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CVS Meds Specificity Flashcards

Characteristic + Elimination

1
Q

Dobutamine Dynamic; Elim; Specifics, Indicate

A

Dynamic: B1 adrenergic
Elim: Hepatic + Renal
Indicate: Acute CHF 2/2 MI and Septic Induced Cardial Dysfxn.

Specific: Decreases SVR, BP effect is dependent on Preload + Inotropy
Less tachyarrhymia vs dopamine
Tolerance in 3 days
Do not Mix with NaHCO3​ or in pt with AFIB

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2
Q

Dopamine Dynamic; Elim; Specifics, Indicate

A

Dynamic: Dopaimine; B: 3-10 mcg/kg/min; A+B: 10+
Elim: MAO/COMT (monoamine oxidase/ Catechol-o-methyltransferase)
Indicate: Hypotension, acute CHF

​Specific: Contra in Pheo or V-Fib, relative in PVD
Increases renal blood flow in low dose [does not prevent renal dysfxn or death]

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3
Q

Ephedrine Dynamic; Elim; Specifics

A

Dynamic: NE release at sympathic nerve ending -> A+B
BP inc by CO + SVR;

Elim: Renal (unchanged)

​Specific:
CNS stimulation; Dec uterine activity and mild bronchodilation
Only with pts with normal catecholamine stores
Ineffective to MAOI takers Less effective with repetative doses (NE depletion)

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4
Q

Isoproterenol: Dynamic; Elim; Specifics, Indicates

A

Dynamic: Nonselective B Agon, potent chronictrop+ionotrop. More systemic vasodilate.

Elim: Hepatic + Pulm via MAO/COMT; 40-50% Renal excrete
Indicates: AV blocks +/- ventricular arrhythmia; Shock, Bronchospasm during anes; CHF + BradyC

​Specific:
Increases Myocardial O2 Demand,
Can trigger asthma attack (B2)
Avoid in Digitalis; TachyA; MAOI/TCA

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5
Q

Phenylephrine Dynamic; Elim; Specifics

A

Dynamic: Alpha 1 Receptor only,
Elim: Hepatic and intestinal wall metabolism; Renal Elimination

​Specifics:
Useful also in Tetraology of Fallot Spells
Effective in Neuroaxial block; Outflow tract obstruction in HOCM
Causes Reflex Bradycardia, Microcirculation constriction
Uterine Contraction +/- Vasoconstriction
Decreases CO in CAD pts.
Caution in pts taking MAOI or TCA or Closed-angel glaucoma

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6
Q

Levophed Dynamic; Elim; Specifics

A

Dynamic: Precusor of EPI; Potent Alpha Adrenergic, modest B-adrenergic; Alpha potency Inc with doses >4-5 mcg/min; Positive Iontropy with min-chronotropy
Elim: MAO/COMT metabolism
Useful in septic shock. but not useful in MI relatred shock

​Specific: May cause Uterine contraction Inc,
Constricts micorcirculations, possibly splanic ciruclation
Cardiotoxic in prolong doses and use with care in MAOI pts

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7
Q

Vasopressin Dynamic; Elim; Specifics

A

Indications: DIabetic INsipidus, Abdominal distention
Postcardiotomy and vasodilatory shock (second line); Pulseless Vtach/Fib

Dynamic: V1 Receptor smooth muscle constriction, vasoconstrict of splanichnic, coronary, muscular and cutaneous
V2: Increase Urine osmolarity, Decrease Urine Output
Elim: Hepatic + renal Metabolism with Renal Elimination

​Specific:
Potential Intestinal/Skin Ischemia,
Water intoxication, Pulm Edema,
Abdominal Cramps, Gallbladder Contrction;

Possible Anaphylaxsis

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8
Q

Amrinone Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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9
Q

Mirnone: Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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10
Q

Phenoxybenazmine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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11
Q

Phentolamine Onset; Duration, Dose

A

Dynamic:
Elim:

​Specific

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12
Q

Labetalol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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13
Q

Metoprolol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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14
Q

Esmolol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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15
Q

Propanolol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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16
Q

Clonidine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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17
Q

Methyldopa Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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18
Q

Diltazem Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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19
Q

Verapamil Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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20
Q

Nicardipine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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21
Q

Clevidipine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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22
Q

Fenoldopam Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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23
Q

Hydralazine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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24
Q

