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Flashcards in CV Pharmacology PPT Deck (101):
1

Name __ sympathomimetics

Epinephrine
Norepinephrine
Dobutamine
Dopamine
Milrinone
Phenylephrine

2

Epinephrine is what type of catecholamine

Endogenous

3

Epinephrine stimulates what receptors with low doses (0.01-0.04 mcg/kg/min)

B1 and B2

4

Epinephrine's B2 stimulation occurs where in the body? and causes what reactions?

periphery
DECREASES afterload
bronchodilation

5

Epinephrine's B1 stimulation occurs where in the body? and cause what reaction?

Heart
increases inotropy/chronotropy/dromotropy
== increased CO

6

with low doses of Epinephrine the is a _______ change in systemic BP!!

minimal

7

with higher doses of Epinephrine there is stimulation of what receptor?

Alpha 1

8

Epinephrine's alpha-1 stimulation occurs where in the body? and causes what reaction?

skin, mesenteric, hepatarenal constriction
=increased afterload

9

2 main SE of Epinephrine

-glycogenolysis and gluconeogenesis= hyperglycemia
- Increase Na+/K+ pump activity= mild HypoK+

10

Norepinephrine is what type of catecholamine?

endogenous

11

Norepinephrine effects what receptors? and causes what reactions?

(same B1 as epinephrine)
- B1 increases inotropy/chronotropy/dromotropy == increased CO
- minimal B2 stimulation
-POTENT Alpha a effects- more vasoconstriction
---hepatorenal, mesenteric, skin, and skeletal muscle constriction

12

Starting dose for Norepinephrine

same as epinephrine 0.01-0.02 mcg/kg/min

13

Norepinephrine is 1st line agent for what?

Low CO post CPB vasodilation

14

Dobutamine is what type of Catecholamine?

Synthetic

15

Dobutamine works on what receptors

partially selective B1 agonist, some B2 effects

16

What does the isomer of Dobutamine do?

opposing effects on alpha 1 receptors
-Dextro- blocks alpha 1
-Levo- stimulates Alpha 1

17

Dobutamine doses and receptors stimulated

< 5 mcg/kg/min = predominant B1-B2 agonism= increased CO, Decreased afterload

>5mcg/kg/min= B1 stim and Alpha 1 stim= increased CO, stable afterload

18

Dopamine is what type of Catecholamine

endogenous

19

Dopamine is a precursor to what drug (catecholamine)

Noreponephrine

20

Dopamine stimulates what receptors

D1, D2, B1, B2, and Alpha 1

21

Dopamine doses? receptors stimulated and effects?
Low dose?

0.5-3 mcg/kg/min
D1
renal vascular dilation

22

Dopamine doses? receptors stimulated and effects?
Moderate dose?

3-10 mcg/kg/min
B1
inotrope and chronotrope

23

Dopamine doses? receptors stimulated and effects?
High doses?

>10 mcg/kg/min
A1
increased afterload

24

Milrinone is what drug class?

Phosphodiasterase inhibitor

25

Milrinone is what type of catecholamine

Non-catecholamine inotrope
(you dummy remember it is a phosphodiasterase inhibitor)

26

Milrinone MOA

inhibits PDE II = decrease hydrolysis of cAMP = INCR intracellular cAP = INCR intracellular Ca++ movement

27

Milrinone does what to inotropy?

increases it

28

Milrinone does what to vascular smooth muscle?

dilates it

29

Milrinone may selectively dilate _______ vasculature > systemic

pulmonary

30

will Milrinone work in the presence of B blockade?

fuck yeah!!! you beat you ass!!!

31

caution dosing Milrinone in what pt's and why?

Renal failure b/c 80% eliminated unchanged by kidneys

32

WHat type of catecholamine is Phenylephrine?

synthetic non-catecholamine

33

Phenylephrine effects what receptor

direct Alpha 1

34

Phenylephrine effects of alpha 1 stimulation

venous and arterial constriction
increase afterload
increase venous tone

35

Name 3 vasodilators

Nitroglycerine
sodium nitroprusside
nicardipine

36

Nitro is an organic nitrate that acts on what?

venous capacitance vessels

37

nitroglycerine works by generating what?

Endothelial nitric oxide

38

nitroglycerine causes peripheral venous _______?

pooling

39

nitroglycerine causes decreased LV wall tension which equals what?

decreased preload

40

with nitroglycerine higher doses will dilate ARTERIAL vascular smooth muscle! at what dose does this occur??

>2 mcg/kg/min

41

what vasodilator is a non-selective arterial and venous vascular smooth muscle dilator

Sodium Nitroprusside

42

Sodium Nitroprusside inhibits what natural body response

HPV

43

the Sodium Nitroprusside molecule is 44% _____ by weight

cyanide

44

Sodium Nitroprusside interacts with oxyhemoglobin forms methemoglobin and releases _________ and ______

cyanide
NO

45

NO MOA

NO activates guanylate cyclase = increase intracellular cGMP (inhibints Ca++ entry) =vascular dilation

46

Be cautious of cyanide toxicity with SNP dose greater than what?

