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195 Cards in this Set
- Front
- Back
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Glycopyrrolate
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Cholinergic Antagonist
- IV: used to dry up secretions |
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Succinycholine
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Depolarizing NMB
Tx: 1. 1st anaesthetic for surgery!! Side: malignant hyperthermia(105F) - Rapid: 5 - 10 minute t1/2 |
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Dantrolene
MOA |
Non-depolarizing NM blocker:
MOA: inhibits calcium fluxing Tx: 1. Malignant hyperthermia (comp. of succinylcholine) 2. Muscle spastisity 3. MS (last line) |
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Neuromuscular blockers (NMBs)/Skeletal Muscle Relaxants (SMRs)
- MOA |
MOA:
-Depolarizes at NMJ "TWITCH" |
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Adrenergic System
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Definition 5
Sympathetic nervous system -NT at R: acetycholine also: NE & epi |
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Sympathetic NS neurotransmitter?
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-NT at R: acetycholine
also: NE & epi |
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Norepinephrine
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Adrenergic Direct Agonist
alpha-1: STRONGEST VASOCONSTRICTOR!!!!!!!!!!!! beta-1: increases HR - GI & blader sphincters??? |
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Epinephrine
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Adrenergic Direct Agonist:
alpha-1: vasoconstrictor beta-1: increase HR & CO **STRONGEST!!!!!!!!!!!!!!!! beta-2: bronchodilator & vasodilate |
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Phenylephrine
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Adrenergic Direct Agonist:
alpha-1: vasoconstrict (increase BP) *Stuffy Nose --USE ONLY if heart is FINE! |
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Clonidine
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Adrenergic Direct Agonist:
alpha-2: inhibits symp NS by negative feedback Tx: 1. Hypertensive URGENCY! **3 or 4th line b/c multiple times a day, unless use a patch! 2. Alcoholic w/draw (reduce tremors) 3. Psychiatric Side: dry mouth w/ beta blockers can cause orthostatic HTN |
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Dobutamine
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Adrenergic Direct Agonist:
INOTROPE (contractility of heart) IV beta-1: DECOMPENSATED Heart failure!!! **STRONG increase HR beta-2: NOT bronchodilator |
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Terbutaline
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Adrenergic Direct Agonist:
beta-2: - bronchodilator - uterine muscle relaxant (slow labor) |
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Dopamine
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Adrenergic Agonist:
IV! beta-1: -increase HR alpha1: -increase BP (vasoconstrict) **Make sure patient is hydrated TX: DECOMPINSATED HEART FAILURE!!!! |
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Ephedrine
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Indirect Adrenergic Agonist
Tx: increase BP (vasoconstrict) |
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Amphetamine
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Indirect Adrenergic Agonist:
Tx: ADD, weight loss |
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Adrenergic Antagonist
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Competitve antagonist: block agonist at the receptor
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Bethanechol
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Cholinergic Direct Agonist:
Tx: Makes bladder contract & glaucoma Side: GI - diarrhea - back off on dose |
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Methacholine
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Cholinergic Direct Agonist:
Diagnostic: to test for Asthma "attack" |
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Pilocarpine
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Cholinergic Direct Agonist:
Tx: 1. Glaucoma (eye drops) 2. Sjorgan's syndrome (drymouth) via sublingual |
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Edrophonium
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Diagnostic for: Myasthenia Gravis
Side: if you don't have M.G. can cause - urinary or GI obstruction |
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Pyridostigmine
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Acetylcholinesterase Inhibitor
PO Tx: M.G. |
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Physostigmine
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Acetylcholinesterase Inhibitors
Reverse neuromuscular block after surgery (from anesthesia) |
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Atropine
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Cholinergic Antagonist
IV Tx: -DOC = speads up HR (during CRASH) -Dries secretions for diagnostics |
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Benztropine
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Cholinergic Antagonist:
