week 9 heart&hyperBP meds Flashcards
cardiac output formula:
Blood Pressure formula:
= CO = SV X HR
= BP=(SV X HR) X SVR
Autorhythmic cell/ “slow leaking cell” RP:
AP:
= -60mV
= -40mV
Slow simple what leaking channels leads to autorhythmic AP
= Sodium
(autorhythmic cell) Voltage gated calcium channels open @mV?→ what influxxes rapidly—> + charge (depolarization)
= -40mV
= Calcium
(Autorhythmic cell) + charge (depolarization) makes cell/heart?→ repolarization→ what closes & what opens & effluxes:
= Cell/heart fires
= Ca channels close & K channel opens & efflexes
CALCIUM & sodium channel blockers can lead to what:
= Lethal dysrhythmias
Contractile Cell RP:
AP:
Depolarizes w/:
= -90mV
= -85mV
= SA node/ authorhythmic cell GAP JUNCTIONS
Contractile cell @-85mV what ion influxs:
= Sodium channel open and rapid efflux
(Contractile cell)Phase 0=
Phase 1=
Phase 2=
Phase 3= repolarization
Phase 4 refractory =
plateau=
= Gap junction
= early depolarization
= Ca+ channels open w/ K+ leaves “ + for -” Influx Ca thus contraction
= repolarization
= K+ Na+ pumps working
= phase 2 contraction
Enteric system:
= GI system operates w/o CNS
Heart pumps & holds ?mLs: usually 70mLs & heart holds 100-110mL
= usually 70mLs & heart holds 100-110mL
Chronotropy:
Dromotropy:
Inotropy:
= heart rate
= speed of heart electrical impulses
= strength of heart pump/squeeze
Sympathetic system touches what in heart:
= Left & Right Atriums, SA & AV Node, Ventricles (EVERYWHERE)
cell upregulation:
process of communication to cell to make cell membrane change channels (heart Ca+ channels)
alpha 2 receptors do:
= regulation of A1 / makes sure doesn’t over-constrict
Med/s used to treat hypertension categories:
= Diuretics
= ACE Inhibitors
= Calcium Channel Blockers
= Beta Blockers & Antiadrenergic Meds
= Direct Vasodilators
How do Diuretics decrease blood pressure?
3 different kinds of Diuretics:
= Causes excretion of water w/urine to reduce overall blood volume
= Loop Diuretics, Thiazides, K+ Sparring
(Furosemide) Classification
Action:
= Loop diuretic
= Blocks absorption of Na,Cl & water from kidney tubules, +output of urine.
(Furosemide) Indications:
Contraindications:
Adverse Effects:
= PTs w/>90-100 Acute pulmonary edema, Hypertensive emergencies
= Hypovolemia tension & kalemia & other suspected electrolyte abnormalities.
= May cause dehydration, May cause an acute electrolyte imbalance
(Furosemide) Adult Dose:
No response to 1st dose then 2nd dose:
= 0.5-1 mg/kg given over 1-2 minutes.
= double 1st dose to 2 mg/kg given slowly over 1-2 minutes.
(Captopril) Classification:
Pharmacodynamics:
= ACE Inhibitor
= Prevents production of angiotensin II by
inhibiting angiotensin converting enzyme (ACE) thus causes vasodilation & helps reduce the amount of water held back by the kidneys
(Captopril) Indications:
Contraindications:
= Severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors
(Captopril) Adverse Effects:
Dose:
= Allergic reaction, Dry cough, Dizziness, Taste changes (long term)
= 25mg PO
Angiotensin II Antagonist:
Effects:
= New classification of antihypertensive meds
= Same effect of ACE inhibitor w/o side effects of cough & angioedema
Calcium Channel Blockers do what & where:
Causes what to happen:
Common Ca channel blocker w/ dose:
= block Ca channels & affects only smooth muscle of the arterioles.