Isosorbide Dinitrate Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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25
Nitroglycerin Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
26
Nitroprusside Sodium Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
27
Adenosine Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
28
Amiodarone Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
29
Lidocaine Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
30
Procainamide Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
31
Digioxin Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
32
Nesiritide Dynamic; Elim; Specifics
Dynamic: Elim: ​Specific
33
phenoxybenzamine leading to paradoxical inc BP and HR (why)
due to alpha2 blockade, leading to inc NE release
34
Diuretic Effect on CHF
Dilating Venous Capacitance -\> Dec MAP + LV end diastolic vol -\> Increased contractility, decrease myocardial wall stress,
35
MOA of digioxin and what can potentiate this effect
Na/K atpase inhibitor -\> decrease ca removal via na/ca -\> ca sequestered into SR by ca atpase. Anything that leads to hypokalemia will potentiate this effect.
36
Levosimedan MOA and benefits
Calcium Sensitzer of cardaic myocyte by binding to troponin c, and improves cardiac contractility without inc in itnracellular calcium. ALong with vasodilatory (opening atp-k channel in vascular smooth muscle) inc contraction while dec afterload and preload
37
tolvaptan
vasopressin receptor antagonist for SIADH
38
Theophyilline AE
SZ and arrhymogenic,
39
Effect of LA systemic tox on heart
blockade of intracellular site of NA channel. leading to prolong PR and widening of qrs. and impair recovery of sodium channels during hyperpolarization
40
Dobutamine Use
cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.
41
Lasix AE
Low K, Cl, H,
42
Acetazolamide, MOA AE
inhib carbonic anhydrase; can lead to mild hyperchloremic MAcidosis
43
Mirinone MOA AE,
Phosdiesterase 3-I (cAMP only -\> inotropy with Lusitropy) Benefit: Inc Cardiac Index without Inc O2 Demand. Synergenistic with adrenergic but cannot be inhbited by blockers. Reduces Systemic+pulm vasc resistance+ AE: Renal Excreted, TachyC, Hypotension, high dose -\> Afib.
44
Nicardipine Cardiovascular effects and Pulm; Contra
Vasodilation (CCB); Promote sympathetic response ( chronotropic+ionotropic); Inc FEV1, FVC ; Contra: Prolong 1/2 life in Liver Dz pt. May cause Direct Cerebral Vasodilation without inc ICP or major CBF
45
Fenoldopam MOA and Special
Dopamine-1 Agonist only; increases renal flow while being anti htn.
46
Esmolol Degradation and Selectivity
B1 Selective; metabolized by RBC esterases
47
ATenolol metabolism
Renally cleared (ATN)
48
Cardiac Drug to avoid IM?: Atropine, Glyco, Ephedrine, EPI, NE, Phenyl, Hydralazine
Mostly Vasoactive Meds e.g. NE due to acute tissue ischemia
49
Precedex Metabolism site and selectivism with MOA
Liver; a2-a1: 1600:1; MOA: Presynaptic NE release @ peripheral and CNS (spinal + locus creuleus @brain stem). Analgesia, Sedation, and sympatholysis.
50
Methylene Blue use in OR; and Contra
Methemoglinemia; Catecholamine-Resistant Vasoplegic Shock (inhib inducible isoform of NO-synthase; Guanylate cyclase -\> less NO); Contra: It is inhibitors of MAO-I (esp A type); May preciptate serotonin syndrome if given SSRI or SNRI, or MAOI. G6PD Deficient Indivudal.
51
Nifdepine Contra
Cirrhosis (mesenteric vasodilation -\> portal hypotension worsen)
52
Clevidipine Special and Metabolism
Ultrashort (5-15 min) Dihydropyridine CCB with arteriolar vasodilation. used for severe HTN metabolized by plasma and RBC esterases
53
CCB side effects
Peripheral Edema, Flushing and Headache. Potentiator of All types of Muscle NMBD
54
Drug Type Verapamil and special
Phenylalkylamine; Intraarterial with Cerebral vasospasm with Local Anes effect. Marked AV node and some SA Depression
55
Drug Type Diltiazem And specials
Benzothiazepine; Afib Use, Moderate AV depression and slight SA
56
Nondihydropyridnes Effects
Myocardial Depression, SA/AV node Depression -\> Decrease HR
57
Metabolism of CCB
All are by Liver except Clevidpine
