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Nurs 575 Anesthesia Pharmacology > Vasodilators/Antiarrhytmic/Diuretics > Flashcards

Vasodilators/Antiarrhytmic/Diuretics Flashcards

(105 cards)

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1
Q

Calcium Channel Blocker (CCB) Mechanism of Action

A

Inhibit Ca2+ influx through L-type Ca2+ channels in vascular smooth muscle

  • Arterial specific
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2
Q

Nicardipine Drug class & Dosing

A

Dihydropyridine CCB

  • Bolus: 100-400mcg
  • Infusion: 5-15mg/hr
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3
Q

Nicardipine Onset/Half-life/Metabolism

A
  • Onset: 2-10 min
  • Half-life: 2-4 hrs
  • Liver
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4
Q

Clevidipine Drug class & Dosing

A

Dihydropyridine CCB
Infusion: 1-16mg/hr

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5
Q

Clevidipine Onset/Half-life/Metabolism

A
  • Onset: 2-4 min
  • Half-life: 1 min
  • Plasma esterases
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6
Q

Hydralazine Onset/Half-life/Metabolism

A
  • Onset: 5-20min
  • Half-life: 2-8hrs
  • Hepatic
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7
Q

Hydralazine Drug class & dosing

A

Arteriolar Dilator
5-20mg IV Bolus

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8
Q

Fenoldopam Drug Class & Dosing

A

Dopamine type 1 agonist

  • Infusion: 0.05-1.6mcg/kg/min
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9
Q

Fenoldopam Onset/Half-life/Metabolism

A
  • Onset: 5-10 min
  • Half-life: 5 min
  • Hepatic
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10
Q

S/E of Fenoldopam

A
  • Increase in HR (baroreceptor) & catecholamines
  • Increase IOP pressure don’t give with glaucoma
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11
Q

Sodium Nitroprusside Drug class & Dosing

A

NO donor

Infusion: 0.25-4mcg/kg/min

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12
Q

Sodium Nitroprusside Onset/Half-life/Metabolism

A

Onset: 1-2min
Half-life <10min
Erythrocytes & hepatic

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13
Q

S/E of Nitroprusside

A
  • Baroreceptor reflex tachycardia
  • Coronary steal -> Inc. MI damage area
  • Cyanide Toxicity
  • Methemoglobinemia
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14
Q

Clinical use of SNP?

A
  • Use significantly declined
  • Controlled HoTN
  • HTN emergency
  • Ao. & Cardiac Surgery
  • HF
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15
Q

Nitroglycerin Drug class & Dosing

A

NO donor

  • Bolus: 20-400 mcg
  • Infusion: 10-400 mcg/min
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16
Q

Nitroglycerin Onset/Half-life/Metabolism

A

Onset: 1-2min
Half-life: 1-3 min
Hepatic/Erythrocytes/vascular walls

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17
Q

Hepatic dysfunction pts receiving Nitroglycerin are @ high risk for what?

A

High dose -> methemoglobinemia

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18
Q

Clinical use of Nitroglycerin

A
  • Most common use: Angina Pectoris (IV/sublingual)
  • MI
  • Controlled HoTN (tolerance is problem)
  • Not for Ao. Stenosis or HCM
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19
Q

Should chronically administered antiarrhytmics be taken up until induction? Why or Why not?

A

Should be continued up to induction

  • Pose little threat to anesthesia
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20
Q

Catheter ablation techniques are the preferred treatments for what arrhythmias?

A
  • Supraventricular arrhythmias
  • Afib/flutter
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21
Q

When might pharmacologic management of arrhythmias be appropriate?

A
  • Suppression of Afib/flutter not responsive to catheter ablation
  • Pts with AICDs who be getting zapped alot
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22
Q

What are the two physiological mechanisms by which ectopic cardiac arrhythmias occur?

A
  • Reentry
  • Enhanced automaticity
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23
Q

What factors that facilitate arrhytmias may be encountered perioperatively?

(7)

A
  • Hypoxemia
  • Electrolyte imbalance
  • Acid/Base abnormalities
  • Myocardial ischemia
  • Altered SNS activity
  • Bradycardia
  • Certain drugs
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24
Q

How do antiarrhythmic drugs exert their pharmacological effects?

