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SUM '20 - Pharm II > Week 1 Cardiac Pharmacology 4 of 4 > Flashcards

Week 1 Cardiac Pharmacology 4 of 4 Flashcards

slide 49-64

1
Q

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

A

beta blockade offered cardiac protection in coronary heart disease

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

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2
Q

name the classification of labetalol

A

non selective beta blocker alpha blocker

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3
Q

labetalol beta to alpha blockade

A

7:1

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4
Q

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

A

vasodilation

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5
Q 
IV dose labetalol (weight base)
IV dose (non weight based)
A

weight base 0.25mg/kg PRN

non weight based 5-10mg PRN

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6
Q

labetaolol IV infusions dose

A

2mg/min

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7
Q

labetalol duration of action

A

2-6hrs (depending on the dose)

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8
Q

what must be adequate in order to give labetalol

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

A

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

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9
Q

what are the concerns with anemia and periop beta blockers

A

anemia may further limit 02 delivery

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10
Q

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

A

> 35%

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11
Q

should beta blocker therapy be started on day of surgery

A

NO

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12
Q

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

A

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

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13
Q

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

A

YES

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14
Q

how is beta blocker management after surgery guided?

Do we administer it no matter what after surgery?

A

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

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15
Q

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

A

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

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16
Q

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

A

before surgery.

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17
Q

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

A

uncertain of benefit

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18
Q

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

A

MI

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19
Q

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

A

pharmacogenetics variation in metabolism

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20
Q

what gender benefits from beta blockers with reduced MI

A

Men

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21
Q

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

A

women

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22
Q

what situations where beta blockers are contraindicated?

A

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

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23
Q

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

A

NO

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24
Q

HR should be titrated to what prior to surgery

A

55-70

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25
Q

name the three main anticholinergics

A

atropine glycopyrrolate scopolamine

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26
Q

what is the anticholinergics drug classification

A

competitive antagonist of acetylcholine at muscarinic receptors.

27
Q

Sedation
atropine
scopolamine
glycopyrrolate

A

scopolamine +++

atropine +

glycopyrolate

28
Q

antisialagogue

compare anticholinergic

A

Scopolamine +++

glycopyrrolate ++

atropine +

29
Q

increase Heart rate

compare anticholinergic

A

atropine +++

glycopyrrolate ++

Scopolamine +

30
Q

relax smooth muscle

compare anticholinergic

A

atropine ++

glycopyrrolate ++

scopolamine +

31
Q

mydriasis, cycloplegia

compare anticholinergic

A

scopolamine +++

atropine +

glycopyollate 0

32
Q

prevent motion induced nausea

A

scopolamine +++

atropine +

glycopyrrolate 0

33
Q

decrease gastric hydrogen ion secretion

A

atropine +

scopolamine +

glycopyrrolate +

34
Q

atropine IV dose

A

0.4-0.6mg

35
Q

onset of atropine

A

1-2 min

36
Q

name the prototype anticholinergic

A

atropine

37
Q

belladonna alkaloid are what two medications

A

atropine & scopolamine

38
Q

atropine can be used concurrently with anti cholinesterase for what purpose

A

reversal of muscle relaxants

39
Q

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

A

cross the BBB

40
Q

at clinical doses of atropine do you see cns effects

A

no its rare

41
Q

at low doses of atropine what may result

A

transient bradycardia

42
Q

what is the elimination half time of atropine

A

4hrs

43
Q

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

A

atropine

44
Q

atropine overdose or belladonna alkaloid toxicity manifest as

A

extreme antimuscarinic effects with potential progression to CNS depression and coma

45
Q

metabolism of atropine

A

1/2 liver with remainder unchanged in the urine

46
Q

anticholinergic overdose mneumonic

A 
Red as a beet
blind as a bat
dry as a bone
mad as a hatter
hot as a hare
47
Q

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

A

glycopyrrolate

48
Q

general dose of glycopyrrolate

A

0.1-0.2mg

49
Q

onset of glycopyrrolate

duration of glycopyrrolate

A

onset rapid

duration 4 hours

50
Q

benefit of glycopyrolate over atropine

A

less tachycardia than atropine

51
Q

does glycopyrrolate cross the BBB

A

no

52
Q

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

A

no

53
Q

compared to belladonna alkaloids what is the duration of glycopyrrolate

A

longer duration of action

54
Q

triotropium (Spiriva)- classification

A

long acting inhaled muscarinic antagonist

55
Q

spiriva (uses)

A

bronchodilator for patients with copd

56
Q

benefits of triotropium (spiriva) (4 points)

A

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

57
Q

scopolamine patch dose

A

1.5mg behind ear

58
Q

scopolamine patch onset

A

4 hours

59
Q

scopolamine duration

A

3 days

60
Q

scopolamine patch instructions

A

dont touch your eyes

61
Q

scopolamine compared to atropine CNS effects

A

CNS effects are much more pronounced at lower doses

62
Q

scopolamine diminishes the incidence of …

A

post op n/v

63
Q

what drugs are tertiary amine

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

A

scopolamine and atropine

it means it can cross the BBB

64
Q

belladonna alkaloid are which two drugs

A

scopolamine and atropine

SUM '20 - Pharm II (30 decks)

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