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Med Math / Pharm > week 9 heart&hyperBP meds > Flashcards

week 9 heart&hyperBP meds Flashcards

1
Q

cardiac output formula:
Blood Pressure formula:

A

= CO = SV X HR
= BP=(SV X HR) X SVR

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2
Q

Autorhythmic cell/ “slow leaking cell” RP:
AP:

A

= -60mV
= -40mV

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3
Q

Slow simple what leaking channels leads to autorhythmic AP

A

= Sodium

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4
Q

(autorhythmic cell) Voltage gated calcium channels open @mV?→ what influxxes rapidly—> + charge (depolarization)

A

= -40mV
= Calcium

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5
Q

(Autorhythmic cell) + charge (depolarization) makes cell/heart?→ repolarization→ what closes & what opens & effluxes:

A

= Cell/heart fires
= Ca channels close & K channel opens & efflexes

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6
Q

CALCIUM & sodium channel blockers can lead to what:

A

= Lethal dysrhythmias

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7
Q

Contractile Cell RP:
AP:
Depolarizes w/:

A

= -90mV
= -85mV
= SA node/ authorhythmic cell GAP JUNCTIONS

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8
Q

Contractile cell @-85mV what ion influxs:

A

= Sodium channel open and rapid efflux

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9
Q

(Contractile cell)Phase 0=
Phase 1=
Phase 2=
Phase 3= repolarization
Phase 4 refractory =
plateau=

A

= Gap junction
= early depolarization
= Ca+ channels open w/ K+ leaves “ + for -” Influx Ca thus contraction
= repolarization
= K+ Na+ pumps working
= phase 2 contraction

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10
Q

Enteric system:

A

= GI system operates w/o CNS

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11
Q

Heart pumps & holds ?mLs: usually 70mLs & heart holds 100-110mL

A

= usually 70mLs & heart holds 100-110mL

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12
Q

Chronotropy:
Dromotropy:
Inotropy:

A

= heart rate
= speed of heart electrical impulses
= strength of heart pump/squeeze

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13
Q

Sympathetic system touches what in heart:

A

= Left & Right Atriums, SA & AV Node, Ventricles (EVERYWHERE)

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14
Q

cell upregulation:

A

process of communication to cell to make cell membrane change channels (heart Ca+ channels)

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15
Q

alpha 2 receptors do:

A

= regulation of A1 / makes sure doesn’t over-constrict

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16
Q

Med/s used to treat hypertension categories:

A

= Diuretics
= ACE Inhibitors
= Calcium Channel Blockers
= Beta Blockers & Antiadrenergic Meds
= Direct Vasodilators

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17
Q

How do Diuretics decrease blood pressure?
3 different kinds of Diuretics:

A

= Causes excretion of water w/urine to reduce overall blood volume
= Loop Diuretics, Thiazides, K+ Sparring

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18
Q

(Furosemide) Classification
Action:

A

= Loop diuretic
= Blocks absorption of Na,Cl & water from kidney tubules, +output of urine.

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19
Q

(Furosemide) Indications:
Contraindications:

Adverse Effects:

A

= 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

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20
Q

(Furosemide) Adult Dose:
No response to 1st dose then 2nd dose:

A

= 0.5-1 mg/kg given over 1-2 minutes.
= double 1st dose to 2 mg/kg given slowly over 1-2 minutes.

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21
Q

(Captopril) Classification:
Pharmacodynamics:

A

= 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

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22
Q

(Captopril) Indications:
Contraindications:

A

= Severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors

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23
Q

(Captopril) Adverse Effects:
Dose:

A

= Allergic reaction, Dry cough, Dizziness, Taste changes (long term)
= 25mg PO

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24
Q

Angiotensin II Antagonist:
Effects:

A

= New classification of antihypertensive meds
= Same effect of ACE inhibitor w/o side effects of cough & angioedema

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25
Q

Calcium Channel Blockers do what & where:
Causes what to happen:
Common Ca channel blocker w/ dose:

A

= block Ca channels & affects only smooth muscle of the arterioles.
= Causes vasodilation & decreases systemic vascular resistance
= Nifedipine 10mg

26
Q

Beta-Blocker meds: Blocks β adrenergic receptors
Cardio-Selective beta-blockers:
Non-selective beta-blockers:

A

= Blocks β adrenergic receptors
= Atenolol, esmolol, & metoprolol
= Propranolol, nadolol, labetalol, & sotalol

27
Q

Alpha Adrenergic meds:
Effects:
α2 Agonist:
α1 Antagonist:

A

= Inhibits the release of NorEpi into the synapse
= -Chronotropy & -Inotropy
= Clonidine (Catapres)
= Minipress

28
Q

( Atropine) Classification:
Pharmacodynamics:

A

= Parasympatholytic, 1st line med for syptomatic sinus bradycardia
= selectively blocks muscarinic receptors inhibiting parasympathetic NS letting the sympathetic NS take over

29
Q

( Atropine) Indications:

Contraindications:
Use w/ extreme caution in presence of & b/c:
Doses <0.5 mg may result in & b/c:

A

=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

30
Q

( Atropine) Adverse Effects:
Dose for bradycardia (w/ or w/o ACS)
severe clinical conditions dose:
Organophosphate Poisoning dose:

A

= 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

31
Q

Vaughn-Williams Classification:
Class I Medications:
Class II Medications:
Class III Medications:
Class IV Medications:
Miscellaneous:

A

= 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

32
Q

(Epi 1:10,000) Classification:
Pharmacodynamics:

