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Emily: Pharm 2 > Quiz 2: Antihypertensives, Negative Inotropes, Negative Chronotropes. > Flashcards

Quiz 2: Antihypertensives, Negative Inotropes, Negative Chronotropes. Flashcards

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1
Q

Phenoxybenzamine (Dibenzyline) works on what receptor and is it an agonist or antagonist?

A
  • Alpha 1

- antagonist

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2
Q

Phenoxybenzamine (Dibenzyline) _________ binds to the receptor.

A

-irreversibly

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3
Q

What are the uses of Phenoxybenzamine?

A
  • Treat pheochromocytoma
  • Relieves ischemia for PVD
  • BPH to improve flow
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4
Q

T/F: Phenoxybenzamine does not cross the BBB.

A

FALSE

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5
Q

Phenoxybenzamine block serotoinin, _______, and cholinergic receptors.

A

-histamine

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6
Q

What are the side effects of phenoxybenzamine?

A

CNS: sedation, depression, tiredness, lethargy, headache
GI: N/V
CV: postural hypotension, tachycardia, arrhythmias

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7
Q

What is the half life of Phenoxybenzamine?

A

-24 hours

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8
Q

Phentolamine works at what recepotor and is it an antogonist or agonist?

A
  • Alpha

- Antagonist

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9
Q

What are the uses of Phentolamine?

A
  • HTN secondary to Pheochromocytoma
  • Clonidine withdrawal hypertension
  • Erectile dysfunction
  • EXTRAVASATION OF CATECHOLAMINES
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10
Q

Prazosin (Minipres) works at what receptor?

A
  • Alpha 1

- Antagonist

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11
Q

What are the uses of prazosin?

A
  • Vasodilates the arteries > veins
  • Increases HR
  • Increases urinary flow
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12
Q

What receptor does clonidine work on and is it an agonist or antagonist?

A
  • Alpha 2

- Agonist

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13
Q

What is the affinity of clonidine over the alpha 2 to alpha 1.

A
  • 220 to 1
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14
Q

Yes/No: Baroreceptors reflexes are preserved using clonidine.

A

Yes

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15
Q

What will happen with sudden discontinuation of clonidine?

A

-Excessive HTN, Tachy, Restlesness, insominia, headache, nausea

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16
Q

Half life of clonidine?

A
  • 9 to 12 hours
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17
Q

What will clonidine do for anesthesia?

A

-Reduce requirement of anesthesia drugs

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18
Q

What receptor does dexmedetomidine (precedex) use and is it an agonist or antagonist?

A
  • Alpha 2

- Agonist

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19
Q

What is the affinity of precedex over the alpha 2 receptor than the alpha 1 receptor?

A
  • 1620:1
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20
Q

Yes/No: Precedex can be used to inhibit post-op shivering

A

Yes

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21
Q

Precedex will cause N/V, fever, hypoxia in volunteer healthy adults, but a bolus will cause ______ and _______ as will an regular infusion will cause _____.

A
  • HTN
  • Bradycardia (Sinus arrest)
  • hypotension
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22
Q

What is the max amount of time to administer precedex IV.

A

24 hours

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23
Q

Methyldopa (Aldomet) is metabolized in the CNS to ___________.

A

methylepinephrine

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24
Q

Methylepinephrine acts on what receptor and is it a agonist or antagonist.

