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Anesthesia Pharm Spring 25 > Pressors/Dilators > Flashcards

Pressors/Dilators Flashcards

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1
Q

What is the first intervention after a right carotid endarterectomy with rising BP and HR?

A

Something else

Consider evaluating the patient’s condition and adjusting medications or interventions accordingly.

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2
Q

What kind of proteins are Beta receptors?

A

G protein coupled

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3
Q

What happens when Beta receptors are occupied by agonists?

A

Activates adenylyl cyclase to produce cAMP
Enhances Ca++ influx
Chronotropic, inotropic, and dromotropic effects

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4
Q

Which medication might worsen PaO2 in an end-stage COPD patient?

A

Sodium nitroprusside

It can cause vasodilation and may lead to decreased oxygenation.

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5
Q

What drug prevents tachycardia and hypertension associated with intubation?

A

Esmolol

It has a rapid therapeutic effect and is useful against intraoperative noxious stimuli.

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6
Q

What is the initial dose of Esmolol (Brevibloc)?

A

20-30 mg IV

It has a therapeutic effect in about 5 minutes.

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7
Q

What is the beta to alpha blocking ratio for Labetalol IV form?

A

7:1

It effectively lowers systemic BP and attenuates reflex tachycardia.

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8
Q

Fill in the blank: Beta blockers are used to prevent __________ binding on the heart, blood vessels, and airway smooth muscle.

A

catecholamines and other sympathomimetics

This prevents excessive sympathetic nervous system stimulation.

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9
Q

True or False: Beta antagonists selectivity is dose dependent and is lost at high doses of the antagonists

A

True

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10
Q

True or False: Chronic administration of beta-antagonists cause up-regulation of receptors.

A

True

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11
Q

Beta antagonist effects on arterial vascular tone

A

decreases arterial vascular tone and reduces afterload

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12
Q

Beta antagonists effect of CO

A

Decrease CO and inhibit renin release

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13
Q

Cardiac effects of beta antagonists

A

decrease the slope of phase 4 which decreases rate of spontaneous depolarization
- decreases dysrhythmias during ischemia and reperfusion
-Increases diastolic perfusion time

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14
Q

Beta antagonists indications

A

Excessive SNS stimulation
Thyrotoxicosis
Cardiac dysrhythmias
Essential hypertension
SCIP

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15
Q

SCIP (surgical care improvement protocol)

A

Beta blockers within 24 hours

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16
Q

B1 selective agents

A

Atenolol
Metoprolol
Esmolol

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17
Q

How many beta receptors in myocardium are B1 specific?

A

75%
They don’t cause vasodilation

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18
Q

What B1 antagonists are hepatically cleared?

A

Propranolol
Metoprolol

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19
Q

Which B1 selective antagonist has active metabolites?

A

propranolol

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20
Q

Rank the B1 antagonists from shortest to longest elimination half-life

A

Esmolol
Propranolol
Metoprolol
Atenolol

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21
Q

Which B1 antagonist has high protein binding and what does this mean?