= Causes vasodilation & decreases systemic vascular resistance
= Nifedipine 10mg
Beta-Blocker meds: Blocks β adrenergic receptors
Cardio-Selective beta-blockers:
Non-selective beta-blockers:
= Blocks β adrenergic receptors
= Atenolol, esmolol, & metoprolol
= Propranolol, nadolol, labetalol, & sotalol
Alpha Adrenergic meds:
Effects:
α2 Agonist:
α1 Antagonist:
= Inhibits the release of NorEpi into the synapse
= -Chronotropy & -Inotropy
= Clonidine (Catapres)
= Minipress
( Atropine) Classification:
Pharmacodynamics:
= Parasympatholytic, 1st line med for syptomatic sinus bradycardia
= selectively blocks muscarinic receptors inhibiting parasympathetic NS letting the sympathetic NS take over
( Atropine) Indications:
Contraindications:
Use w/ extreme caution in presence of & b/c:
Doses <0.5 mg may result in & b/c:
=1st line med for symptomatic sinus bradycardia, Maybe beneficial in presence of AV nodal block, Organophosphate poisoning
=Allergic to drug, Avoid in hypothermic bradycardia
= MI & hypoxia – causes increased myocardial O2 demand
= paradoxical heart slowing b/c small doses = parasympathomimetic
( Atropine) Adverse Effects:
Dose for bradycardia (w/ or w/o ACS)
severe clinical conditions dose:
Organophosphate Poisoning dose:
= Blurred vision, Dry mouth, Dilated pupils, Confusion
= 1 mg IVP every 3-5 Mins as needed, w/ max dose 0.04 mg/kg (3 mg)
=Shorter intervals (3 mins)1 mg IVP w/ max dose 0.04 mg/kg (3 mg)
= 2-4 mg (or higher) IVP
Vaughn-Williams Classification:
Class I Medications:
Class II Medications:
Class III Medications:
Class IV Medications:
Miscellaneous:
= Antiarrhythmic med classifying
= Sodium Channel Blockers: Lidocaine
= Beta Blockers: Labetalol
= Potassium Channel Blockers: Aminodarone
= Calcium Channel Blockers: Diltiazem (atrial rhythms)
= Adenosine attaches to adenosine recpetors & others
(Epi 1:10,000) Classification:
Pharmacodynamics:
= Sympathetic agonist, Sympathomimetic
= Powerful Alpha & Beta agonist
(Epi 1:10,000) Ind:
Contra:
= Cardiac arrest , symptomatic bradycardia (drip), Normovolemic hypotension, severe anaphylaxis (impending cardiac arrest)
= few, benefits outweigh risks
(Epi 1:10,000) Adverse effect:
Adult Cardiac arrest dose:
Adult hypotension/bradycardia dose: 2-10 mcg/min IV/IO infusion
PEDI Bradycardia/Cardiac arrest dose: 0.01mg/Kg or 0.1mL/Kg
PEDI Hypoperfusion & severe anaphylaxis dose:
EPI infusion for above:
= palps, anxiety, tremors, H/A, dizziness, hypertension, tachycardia, can worsen cardiac ischemia, (ALWAYS PUT ON MONITOR)
= 1mg IVP/IOP every 3-5mins
= 2-10 mcg/min IV/IO infusion
= 0.01mg/Kg or 0.1mL/Kg
= 0.1-1mcg/kg/min infusion
= Mix 1mg of EPI 1:10,000 into 1L IV bag fluid
(Dopamine) class:
Action: A&B adrenergic agonist, rate dependent vasopressor, trophies
= (rate dependent <caustic>) sympathetic agonist
= A&B adrenergic agonist, rate dependent vasopressor, +trophies</caustic>
(Dopamine) indications:
Contraindications:
= CHF, hypotension w/ shock signs, 2nd line med for symptomatic bradycardia (after atropine for adults),
= bleeding out, shouldn’t used in hypovolemic PTs until Vol replaced, known history of Pheochromocytoma (tumor adrenal Gs “opens Epi/Dop gates”), DONT MIX W/ SODIUM BICARB (crystalloids)
( Dopamine) Adverse effects:
NEVER WHAT:
Adult & PEDIs Dose:
“REAL DOSE”:
“Cardiac dose”:
“Vasopressor dose”:
