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Med Math / Pharm > week 9 heart&hyperBP meds > Flashcards

week 9 heart&hyperBP meds Flashcards

1
Q

cardiac output formula:
Blood Pressure formula:

A

= CO = SV X HR
= BP=(SV X HR) X SVR

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2
Q

Autorhythmic cell/ “slow leaking cell” RP:
AP:

A

= -60mV
= -40mV

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3
Q

Slow simple what leaking channels leads to autorhythmic AP

A

= Sodium

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4
Q

(autorhythmic cell) Voltage gated calcium channels open @mV?→ what influxxes rapidly—> + charge (depolarization)

A

= -40mV
= Calcium

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5
Q

(Autorhythmic cell) + charge (depolarization) makes cell/heart?→ repolarization→ what closes & what opens & effluxes:

A

= Cell/heart fires
= Ca channels close & K channel opens & efflexes

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6
Q

CALCIUM & sodium channel blockers can lead to what:

A

= Lethal dysrhythmias

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7
Q

Contractile Cell RP:
AP:
Depolarizes w/:

A

= -90mV
= -85mV
= SA node/ authorhythmic cell GAP JUNCTIONS

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8
Q

Contractile cell @-85mV what ion influxs:

A

= Sodium channel open and rapid efflux

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9
Q

(Contractile cell)Phase 0=
Phase 1=
Phase 2=
Phase 3= repolarization
Phase 4 refractory =
plateau=

A

= Gap junction
= early depolarization
= Ca+ channels open w/ K+ leaves “ + for -” Influx Ca thus contraction
= repolarization
= K+ Na+ pumps working
= phase 2 contraction

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10
Q

Enteric system:

A

= GI system operates w/o CNS

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11
Q

Heart pumps & holds ?mLs: usually 70mLs & heart holds 100-110mL

A

= usually 70mLs & heart holds 100-110mL

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12
Q

Chronotropy:
Dromotropy:
Inotropy:

A

= heart rate
= speed of heart electrical impulses
= strength of heart pump/squeeze

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13
Q

Sympathetic system touches what in heart:

A

= Left & Right Atriums, SA & AV Node, Ventricles (EVERYWHERE)

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14
Q

cell upregulation:

A

process of communication to cell to make cell membrane change channels (heart Ca+ channels)

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15
Q

alpha 2 receptors do:

A

= regulation of A1 / makes sure doesn’t over-constrict

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16
Q

Med/s used to treat hypertension categories:

A

= Diuretics
= ACE Inhibitors
= Calcium Channel Blockers
= Beta Blockers & Antiadrenergic Meds
= Direct Vasodilators

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17
Q

How do Diuretics decrease blood pressure?
3 different kinds of Diuretics:

A

= Causes excretion of water w/urine to reduce overall blood volume
= Loop Diuretics, Thiazides, K+ Sparring

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18
Q

(Furosemide) Classification
Action:

A

= Loop diuretic
= Blocks absorption of Na,Cl & water from kidney tubules, +output of urine.

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19
Q

(Furosemide) Indications:
Contraindications:

Adverse Effects:

A

= PTs w/>90-100 Acute pulmonary edema, Hypertensive emergencies
= Hypovolemia tension & kalemia & other suspected electrolyte abnormalities.
= May cause dehydration, May cause an acute electrolyte imbalance

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20
Q

(Furosemide) Adult Dose:
No response to 1st dose then 2nd dose:

A

= 0.5-1 mg/kg given over 1-2 minutes.
= double 1st dose to 2 mg/kg given slowly over 1-2 minutes.

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21
Q

(Captopril) Classification:
Pharmacodynamics:

A

= ACE Inhibitor
= Prevents production of angiotensin II by
inhibiting angiotensin converting enzyme (ACE) thus causes vasodilation & helps reduce the amount of water held back by the kidneys

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22
Q

(Captopril) Indications:
Contraindications:

A

= Severe CHF (w/ HTN) in conjunction w/ Nitrates & CPAP
= Pregnancy, Angioedema, Hypersensitivity to ACE inhibitors

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23
Q

(Captopril) Adverse Effects:
Dose:

A

= Allergic reaction, Dry cough, Dizziness, Taste changes (long term)
= 25mg PO

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24
Q

Angiotensin II Antagonist:
Effects:

