Peripheral Vasodilators ppt Flashcards Preview

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Flashcards in Peripheral Vasodilators ppt Deck (74)
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31

****** what is important about NO half life

ultra short (<5 sec)

32

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what is important about inhaled NO, and what is it used for

it is selective pulm vasodilator
only used for pulm HTN

33

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other name for Sodium nitroprusside

Nipride

34

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what is a main thing to remember about Niprides discontinuation

rapid termination effect 1-3 min after discontinuation
***never just turn off b/c the rebound HTN if very drastic

35

what are the 4 main advantages for Nipride

-emergent b/p control
-hypotensive technigues
-tx of pulmm edema
-onset within seconds

36

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what does Nipride do to
preload
Afterload
PVR

direct preload
direct afterload
decreased PVR

37

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Nipride is primarily a what dilator (venous or arterial) why?

Arterial
b/c it is primarily reduces afterload

38

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if you had a pt with an 99% occluded Left circ would you give a Direct afterload reducer (a drug that primarily affect arteries) drug? why/why not? what drug is a direct afterload reducer you would not want to give?

-the LAD would dilate gets great flow (really didn't need it)
-now the left circ will not dilate and all flow goes down LAD
- boom!! killed him now ischemic inleft circ MI dead

39

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how do pure afterload reducers work in the body. basically say how it will decrease the potential for ischemia?

pure afterload reducers decrease preload
-this decreases myocardial work and O2 requirements
-which equals decreased potential for ischemia

40

Does nipride have direct myocardial depressive effects

Nope

41

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what are 2 bad CV effects of Nipride

reflex tachycardia
Dilation of coranary arteries = coronary steal

42

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what is the main pulmonary effect of Nipride?

May prevent the normal response of the pulm vasculature to hypoxia (HPV) by dilating the pulm arteries

43

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a bolus of nipride of how much has been shown effective to blunt the HTN response to DL/intubation

1-2 mcgs/kg

44

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guidlines for nipride infusion
starting dose
max not to exceed
max infusion for short term
max infusion for intermediate term

- start small 0.5mcg/kg/min
***rarely exceeds 3 mcg/kg/min
- 10 mcg/kg/min should not be used for more than 10-15 min
-2mcg/kg/min should not be administerd for more than 1-3 hours

45

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what is nipride mixed in

5% dextrose

46

*** what must you do the the bottle of nipride

protect from light

47

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nipride should always be given via what?

IV pump

48

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with nipride how often should you monitor b/p

continuously A-line (always)

49

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Nipride is associated with N/V why?

actute hypotension

50

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s/s of cyanide toxicity

-Tachyphylaxis (describing an acute (sudden) decrease in the response to a drug after its administration)
-methemoglobinemia
-increased MVO2 content
- tachycardia
- increased ICP
Metabolic Acidosis

51

how to treat cyanide toxicity

-discontinue gtt
-give O2
-treat met acidosis
-sodium thiosulfate 150mg/kg over 15min
-3% sodium nitrate-5mg/kg over 5min

52

methoglobinemia can be treated with what

methylene blue 1-2 mg/kg of 1% solution over 5 min

53

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what is the main difference b/t Nipride and NTG?

NTG is primarily direct preload effects so works on venous.

54

MOA for NTG

relaxes smooth muscle, with venous pooling,
metabolism to NO to increase cGMP, decreases Intracellular Ca++, vascular smooth muscle relaxation

55

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what does NTG do to
preload?
LEDP (wedge pressure)?
Myocardial O2 demand?
endocardial perfusion

decreases it
decreases it
decreases it
increased

56

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how does NTG increase endocardial perfusion

decreases the size of LV (stretch) sine the cononary arteries fill during diastole this decreased stretch allows increased filling of steries and thus increased endocrdial perfusion

57

other effects of NTG

-releives coranary spasm
-redistributes coronary blood flow to ischemic areas
-relaxes bronchial smooth muscle
-provides uterine relaxation
-relaxes sphincter of oddi

58

what is more potent NTG or nipride

nipride

59

NTG can potentiate the effects of what musle relaxant

pancurium

60

what is the difference b/t bolus and infusion gtts of NTG

short term bolus can halp B/P
long term gtt have less an effect