A

Blocking passage of ions across ion channels in the heart

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25
Which ions may be blocked by antiarrhythmics?
* Na+ * K+ * Ca2+
26
What factors determine the clinical effects of antiarrhythmics?
Their effects on: * Action potentials * Effective refractory period
27
Grouping of antiarrhythmics are based on what two abilities?
* Control of arrhythmias by blocking specific ion channels * Altering currents during the action potential
28
What historical use is lidocaine no longer recommended for?
Prophylaxis for pts presenting with an early MI without ventricular ectopy
29
What is a common complication after heart surgery that is associated with prolonged hospitalization & CV morbidity?
A fib
30
Prophylactic treatment of Afib with what drugs is effective in reducing what?
Drugs: * Amiodarone * b blockers * Sotalol * Magnesium Effective in reducing: * Afib occurrence * Length of hospital stay * Cost of tx * risk of stroke
31
When is the benefit of antiarrhythmics clear?
Results in termination of a sustained tachycardia
32
What class is Quinidine? Arrhythmias it treats?
Class IA * Acute/Chronic SVT * SVTs associated with WPW (quite effective)
33
Would you treat a patient in SVT with quinidine? Why or why not?
No, it is rarely used because of its side effects
34
MoA of Quinidine
* Decreases slope of phase 4 depolarization * via suppression enhanced automaticity
35
Where is Quinidine metabolized? Eliminated?
* Hydroxylated in Liver * Inactive metabolites in urine
36
Side effects of Quinidine
* Heart Block * HoTN * Proarrhythmia effects
37
Class of Procainamide? Arrhythmias it treats?
Class IA: * V. tachyarrhythmias > A. tachyarrhythmias, compared to quinidine * pSVT * PVCs
38
How is procainamide metabolized? What can this effect?
* Via acetylation by N-acetyltransferase enzyme * Genetically determined -> Rapid acetylation = Half-life 2.5 hrs * Slow acetylators = 5 hrs
39
S/E of Procainamide?
* HoTN r/t myocardial depression > vasodilation * Chronic use -> lupus erythematosus like syndrome
40
Like qunidine, Procainamide use has what?
Decreased due to: * Side effects * Availability of newer agents
41
Antiarrhythmic strengths & weaknesses of Lidocaine?
* Suppression of V. arrhythmias * minimal (if any) effect on SVTs
42
Class of Lidocaine & advantages over IA?
Class IB: * Rapid onset/offset * Reduced S/E profile * Greater therapeutic index
43
Clinical effect of Lidocaine?
* Decreases rate of spontaneous depolarization in ventricular cells -> decreases PVCs * Not so much in atrial cardiac cells
44
Clinical use of Phenytoin as an antiarrhythmic
* Suppress V. arrhythmias r/t digitalis toxicity * pVT * TDP
45
Dosing of Phenytoin
* 100mg (1.5mg/kg) q 5 min until arrhythmia controlled * or 10-15mg/kg (1000mg MAX)
46
Which drug has more of an effect on QTc? Phenytoin or Lidocaine?
Phenytoin * shortens QTc more than any other antiarrhythmic
47
What are some concerns about co-administration of Phenytoin and Volatile anesthetics?
Phenytoin depresses SA node * Volatile Anesthetics depress SA node too
48
S/E of Phenytoin?
* Toxicity causes CNS disturbances * Inhibits insulin secretion * Bone marrow suppression -> Leukopenia, granulocytopenia, & thrombocytopenia
49
Symptoms of Phenytoin CNS toxicity?
* Ataxia * Nystagmus * Vertigo * Slurred Speech * Confusion
50
What is Flecanide and what does it treat?
Class IC antiarrhythmic * Treats PVCs & VT > quinidine & procainamide * Treats A. tachyarrhythmias
51
S/E of Flecanide
* Proarrhythmic w/ LV dysfunction * Prolonged QRS & depress SA node function (NO Heart blocks) * **Dose-dependent blurred vision** * **Increases threshold potential of PPMs**
52
Most Common non-cardiac adverse effect of Flecainide?
Dose dependent blurred vision
53
Flecainide's effects on PPMs?
Increases the capture threshold
54
Class of Propafenone and effects?
Class IC * Supresses V. & A. tachy arrhythmias
55
S/E of Propafenone?
* Depress myocardium * AV Block * BBB * SA node slowing
56
What dysrhythmias are b-blockers effective at treating
Cardiac arrhythmias r/t enhanced activity of the SNS
57
Which β-blockers are approved for prevention of sudden cardiac death following MI?
* Acebutolol * Propanolol * Metoprolol
58
Propanolol may be effective in controlling what arrhythmias?
TDP for pts w/ prolonged QTc
59
Class of Amiodarone and treated arrhythmias?
Class III (K channel inhibitor) * V. Tachyarrhythmias * Refractory SVTs * V-tach/Vfib resistant to defibrillation * WPW tachyarrhythmias
60
Preoperative oral administration of Amiodarone decreases the incidence of what?
Atrial fibrillation post cardiac surgery
61
Mechanism of action of Amiodarone?
Non-competitive a and b blockade * Prolongs refractory period in all cardiac tissues * Dilates coronary arteries -> antianginal
62
Half-life of Amiodarone?
29 days
63
Side effects of Amiodarone | 8
* Pulmonary alveolitis * QTc Prolong * HR slowing resistant to atropine * Corneal Microdeposits * Optic neuropathy * Neurologic toxicity * Inc. plasma transaminase * Fatty liver infiltration
