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Week 140 - Collapse > Vascular Pharmacology > Flashcards

Vascular Pharmacology Flashcards

0
Q

What type of antibiotic would you prescribe for a Staph. Pneumoniae (strept. Group A + B infection?

A

Benzyl penicillin or Amoxicillin

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1
Q

What type of antibiotic would you prescribe for a Staph. aureus infection?

A

Flucloxacillin (May add Fusidic acid or Gentamycin)

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2
Q

What type of antibiotic would you prescribe for an Enterococcus infection?

A

Amoxicillin

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3
Q

What type of antibiotic would you prescribe for an E. coli infection?

A

Cefuroxime

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4
Q

What type of antibiotic would you prescribe for a pseudomonas species infection?

A

Ciprofloxacin/Ceftazidine/Gentamycin

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5
Q

What type of antibiotic would you prescribe for a N. Meningitidis infection?

A

Cefotaxime/Benzyl penicillin or Chloramphenicol

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6
Q

Which blood vessels experience the greatest drop in resistance to blood flow?

A

Arterioles

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7
Q

What generalised affect do vascular dilators have on vasculature?

A

They act to relax smooth muscle in arteries and / or veins

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8
Q

What vasodilator is used in the treatment of angina?

A

GTN

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9
Q

Give examples of the major groups of vasodilatory drugs?

A

ACE inhibitors; Beta Blockers; Ca2++ Blockers; Nitrates; alpha1 Blockers

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10
Q

What action is desirable from a drug treating heart failure?

A

One which lowers stroke volume and therefore cardiac output (gives it less work to do)

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11
Q

What has Mg++ recently been noted to act well as?

A

A vasodilator

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12
Q

What does the Frank Starling curve demonstrate?

A

Stroke volume against preload; the more the ventricles fill the greeter the stroke volume (until ventricles become overstretched - then there’s rapid decline in stroke volume)

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13
Q

What are the main general indications for vascular dilators?

A

Hypertension
Left ventricular failure (or cardiogenic shock; to reduce preload or afterload)
Angina
Cardiac arrest; anaesthesia

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14
Q

What is the common final pathway in vasodilatory drugs?

A

Nitric Oxide

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15
Q

What are the main two classifications of vascular constricting drugs?

A

Catecholamines and non-catecholamines

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16
Q

What are the major catecholamines?

A

Adrenaline, noradrenaline and dopamine (phenylephrine is synthetic)

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17
Q

What are the two main non-catecholamine vascular constrictors?

A

Angiotensin and vasopressin

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18
Q

On what receptors does adrenaline act?

A

Alpha and beta, as an agonist

19
Q

In low doses what affect does adrenaline have in the body?

A

Increases HR - acting as beta-1 agonist

bronchodilation - acting as beta-2 agonist

20
Q

In high doses what affect does adrenaline have in the body?

A

Acting as an alpha1 agonist causes vasoconstriction, increasing BP

21
Q

When should noradrenaline be administered in vascular treatment?

A

When an ITU specialist is treating; to rescue seriously low BP (potent vasoconstrictor!)

22
Q

What do alpha-1 receptors do when activated?

A

1) Vasoconstrict blood vessels of skin, GIT, kidney & brain
2) Contract smooth muscles of ureters, vas deferens, urethral sphincter, uterus & ciliary body (mydriasis)
3) stimulate glucose metabolism

23
Q

What do Beta-1 receptors do when activated?

A

1) Heart: Increase HR, pulse conduction, contraction, ejection fraction
2) Kidneys: increase renin release by juxtaglomerular cells
3) Stomach: increasing ghrelin release and therefore hunger

24
Q

What do Beta-2 receptors do when activated?

A

1) smooth muscle relaxation: bronchus, bronchioles, uterine muscle
2) contraction of urethral sphincter
3) increase renin release by juxtaglomerular cells
4) glucose metabolism
5) lipolysis and thickened salivary secretion

25
Q

What is the method of action of GTN?

A

It produces nitric oxide > increases cGMP > reduces Ca++ > vasodilatation and reduced venous return > reduces preload and myocardial O2 demand > increases coronary blood flow

26
Q

What is LVF?

A

Left ventricular failure occurs when the LV is overwhelmed by fluid and has lost its contractility power to eject blood adequately

27
Q

What does angina concern?