A

= Sympathetic agonist, Sympathomimetic
= Powerful Alpha & Beta agonist

33
Q

(Epi 1:10,000) Ind:

Contra:

A

= Cardiac arrest , symptomatic bradycardia (drip), Normovolemic hypotension, severe anaphylaxis (impending cardiac arrest)
= few, benefits outweigh risks

34
Q

(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:

A

= 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

35
Q

(Dopamine) class:
Action: A&B adrenergic agonist, rate dependent vasopressor, trophies

A

= (rate dependent <caustic>) sympathetic agonist
= A&B adrenergic agonist, rate dependent vasopressor, +trophies</caustic>

36
Q

(Dopamine) indications:

Contraindications:

A

= 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)

37
Q

( Dopamine) Adverse effects:
NEVER WHAT:
Adult & PEDIs Dose:
“REAL DOSE”:
“Cardiac dose”:
“Vasopressor dose”:

A

= 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

38
Q

(Dobutamine) Classification
Action:
Pronounced property:

A

= Synthetic sympathetic agonist “baby dopamine”
= Alpha & Bet adrenergic agonist
= Inotropic prop/s more pronounced than chronotropic properties

39
Q

(Dobutamine) Indications:
Contraindications:

A

= CHF w/ pump problems/ hypotension
= shouldn’t use in hypovolemic PTs until Vol replaced, DONT MIX W/ SODIUM BICARB

40
Q

( Dobutamine) Adverse:
Adult Dose:
Pedi= 2-20mcg/kg/min

A

= 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

41
Q

(Norepi) best used for what PTs:
Pharmacodynamics:

A

= PTs in septic shock
= Alpha & Beta adrenergic agonist (Alpha effect more pronounced)

42
Q

(NORepi) Indications:
Contraindications:
CANT MIX W/:

A

= Normovolemic hypo/BP, sepsis, cardio/ shock (usually too powerful)
= shouldn’t use in hypovolemic PTs until Vol replaced,tissue necrosis
= SODIUM BICARB CAUSES CRYSTALLOIDS

43
Q

(NorEpi) Adverse effects:

Adult dose:
Pedi dose:

A

= 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

44
Q

Parasympathetic NS has cranial nerves:

A

3, 7, 9, 10

45
Q

( Lidocaine) class:
Pharmacodynamics:

A

= class Ib antiarrhythmic (Blocks sodium channel)
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity

46
Q

( Lidocaine) Indications:

Contraindications:

A

= 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

47
Q

(Lidocaine) Adverse Effects:
Cardiac Arrest from VF/pVT Dose:
For refractory VF dose:
Perfusing Arrhythmia Dose:
Maintenance Infusion Dose:

A

= 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)

48
Q

Autorhythmic cells beta blockers do what:

A

= down regulate & slows down repolarization (slower sodium influx)

49
Q

(Labetalol) class:
Action:

A

= beta blocker class 2
= slows HR by blocking adrenergic stimulation on B receptors

50
Q

(Labetalol) Indications:

Contraindications:

A

= 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

51
Q

(Labetalol) Adverse Effects:

dose:

A

= 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)

52
Q

( Amiodarone) Classification: Class III antiarrhythmic
Pharmacodynamics:

A

= Class III antiarrhythmic
= Slows potassium efflux which delays repolarization.

53
Q

( 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:

A

= 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

54
Q

(Amiodarone) Slow Infusion dose:
VF/Pulseless VT, Cardiac Arrest no response to CPR, Shock & Epi Doses:
Maintenance Infusion dose:
Life-Threatening Arrhythmia Dosage:

A

= 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

55
Q

(Diltiazem) Classification:
Pharmacodynamics:

A

= Class IV Antiarrhythmic – Calcium Channel Blocker “Damn smurf”
= Slows AP of autorhythmic heart cells by blocking calcium channels

56
Q

(Diltiazem) Indications:

Contraindications:

A

= 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

57
Q

(Diltiazem) Adverse Effects:
1st dose:
2nd dose:

A

= 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)

58
Q

(Adenosine) Classification:
Pharmacodynamics:

A

= 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

59
Q

(Adenosine) Indications:

Does not convert what:
Contraindications:

A

= 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

60
Q

(Adenosine) Adult 1st Dose:
2nd Dose:
Rapid flush best accomplished with:
Side Effects:
Reduce initial dose in half in PTs receiving/ed:

A

= 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

61
Q

RAAS Renin-Angiotensin Aldosterone System: step 1:
step 2:
step 3:

Step 4:
step 5:

in short:

A
  1. Kidneys: Detect low BP & release Renin to lover
    2.Liver:makes angiotensinogen & converted by Renin to angiotensin1
  2. Lungs & Kidneys: Angiotensin-Converting Enzyme (ACE) converts angiotensin1 to angiotensin2
  3. Blood Vessels: Angiotensin2 causes vasoconstriction
  4. Adrenal Glands:Angiotensin2 stim/s glands release aldosterone
    =Kidneys Aldosterone increases Na & water retention, raising BP & volume w/ vasoconstriction
62
Q

Heart impulse starts @:
goes through:

step 3:
Step 4:
Step 5:

A
  1. SA Node: Generates electrical impulses.
  2. Intra-atrial Pathways: Backman’s bundle Conducts impulses through atrium
  3. AV Node/”gatekeeper”: Delays impulse to allow ventricular filling
  4. Bundle of His: Conducts impulses from AV node to the ventricles.
  5. Purkinje Fibers: Distributes impulses to ventricles thus a contraction

Med Math / Pharm (8 decks)

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