58
CCB for Preg, heart, CVA
Gest HTN: Nifdepine; Coronary Vasospasm: Nicardipine; Nimodipine: CVA
59
Initial Effect of Precedex at Bolus of 2 mcg/kg
Decrease Central Symp tone + Inc parasymp + Reset baroreceptor to lower set bp -\> CO, Dec HR (2/2 a2 and inc bp), Inc BP @ 3 min.with return at 10 min.
60
precedex infusion effect
slight bp dec, but co and hr are still low.
61
Lisinopril Effects on Heart
Decrease Cardiomyocyte proliferation and fibroblast activity via Reducing AT1 Receptor stimulation
62
Dobutamine Use
cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.
63
fenoldopam MOA and Special
D1 agonist, Natriuretic, Diuretic, Direct Renal Vasodialtor
64
scopolamine vs atropine in AE
Increase risk of central anticholinergic syndrome (crosses bbb better)
65
Amiodarone AE
bradycardia, hypotension, Prolong QT, hypothyroidism, life-threatening hyperthyroid storm, pulmonary toxicity (with a pulmonary fibrosis appearance and TB like sx, correlate with total dose given vs daily dose), prolonged QT interval, and elevated liver function markers, blue-grey pigmentation
66
adenosine dosing
6 then 12 if piv, 3 then 6 if cvc
67
Lasix AE
Low K, Cl, H,
68
Acetazolamide, MOA AE
inhib carbonic anhydrase; can lead to mild hyperchloremic MAcidosis
69
Mirinone MOA AE,
Phosdiesterase 3-I (cAMP only -\> inotropy with Lusitropy) Benefit: Inc Cardiac Index without Inc O2 Demand. Synergenistic with adrenergic but cannot be inhbited by blockers. Reduces Systemic+pulm vasc resistance+ AE: Renal Excreted, TachyC, Hypotension, high dose -\> Afib.
70
Nicardipine Cardiovascular effects and Pulm; Contra
Vasodilation (CCB); Promote sympathetic response ( chronotropic+ionotropic); Inc FEV1, FVC ; Contra: Prolong 1/2 life in Liver Dz pt. May cause Direct Cerebral Vasodilation without inc ICP or major CBF
71
Fenoldopam MOA and Special
Dopamine-1 Agonist only; increases renal flow while being anti htn.
72
Esmolol Degradation and Selectivity
B1 Selective; metabolized by RBC esterases
73
ATenolol metabolism
Renally cleared (ATN)
74
Cardiac Drug to avoid IM?: Atropine, Glyco, Ephedrine, EPI, NE, Phenyl, Hydralazine
Mostly Vasoactive Meds e.g. NE due to acute tissue ischemia
75
Precedex Metabolism site and selectivism with MOA
Liver; a2-a1: 1600:1; MOA: Presynaptic NE release @ peripheral and CNS (spinal + locus creuleus @brain stem). Analgesia, Sedation, and sympatholysis.
76
Methylene Blue use in OR; and Contra
Methemoglinemia; Catecholamine-Resistant Vasoplegic Shock (inhib inducible isoform of NO-synthase; Guanylate cyclase -\> less NO); Contra: It is inhibitors of MAO-I (esp A type); May preciptate serotonin syndrome if given SSRI or SNRI, or MAOI. G6PD Deficient Indivudal.
77
Nifdepine Contra
Cirrhosis (mesenteric vasodilation -\> portal hypotension worsen)
78
Clevidipine Special and Metabolism
Ultrashort (5-15 min) Dihydropyridine CCB with arteriolar vasodilation. used for severe HTN metabolized by plasma and RBC esterases
79
CCB side effects
Peripheral Edema, Flushing and Headache. Potentiator of All types of Muscle NMBD
80
Drug Type Verapamil and special
Phenylalkylamine; Intraarterial with Cerebral vasospasm with Local Anes effect. Marked AV node and some SA Depression
81
Drug Type Diltiazem And specials
Benzothiazepine; Afib Use, Moderate AV depression and slight SA
82
Nondihydropyridnes Effects
Myocardial Depression, SA/AV node Depression -\> Decrease HR
83
Metabolism of CCB
All are by Liver except Clevidpine
84
CCB for Preg, heart, CVA
Gest HTN: Nifdepine; Coronary Vasospasm: Nicardipine; Nimodipine: CVA
85
Initial Effect of Precedex at Bolus of 2 mcg/kg
Decrease Central Symp tone + Inc parasymp + Reset baroreceptor to lower set bp -\> CO, Dec HR (2/2 a2 and inc bp), Inc BP @ 3 min.with return at 10 min.
86
precedex infusion effect
slight bp dec, but co and hr are still low.
87
Lisinopril Effects on Heart
Decrease Cardiomyocyte proliferation and fibroblast activity via Reducing AT1 Receptor stimulation
88
Dobutamine Use
cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.
89
fenoldopam MOA and Special
D1 agonist, Natriuretic, Diuretic, Direct Renal Vasodialtor
