Week 1 Cardiac Pharmacology 4 of 4 Flashcards
slide 49-64
the 2008 poise study - name the positive indication and negative indication that the study concluded
beta blockade offered cardiac protection in coronary heart disease
showed a significant increase all cause mortality (particularly in patients who became septic or hypotensive)
name the classification of labetalol
non selective beta blocker alpha blocker
labetalol beta to alpha blockade
7:1
unlike standard beta blockers, what does labetalol produce due to its alpha blocking properties
vasodilation
IV dose labetalol (weight base) IV dose (non weight based)
weight base 0.25mg/kg PRN
non weight based 5-10mg PRN
labetaolol IV infusions dose
2mg/min
labetalol duration of action
2-6hrs (depending on the dose)
what must be adequate in order to give labetalol
I feel like this goes without saying, but its in the power point
because of beta and alpha blockade- adequate HR must be present
what are the concerns with anemia and periop beta blockers
anemia may further limit 02 delivery
beta blockers are associated with worse outcomes when Hgb levels are decreased by
> 35%
should beta blocker therapy be started on day of surgery
NO
in patients in whom beta blocker therapy is initiated, when should therapy be initiated
begin perioperative beta blocker therapy far enough in advance to assess safety and tolerability preferably more than one day before surgery
should beta blockers be continued in patients undergoing surgery who have been on beta blockers chronically
YES
how is beta blocker management after surgery guided?
Do we administer it no matter what after surgery?
it should be guided by clinical circumstance independent of when patient was started on medication
in patients with intermediate or high risk Myocardial ischemia noted in preoperative risk stratification test when it is reasonable to begin perioperative beta blockers
it may be reasonable to begin perioperative beta blocker given the circumstance
in patients with three or more revised cardiac risk index (RCRI) risk factors eg. diabetes mellitus, heart failure coronary artery disease, renal insufficiency or cerebrovascular accident. when is it reasonable to begin beta blockers
before surgery.
in patients with a compelling long term indication for beta blocker therapy but no other RCRI risk factors. initiating beta blockers in the perioperative setting as an approach to reduce perioperative risk - will this benefit the patient
uncertain of benefit
beta blockers may benefit vascular surgery patients at high risk for ___ but not for stroke
MI
metoprolol may not be the best choice of beta blocker in the periop period - what is the reason for this?
pharmacogenetics variation in metabolism
what gender benefits from beta blockers with reduced MI
Men
what gender suffered from clinically significant increases in CHF with betal blocker use
women
what situations where beta blockers are contraindicated?
asthma
Brady arrhythmias, acute heart failure advanced heart block, an adrenergic agonist such as clonidine may have some benefit
should we start beta blockers immediately before surgery, emergency surgery or in patient with prior cerebrovascular disease or sepsis
NO
HR should be titrated to what prior to surgery
55-70
name the three main anticholinergics
atropine glycopyrrolate scopolamine