Tx: adverse effects of otehr drugs increasing Ach in CNS Side: dry mouth & delirium |
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Trihexyphenidyl
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Cholinergic Antagonist:
Tx: Adverse effects of other drugs that increase Ach in CNS Side: dry mouth & delirium |
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Dicyclomine
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Cholinergic Antagonist:
Tx: Irritable Bowel Syndrome Side: Urinary retention and dry mouth |
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Ipratropium
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Cholinergic Antagonist:
Inhalant: Tx: decrease secretions in COPD!!! |
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Tiotropium
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Cholinergic Antagonist:
Inhalant: Tx: decrease secretions in COPD! |
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Oxybutynin
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Cholinergic Antagonist:
Tx: bladder incontinence Side: dry mouth |
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Tolterodine
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Cholinergic Antagonist:
Tx: bladder incontinence Side: dry mouth |
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Darifenacin
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Cholinergic Antagonist:
Tx: bladder incontinence Side: dry mouth |
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Solifenacin
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Cholinergic Antagonist:
Tx: bladder incontinence Side: dry mouth |
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Trospium
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Cholinergic Antagonist:
Tx: bladder incontinence Side: dry mouth |
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Scopolamine
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Cholinergic Antagonist:
Tx: 1. Motion sickness 2. Nausea after anaesthesia **Takes 12 hours to work |
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Alpha 1 Adrenergic Antagonist
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Tx:
- Lower BP (vasodilator) - HTN & benign prostate hypertrophy NOT FIRST LINE THERAPY - add on drug Side: orthostatic hypotension (all except FLOMAX!) |
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Doxazosin
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Alpha 1 Adrenergic Antagonist
Tx: - Benign Prostate Hypertrophy - HTN **4th or 5th line therapy! Side: orthostatic hypotension |
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Prazosin
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Alpha 1 Adrenergic Antagonist:
Tx: - Benign Prostate Hypertrophy - HTN **4th or 5th line therapy! Side: orthostatic hypotension |
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Terazosin
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Alpha 1 Adrenergic Antagonist:
Tx: - Benign Prostate Hypertrophy - HTN **4 or 5th line therapy Side: orthostatic hypotension |
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Tamsulosin (Flomax)
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Alpha 1 Adrenergic Antagonist
Tx: - BEST tx for BPH |
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Characteristics of Adrenergic Beta Blockers
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1. slow HR (antagonize Epi, NE)
2. decrease BP (reduce contract) 3. Block renin release 4. Reduce sympathetic outflow 5. Equally effective in reducing BP at equipotent doses ***NUMBER ONE FOR TX OF HTN!!! |
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Side effects of B- Blockers
Relative Absolute |
RELATIVE:
-DM - masks complications of hypoglycemia (no tachycardia or tremor) -COPD/Asthma ABSOLUTE: -Heart block |
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Benefits of combination therapy in B-Blockers?
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Benefit:
- Lower doses of both drugs reduces side effects - Increases compliance - "SYNERGY" - Titrate drug to maximum tolerated and minimum effected dose |
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Alpha agonists
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Reduce sympathetic activity and used to treat HTN
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Alpha Antagonists
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Vasodilation - decrease BP
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Action of B1 & B2?
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Definition 45
- B1: heart - antagonist decreases HR - B2: smooth muscle - antagonist contract (bronchial constriction) |
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Beta-Blocker Combinations:
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Definition 46
Beta Blockers W/: + Calcium Channel Blockers (except verapamil or diltiazem) + ACE Inhibitors + Diuretic + Alpha blocker (caution: may exacerbate postural hypotension) |
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Beta - Blocker Adverse Effects:
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Bradycardia
Hypotension Bronchospasm "wheezing" Impotence |
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Atenolol
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beta-1 blocker!
