Effects

Calcium Channel Blocker

A

Tachycardia; HTN

Marked delay conduction thru the AV node
& moderate SA node depression

Moderate myocardial depression

Moderate coronary artery dilation

Moderate peripheral artery dilation

23
Q

Verapamil (Calan)
Dosing

Calcium Channel Blocker

A

IV: 5-10 mg over 2 min
Can give 2nd dose after 15 min

24
Q

Verapamil (Calan)
Onset
Duration
1/2 Life

Calcium Channel Blocker

A

Onset
1-3 min
Duration
0.5-6 hrs
1/2 Life
3-7 hrs

25
Q

Verapamil (Calan)
Side Effects
&
Considerations

Calcium Channel Blocker

A

Dose-dependent ↓BP, ↓HR;
recommended continuous
hemodynamic monitoring

Maintenance of hemodynamics
during surgical cases

26
Q

Diltazem (Cardizem)
MOA
&
Receptors

Calcium Channel Blocker

A

Benzothiazipines

Cardiac selective inhibition of voltage-gated Ca++ channels is frequency-dependent;
↓ Ca++ influx inhibits
excitation-contraction coupling

Selective for AV node

27
Q

Diltazem (Cardizem)
Indications
&
Effects

Calcium Channel Blocker

A

Tachycardia; HTN

Moderate delay conduction thru the AV node & slight SA node depression

Moderate myocardial depression

Moderate coronary artery dilation

Moderate peripheral artery dilation

28
Q

Diltazem (Cardizem)
Dosing

Calcium Channel Blocker

A

IV: 0.25 mg/kg over 2 min
Can give 2nd dose of
0.35 mg/kg after 15 min
Infusion: 5-15 mg/hr

29
Q

Diltazem (Cardizem)
Onset
Duration
E 1/2 Time

Calcium Channel Blocker

A

Onset
IV: 3 min
Duration
IV: 1-3 hrs
Infusion: 0.5-10 hrs
E 1/2 Time
4-6 hrs

31
Q

Diltazem (Cardizem)
Side Effects
&
Considerations

Calcium Channel Blocker

A

Dose-dependent ↓BP, ↓HR;
recommended continuous
hemodynamic monitoring

Maintenance of hemodynamics
during surgical cases

Anesthesia Pharmacology (16 decks)

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