90
scopolamine vs atropine in AE
Increase risk of central anticholinergic syndrome (crosses bbb better)
91
Amiodarone AE
bradycardia, hypotension, Prolong QT, hypothyroidism, life-threatening hyperthyroid storm, pulmonary toxicity (with a pulmonary fibrosis appearance and TB like sx, correlate with total dose given vs daily dose), prolonged QT interval, and elevated liver function markers, blue-grey pigmentation
92
adenosine dosing
6 then 12 if piv, 3 then 6 if cvc
93
Lasix AE
Low K, Cl, H,
94
Acetazolamide, MOA AE
inhib carbonic anhydrase; can lead to mild hyperchloremic MAcidosis
95
Mirinone MOA AE,
Phosdiesterase 3-I (cAMP only -\> inotropy with Lusitropy) Benefit: Inc Cardiac Index without Inc O2 Demand. Synergenistic with adrenergic but cannot be inhbited by blockers. Reduces Systemic+pulm vasc resistance+ AE: Renal Excreted, TachyC, Hypotension, high dose -\> Afib.
96
Nicardipine Cardiovascular effects and Pulm; Contra
Vasodilation (CCB); Promote sympathetic response ( chronotropic+ionotropic); Inc FEV1, FVC ; Contra: Prolong 1/2 life in Liver Dz pt. May cause Direct Cerebral Vasodilation without inc ICP or major CBF
97
Fenoldopam MOA and Special
Dopamine-1 Agonist only; increases renal flow while being anti htn.
98
Esmolol Degradation and Selectivity
B1 Selective; metabolized by RBC esterases
99
ATenolol metabolism
Renally cleared (ATN)
100
Cardiac Drug to avoid IM?: Atropine, Glyco, Ephedrine, EPI, NE, Phenyl, Hydralazine
Mostly Vasoactive Meds e.g. NE due to acute tissue ischemia
101
Precedex Metabolism site and selectivism with MOA
Liver; a2-a1: 1600:1; MOA: Presynaptic NE release @ peripheral and CNS (spinal + locus creuleus @brain stem). Analgesia, Sedation, and sympatholysis.
102
Methylene Blue use in OR; and Contra
Methemoglinemia; Catecholamine-Resistant Vasoplegic Shock (inhib inducible isoform of NO-synthase; Guanylate cyclase -\> less NO); Contra: It is inhibitors of MAO-I (esp A type); May preciptate serotonin syndrome if given SSRI or SNRI, or MAOI. G6PD Deficient Indivudal.
103
Nifdepine Contra
Cirrhosis (mesenteric vasodilation -\> portal hypotension worsen)
104
Clevidipine Special and Metabolism
Ultrashort (5-15 min) Dihydropyridine CCB with arteriolar vasodilation. used for severe HTN metabolized by plasma and RBC esterases
105
CCB side effects
Peripheral Edema, Flushing and Headache. Potentiator of All types of Muscle NMBD
106
Drug Type Verapamil and special
Phenylalkylamine; Intraarterial with Cerebral vasospasm with Local Anes effect. Marked AV node and some SA Depression
107
Drug Type Diltiazem And specials
Benzothiazepine; Afib Use, Moderate AV depression and slight SA
108
Nondihydropyridnes Effects
Myocardial Depression, SA/AV node Depression -\> Decrease HR
109
Metabolism of CCB
All are by Liver except Clevidpine
110
CCB for Preg, heart, CVA
Gest HTN: Nifdepine; Coronary Vasospasm: Nicardipine; Nimodipine: CVA
111
Initial Effect of Precedex at Bolus of 2 mcg/kg
Decrease Central Symp tone + Inc parasymp + Reset baroreceptor to lower set bp -\> CO, Dec HR (2/2 a2 and inc bp), Inc BP @ 3 min.with return at 10 min.
112
precedex infusion effect
slight bp dec, but co and hr are still low.
113
Lisinopril Effects on Heart
Decrease Cardiomyocyte proliferation and fibroblast activity via Reducing AT1 Receptor stimulation
114
Dobutamine Use
cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.
115
fenoldopam MOA and Special
D1 agonist, Natriuretic, Diuretic, Direct Renal Vasodialtor
116
scopolamine vs atropine in AE
Increase risk of central anticholinergic syndrome (crosses bbb better)
117
amiloride ae:
Diuresis via blocking na channel hyperkalemia, nv, rash, headache
118
Amiodarone AE
bradycardia, hypotension, Prolong QT, hypothyroidism, life-threatening hyperthyroid storm, pulmonary toxicity (with a pulmonary fibrosis appearance and TB like sx, correlate with total dose given vs daily dose), prolonged QT interval, and elevated liver function markers, blue-grey pigmentation
119
adenosine dosing
6 then 12 if piv, 3 then 6 if cvc

Pharmacology (21 decks)

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