PO, IV qd Tx: 1. After MI (dysarrhythmia) 2. Preoperative |
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Metoprolol
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beta-1 Blocker:
PO, IV qd or bid Tx: 1. DOC for CHF (easily titrated) 2. After MI |
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Esmolol (Brevibloc)
Tx Contraindications |
B1 Blocker:
IV Tx: 1. Refractory A- FIB in hospitals (not 1st drug used) 2. supraventricular tachycarida Contraindications: IV only and expensive |
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Propranolol
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B1 & 2 Blocker:
PO, IV Tx: 1. Stage fright (anxiety) 2. Migraine prophylaxis 3. After MI Contraindications: NOT selective |
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Labetalol
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Beta 1&2, Alpha 1
PO, IV bid Tx: 1. Hypertensive urgency/emergency! #1 tx for HTN!!! 2. Slows HR |
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Carvedilol
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B1 and B2 Blocker:
PO bid Tx: - CHF - HTN **1st line tx!!! Easily titrated Contraindication: non-selective, bid |
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Beta Blocker treatment in arrhythmias?
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Tx:
1. SVA 2. Acute/Chronic Asymptomatic A-FIB!!!! **Suppress vent response - doesn't cardiovert! 3. PVC **AFTER MI TO PREVENT Dysarrythmia Side: bradycardia, bronchospasm, fatigue |
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What are the contraindications when NOT to use Beta-blockers?
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Contraindications:
Relative: - Diabetes - Sinus bradycardia - Asthma/COPD - Pregnancy Absolute: 1st degree heart block - will move them into a higher heart block!! |
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CHF
Pathology |
Pathophysiology:
- Problem with the cardiac pump - decreased perfusion - Kidneys percieve they are "under-perfused" and secrete RENIN (enzyme) converts Angiotensin I --> Angiotensin II (vasoconstrictor) --> Aldosteron --> sodium and water retenion --> lungs and peripheries |
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Digoxin
MOA |
Inotropin: "Cardiac Glycoside"
MOA: CALCIUM FLUX - improve contractility **Slows conduction through AVN Tx: 1. Disease stabilizing CHF 2. Acute asymptomatic A-FIB!!! 3. Chronic asymptomatic A-FIB!! Side: nausea, diarrhea, confusion, bradycardia |
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ACE Inhibitors
MOA |
1st DOC for CHF - decrease M & M
#1 choice for HTN in DIABETICS!! MOA **Reduces conversion of AI --> AII |
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Enalapril
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ACE Inhibitor
IV (hospitals, can't take oral) Tx: 1. HTN emergency!!! **Expensive |
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Captopril
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ACE Inhibitor:
PO bid Tx: -HTN urgency! |
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Lisinopril
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ACE Inhibitor:
PO qd Tx: 1. 1st DOC for CHF!!! |
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Fosinopril (Monopril)
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ACE Inhibitor:
Tx: HTN **Side: LEAST incidence of causing COUGH! |
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Quinapril (Accupril)
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ACE Inhibitor:
Tx: HTN & CHF |
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When patient is on ACE Inhibitors what do you have to monitor?
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- Serum potassium
- Creatinine - Blood pressure - Cough - Angioedema - serious but not frequent! |
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Thiazide Diuretics
MOA |
MOA:
-Distal convoluted tubule **INHIBIT Na reabsorption SIDE: hypokalemia (metabolic alkalosis) **Hypokalemia DOC for treatment of primary HTN |
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Hydrochlorothiazide
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Thiazide Diuretic: DCT
Tx: - Mild edema - Mild HTN **ADD on therapy - if mild and maxed out on other drugs! |
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Metolazone
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Thiazide Diuretic:DCT
Synergy: given 1st then loop diuretic!! Tx: 1. Edema 2. HTN **ADD on therapy - if mild and maxed out on other drugs! |
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Loop Diuretics
MOA |
POTENT and rapid onset of action!!
