Cardio: Drugs for Aortic Dissection

Question 1

What four drugs are first line for aortic dissection?

Answer 1

Labetalol, esmolol, nitroprusside, nicardipine

Question 2

MOA of labetalol

Answer 2

Blocks both a1 and non-selective B

-decreases PVR

Question 3

Indications for labetalol

Answer 3

Arterial HTN (emergencies to stable HTN)
-also used in combo with other HTN drugs

Question 4

Contraindications of labetalol/esmolol?

Answer 4

HF, 2nd-3rd degree AV block, bradycardia, cardiogenic shock, severe hypotension

Question 5

What are some precautions when prescribing labetalol?

Answer 5

Hepatic injury (monitor LFTs)
Cardiac failure
Withdrawl syndrome
Bronchospasm and DM (decreases B2 activity)
Pheochromocytoma

Question 6

What are some drugs to look out for when prescribing labetalol?

Answer 6

Tricyclic antidepressants (tremor)
B-blockers
Cimetidine*
Halothane
Nitroglycerin (hypotension)
CCBs (verapamil)
Digitalis

Question 7

What special population (2) may require an adjusted dose when prescribing labetalol?

Answer 7

Geriatric patients
-elimination is reduced, so may have to decrease dose

Pregnancy
-clearance increases, so may have to increase dose

Question 8

MOA of Esmolol?

Answer 8

B1 specific B-blocker

Question 9

Indications for Esmolol?

Answer 9

Control of rapid heart beats, especially indicated around surgery

Question 10

Should you prescribe esmolol during pregnancy?

Answer 10

It can be used, but it can cause fetal bradycardia

-have to monitor pts closely, or switch drugs

Question 11

Does esmolol interact with other drugs?

Answer 11

yes, many interactions

Question 12

What special population may require a lower dose when prescribing esmolol?

Answer 12

The elderly

-clearance decreases, so may have to reduce

Question 13

Main adverse effects of esmolol?

Answer 13

Hyperkalemia
-especially in renal failure pts

Hypotension
-must monitor them closely within 30min of dosage

Question 14

Which B-blocker is very short acting?

Answer 14

Esmolol

-half life 9 mins

Question 15

Nitroprusside MOA

Answer 15

Releases NO when broken down

• NO activates guanylate cyclase, which increase cGMP
• cGMP increases PKG=inactivation of myosin light chains (phosphorylation)
• -decreases contraction=vasodilation

Question 16

Should you prescribe nitroprusside with PDE-5 inhibitors?

Answer 16

No way, Jose

-both work to vasodilate, and can cause massive drops in BP

Question 17

Indications for nitroprusside

Answer 17

Hypertensive emergencies!

-can also use it during surgeries and HF

Question 18

Adverse effects of nitroprusside

Answer 18

Bradyarrythmias
Hypotension
Palpitations
Tachyarrhythmias (reflex)

and many more, dude lists like 50

Question 19

What is the major toxicity of nitroprusside?

Answer 19

Nitroprusside is broken down into Cyanide

-so look out for seizures and lactic acidosis

Question 20

What hematological issue can nitroprusside cause?

Answer 20

Methemoglobinemia

-sequesters hemoglobin, so patients may develop blue skin and “chocolate brown” blood

Question 21

When would nitroprusside cause thyiocyante toxicity?

Answer 21

Pts w renal impairment
-CN- binds to thiosulfate, which is normally excreted in urine

Renal failure means less is excreted

Question 22

MOA of Nicardipine

Answer 22

dihyropyridine CCB

-causes vasodilation

Question 23

Indications for Nicardipine

Answer 23

IV: short-term tx of hypertension, but switch to oral ASAP

Oral: long term BP control

Question 24

Contraindications for Nicardipine?

Answer 24

Pts w advanced aortic stenosis

Question 25

Adverse effects of nicardipine?

Answer 25

Headache, hypotension, tachycardia (reflexive), N/V

Question 26

What are some precautions to think about when prescribing nicardipine?

Answer 26

Can cause hypotension Can worsen angina Can worsen HF (due to negative inotropic effects)

Question 27

In someone with hepatic or renal impairment, what should you think about when giving nicardipine?

Answer 27

Hepatic impairment: Lower doses and monitor blood flow Renal: Can significantly lower clearance and increase AUC curve (?)

Question 28

Where should you administer nicardipine?

Answer 28

In large peripheral/central veins rather than smaller ones of wrist/hand -minimizes risk of thrombophlebitis, local irritation

Question 29

Is nicardipine safe in kids?

Answer 29

No, safety has not been established yet

Question 30

What should you do w doses of nicardipine in elderly?

Answer 30

Lower the doses!

Question 31

What drugs do nicardipine interact with?

Answer 31

Those that inhibit CYP3A4: Cimitidine, cyclosporines, tacrolimus -increases concentration

Question 32

Is nicardipine safe to give w B-blockers?

Answer 32

yes, but need to monitor in those with HF