64
What drugs are Class IV antiarrhythmics, what do they do?
CCBs or inhibit slow Ca2+ channels * Verapamil * Diltiazem
65
What arrhythmias is Verapamil effective in treating?
* pSVT * reentrant tachycardia * Afib/Flutter by controlling V. rate
66
Dose of Amiodarone for defibrillation resistant Vfib/Vtach?
300 mg IV
67
Dose/dosing of verapamil for pSVT?
75-150 mcg/kg over 1-3 min * Follow by 5mcg/kg/min infusion
68
Administration of what drug and dose to reduce Verapamil induced HoTN? When do you give it?
1gm IV of Calcium gluconate * 5 min before
69
Verapamil/Diltiazem Mechanism of Action?
Inhibit flux of Ca2+ across slow channels in vascular/cardiac smooth muscle * Decreased rate of spontaneous (phase 4) depolarization
70
Verapamil/Diltiazem S/Es?
* AV HB in pts w/ pre-existing conduction defects * Myocardial depression -> Dec. CO * Vasodilation -> HoTN * Effects of NMB exaggerated
71
What arrhythmias are Digitalis preparations effective treating?
Atrial tachyarrhythmias via Atrial stabilization
72
What patients might you want to avoid Digitalis in? Why?
Wolf-parkinson-white syndrome * enhances conduction through acessory bypass tracts * Increases ventricular response rate
73
Dosing of Digitalis?
0.5 - 1 mg over 30 min-1 hr
74
Most common sign for Digitalis toxicity?
May manifest as any arrhythmia but most commonly atrial tachycardia w/ block
75
Adenosine clinical action & arrhythmias treated?
Slows conduction of cardiac impulses through AV node * Alternative of CCBs for pSVT * WPW syndrome
76
What arrhythmias is Adenosine poor at treating?
* Afib * Aflutter * ventricular tachycardia
77
Dosing of Adenosine
6mg IV May repeat 3 min later with 6-12mg IV
78
Adenosine mechanism of action?
Stimulates cardiac adenosine1 receptors to increase K+ currents * Shortens action potential duration * hyperpolarize cardiac cell membrane
79
S/E of Adenosine?
* Transient AV HB * Bronchospasm after IV administration
80
How do **most** diuretics exert their effects?
Block Na+ reabsorption in differeent locations of the nephron * Increases Na+ delivery to distal tubules
81
Loop diuretics are first-line therapy in what population
Pts w/ fluid retention with HF
82
Maximum dose of Furosemide in pts w/ normal renal function?
40mg IV will produce max naturiuresis
83
How do loop diuretics manage hypertension?
By their effects on fluid volume & Salt excretion
84
Is Furosemide or Mannitol more effective in managing ICP?
Combination of Furosemide & Mannitol most effective in decreasing ICP compared to each drug alone
85
How does Furosemide lower ICP?
* Systemic diuresis * Decrease CSF production
86
Furosemide dosing? With Mannitol?
0.5-1.0 mg/kg IV * 0.1-0.3 mg/kg w/ Mannitol
87
S/E of Furosemide?
* Hypokalemia * Tolerance * HoTN * Exacerbation of Renal ischemic injury
88
Loop diuretics increase renal concentrations of what drugs? What effect is this?
Aminoglycosides (gentamycin, tobramycin, neomycin) & Cephalosporin * nephrotoxic effects
89
What drugs are potentiated by Loop diuretics?
ND NMBs
90
What is a transient or permanent, but rare, side effect of Loop Diuretics?
Ototoxicity that is dose-dependent
91
Thiazide diuretics are most often recommended and administered for what disorder?
Long-term treatment of essential HTN
92
What effects are synergistic in the treatment of essential HTN?
Combination of: * Diuresis * Natiruresis * Vasodilation
93
Where does the sustained control of HTN in Thiazide diuretics come from?
Peripheral vasodilation that requires several weeks of therapy to develop
94
Describe osmotic diuretics
Inert substances that do not undergo metabolism & are freely filtered @ the glomerulus
95
What drugs are osmotic diuretics?
* Mannitol * Urea * Isosorbide * Glycerin
96
Mechanism of Action of Osmotic Diuretics?
* Increased plasma & renal tubular fluid osmolality * Results in osmotic diuresis
97
Which osmotic diuretic is the only one in use?
Mannitol
98
Describe Mannitol's structure?
6 carbon sugar alcohol that does NOT undergo metabolism
99
Primary uses of Mannitol?
* Acute elevation of ICP * Tx of Glaucoma
100
What is required for cerebral effects of mannitol?
Intact blood-brain barrier
101
What are you worried about if the blood-brain barrier isn't intact with Mannitol administration?
It may enter the brain while drawing fluid with it * worsening of the cerebral edema
102
What additional benefit does Mannitol exert on the body? what can this benefit do?
Scavenges free-radicals * Protects the kidneys
103
What has Mannitol NOT been shown to prevent?
Perioperative renal failure in cardiac & major vascular surgery
104
Which diuretic may be preferred in patients with increased ICP & LV dysfunction?
Furosemide
105
Long term effects of Mannitol?
* Hypovolemia * Hypokalemic/hypochloremic alkalosis * Plasma hyperosmolarity 2/2 Na+ & H2O excretion

Nurs 575 Anesthesia Pharmacology (18 decks)

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