A
  • Alpha 2

- agonist

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25
What is methyldopa (Aldomet) used for:
-treat hypertension during pregnancy
26
What are the side effects of methyldopa:
- sedation - HA - dizzy - fluid retention - orthostasis - bradycardia - Dry mouth - positive Coombs test - impotence - bone marrow suppression
27
A.C.E. predominately ________ vasodilators.
arterial
28
What are A.C.E. inhibitors given to traet?
- CHF - MR by afterload reduction - Increase CO without a decrease in preload
29
What is the only ACE inhibitor injection?
enalaprilat
30
What will an ACE inhibitor do for a patient with HTN renal blood flow?
-It will decrease vascular resistance and increase GFR and RBF.
31
What type of renal patient would you avoid ACE inhibitors.
- decreased renal funcion | - renal artery stenosis
32
What are some side effects of an ACE inhibitor?
- Cough - rhinorrhea - angioedema
33
T/F: ACE inhibitor is suddenly stopped and patient is going through withdrawal. The patient S/S would be CHF, bronchospasm, hypokalemia, hyponatremia, and rebound hypertension.
FALSE
34
If ARF and Hyper K+ is seen with an ACE inhibitor what would be the next step?
Discontinue the drugs
35
Is it okay to use and ACE inhibitor during pregnancy?
NO
36
What are perioperative issues with ACE inhibitors.
- Hypotension | - Decrease in Glomerular perfusion pressure
37
What would you treat a hypotensive episode with a patient on an ACE inhibitor?
FLUID
38
What is the difference with Angiotensin 2 receptor antagonists than an ACE inhibitor?
- Less cough/angioedema | - no IV meds available
39
What drugs are Angiotensin 2 receptor antagonist?
- Losartan (Cozaar) | - Irbesartan (Avapro)
40
What is the function of calcium?
- Signal transduction (heart, CNS) - Muscle contraction - bone health - clotting cascade
41
What is the primary action of a calcium channel blocker?
- Negative inotropic effect - negative dromotropic effect (AV conduction block) - Vasodilation of systemic, splanchnic, coronary and pulmonary beds
42
What is phenylalkylamines. What drugs belong to this class and what are the indications?
- Calcium Channel blocker - Verapamil - Conversion of supraventricular (atrial) tachycardia and or coronary artery spasm
43
What is bensothiazines. What drugs belong to this class and what are the indications?
- Calcium Channel blocker - Diltiazem - Rate control of tachycardia, tachyarrhythmias, renal protection
44
What is dihydropyridines. What drugs belong to this class and what are the indications?
- Calcium Channel Blocker - Nifedipine, nicardipine, Nimodipine,Nitrendipine, Isradipine. - HTN, Afterload reduction, Cerebral vasospasm, ischemia, renal protection
45
What are some the qualities about dihydropyridines?
- Pure arterial vasodilator with minimal reflex tachycardia - minimal negative inotropic and dromotropic effects - used as an antihypertensive
46
Nicardipine (Class: Dihydropyridines) good qualities are:
- without negative inotropic or dromotropic effect - arteriole specific vasodilator - NO CORONARY STEAL SYNDROME - no rebound HTN with withdrawal - reflex tachycardia < 10 bpm
47
What are disadvantages of Nicardipine (Class: Dihydropyridines)?
- slow on/off onset - may accumulate - variable duration of action - hypotension - VENOUS IRRITATION MAY CAUSE TACYCARDIA
48
Clevidipine is a _____ ___ _____.
Calcium Channel Blocker (NEWEST OUT)
49
What are the advantages of clevidipine?
- Rapid on/off onset - no dose adjustment for renal/hepatic disease - no effect on preload - low potential for drug interaction
50
What is the disadvantage of clevidipine?
- Lipid emulsion - Continuous monitoring - contraindicated for egg and soy bean allergy, pancreatitis, and HLD
51
Verapamil is a negative ________, _________, and ________.
- inotrope - dromotrope - vasodilator (little effect)
52
What is verapamil used for?
- Aortic stenosis - IHSS - Conversion of atrial reentry tachyarrhythmias - Coronary artery vasospasm (Prinzmetal angina)
53
Where does Diltiazem (Cardizem) fit in the calcium channel blockers? And what is its used?
- Between Phenylalkylamine and dihydropyridines class. | - Rate control for ATRIAL Fib. and atrial tachycardia versus the conversion agent like verapamil.
54
What are the myocardial oxygen effects of verapamil and diltiazem?
Enhance myocardial oxygen balance by: - Decreasing afterload just a bit and negative inotropic effects - increase coronary O2 delivery through vasodiliation
55
Dihydropyridine vasodilator may worsen MvO2 by causing ________ hypotension and ______tachycardia (except ________).
- diastolic - reflex - nicardipine
