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Pharm Fall 2019 > Ex3 Vasodilators > Flashcards

Ex3 Vasodilators Flashcards

1
Q

BP =

A

COxSVR

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2
Q

CO=

A

HRxSV

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3
Q

increased BP is a result of

A

either increase in CO or increase in SVR

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4
Q

Increased CO occurs d/t

A

SNS: Beta-1 activation in heart

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5
Q

Increased SVR d/t

A

SNS: Alpha-2 activation
RAAS: increased aldosterone=H2O retention, AngiotensinII activation=vasoconstriction

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6
Q

Goal SBP

A

BASELINE - if baseline = 180, aim for that

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7
Q

secondary causes of HTN

A

OSA, pheochromocytoma, hyperparathyroidism

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8
Q

Essential HTN

A

primary HTN

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9
Q

B1 Blockers will result in

A

Decreased: HR, CO

Negative chronotropic effects

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10
Q

B1 Blockers = increased CO in which patients?

A

Rapid Afib

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11
Q

B2 agonist

A

Bronchodilation

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12
Q

Atenolol

A

+ B1-selective

NO a1 blockade

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13
Q

Carvedilol

A

NO B1 selective

+ a1 blockade

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14
Q

Esmolol

A

+ B1 Selective

NO a1 blockade

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15
Q

Labetalol

A

NO B1 selective

+ a1 blockade

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16
Q

Metoprolol

A

+ B1 selective

NO a1 blockade

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17
Q

Propranolol

A

No B1 selective/a1 blockade

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18
Q

Selective Beta-1 beta blockers

A

Atenolol
Esmolol
Metoprolol

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19
Q

Non-selective beta blockers

A

(+a1 blockade)
Carvedilol
Labetalol
Propranolol (-)a1 blockade

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20
Q

Which beta blockers are not beta selective or alpha1 blockers?