> 2 mcg/kg/min

47

2 SE of cyanide toxicity

1) tissue hypoxia, anearobic metabolism (lactic acid)
2) Mixed venous PO2 and SpO2 increased

48

Increased SvO2 and poor tissue oxygenation is S/S of what disorder

methemoglobinemia

49

what is a rare SE of SNP infusion

Thiocyanate toxicity

50

s/s of Thiocyanate toxicity

-slow clearance by kidneys= fatigue, tinnitus, N/V
- Inhibits uptake of iodine by the thyroid = hypothyroidism

51

Nicardipine class

1,4 DHP CCB

52

does Nicardipine have SA or AV node blockade?

Neither dummy

53

Nicardipine has minimal myocardial depression!!!! true or false???

true

54

Nicardipine is a venous or arterial dilator?

arterial ( blocks intracellular Ca++)

55

Nicardipine is a predominate _________ dilator

coronary

56

Name 2 antidysrhythmics

Amiodarone
Lidocaine

57

Amiodarone Actions

-Blocks inhibitory K+ channels
- prolongs action potentials. repolarization and refractory period

58

Amiodarone treats what?

reentry and enhanced automaticity
ex: SVT, VT and A-fib

59

Amiodarone MOA

-depresses conduction in the AV node and the accessory bypass tracts
-prolongs the refractory period in all cardiac tissues

60

Amiodarone is 37% what?

iodine

61

Amiodarone's antiadrenergic effects are blockade of what?

blockade of A and Beta

62

Amiodarone has ___ and _____ channel blocking effects

K+
Ca++

63

Amiodarone has minor _____ inotropic and potent ________ properties

negative
vasodilating

64

Amiodarone t 1/2 is how long?

29 days

65

Amiodarone is metabolized by what?

hepatic

66

SE of Amiodarone

pulmonary alveolitis
prolonged QT
skin/corneal/thyroid effects

67

Lidocaine is for the tx of what?

re-entry dysrhythmias
ex: PVCs V-tach

68

Lidocaine decreases phase ____ causing decreased K+ ion permeability

4

69

Lidocaine causes decreased __ node and ____ ____ conduction

AV
his bundle

70

Lidocaine is metabolized by what?

Hepatic
with active metabolites

71

Lidocaine what occurs with the following levels?
Toxic plasma conc-
plasma level > 5 mcg/ml
plasma level > 10 mcg/ml

Toxic plasma conc- vasodilation and myocardial depression

plasma level > 5 mcg/ml- SZ

plasma level > 10 mcg/ml- CNS depression/ apnea/ arrest

72

Name 3 commonly used adjuncts

inhaled NO
Prostacyclin (PGI2)
IABP

73

Inhaled NO is at what concentration levels?

2-40 ppm (blended into FGF)

74

Inhaled NO is rapidly inactivated by what???? this is why there are no systemic effects!

Hemoglobin

75

Inhaled NO relaxes what?

Pulmonary vascular smooth muscle

76

Inhaled NO desired effects

decreased PAP
reduced afterload

77

Inhaled NO is for tx of what?

low CO in cor pulmonale
improves V/Q matching in ARDS (does not improve mortality)

78

Prostacyclin (PGI2) is administered how

inhaled or IV

79

what is Prostacyclin (PGI2)

potent vasodilator!

80

IV doses of Prostacyclin (PGI2) is used to do what?

reduce PAP often causes systemic hypotension

81

does Prostacyclin (PGI2) have systemic effects when inhaled?? why or why not?

nope
rapid inactivation

82

what is teh advantage of Prostacyclin (PGI2) over inhaled NO

much cheaper (so we should use it of the no insurance ones)

83

what is the IABP?

Aortic balloon counterpulsation

84

IABP inflates with what?

helium!! 9like all balloons silly)

85

IABP inflates when? and why?

diastole
increased coronary perfusion

86

the IABP deflates when? and why?

just before AV opening
(decreased LV afterload)

87

what are the ONLY 2 functions of the IABP

1) increased Myocardial O2 supply (diastolic augmentation)
2) decreased myocardial oxygen demand (reduced afterload)

88

3 anticoagulants Boyd cares about!!!

Heparin
Bivalirudin (angiomax)
Argatroban

89

Heparin sodium is what? and made from what?

unfractionated heparin
made of porcine or bovine

90

Heparin sodium increases antithrombin III activity by how much?

1000x's

91

Does Heparin sodium cross the placenta???

no way

92

what is teh CPB minimum dose for Heparin sodium

300 U/kg ( min ACT 400s-nl is 90-120s)

93

with Heparin sodium 100 units = _____mg

1 mg

94

Bivalirudin (angiomax) is what type of drug??? dont say anticoagulant!!

direct thrombin inhibitor

95

Bivalirudin (angiomax) has a short half life of how long?

25 min

96

Bivalirudin (angiomax) is eliminated how????

non-organ
by proteolysis

97

what is a huge disadvantage of Bivalirudin (angiomax)

difficult to monitor

98

Argatroban is what type of drug???? don't say anticoagulant dumbass!!

direct thrombin inhibitor

99

Argatroban is LESS or MORE potent than Bivalirudin?

less

100

Argatroban pump load (dose) and IV load (dose)

pump- 0.05 mg/kg
IV- 0.1 mg/kg

101

what is a disadvantage of Argatroban

difficult to monitor