A

= New classification of antihypertensive meds
= Same effect of ACE inhibitor w/o side effects of cough & angioedema

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25
Calcium Channel Blockers do what & where: Causes what to happen: Common Ca channel blocker w/ dose:
= block Ca channels & affects only smooth muscle of the arterioles. = Causes vasodilation & decreases systemic vascular resistance = Nifedipine 10mg
26
Beta-Blocker meds: Blocks β adrenergic receptors Cardio-Selective beta-blockers: Non-selective beta-blockers:
= Blocks β adrenergic receptors = Atenolol, esmolol, & metoprolol = Propranolol, nadolol, labetalol, & sotalol
27
Alpha Adrenergic meds: Effects: α2 Agonist: α1 Antagonist:
= Inhibits the release of NorEpi into the synapse = -Chronotropy & -Inotropy = Clonidine (Catapres) = Minipress
28
( Atropine) Classification: Pharmacodynamics:
= Parasympatholytic, 1st line med for syptomatic sinus bradycardia = selectively blocks muscarinic receptors inhibiting parasympathetic NS letting the sympathetic NS take over
29
( Atropine) Indications: Contraindications: Use w/ extreme caution in presence of & b/c: Doses <0.5 mg may result in & b/c:
=1st line med for symptomatic sinus bradycardia, Maybe beneficial in presence of AV nodal block, Organophosphate poisoning =Allergic to drug, Avoid in hypothermic bradycardia = MI & hypoxia – causes increased myocardial O2 demand = paradoxical heart slowing b/c small doses = parasympathomimetic
30
( Atropine) Adverse Effects: Dose for bradycardia (w/ or w/o ACS) severe clinical conditions dose: Organophosphate Poisoning dose:
= Blurred vision, Dry mouth, Dilated pupils, Confusion = 1 mg IVP every 3-5 Mins as needed, w/ max dose 0.04 mg/kg (3 mg) =Shorter intervals (3 mins)1 mg IVP w/ max dose 0.04 mg/kg (3 mg) = 2-4 mg (or higher) IVP
31
Vaughn-Williams Classification: Class I Medications: Class II Medications: Class III Medications: Class IV Medications: Miscellaneous:
= Antiarrhythmic med classifying = Sodium Channel Blockers: Lidocaine = Beta Blockers: Labetalol = Potassium Channel Blockers: Aminodarone = Calcium Channel Blockers: Diltiazem (atrial rhythms) = Adenosine attaches to adenosine recpetors & others
32
(Epi 1:10,000) Classification: Pharmacodynamics:
= Sympathetic agonist, Sympathomimetic = Powerful Alpha & Beta agonist
33
(Epi 1:10,000) Ind: Contra:
= Cardiac arrest , symptomatic bradycardia (drip), Normovolemic hypotension, severe anaphylaxis (impending cardiac arrest) = few, benefits outweigh risks
34
(Epi 1:10,000) Adverse effect: Adult Cardiac arrest dose: Adult hypotension/bradycardia dose: 2-10 mcg/min IV/IO infusion PEDI Bradycardia/Cardiac arrest dose: 0.01mg/Kg or 0.1mL/Kg PEDI Hypoperfusion & severe anaphylaxis dose: EPI infusion for above:
= palps, anxiety, tremors, H/A, dizziness, hypertension, tachycardia, can worsen cardiac ischemia, (ALWAYS PUT ON MONITOR) = 1mg IVP/IOP every 3-5mins = 2-10 mcg/min IV/IO infusion = 0.01mg/Kg or 0.1mL/Kg = 0.1-1mcg/kg/min infusion = Mix 1mg of EPI 1:10,000 into 1L IV bag fluid
35
(Dopamine) class: Action: A&B adrenergic agonist, rate dependent vasopressor, trophies
= (rate dependent ) sympathetic agonist = A&B adrenergic agonist, rate dependent vasopressor, +trophies
36
(Dopamine) indications: Contraindications:
= CHF, hypotension w/ shock signs, 2nd line med for symptomatic bradycardia (after atropine for adults), = bleeding out, shouldn't used in hypovolemic PTs until Vol replaced, known history of Pheochromocytoma (tumor adrenal Gs “opens Epi/Dop gates”), DONT MIX W/ SODIUM BICARB (crystalloids)