A

Coronary artery blood flow - when reduced ischaemia and chest pain can result

28
Q

A patient comes to MAU with widespread patchy red/purple markings on their skin. HR 110, Temp 38.2, RR 22 and BP 60/40. How would you manage them?

A

Call for help - ITU
ABCDE
Broad spec ABs immediately and fluid resus
Increase BP with vasoconstrictors to improve perfusion

29
Q

An 18 male is rushed in to A&E with swollen lips, puffy face and stridor. HR 100, BP 70/49. How do you manage this?

A

500 microgram IM adrenaline
ABCDE
Continue to monitor closely for next 12-24 hours

30
Q

A known hypertensive pregnant lady of 32 weeks gestation present with severe upper abdo pain, deranged LFTs and low platelet count. She has noticed swelling of her hands, feet and face in the past couple of days. What does she have and how do you treat her?

A

Pre-eclampsia.

Deliver the baby and control her BP

31
Q

A woman is brought in with drowsiness, malaise and abdo pain. RR 20, HR 84, BP 76/40. O/E you notice dark red patches on her oral mucosa and palmar erythema. What is she likely to have and how do you treat?

A

Primary Addison’s Disease (hyperpigmentation and drowsiness). Give her a 500mL bolus of fluid (preferably containing glucose to increase her energy levels)

32
Q

A man is brought in to MAU following a collapse and short seizure. He has not regained consciousness. HR 32, RR 8, BP 200/100. How do you manage him?

A

Head tilt-chin lift
Call for help
Maintain airway and give high flow O2
Gain IV access but withhold Tx until more info
Check blood glucose and pupils
Request urgent CT head with airway protection

33
Q

Why would you not treat a very high BP (e.g. 200/100) accompanied by low RR and low HR without obtaining a CT head first?

A

Could be Cushing’s reflex which increases BP in an attempt to perfuse the brain (occurs commonly following head trauma). If you reduce the blood pressure you will reduce intracranial perfusion and likely kill the patient.

34
Q

A man comes to A&E with trauma to his right shoulder/neck. He bled at the scene of injury but it has since stopped. He is talking to you with a BP of 80/50. How do you manage?

A

ABCDE

Treat the injury if CNS adequate. He is talking to you so BP must also be adequate for now. Get him to surgery.

35
Q

How do thiazides diuretics reduce BP?

A

Reduce blood volume, venous return and cardiac output. Output returns to normal but reduced peripheral resistance has been achieved by this point due to persistent reduction in body Na+

36
Q

What are the possible side effects of thiazides diuretics?

A

Hypokalaemia, diabetes mellitus and gout

37
Q

How do beta-blockers reduce BP?

A

Decreases cardiac output by reducing contractility of the heart.
Again this returns to normal but peripheral resistance has been ‘reset’ to a lower level in the meantime.

38
Q

Name 4 major vasodilator drug groups?

A

ACE inhibitors (e.g. Ramipril / lisinopril)
Angiotensin receptor antagonists (e.g. Losartan)
Calcium-channel blockers (e.g. nifedipine / amlodipine)
Alpha-1 adrenoceptor antagonists (e.g. Doxazosin)

39
Q

How do ACE inhibitors work?

A

They inhibit the conversion of angiotensin I to angiotensin II therefore reducing the vasoconstricting effect of angiotensin II

40
Q

What is the most common side effect of ACE inhibitors?

A

Dry cough

41
Q

Why might a GP change a patients BP medication from ACE inhibitor to an angiotensin receptor antagonist?

A

Does not cause cough

42
Q

How do Calcium-channel blockers work?

A

Bind to L-type channels blocking entry of Ca++ into cell causing relaxation of arteriolar smooth muscle

43
Q

What are the more common side effects of calcium-channel blockers?

A

Dizziness, hypotension, flushing and ankle oedema (caused by excessive vasodilation)

44
Q

Where and how does Methyldopa act?

A

Centrally.
Converts to alpha-methynorepinephrine in adrenergic nerve endings which stimulates alpha-2 receptors in the medulla and reduces sympathetic outflow

45
Q

What is the most common side effect of Methyldopa?

A

Drowsiness (20% of patients)

Week 140 - Collapse (3 decks)

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