MOA: loop of HENLEY -Inhibit CHLORIDE REABSORPTION Tx: - Reduce PULMONARY edema in patients with CHF Side: hypokalemia |
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Furosemide (Lasix)
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Loop Diuretic:
- Least potent Tx: 1. CHF 2. Peripheral edema Side: hypokalemia |
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Bumetanide (Bumex)
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Loop Diuretic:
MOST potent - need to monitor for DEHYDRATION!!! Tx: 1. CHF 2. Peripheral edema Side: hypokalemia |
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Torsemide (Demadex)
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Loop Diuretic:
Tx: 1. CHF 2. Peripheral edema Side: hypokalemia |
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Aldosterone Antagonist
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Potassium Sparing Diuretics in distal tubule
TX: CHF Side: hyperkalemia |
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Spironolactone (Aldactone)
MOA |
Aldosterone Antagonist - potassium sparing diuretic
MOA: sodium retention Tx: CHF Side: hyperkalemia |
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Eplerenone (Inspra)
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Aldosterone Antagonist: potassium sparing diuretic
Tx: CHF Side: hyperkalemia |
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Vasodilators
- When are they indicated? |
Indicated: patients don't tolerate ACE inhibitors or can't afford them
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Hydralazine
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MOA
- Arterial dilator (DECREASE afterload) Tx: CHF **Tx HTN if patient needs 3 - 4 drugs Contraindication: 3 - 4 times a day |
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Long acting Nitrates
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Vasodilator:
MOA: vasodilator (decrease PRELOAD) Tx: CHF |
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Losartan
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Antiotensin II Antagonist
- First alternate to ACE INHIBITOR!!! Tx: CHF Contraindication: expensive decreasing compliance |
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Valsartan
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Antiotensin II Antagonist
**First alternate to ACE Inhibitors! Tx: CHF Contraindication: expensive, decreasing compliance!! |
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Aliskiren
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Direct Renin Inhibitor:
- Inhibits production of Angiotensin II Tx: 4th alternate for heart failure |
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Amlodipine
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Calcium Channel Blocker
Tx: 1. Angina 2. HTN **Not helpful/harmful to use in CHF |
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Nesiritide
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IV:
Tx: - Decompensated CHF - Lowers BP Side: hypotension *Don't monitor naturetic paeptide be HIGH (not helpful)! |
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Angina
Stable Unstable Variant **GOAL of treatment |
CP caused from lack of O2
-Stable: exertional angina, disappears at rest -Unstable: EMERGENCY --> don't know if unstable angina or MI **3 differences in symptoms: SOB, lasts longer, and character (STABBING) Variant: occurs at ANYTIME! GOAL of treatment: reduce frequency and severity of attacks!! |
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Nitroglycerin
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**Give ntirates to all patients with angina!!
Side: hypotension with short acting, headache |
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SHORT acting Nitro
Direction |
IV:
**Hypertensive EMERGENCY! Side: if BP is too low changes perfusion pressure to brain and heart causing more ischemia and pain Sublingual: most time perscribe - short acting (patient directed) Nitro spray: patient directed **Direction: take with chest pain, wait 5 mintues take another dose, call ambulance then take third dose |
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Long Acting Nitrates
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Lasts: 12 - 18 hours
Nitro patch: convenient - Patient builds up tolerance to vasodilation (needs to have nitrate free interval) Nitro ointment - doesn't dry |
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Isosorbide Dinitrate (Isordil)
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LONG acting Nitro
PO - venous dilator Problem: have to take 2 -3 times a day, decreasing compliance |
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Isosorbide Mononitrate (Ismo, Imdur)
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Long acting nitro
Take once a day, wears off a/f 12 - 18 hours |
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Oral nitroglycerin (Nitrobid)
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Long acting Nitro
- Poor absorption |
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Calcium Channel Blockers
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Inhibit entrance of calcium into the cells, cause a decrease in AFTERLOAD
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Verapamil
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Calcium Channel Blocker - bind to AV node
IV: Tx: 1. Stable angina 2. Migrane 3. HTN **Don't use in African Americans!!! 4. Acute/Chronic asymptomatic A-FIB!!! Side: -Constipation, negative inotrope -BRADYCARDIA - don't give to someone who is on a B-blocker!!! |
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Diltiazem
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Calcium Channel Blocker: bind AVN
IV: Tx: 1. Variant Angina 2. Raynaud's phenomenon (lack of blood flow to ext) 3. HTN 4. Acute/Chronic asymptomatic A-FIB!!! Side: HEADACHE, bradycardia, constipation ***DON"T GIVE WITH B-BLOCKER! |
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Nifedipine (Procardia)
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Calcium channel blocker:
Tx: 1. Angina 2. HTN Side: dizziness, headache, peripheral edema, flushing, tachycardia, rash |
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Amlodipine
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Calcium Channel Blocker
Tx: 1. Angina 2. HTN 3. CHF Side: dizziness, headache, peripheral edema, flushing, tachycardia, rash |
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Dihydropyridines CCB + B-Blocker
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USEFUL
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AVOID Verapimin + _______?
