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Pharm 2 > Class 4 Deck 2 > Flashcards

Class 4 Deck 2 Flashcards

1
Q

What does NTG do to non cardiac vasculature?

A
  • Dilates meningeal vessels (Cautious w/ ↑ ICP)
  • Decrease renal blood flow
  • Dilates pulmonary vessels (↓ PVR)
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2
Q

What are the indication for NTG?

A
  • Ventricular failure
  • HTN
  • Ischemic heart disease
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3
Q

How is NTG used in OB?

A

-To help relax the uterus

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4
Q

NTG adverse effects

A
  • Postural HTN
  • Tachy
  • Headache
  • Dizzy
  • Weakness
  • Methemoglobin
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5
Q

What patients need to avoid NTG?

A
  • PDE5 inhibitors (Viagra)
  • Glaucoma
  • Head injury
  • Anemia
  • Hypotension
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6
Q

What are the advantages of NTG

A
  • Rapid onset / Short duration
  • Coronary vasodilator
  • ↓ myocardial O2 consumption
  • no toxicity / no steal
  • ↓ PVR
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7
Q

What is hydralazine?

A

-Direct acting vascular smooth muscle dilator. (interferes with calcium ion transport)

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8
Q

What does hydralazine increase?

A
  • CO
  • HR
  • SV
  • Sympathetic output (baroreceptor reflex)
  • contractility
  • Renin
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9
Q

What does hydralazine decrease?

A
  • SVR

- diastolic BP more than systolic

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10
Q

Hydralazine has a greater effects on _______ than _____?

A

Arterioles / Veins

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11
Q

What are the advantages of hydralazine

A
  • Maintains cerebral blood flow

- Increases CO and SV

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12
Q

What are the disadvantages of hydralazine?

A
  • Reflex tach
  • reduced response to ephedrine
  • sodium and water retention
  • longer duration of action
  • Increase myocardial O2 demands
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13
Q

What type of patients should hydralizine be avoided?

A
  • CAD
  • ↑ ICP
  • Lupus
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14
Q

What are the side effects of hydralazine?

A
  • Sodium and water retention

- Vertigo, Nausea, diaphoresis

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15
Q

What is the drawback of hydralizine in anesthesia?

A

-Long onset time

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16
Q

Name 3 alpha antagonists

A
  • Phentolamine
  • Phenoxybenzamine
  • Prozosin
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17
Q

How does phentolamine work?

A
  • Alpha adrenergic blocker
  • Direct acting vasodilator
  • Greater arterial than venous
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18
Q

What does phentolamine do?

A
  • ↓ afterload and preload
  • Promote EF and CO
  • Decrease PVR
19
Q

When is phentolamine used

A
  • HTN from pheochromacytoma
  • Clonidine withdrawl
  • ED
  • Extravisation of catecholamines
  • improves asthma symptoms
20
Q

What is phenoxybenzamine? what does is bind to?

A
  • Prototype alpha 1 antagonist

- irreversibly binds to receptor

21
Q

When is phenoxybenzamine used?

A
  • Long term treatment of pheochromacytoma
  • Ischemic PVD
  • BPH
22
Q

phenoxybenzamine can cause what effects?

A
  • ↓ PVR to ↓ BP
  • ↑ in NorEpi
  • Crosses BBB
23
Q

What is prazosin? What does it do?

A
  • Oral selective alpha 1 antagonist
  • Peripheral vasodilator (arteries more than veins)
  • ↑ HR
  • Improves urinary flow
24
Q

Clonidine is what type of drug?

A

Alpha 2 agonist (decreases release of sympathetic neurotransmitters)

25
Q

What are the uses for alpha 2 agonists (clonidine)

A
  • Sedation
  • Anesthesia sparing effect
  • Peripheral nerve block
  • Analgesia (postop, labor, chronic)
  • Post op shivering
  • Drug withdrawl
26
Q

How does clonidine effect anesthesia?

A
  • Reduce need for propofol and thiopental
  • Alternative to N2O for shortening induction time
  • Decrease adrenergic response to intubation
  • Supplement regional blocks
27
Q

What are the actions of clonidine?

A
  • Decrease HR,BP, CO, SVR

- Baroreceptors reflex preserved (no orthostatic hypotension)

28
Q

What happens if clonidine is stopped abruptly? How quickly can it be seen?

A
  • Rebound HTN

- can happen after 6 days on med

29
Q

How does alpha-Methyldopa work?

A

-In CNS it is metabolized to alpha-methylepinepherine which acts on alpha 2 receptors to decrease sympathetic outflow

30
Q

When is alpha-Methyldopa used?

A

-Treat HTN during pregnancy, usually 3rd trimester

31
Q

What is Dexmedetomidine (Precedex) do?

A
  • Alpha 2 agonist for IV sedation (<24hr) in the ICU
  • Maintain respiratory stability
  • Light analgesia, no amnestic effects
  • Pts are arousable (sleep like state) safer for non-anesthesia personal
32
Q

What 3 drugs can reduce post op shivering?

A
  • Demerol
  • Clonidine
  • Precedex
33
Q

When is precedex used?

A
  • Procedural sedation (Fiber optic intubation, regional anesthesia)
  • Children who failed sedation by other techniques
34
Q

Precedex must be used with caution in what patients and why?

A
  • Heart Block (brady)

- Ventricular dysfunction (sinus arrest)

35
Q

ACE inhibitors are recommended for what types of patients?

A
  • Those that cant take beta blockers
  • Bronchospasms
  • DM (beta blockers decrease insulin)
36
Q

When are ACE inhibitors used?

A
  • Treat CHF and MR by afterload reduction

- Increase CO w/o decrease in preload

37
Q

Why are ACE inhibitors not used in anesthesia?

A

-Risk of acute renal failure

38
Q

How does and ACE inhibitor affect renal function of a hypertensive patient? Normotensive?

A
  • Hypertensive = improves RBF and GFR

- Normo = renal function may decrease

39
Q

Advantages of ACE inhibitors

A
  • Minimal side effects

- No problems with abrupt withdrawl

40
Q

Most serious side effects with ACE inhibitors

A

-Angio edema

41
Q

ACE are not for use in what patients?

A
  • Renal patients

- Pregnant

42
Q

Why choose and ARB over an ACE inhibitor?

A
  • Same hemodynamic effects
  • Less cough and angioedema
  • Can combine with diuretic / CCB
43
Q

What is fenoldopam? When is it used?

A
  • DA1 agonist
  • Short term management of severe HTN
  • Preserve RBF
44
Q

Problems with fenoldpam?

A
  • Tachycardia
  • Hypokalemia
  • Not renal protective
  • expensive

Pharm 2 (23 decks)

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