A

Propranolol

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21
Q

Metoprolol PO 2.5mg = ? IV

A

1mg

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22
Q

Labetolol Beta:Alpha PO

A

3:1

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23
Q

Labetolol Beta:Alpha IV

A

7:1

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24
Q

Main reason to use beta blockers

A

tachyarrhythmias

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25
Beta blockers are condraindicated in
NOT in COPD/asthma - preferable to use B1 selective, but if not just have albuterol on standby
26
Beta Blocker benefit in periop
decreased risk of post-op MI | prophylaxis for Afib
27
Beta blockers common adverse effects
``` hypotension bronchospasm bradycardia/heart block worsening CHF angina pectoris/MI upon abrupt d/c rebound HTN ```
28
Selective Alpha1 blockers
prazosin terazosin doxazosin tamsulosin
29
Non-selective Alpha1 blockers
phenoxybenzamine | phentolamine
30
Tx pheochromocytoma
non-selective alpha1 blockers phenoxybenzamine phentolamine
31
effect of selective alpha1 blockers
systemic vasodilation
32
effect of non-selective alpha blockers
decrease both HR/BP
33
adverse effects of alpha receptor blockers
hypotension | exaggeration of hypotension during epidural anesthesia
34
Tx of alpha blocker hypotension
phenyl or norepi
35
Poor mans Dex
clonidine
36
MOA clonidine
selective partial alpha2 agonist
37
Adverse effects of Alpha2 agonists
``` (clonidine) sedation hypotension bradycardia *rebound HTN ```
38
ACE-Inhibitors with + active metabolites
Enalapril | Ramipril
39
Caution with ACEI in OR
Renally eliminated | + active metabolites in some
40
Adverse effects - ACEI, ARB
``` hypotension angioedema ARF hyperK **cough (only ACEI) ```
41
Rx intxn -ACEI, ARB
potassium supplements potassium sparing diuretics ** cautious w/ other hypotensive agents
42
Contraindicated ACEI, ARB
pregnancy
43
dihydropyridine CCB
nifedipine amlodipine nicardipine clevidipine
44
non-dihydropyridine CCB
verapamil | diltiazem
45
CCB that decreases HR
diltiazem verapamil (nondhp)
46
CCB that increases/doesn't effect HR
nifedipine nicardipine clevidipine
47
CCB that decreases will HR will also
decrease SA/AV node conduction
48
CCB that causes coronary artery dilation most
nifedipine nicardipine clevidipine
49
CCB that causes peripheral artery dilation most
nifedipine nicardipine clevidipine
50
Uses for diltiazem/verapamil in OR
IV - supraventricular tachydysrhythmias HTN
51
Use for nifedipine, nicardipine, clevidipine in OR
HTN
52
Use for nimodipine in OR
cerebral artery vasospasm prophylaxis
53
CCB anesthetic Rx intxn
additive negative inotropy/peripheral vasodilation
54
CCB Rx intxn
Dig, BB, amio | increased risk for AV block
55
Adverse effects DHP CCB
reflex tachycardia
56
Adverse effects non-DHP CCB
bradycardia--> cardiac arrest
57
HTN urgency
SBP >/= 180 and/or DBP >/= 110 w/o evidence of target organ damage
58
HTN emergency
SBP > 200 and/or DBP > 120 w/ concurrent target organ dysfunction
59
HTN emergency organ damage
AKI, liver injury, retinopathy, seizures
60
High risk HTN emergency
CAD, DM, PVD, impaired renal fxn, smoking, elevated LDL
61
Overall Tx of HTN emergency
Gradual decrease in BP
62
HTN emergency in acute aortic dissection
Goal HR <60 BPM Goal SBP <100-120 mmHg ASAP (<5-10min)
63
HTN emergency in ischemic stroke pt
HTN after stroke is bodys way of maintainin CPP | -increased risk for hemorrhagic conversion if given thrombolytics
64
Goal BP in intracerebral hemorrhage
SBP 140-160
65
HTN urgency vs HTN emergency treatment
emergency: must come down quicker than urgency Urgency: discharge onto PO Rx
66
Nitroprusside effect on preload, afterload, CO
(-)preload (--)afterload (+)CO Fast on/off
67
Hydralazine effect on preload, afterload, CO
Avoid in OR, unpredictable (n/a)preload (-)afterload (+)CO
68
Nicardipine effect on preload, afterload, CO
``` (n/a)preload (-)afterload (+)CO Fast on Slow off ```
69
Clevididipine effect on preload, afterload, CO
*same as nicardipine, except fast on AND OFF (n/a)preload (-)afterload (+)CO
70
Nitroglycerin effect on preload, afterload, CO
(--)preload (-, n/a)afterload (+,n/a)CO Fast on/off
71
Esmolol effect on preload, afterload, CO
(n/a)preload (n/a)afterload (-)CO Fast on/off
72
Metoprolol effect on preload, afterload, CO
*same as esmolol --> except longer duration (n/a)preload (n/a)afterload (-)CO
73
Enalaprilat
discouraged in OR d/t prolonged duration
74
Phentolamine
quick on/off, DOC pheo, catecholamine induced HTN emergency
75
Nitroprusside characteristics
- Toxic metabolites w/ renal/liver failure (>72h or >3mcg/kg/min)=avoid - avoid in neuro d/t increased ICP
76
Hydralazine characteristics
- OK for pregnant pts - Lupus like syndrome (w/ long term use) - avoid in OR d/t prolonged duration
77
Nicardipine characteristics
- Reflex tachycardia
78
Clevidipine characteristics
- Lipid (calories/infxn risk) - caution: egg/soy allergy - metabolized by plasma esterases (off quick)
79
Nitroglycerin characteristics
- tachyphylaxis - flushing, erythema - dilates veins > arteries - "vasospasm prophylaxis" after CABG
80
Esmolol characteristics
- C/I in heart failure - metabolism via plasma esterases - aortic dissection = need arterial vasodilator for tachy (i.e. nitroprusside)
81
Metoprolol, Labetolol characteristics
Contraindicated in heart failure
82
Avoid which drugs in HF?
Beta Blocker
83
Preferred Rx in HTN pregnant patient
DOC: Labetolol 2nd: hydralazine
84
Enalaprilat characteristics
- too long acting for OR | - do not use in pregnant
85
Fenoldopam characteristics
- pure dopamine agonist - pure vasodilator =reflex tachy - hypokalemia (from diuresis) - avoid in neuro (ICP)
86
Drugs to avoid in neuro patients
Nitroprusside | Fenoldopam

Pharm Fall 2019 (33 decks)

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