37
( Dopamine) Adverse effects: NEVER WHAT: Adult & PEDIs Dose: "REAL DOSE": "Cardiac dose": "Vasopressor dose":
= hyper/BP, palpitations, H/A, can worsen ischemia, tissue necrosis = OPEN WIDE OPEN = 2 – 20 mcg/kg/min (start at 5mcg & titrate to effect = 2-5mcg/kg/min = 5-10mcg/kg/min = 10-20 mcg/kg/min
38
(Dobutamine) Classification Action: Pronounced property:
= Synthetic sympathetic agonist “baby dopamine” = Alpha & Bet adrenergic agonist = Inotropic prop/s more pronounced than chronotropic properties
39
(Dobutamine) Indications: Contraindications:
= CHF w/ pump problems/ hypotension = shouldn't use in hypovolemic PTs until Vol replaced, DONT MIX W/ SODIUM BICARB
40
( Dobutamine) Adverse: Adult Dose: Pedi= 2-20mcg/kg/min
= hypertension, palpitations, H/A, can worsen ischemia, tissue necrosis = 2-20mcg/kg/min- titrate so HR don't increase >10% baseline = 2-20mcg/kg/min
41
(Norepi) best used for what PTs: Pharmacodynamics:
= PTs in septic shock = Alpha & Beta adrenergic agonist (Alpha effect more pronounced)
42
(NORepi) Indications: Contraindications: CANT MIX W/:
= Normovolemic hypo/BP, sepsis, cardio/ shock (usually too powerful) = shouldn't use in hypovolemic PTs until Vol replaced,tissue necrosis = SODIUM BICARB CAUSES CRYSTALLOIDS
43
(NorEpi) Adverse effects: Adult dose: Pedi dose:
= Hypertension, Organ ischemia, Cardiac arrhythmia, May cause tissue necrosis if extravasation occurs, Palpitations, Anxiety, N/V = 0.1-0.5 mcg/kg/min IO/IV infusion = 0.1-0.2 mcg/kg/min IV/IO infusion
44
Parasympathetic NS has cranial nerves:
3, 7, 9, 10
45
( Lidocaine) class: Pharmacodynamics:
= class Ib antiarrhythmic (Blocks sodium channel) = Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity
46
( Lidocaine) Indications: Contraindications:
= alt/ to Amiodarone in cardiac arrest from VF/pVT, stable monomorphic VT w/ preserved LVF left ventricle function (good BP) = PT already received IV Ca channel blockers, not given AMI setting prophylactically
47
(Lidocaine) Adverse Effects: Cardiac Arrest from VF/pVT Dose: For refractory VF dose: Perfusing Arrhythmia Dose: Maintenance Infusion Dose:
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension = 1-1.5 mg/kg IV/IO = may give additional 0.5-0.75 mg/kg IV 5-10 mins (Max dose 3mg/kg) = 1-1.5 mg/kg IV/IO = 1– 4 mg/min (30-50mcg/kg/min)
48
Autorhythmic cells beta blockers do what:
= down regulate & slows down repolarization (slower sodium influx)
49
(Labetalol) class: Action:
= beta blocker class 2 = slows HR by blocking adrenergic stimulation on B receptors
50
(Labetalol) Indications: Contraindications:
= high hyper/BP, 2nd med after Adenosine for SVF, A-Fib/Flutter w/ RVR (rapid ventricular response >150BPM) reduce MI in AMI PTs w/ +HRs = no admin in STEMIS, signs of heart failure, low cardiac output, increased risk of cardiogenic shock, hypotension, bradycardia, NO MIXING WITH CA BLOCKERS
51
(Labetalol) Adverse Effects: dose:
= Concurrent admin w/ IV Ca channel blockers can cause severe hypotension, bradycardia/heart blocks & CHF. = 10 mg IVP 1-2 Mins & may repeat every 10Mins (max dose 150 mg)
52
( Amiodarone) Classification: Class III antiarrhythmic Pharmacodynamics:
= Class III antiarrhythmic = Slows potassium efflux which delays repolarization.
53
( Amiodarone) Indications: B/c use associated w/ toxicity, amiodarone is indicated for: With expert consultation, amiodarone may be used for: Precautions: Terminal elimination is extremely long: Contraindications:
= VF/Pulseless VT unresponsive to shock CPR & Epi, Recurrent, hemodynamically unstable VT w/ pulse. = PTs w/ life-threatening arrhythmias & need appropriate monitoring = treatment of some atrial & ventricular rhythms = Severe life-threatening hypotension = half-life lasts up to 40 days = Allergic to med, Bradycardias w/ AV blocks, Breastfeeding mothers
54
(Amiodarone) Slow Infusion dose: VF/Pulseless VT, Cardiac Arrest no response to CPR, Shock & Epi Doses: Maintenance Infusion dose: Life-Threatening Arrhythmia Dosage:
= 360 mg IV over 6 hours (1 mg/min) = 1st Dose: 300 mg IVP push & 2nd Dose: 150 mg IVP if needed = 540 mg over 18 hours (0.5 mg/min) (Max dose per day 2.2Gs) = 1st Infusion of 150mg over 10 Mins (15 mg/min) 2nd Dose May repeat same dose every 10Mins if needed
55
(Diltiazem) Classification: Pharmacodynamics:
= Class IV Antiarrhythmic – Calcium Channel Blocker "Damn smurf" = Slows AP of autorhythmic heart cells by blocking calcium channels
56
(Diltiazem) Indications: Contraindications:
= 1st line med for A-Fib/Flutter w/ RVR (Usually >150 bpm), 2nd line med for SVT refractory to Adenosine = Hypotension (<90mmHg), CHF/Cardiogenic Shock, Wide-Complex Tachycardia, WPW, Hypersensitivity to med
57
(Diltiazem) Adverse Effects: 1st dose: 2nd dose:
= Hypo/BP, maybe CHF if used w/ Beta-Blockers, N/V/D, Dizziness, H/A = 0.25 mg/kg w/ (max dose 20 mg) = 0.35 mg/kg w/ (max dose 25 mg)
58
(Adenosine) Classification: Pharmacodynamics:
= Nucleoside, Miscellaneous Antiarrhythmic = Binds Adenosine A1 receptors causes K+ efflux & inhibits Ca influx (In autorhythmic cells) & Causes hyperpolarization of cells (SA/AV Node) thus Slows AV conduction w/ very short half-life
59
(Adenosine) Indications: Does not convert what: Contraindications:
= 1st med for stable narrow complex SVT, Regular & monomorphic wide-complex tachycardia thought from reentry SVT (SVT w/ BBB) = A-Fib or A-Flutter = A-Fib/Flutter, Torsades de Pointes, tachycardia from poison/drug, 2nd/ 3rd AVB, WPW
60
(Adenosine) Adult 1st Dose: 2nd Dose: Rapid flush best accomplished with: Side Effects: Reduce initial dose in half in PTs receiving/ed:
= 6 mg rapid IV/IO push followed by a rapid 20 mL flush of fluid = 12 mg rapid IV/IO push followed by a rapid 20 mL flush of fluid = utilizing a 3-way stopcock. = Period: Sinus-bradycardia, asystole, & ventricular-ectopy w/ admin = dipyridamole/carbamazipine, heart-transplant, or admin central line
61
RAAS Renin-Angiotensin Aldosterone System: step 1: step 2: step 3: Step 4: step 5: in short:
1. Kidneys: Detect low BP & release Renin to lover 2.Liver:makes angiotensinogen & converted by Renin to angiotensin1 3. Lungs & Kidneys: Angiotensin-Converting Enzyme (ACE) converts angiotensin1 to angiotensin2 4. Blood Vessels: Angiotensin2 causes vasoconstriction 5. Adrenal Glands:Angiotensin2 stim/s glands release aldosterone =Kidneys Aldosterone increases Na & water retention, raising BP & volume w/ vasoconstriction
62
Heart impulse starts @: goes through: step 3: Step 4: Step 5:
1. SA Node: Generates electrical impulses. 2. Intra-atrial Pathways: Backman's bundle Conducts impulses through atrium 3. AV Node/"gatekeeper": Delays impulse to allow ventricular filling 4. Bundle of His: Conducts impulses from AV node to the ventricles. 5. Purkinje Fibers: Distributes impulses to ventricles thus a contraction

Med Math / Pharm (8 decks)

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