= hyper/BP, palpitations, H/A, can worsen ischemia, tissue necrosis
= OPEN WIDE OPEN
= 2 – 20 mcg/kg/min (start at 5mcg & titrate to effect
= 2-5mcg/kg/min
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
(Dobutamine) Classification
Action:
Pronounced property:
= Synthetic sympathetic agonist “baby dopamine”
= Alpha & Bet adrenergic agonist
= Inotropic prop/s more pronounced than chronotropic properties
(Dobutamine) Indications:
Contraindications:
= CHF w/ pump problems/ hypotension
= shouldn’t use in hypovolemic PTs until Vol replaced, DONT MIX W/ SODIUM BICARB
( Dobutamine) Adverse:
Adult Dose:
Pedi= 2-20mcg/kg/min
= hypertension, palpitations, H/A, can worsen ischemia, tissue necrosis
= 2-20mcg/kg/min- titrate so HR don’t increase >10% baseline
= 2-20mcg/kg/min
(Norepi) best used for what PTs:
Pharmacodynamics:
= PTs in septic shock
= Alpha & Beta adrenergic agonist (Alpha effect more pronounced)
(NORepi) Indications:
Contraindications:
CANT MIX W/:
= Normovolemic hypo/BP, sepsis, cardio/ shock (usually too powerful)
= shouldn’t use in hypovolemic PTs until Vol replaced,tissue necrosis
= SODIUM BICARB CAUSES CRYSTALLOIDS
(NorEpi) Adverse effects:
Adult dose:
Pedi dose:
= Hypertension, Organ ischemia, Cardiac arrhythmia, May cause tissue necrosis if extravasation occurs, Palpitations, Anxiety, N/V
= 0.1-0.5 mcg/kg/min IO/IV infusion
= 0.1-0.2 mcg/kg/min IV/IO infusion
Parasympathetic NS has cranial nerves:
3, 7, 9, 10
( Lidocaine) class:
Pharmacodynamics:
= class Ib antiarrhythmic (Blocks sodium channel)
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity
( Lidocaine) Indications:
Contraindications:
= alt/ to Amiodarone in cardiac arrest from VF/pVT, stable monomorphic VT w/ preserved LVF left ventricle function (good BP)
= PT already received IV Ca channel blockers, not given AMI setting prophylactically
(Lidocaine) Adverse Effects:
Cardiac Arrest from VF/pVT Dose:
For refractory VF dose:
Perfusing Arrhythmia Dose:
Maintenance Infusion Dose:
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV 5-10 mins (Max dose 3mg/kg)
= 1-1.5 mg/kg IV/IO
= 1– 4 mg/min (30-50mcg/kg/min)
Autorhythmic cells beta blockers do what:
= down regulate & slows down repolarization (slower sodium influx)
(Labetalol) class:
Action:
= beta blocker class 2
= slows HR by blocking adrenergic stimulation on B receptors
(Labetalol) Indications:
Contraindications:
= high hyper/BP, 2nd med after Adenosine for SVF, A-Fib/Flutter w/ RVR (rapid ventricular response >150BPM) reduce MI in AMI PTs w/ +HRs
= no admin in STEMIS, signs of heart failure, low cardiac output, increased risk of cardiogenic shock, hypotension, bradycardia, NO MIXING WITH CA BLOCKERS
(Labetalol) Adverse Effects:
dose:
= Concurrent admin w/ IV Ca channel blockers can cause severe hypotension, bradycardia/heart blocks & CHF.
= 10 mg IVP 1-2 Mins & may repeat every 10Mins (max dose 150 mg)
( Amiodarone) Classification: Class III antiarrhythmic
Pharmacodynamics:
= Class III antiarrhythmic
= Slows potassium efflux which delays repolarization.
( Amiodarone) Indications:
B/c use associated w/ toxicity, amiodarone is indicated for:
With expert consultation, amiodarone may be used for:
Precautions:
Terminal elimination is extremely long:
Contraindications:
= VF/Pulseless VT unresponsive to shock CPR & Epi, Recurrent, hemodynamically unstable VT w/ pulse.