A

Propranolol
-small Vd

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22
Q

Propranolol’s B1 activity______B2 activity

A

equals

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23
Q

Propranolol________clearance of __________

A

decreases
opioids and amine LAs

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24
Q

Dose of atenolol

A

usually 5mg IV q10 minutes

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25
Why is atenolol useful in pre/post noncardiac surgery of CAD patients?
decreases myocardial ischemia for 2 years
26
How long does it take for esmolol to become effective?
5 minutes
27
What is the initial dose of esmolol?
20-30mg IV
28
Which drug prevents tachycardia and hypertension assoc with intubation?
29
Which medication is the most beta-1 selective?
Atenolol ## Footnote It is crucial when beta-2 agonist receptor activity is important.
30
What is the half-life of Metoprolol (Lopressor)?
3-4 hours ## Footnote It is usually dosed every 6-12 hours.
31
Which drug is a direct systemic arterial vasodilator?
Hydralazine ## Footnote It decreases intracellular calcium release.
32
What is the effect of Sodium Nitroprusside on vascular smooth muscle?
Relaxation ## Footnote It causes both arterial and venous relaxation.
33
Fill in the blank: The initial dose of Sodium Nitroprusside is __________ mcg/kg/min.
0.3 ## Footnote This can be titrated up to 2 mcg/kg/min.
34
What condition is treated with Esmolol during surgery?
Intraoperative noxious stimuli ## Footnote It helps to manage the cardiovascular response to intubation.
35
What is the mechanism of action for Calcium Channel Blockers?
Bind to receptors on voltage-gated calcium ion channels ## Footnote This decreases calcium influx and inhibits excitation-contraction coupling.
36
What is the primary use of sympathomimetics?
Increase myocardial contractility Increase SBP ## Footnote They are also used to increase systemic blood pressure.
37
Sympathomimetics lacking B1 specificity may:
- Cause intense vasoconstriction - Reflex-mediated bradycardia
38
Sympathomimetic MOA
- Activate directly or indirectly beta or alpha adrenergic G protein-coupled receptors - cAMP enhance calcium influx to the cytosol - Actin and myosin interact more forcefully
39
What is the only indirect-acting sympathomimetic?
Ephedrine
40
How do direct sympathomimetics work?
Directly activate adrenergic receptor
41
How do indirect sympathomimetics work?
Evoke the release of norepinephrine from postganglionic sympathetic nerve endings
42
Direct sympathomimetics
- Epi - Nrepi - Phenylephrine - Dopamine
43
Dose-dependent doses of epinephrine
1-2 mcg/min….beta-2 4 mcg/min….beta-1 10-20 mcg/min…. Predominately alpha
44
How long does a single bolus of epinephrine last?
2-8mcg bolus lasts 1-5 minutes
45
What is the initial IV dose of Hydralazine?
2.5 mg ## Footnote It is a direct vasodilator acting on systemic arteries.
46
Can ephedrine be given IM?
yes (50mg)....local vasoconstriction insufficient to delay uptake
47
What is the Preferred sympathomimetic for parturient?
Ephedrine....doesn't affect uterine blood flow Can be used for hypotension s/p SAB
48
Which medication can cause cyanide toxicity when used in high doses?
Sodium nitroprusside ## Footnote Cyanide accumulates due to methemoglobin exhaustion.
49
What drug class does Labetalol belong to?
Mixed Beta/Alpha Antagonists -- Selective alpha1, non-selective B1 and B2 antagonist effect ## Footnote It has selective alpha-1 and non-selective beta antagonist effects.
50
What is the beta:alpha blocking ratio of labetolol?
7:1 for IV form
51
Which beta blocker is used in the context of acute cocaine ingestion?
Propranolol ## Footnote It can help manage excessive sympathetic stimulation.
52
What is the effect of beta blockers on myocardial ischemia?
Protect myocytes from perioperative ischemia and infarction ## Footnote They decrease the risk of myocardial events during surgery.
53
What is the half-life of Esmolol?
0.15 hours ## Footnote It has a very short duration of action.
54
True or False: Beta antagonists can restore receptor responsiveness after desensitization.
True ## Footnote They can help in cases of tachyphylaxis.
55
Which medication primarily alters venous capacitance?
Nitroglycerin ## Footnote It is used for controlled hypotension and acute MI.
56
What is the maximum effect time for Labetalol IV dose?
5-10 minutes ## Footnote Its effects can last longer with repeated dosing.
57
How does labetalol decrease BP?
by decreasing SVR
58
Labetalol dose
2.5-5mg IV, may increase to 10mg d/t tachyphylaxis
59
Brand names for the following: Propranolol Atenolol Metoprolol Esmolol Labetalol