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B-blocker due to excessive bradycardia
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CCB + thiazide =
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USEFUL
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CCB + ACE Inhibitor
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Useful, particulary in resistant HTN
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CCB + Methyldopa =
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USEFUL
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Grapefruit juice inhibits metabolism of what drugs?
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Verapamil and nifedipine
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What raises serum digoxin levels?
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CCB (verapamil) from bradycardia
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Concern with calcium salts?
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Isolated case reports of loss of anti-HTN control when patients started on calcium salts
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What are the benefits of using a CCB?
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-DIABETICS: doesn't alter lipid profile or glycemic control
-Useful for more than one condition -LVH regression -Don't contribute to decrease or stabelizes renal function -Increase compliance: most qd or bid -Increse compliance: well tolerated |
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Asprin
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Inhibit platlet aggregation, reduces fever and inflammation
-Prolongs bleeding time Tx: add to regimen those have: ANGINA or Heart disease Risk of bleeding |
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Glycoprotein IIb/IIIa Inhibitors
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Prevent platelet aggregation by blocking the binding of fibrinogen to glycloprotein IIb/IIIa R on surface of the platelet
Tx: -Procedural drugs: patient on a stent (to prevent thrombosis) |
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Heparin
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Anticoagulant
**START IN ER!!! Tx: 1. Unstable ANGINA 2. Acute asymptomatic/symptomatic A-FIB!!! 3. Chronic asymp/symp A-FIB Side: -Bleeding b/c anti-coagulant |
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Low Molecular Weight Heparin
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Alternate to heparin
Side: bleeding |
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Procainamide
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Anti-Arrhythmia:
Use: 1. Acute symptomatic A-FIB!!!! 2. Acute asymptomatic A-FIB 2. PVC 3. V-tach **Cardiovert to NSR prevent AH Side: lupus (rash), GI |
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Lidocaine
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Anti-Arrhythmia:
IV: HOSP ONLY!!! Local anesthetic Use: 1. Premature ventricular complex 2. Non-sustained ventricular tachycardia 3. V-fib - 2nd line TREATMENT!!!! Side: delerium, hypotension, bradycardia |
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Propafenone (rhythmol)
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Tx:
1. Acute symptomatic A-FIB!!!! 2. Acute asymptotic A-FIB 2. Life Threatening VA 3. Wolff Parkinson White **PT use on own as rescue anti-arrhythmic (cardiovert to NSR) Side: CNS, metallic taste, negative inotrope (DON"T USE IN CHF patients) |
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Encainide
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Sodium channel blocker
Suppress ventricular arrhythmias |
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Flecainide
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Sodium Channel Blocker
Tx: 1. Life threatening ventricular arrhythmia 2 WPW Side: delirium, constipation, NEGATIVE inotrope (DON"T USE IN CHF patients!) |
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Veraptil + _____ is contraindicated in treating stable angina?
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B-blocker
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Hospital care you in angina?
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Nitro (IV, SL/spray) Aspril or clopidogrel or prasugrel Morphine B-blocker (if can't use then use verapamil or diltiazem) Heparin
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What are the pharmacological targets for autonomic treatment?
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1. Synthesis of NT
2. Storage of NT 3. Receptor binding of NT 4. Termination of Action NT (re-uptake/destruction enzyme) |
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Where does acetylcholinesterate inhibitors attack?