= PTs w/ life-threatening arrhythmias & need appropriate monitoring
= treatment of some atrial & ventricular rhythms
= Severe life-threatening hypotension
= half-life lasts up to 40 days
= Allergic to med, Bradycardias w/ AV blocks, Breastfeeding mothers
(Amiodarone) Slow Infusion dose:
VF/Pulseless VT, Cardiac Arrest no response to CPR, Shock & Epi Doses:
Maintenance Infusion dose:
Life-Threatening Arrhythmia Dosage:
= 360 mg IV over 6 hours (1 mg/min)
= 1st Dose: 300 mg IVP push & 2nd Dose: 150 mg IVP if needed
= 540 mg over 18 hours (0.5 mg/min) (Max dose per day 2.2Gs)
= 1st Infusion of 150mg over 10 Mins (15 mg/min) 2nd Dose May repeat same dose every 10Mins if needed
(Diltiazem) Classification:
Pharmacodynamics:
= Class IV Antiarrhythmic – Calcium Channel Blocker “Damn smurf”
= Slows AP of autorhythmic heart cells by blocking calcium channels
(Diltiazem) Indications:
Contraindications:
= 1st line med for A-Fib/Flutter w/ RVR (Usually >150 bpm), 2nd line med for SVT refractory to Adenosine
= Hypotension (<90mmHg), CHF/Cardiogenic Shock, Wide-Complex Tachycardia, WPW, Hypersensitivity to med
(Diltiazem) Adverse Effects:
1st dose:
2nd dose:
= Hypo/BP, maybe CHF if used w/ Beta-Blockers, N/V/D, Dizziness, H/A
= 0.25 mg/kg w/ (max dose 20 mg)
= 0.35 mg/kg w/ (max dose 25 mg)
(Adenosine) Classification:
Pharmacodynamics:
= Nucleoside, Miscellaneous Antiarrhythmic
= Binds Adenosine A1 receptors causes K+ efflux & inhibits Ca influx (In autorhythmic cells) & Causes hyperpolarization of cells (SA/AV Node) thus Slows AV conduction w/ very short half-life
(Adenosine) Indications:
Does not convert what:
Contraindications:
= 1st med for stable narrow complex SVT, Regular & monomorphic wide-complex tachycardia thought from reentry SVT (SVT w/ BBB)
= A-Fib or A-Flutter
= A-Fib/Flutter, Torsades de Pointes, tachycardia from poison/drug, 2nd/ 3rd AVB, WPW
(Adenosine) Adult 1st Dose:
2nd Dose:
Rapid flush best accomplished with:
Side Effects:
Reduce initial dose in half in PTs receiving/ed:
= 6 mg rapid IV/IO push followed by a rapid 20 mL flush of fluid
= 12 mg rapid IV/IO push followed by a rapid 20 mL flush of fluid
= utilizing a 3-way stopcock.
= Period: Sinus-bradycardia, asystole, & ventricular-ectopy w/ admin
= dipyridamole/carbamazipine, heart-transplant, or admin central line
RAAS Renin-Angiotensin Aldosterone System: step 1:
step 2:
step 3:
Step 4:
step 5:
in short:
- Kidneys: Detect low BP & release Renin to lover
2.Liver:makes angiotensinogen & converted by Renin to angiotensin1 - Lungs & Kidneys: Angiotensin-Converting Enzyme (ACE) converts angiotensin1 to angiotensin2
- Blood Vessels: Angiotensin2 causes vasoconstriction
- Adrenal Glands:Angiotensin2 stim/s glands release aldosterone
=Kidneys Aldosterone increases Na & water retention, raising BP & volume w/ vasoconstriction
Heart impulse starts @:
goes through:
step 3:
Step 4:
Step 5:
- SA Node: Generates electrical impulses.
- Intra-atrial Pathways: Backman’s bundle Conducts impulses through atrium
- AV Node/”gatekeeper”: Delays impulse to allow ventricular filling
- Bundle of His: Conducts impulses from AV node to the ventricles.
- Purkinje Fibers: Distributes impulses to ventricles thus a contraction