Inderal Tenormin Lopressor Brevibloc Normodyne/trandate
60
What is the effect of Calcium Channel Blockers on heart rate?
Decrease ## Footnote They slow conduction through the AV node.
61
What is the typical adult IV dose of Phenylephrine?
50-100 mcg ## Footnote It is a potent vasoconstrictor.
62
What is the primary action of Nitric Oxide in the body?
Inhibits calcium entry into smooth muscle and increases uptake by the endoplasmic reticulum ## Footnote It plays a role in cardiovascular tone relaxation.
63
True or False: nitric oxide is a cGMP chemical messenger
True
64
What is Nitric oxide involved in?
- Cardiovascular tone relaxation - Platelet regulation - CNS neurotransmitter - GI smooth muscle relaxation - Immune modulation - Pulmonary artery vasodilation
65
What is a bolus?
A specific amount of medication or fluid administered quickly.
66
What is an Albumin bolus?
A rapid administration of albumin to increase blood volume.
67
What does PRBC’s stand for?
Packed Red Blood Cells.
68
Vasopressin (ADH) MOA
stimulates vascular V1 receptors to cause arterial vasoconstriction Increases renal-collecting duct permeability (water is reabsorbed)
69
What hypotensions is vasopressin useful for?
- effective in reversing catecholamine-resistant hypotension - ACE-I resistant hypotension
70
What medications were administered for induction in the patient?
* Fentanyl 150 mcg * Propofol 140 mg * Vecuronium 10 mg
71
What is the MAP if the BP is 70/30?
Calculated MAP = (DBP + 1/3(SBP - DBP)).
72
What should be done first in response to the low blood pressure?
Administer a bolus of fluids or vasopressors.
73
What are the cardiovascular side effects of Vasopressin?
Coronary artery vasoconstriction.
74
What are gastrointestinal side effects of Vasopressin?
Stimulates GI smooth muscle leading to abdominal pain, nausea, and vomiting.
75
What are other side effects of Vasopressin?
* Decreased platelet counts * Antibody formation
76
Fill in the blank: The patient is intubated and on _______ ET 3% in 1L oxygen/1L air.
Sevoflurane
77
What happens when alpha-1 receptors are occupied by agonists?
- Increase synthesis of 2nd messengers: IP3 …increases Ca++ release from SR - Affect vascular smooth muscle - Determine arteriolar resistance, venous capacity and BP
78
What happens when alpha-2 receptors are occupied by agonists?
Decrease release of norepi from presynaptic nerve terminals (brain stem)
79
Does phenylephrine have more effect on venous or arterial constriction?
venous
80
How does phenylephrine compare to norepinephrine?
clinically mimics, but less potent and lasts longer
81
What is an adverse effect of phenylephrine?
reflex bradycardia
82
What causes of hypotension does phenylephrine treat?
- SNS blockade by regional anesthesia - Inhaled/injected anesthetics - Very useful in CAD and AS… no tachycardia - Commonly used both IVP and IV drip
83
How do nitro-vasodilators decrease systemic BP?
- Decrease SVR through arterial vasodilator - Decrease venous return which alleviates pulmonary/systemic congestion
84
Does sodium nitroprusside affect arterial or venous vascular smooth muscle?
Both
85
What kind of monitoring does sodium nitroprusside require?
-continuous administration -invasive arterial monitoring
86
What happens when sodium nitroprusside comes into contact with oxyhemoglobin?
dissociates immediately into methemoglobin and releases cyanide and NO
87
dose of sodium nitroprusside
0.3mcg/kg/min, max 2mcg/kg/min
88
Sodium nitroprusside uses
Controlled hypertension (aortic surgery, pheochromocytoma, spine surgery) Hypertensive emergencies
89
When to suspect cyanide toxicity with sodium nitroprusside
-Increasing doses needed -Increased mixed venous sats -metabolic acidosis -CNS dysfunction/change in LOC
90
Does nitroglycerin have tachyphylaxis effects?
Yes -dose dependent and duration dependent within 24 hours - Limits vasodilation - Drug free interval of 12-15 hrs reverses tolerance
91
Nitroglycerin Dose
5-10 mcg/min infusion and titrate
92
Nitroglycerin uses
Acute MI Controlled hypotension Sphincter of Oddi spasm Retained Placenta
93
Which CCB is selective for arteriolar beds?
Dihydropyrimidines
94
What channels do CCB bind to?
Voltage-gated Ca++ ion channels (L-type)
95
Cardiac Effects of CCB
-Decrease SVR and systemic BP -Increase coronary blood flow -Slow speed of conduction (especially through AV node)
96
Which CCB has the greatest coronary artery dilation?
nicardipine
97
Which CCB decrease HR?
verapamil and diltiazem
98
Dose of nicardipine
5mg/hr, max of 15mg/hr
99

Anesthesia Pharm Spring 25 (6 decks)

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