Week 1 Cardiac Pharmacology 4 of 4

Question 1

the 2008 poise study - name the positive indication and negative indication that the study concluded

Answer 1

beta blockade offered cardiac protection in coronary heart disease

showed a significant increase all cause mortality (particularly in patients who became septic or hypotensive)

Question 2

name the classification of labetalol

Answer 2

non selective beta blocker alpha blocker

Question 3

labetalol beta to alpha blockade

Answer 3

7:1

Question 4

unlike standard beta blockers, what does labetalol produce due to its alpha blocking properties

Answer 4

vasodilation

Question 5

IV dose labetalol (weight base)
IV dose (non weight based)

Answer 5

weight base 0.25mg/kg PRN

non weight based 5-10mg PRN

Question 6

labetaolol IV infusions dose

Answer 6

2mg/min

Question 7

labetalol duration of action

Answer 7

2-6hrs (depending on the dose)

Question 8

what must be adequate in order to give labetalol

I feel like this goes without saying, but its in the power point

Answer 8

because of beta and alpha blockade- adequate HR must be present

Question 9

what are the concerns with anemia and periop beta blockers

Answer 9

anemia may further limit 02 delivery

Question 10

beta blockers are associated with worse outcomes when Hgb levels are decreased by

Answer 10

> 35%

Question 11

should beta blocker therapy be started on day of surgery

Answer 11

NO

Question 12

in patients in whom beta blocker therapy is initiated, when should therapy be initiated

Answer 12

begin perioperative beta blocker therapy far enough in advance to assess safety and tolerability preferably more than one day before surgery

Question 13

should beta blockers be continued in patients undergoing surgery who have been on beta blockers chronically

Answer 13

YES

Question 14

how is beta blocker management after surgery guided?

Do we administer it no matter what after surgery?

Answer 14

it should be guided by clinical circumstance independent of when patient was started on medication

Question 15

in patients with intermediate or high risk Myocardial ischemia noted in preoperative risk stratification test when it is reasonable to begin perioperative beta blockers

Answer 15

it may be reasonable to begin perioperative beta blocker given the circumstance

Question 16

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

Answer 16

before surgery.

Question 17

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

Answer 17

uncertain of benefit

Question 18

beta blockers may benefit vascular surgery patients at high risk for ___ but not for stroke

Answer 18

MI

Question 19

metoprolol may not be the best choice of beta blocker in the periop period - what is the reason for this?

Answer 19

pharmacogenetics variation in metabolism

Question 20

what gender benefits from beta blockers with reduced MI

Answer 20

Men

Question 21

what gender suffered from clinically significant increases in CHF with betal blocker use

Answer 21

women

Question 22

what situations where beta blockers are contraindicated?

Answer 22

asthma
Brady arrhythmias, acute heart failure advanced heart block, an adrenergic agonist such as clonidine may have some benefit

Question 23

should we start beta blockers immediately before surgery, emergency surgery or in patient with prior cerebrovascular disease or sepsis

Answer 23

NO

Question 24

HR should be titrated to what prior to surgery

Answer 24

55-70

Question 25

name the three main anticholinergics

Answer 25

atropine glycopyrrolate scopolamine

Question 26

what is the anticholinergics drug classification

Answer 26

competitive antagonist of acetylcholine at muscarinic receptors.

Question 27

Sedation atropine scopolamine glycopyrrolate

Answer 27

scopolamine +++ atropine + glycopyrolate

Question 28

antisialagogue | compare anticholinergic

Answer 28

Scopolamine +++ glycopyrrolate ++ atropine +

Question 29

increase Heart rate | compare anticholinergic

Answer 29

atropine +++ glycopyrrolate ++ Scopolamine +

Question 30

relax smooth muscle | compare anticholinergic

Answer 30

atropine ++ glycopyrrolate ++ scopolamine +

Question 31

mydriasis, cycloplegia | compare anticholinergic

Answer 31

scopolamine +++ atropine + glycopyollate 0

Question 32

prevent motion induced nausea

Answer 32

scopolamine +++ atropine + glycopyrrolate 0

Question 33

decrease gastric hydrogen ion secretion

Answer 33

atropine + scopolamine + glycopyrrolate +

Question 34

atropine IV dose

Answer 34

0.4-0.6mg

Question 35

onset of atropine

Answer 35

1-2 min

Question 36

name the prototype anticholinergic

Answer 36

atropine

Question 37

belladonna alkaloid are what two medications

Answer 37

atropine & scopolamine

Question 38

atropine can be used concurrently with anti cholinesterase for what purpose

Answer 38

reversal of muscle relaxants

Question 39

atropine is a tertiary amine what does this allow atropine to do

Answer 39

cross the BBB

Question 40

at clinical doses of atropine do you see cns effects

Answer 40

no its rare

Question 41

at low doses of atropine what may result

Answer 41

transient bradycardia

Question 42

what is the elimination half time of atropine

Answer 42

4hrs

Question 43

what medication do we avoid in patients with narrow-angle glaucoma because it increases intraocular pressure

Answer 43

atropine

Question 44

atropine overdose or belladonna alkaloid toxicity manifest as

Answer 44

extreme antimuscarinic effects with potential progression to CNS depression and coma

Question 45

metabolism of atropine

Answer 45

1/2 liver with remainder unchanged in the urine

Question 46

anticholinergic overdose mneumonic

Answer 46

``` Red as a beet blind as a bat dry as a bone mad as a hatter hot as a hare ```

Question 47

which anticholingergic is the agent of choice in OB as it does not pass the placental barrier

Answer 47

glycopyrrolate

Question 48

general dose of glycopyrrolate

Answer 48

0.1-0.2mg

Question 49

onset of glycopyrrolate | duration of glycopyrrolate

Answer 49

onset rapid | duration 4 hours

Question 50

benefit of glycopyrolate over atropine

Answer 50

less tachycardia than atropine

Question 51

does glycopyrrolate cross the BBB

Answer 51

no

Question 52

are CNS effects seen for glycopyrrolate like post op delirium that may be seen with atropine and scopolamine

Answer 52

no

Question 53

compared to belladonna alkaloids what is the duration of glycopyrrolate

Answer 53

longer duration of action

Question 54

triotropium (Spiriva)- classification

Answer 54

long acting inhaled muscarinic antagonist

Question 55

spiriva (uses)

Answer 55

bronchodilator for patients with copd

Question 56

benefits of triotropium (spiriva) (4 points)

Answer 56

improves lung function improves quality of life decreases exacerbations of copd does not significantly reduce rate of decline in FEV1

Question 57

scopolamine patch dose

Answer 57

1.5mg behind ear

Question 58

scopolamine patch onset

Answer 58

4 hours

Question 59

scopolamine duration

Answer 59

3 days

Question 60

scopolamine patch instructions

Answer 60

dont touch your eyes

Question 61

scopolamine compared to atropine CNS effects

Answer 61

CNS effects are much more pronounced at lower doses

Question 62

scopolamine diminishes the incidence of ...

Answer 62

post op n/v

Question 63

what drugs are tertiary amine what does being a tertiary amine mean the drug can do?

Answer 63

scopolamine and atropine it means it can cross the BBB

Question 64

belladonna alkaloid are which two drugs

Answer 64

scopolamine and atropine