56
Calcium channel blockers can be reversed if they cause ______, reflex _________ release and _________ activation leading to decreases in RBF and GFR.
- hypotension - catecholamine - angiotensin
57
T/F: Clevidipine reduces gastric emptying.
TRUE
58
T/F: Diltiazem decreases sedative effects of midazolam.
FALSE
59
Beta blocker actions decrease ____ (HR and contractility), decrease _______ release, and do ___ __________.
- C.O. - Renin - not vasodilate
60
What are the advantages of beta blockers over vasodilators?
- No reflex tachycardia - No widening of pulse pressure - Improved MvO2 - Intrinsic antiarrhythmic activity
61
What medications are beta 1 selevtive?
- Metoprolol - atenolol - acebutolol - bisoprolol - esmolol
62
What medication are non selective beta?
- Propranolol - Nadolol - Timolol - Pindolol - Carteolol
63
What drugs are alpha 1 and nonselective beta?
- Carvedilol | - Labetalol
64
Beta 1 blocker do what?
- decrease velocity of AV conduction - HR - contractility, - renin release - lipolysis
65
Non-selective beta blockers do what?
- bronchoconstriction - peripheral vasoconstriction - decrease glycogenolysis
66
What are the drug names, beta selectivity, and elimination route of a long acting beta blocker?
NAME - nadolol (nonselective) - atenolol (selective) ELIMINATION ROUTE Kidney
67
What are the drug names, beta selectivity, and elimination route of a intermediate acting beta blocker?
NAME - Propranolol (nonselective) - Metoprolol (selective) ELIMINATION ROUTE -Liver
68
What are the drug names, beta selectivity, and elimination route or a ultra short acting beta blocker:
NAME - Flestolol (Nonselective) - Esmolol (Selective) ELIMINATION ROUTE -Red Cell esterase
69
The lipophylicity of beta blockers are:
LOW: Acebutolol, Atenolol, Bisoprolol, Carteolol, Nadolol MODERATE: Metoprolol, Pindolol, Coreg, Labetalol HIGH: Penbutolol, Propranolol
70
Overdose of Beta Blockers would be treated with:
- Atropine - Isoproterenol, dobutamine, and/or glucagon infusion - Pacing
71
Verapamil will decrease heart rate and _______.
contractility
72
Digoxin will decrease heart rate and _______.
conduction
73
What are the contraindication of beta blockers?
- Sever bradycardia - > 1st degree heart block - cardiogenic shock - Raynaud's disease CAUTION - astma/copd - diabetes - heart failure
74
T/F: Propranolol is or is not a lipid soluble and can or cannot penetrate the BBB?
- Lipid soluble | - Does penetrate BBB
75
If you wanted to blunt the cardiovascular response to intubation what beta blocker would you use?
Esmolol (Brevibloc)
76
T/F: Esmolol is more likely to convert A. Fib. to NSR than verapamil.
TRUE
77
Esmolol can be used in intraop and postop ____ and _________.
- HTN | - Tachycardia
78
What is Metoprolol (Lopressor,Toprol) approved to treat?
- angina | - acute MI
79
Labetalol combines weak ____ blockade with a weak ____________ beta blockade.
- alpha | - non-selective (Beta:Alpha = 7:1)
80
Labetalol provides an effective antihypertensive action by doing a _______ inotrope and chronotrope with ______________.
- negative | - vasodilitation
81
T/F: Labetalol increases ICP.
FALSE
82
What are the indications for labetalol?
- hyperdynamic HTN - Aortic dissection - tachyphylaxis with SNP
83
What would be adverse effects of Labetalol?
- unwanted negative inotropy - prolonged duration with high dose - Bronchospasm in high dose - Acute hyperkalemmia in renal failure - Rewarming a post op hypothermic patient
84
T/F: Beta blockers may mask hypoglycemia and hyperthyroidism.
TRUE
85
T/F: Anticholinesterases will not increase bradycardia.
FALSE
86
What is the line of therapy for patient with intraop HTN:
1. Beta blocker 2. vasodilation 3. Calcium channel blockers. 4. Diuretics 5. Alpha 2 agonist 6. ACE inhibitor
87
When can beta blockers be used in pregnancy?
- 2nd and 3rd trimester | - if used in 1st trimester can cause growth retardation
88
What is the most favorable antihypertensive in pregnancy?
alpha-methyldopa
89
When can you use ACE inhibitor in pregnancy?
NEVER
90
When can hydralazine be used during pregnancy?
ONLY during delivery
91
How should nifedipine be used in pregnancy?
P.O. route only.
92
How fast should you drop HTN crisis in a patient?
No more than 25% within the first few hours
93
What is a emergency HTN:
- SBP > 180 | - DBP > 120
94
What would be examples hypertensive urgencies and emergencies of target organ damage?
- Encephalopathy - ICH - Unstable angina - acute MI - Acute LV failure with pulmonary edema - Dissecting aortic aneurysm - Eclampsia

Emily: Pharm 2 (11 decks)

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