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SUM '20 - Pharm II > Week 1 Cardiac Pharm 3 of 4 > Flashcards

Week 1 Cardiac Pharm 3 of 4 Flashcards

1
Q

Dose of Ephedrine?

A

ppt states 5-25mg
BUT
Hammon in lecture states in practice you will see 5-10mg at a time, that the ppt dose is a bit high for a one time dose. (decide for yourself lol)

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2
Q

Onset/duration of Ephedrine?

A

Immediate; 15 min to 1.5 hours depending on dose.

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3
Q

Why should you use ephedrine cautiously in patients with questionable coronary perfusion?

A

d/t myocardial oxygen consumption may be more dramatically increased as a result of positive inotropic effect

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4
Q

What may develop with subsequent dosing of ephedrine?

A

As with any indirect-acting agent, tachyphylaxis may develop with subsequent dosing b/c catecholamine stores become depleted.

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5
Q

What type of drug is clonidine? (class)

A

Presynaptic Alpha-2 Agonist

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6
Q

What does clonidine cause? (more scientific and detailed explaination)

A

Stimulation of peripheral presynaptic alpha 2 receptor causes inhibition of catecholamine release with subsequent vasodilation.

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7
Q

Would you use clonidine short term or long term?

A

Usually used as a short term drug for severe hypertension as an add-on drug.

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8
Q

What occurs if you abruptly stop clonidine use?

A

Rebound hypertension happens with abrupt stopping of the drug. The resultant increase in catecholamine levels manifests as Tachy and Hptn

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9
Q

if you agonize central alpha 2 receptors (such as with clonidine) it will cause antihypertension, this also results in diminished sympathetic outflow and a resultant decrease in circulating what and what activity?

A

esultant decrease in circulating catecholamines and renin activity.

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10
Q

If someone is on clonidine then what does this mean for medication continuation throughout the perioperative period?

A

Continuing medication throughout the perioperative period is essential.

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11
Q

Would you ever taper a clonidine dose or d/c it prior to surgery?

A

Tapering dose and dc may OCCASIONALLY be indicated prior to surgery.

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12
Q

What could you use during a surgery to prevent withdrawal from clonidine?

A

Patches may be used during surgery to prevent withdrawal.

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13
Q

What are four other uses of clonidine that is not to lower blood pressure?

A

Premedicant sedative

Analgesic combined with opiates for epidural treatment of severe pain

Suppression of alcohol withdrawal symptoms

Used as a catecholamine suppression test in diagnosis of pheochromocytoma

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14
Q

ALPHA RECEPTOR ANTAGONISTS: used to treat what kind of issues?

A 
HPTN
BPH
PHEOCHROMOCYTOMA
RAYNAUD’S PHENOMENON
ERGOT ALKALOID TOXICITY
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15
Q

Common side effects of alpha receptor antagonist?

A

Orthostatic hypotension

Baroreceptor mediated reflex tachy

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16
Q

Would you use an alpha receptor antagonist for treatment of emergent hypertension?

A

They have significantly longer duration of action making it unpredictable and other agents are considered in the treatment of emergent hypertension.

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17
Q

Tell me some medications that are alpha 1 receptor antagonists?

A

Prazosin (Minipress), doxazosin (Cardura), an terazosin (Hytrin)

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18
Q

Are selective alpha 1 receptor antagonists used for acute or chronic treatment of hypertension?

A

Selective alpha 1 antagonist used for chronic tx of hptn.

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19
Q

If the alpha receptor antagonist lacks alpha 2 blocking abilities (such is the case with selective alpha 1 antagonists) then they have no effect on what levels?

A

no effect on norepinephrine levels.
(remember that alpha 2 receptors are what reabsorb norepi from the junction causing it not to be released as much and lowering blood pressure.)

20
Q

What two types of alpha receptor antagonists are there? (broad classes)

A

selective alpha 1 antagonists and non-selective alpha antagonists

21
Q

Which type of alpha receptor antagonist was chosen if there is less norepinephrine induced tachycardia?

