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Pharm 2 > Vasodilators > Flashcards

Vasodilators Flashcards

1
Q

Vasodilators MOA

A

direct smooth muscle relaxation, (production of intracellular NO, SNP and nitrates) (calcium channel blockers)

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2
Q

Alpha 1 antagonists

A

prazosin and labetolol

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3
Q

Alpha 2 agonists

A

clonidine and alpha-methyldopa

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4
Q

ACE Inhibitors

A

captopril and enalopril

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5
Q

____% of coronary artery perfusion to the LV is delivered during diastole

A

70-90%

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6
Q

What governs perfusion pressure?

A

aortic diastolic pressure

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7
Q

T/F: In the presence of ischemic heart disease, the collateral arteries are maximally dilated and coronary perfusion is largely pressure dependent

A

T

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8
Q

Coronary Steal

A

narrowed coronary arteries are always maximally dilated, dilating nearby vessels may shunt blood away from these necessary pathways and cause further ischemia.

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9
Q

Thiocyanide/Cyanide toxicity

A

s/s: hypotension, blurred vision, fatigue, metabolic acidosis, pink skin, absence of reflexes, faint heart sounds

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10
Q

What dose does risk of cyanide toxicity increase?

A

> 4 mcg/kg/min, > 2 days of therapy

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11
Q

Thiocyanate Levels

A 
therapeutic = 6-29 mcg/ml
toxic = 35-100 mcg/ml
fatal = >100 mcg/ml
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12
Q

Cyanide Levels

A 
normal = <0.2, smoker = <0.4
toxic = >2 mcg/ml
fatal = >3 mcg/ml
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13
Q

Tx of Toxocity

A

stop infusion, oxygen, treats acidosis.
hydroxocobolamine (precursor of vit B12)
sodium thiosulfate - donates sulfur group, breaks down thiocyanate

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14
Q

Alpha 1 Receptor Activation

A 
increased intracellular calcium
smooth muscle contraction
peripheral vasoconstriction
inhibits insulin secretion
stimulates glycogenolysis and gluconeogenesis
GI relaxation
Mydriasis
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15
Q

Alpha 2 Receptor Activation

A

Inhibits neuronal firing in PNS and CNS
Sedation
BP drop
Analgesia

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16
Q

Uses of alpha agonists in anesthesia

A

post op shivering, reduce sedation needs

17
Q

Alpha 2 Agonists and Cardiac Surgeries

A

reduce cardiac complications, overall mortality, cardiac mortality, MI
especially beneficial for vascular surgery
monitor for excessive hypotension and bradycardia

18
Q

RAAS - Adrenal Gland response

A

release aldosterone

NA reabsorption and K excretion at distal tubule

19
Q

RAAS - ADH

A

from posterior pituitary

water reabsorption at collecting duct

20
Q

ACE inhibitors and hypertensive pt

A

good, decreased renal vascular resistance

improved RBF and GFR

21
Q

ACE inhibitors and hypotensive pt

A

bad, deteriorate renal function d/t compensatory efferent arteriole constriction mediated by angiotensin 2 in blocked –> decreased GFR pressure –> acute hyperkalemia

22
Q

T/F: ACE Inhibitors have increased hypotensive effect of diuretics, vasodilators and anesthetics

A

T

23
Q

Functions of calcium

A

signal transduction, CNS and heart
muscle contraction: smooth muscle, cardiac muscle, vessel
bone health
clotting cascade

24
Q

How do verapamil and diltiazem enhance myocardial oxygen balance?

A

decreasing myocardial oxygen consumption by afterload reduction and/or negative inotropic effect. increase oxygen delivery through coronary vasodilation

25
Q

Beta 1

A

increase HR, inotropy, conduction velocity and contractility

26
Q

Beta 2

A

smooth muscle relaxation, peripheral vasodilation, decrease bp, bronchodilation, increase insulin secretion, increases glycogenolysis and gluconeogenesis, decrease GI mobility

27
Q

Beta Blocker interaction caution..

A

verapamil - decrease HR and contractility

digoxing - decrease HR and conduction

28
Q

Beta Blocker OD

A 
atropine
isoproterenol, dobutamine and/or glucagon
could need pacing
high dose euglycemic insulin therapy
IV lipid emulsion
less effective: calcium, NaHCO3
29
Q

Beta Blocker contraindications

A

severe bradycardia
>1st degree heart block
cardiogenic shock
raynauds disease

30
Q

Pregnancy and antihypertensives

A

alpha-methyldopa is preferred
labetolol is ok in 2nd and 3rd trimester
hydralazine ok during delivery
PO nifedipine ok, SL not

Pharm 2 (8 decks)

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