A

selective alpha 1 antagonist was chosen bc non selective alpha antagonists have more norepinephrine induced tachycardia. (see slide 41 if this is confusing)

22
Q

Which alpha receptor antagonist induces vasodilation in both arterioles and veins?

A

Prazosin

23
Q

What can be a major side effect of alpha receptor antagonist use?

A

Orthostatic hypotension can be major side effect.

24
Q

True or False

The use of alpha receptor antagonists will only decrease preload?

A

False

PVR (peripheral) and preload/afterload are diminished.

25
Q

Tell me some are alpha 1 selective antagonists that produce relaxation of bladder neck and prostate?

A

Tamsulosin (Flomax) alfuzosin (Uroxatral) silodosin (Rapaflo)

26
Q

Tell me some non selective alpha blockers?

A

phentolamine
Tolazoline
Phenoxybenzamine

27
Q

What type of drug is finasteride (Proscar) and dutasteride (Avodart), and what does it treat?

A

proscar and avodart are 5 alpha-reductase inhibitors commonly used with tamsulosin (flomax), alfuzosin (uroxatral), and silodosin (rapaflo) in the treatment in BPH.

28
Q

Why do alpha receptor antagonists have less risk of hypotension?

A

they do no antagonize beta receptors.

29
Q

What is floppy iris syndrome? What can cause it and why does it matter?

A

Tamsulosin (and maybe others) have been known to cause “floppy iris” syndrome which may complicate cataract surgery.

30
Q

Should you d/c tamsulosin prior to cataract surgery?

A

D/c prior to surgery is not required as long as the ophthalmologist is aware. (bc it can cause floopy iris syndrome)

31
Q

What is required by the FDA prior to droperidol use?

A

12-lead EKG

32
Q

What is Droperidol (Inapsine) used for?

A

used as an antiemetic in anesthesia practice

33
Q

Droperidol produces blockade of what two receptors?

Bc of this blockade what can happen with droperidol use?

A

dopamine and alpha adrenergic blockade.

thus small reductions in blood pressure may occur especially in volume depleted patients.

34
Q

Why does Droperidol have a Black box label?

A

associated with prolonged QT interval in certain patients increasing probability of development of torsades de points leading to serious morbidity and death.

35
Q

What use of droperidol is considered an off label use? (what we only use it for as far as I know lol)

A

very low doses as an antiemetic may still be useful

36
Q

Tell me three Beta adrenergic blocking agents that anesthesia tends to use?

A

Metoprolol
Esmolol
Labetalol

37
Q

Which Beta blocker is the shortest acting?

A

Esmolol

38
Q

What drug did esmolol replace and why?

A

Esmolol replaced propranolol in anesthesia because of its rapid onset and short duration.

39
Q

What is Esmolol metabolized by?

A

Esmolol is metabolized by nonspecific plasma esterases found in the cytosol of RBC.

40
Q

What beta blocker according to Dr. Hammon is used for routine BP control in the OR?

I would have thought esmolol-LF???

A

Labetalol

41
Q 
Esmolol:
onset?
elimination half life?
duration of action?
IV loading dose?
Followed by infusion of?
A 
Onset of 2 minutes
Elimination half-life of ~ 9 minutes
Duration of action 10-15 minutes
IV loading dose:  500 mcg/Kg
Followed by infusion of 100-300 mcg/kg/min
42
Q

small boluses of how much Esmolol may be given with repeat administration according to patient response?

A

Small boluses of 10-15mg may be given with repeat administrations according to patient response.

43
Q

what beta blocker is frequently used after MI?

A

Metoprolol

44
Q

other than after MI, what other times do we commonly use metoprolol?

A

in some types of angina and Hptn once pt is stable

45
Q

How much metoprolol will you give and in what intervals and what is the max dose?

A

5 mg doses IV q 5 minutes to max of 15 mg is recommended

SUM '20 - Pharm II (30 decks)

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