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The conversion of:
Acetyl Co-A + Choline --> ACh PARA NS |
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ACh
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ALL ganglia, ALL PARA, some symp
-Nicotinic: all autonomic, adrenal gland -Muscurinic: para, end organs, brain, sweat glands |
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Tyrosine --> DOPA --> DA --> NE --> Epi
**CNS diseases attack what part of pathway? |
DA
**NE = SYMP ONLY!!! |
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α - 1
Agonist Antagonist |
B.V = vasoconstrict
Eye Urinary sphincter *Agonist: NE, Phenylephrine *Antagonist: Doxazosin, Prazosin, Terazosin, Tamsulosin, Labetalol (vasodilate) |
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α-2
*Agonist |
CNS
Adrenergic nerve endings End organs (heart, kidney, brain,eye) *Agonist: Clonidine |
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B1
*Agonist *Antagonist |
1 heart 1 Brain, kidney
*Agonist: NE, Epi, Dobutamine *Antagonist: Atenolol, Metoprolol, Esomolol, Propranolol, Labetalol, Carvedilol |
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B-2
*Agonist *Antagonist |
Airways
Dilate Skeletal muscle Relax uterus during preganncy *Agonist: Epi, Dobutamine, Terbutaline *Antagonist: Propranolol, Labetalol |
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Acetycholinesterase
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Drugs only for Acetylcholinesterase INHIBITORS - slows down rate (doesn't breakdown Ach)
*Myasthenia gravis |
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Catechol-o-methyltransferase (COMT)
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Breaksdown: Epi, NE, DA
Tx: Antagonist for Parkinson's (increase DA) |
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Monoamineoxidase
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Breaks down monoamine (DA, NE, Epi)
Tx: 1. Parkinson's (increase DA) 2. Depression |
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Cholinergic Agonists
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-Bethanechol - glaucoma, incontinence
-Methacholine: diagnostic asthma -Pilocarpine: glaucoma, sjorgan's |
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Acetylcholinesterase Inhibitors
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(Increase ACh at the synpase)
-Edrophonium: diagnostic MG -Pyridostigmine: tx MG -Physostimgine: reverse NMJ a/f surgery |
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B-Blockers in tx of CHF?
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Slow HR
Decrease edema Increase exercise capacity |
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Botulinum Toxin
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Nondepolarizing NM Blocker
MOA: Cl Channel Blocker Tx: 1. Paralyze spastic muscles 2. Migraine 3. Wrinkles |
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What are the differences between beta-blockers?
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1. Pharmacokinetics
2. Receptor sensitivity 3. Potency |
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For what arrhythmias would you use Beta-blocker?
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SVT
PVC Tremor |
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Drawbacks to using combination therapy?
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-Compliance ALWAYS a problem
- If have side effects - difficult to determine the source - Increased costs |
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What combination should be avoided when using beta-blockers?
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CLONIDINE - central alpha antagonist!!!
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CHF Goals of Treatment?
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1. INCREASE contractility (CO)
2. DECREASE preload 3. DECREASE afterload |
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What needs to be monitored in someone who is on a loop or thiazide diuretic?
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1. serum K & Na
2. fluid balance 3. serum creatinine 4. BP decreased too much in thiazides |
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For the treatment of arrhythmias what is the target for drug therapy?
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AV node
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Amiodarone
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Tx:
1. Acute symptomatic A-FIB!!! 2. Acute asymptomatic A-FIB!!! 2. LTVA **LONGEST half life - need lot monitoring Side: pulmonary fibrosis, hyper than hypo thyroidism, hepatotoxicity, skin, photosensitivity, neuropathy |
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Sotalol
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Tx:
1. Acute symptomatic A-FIB!!! 2. Acute asymptomatic A-FIB!! 2. LTVA Side: Control ventricular response from beta-response |
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Sotalol (Betapace)
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Tx:
1. A-Fib 2. LTVA Side: beta-blocker (racemic mixture), insomnia **No cardiovert |
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Dronedarone
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Use:
1. Acute symptomatic A-FIB!!! 2. Acute asymptomatic A-FIB! |
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Calcium channel blockers bind?
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TO THE AV NODE
- DON"T cardiovert - controls rate only |
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Adenosine
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Use:
1. Diagnostic - causes flat line (if odn't know vent dysarrhythmia) TOXIC: -Transient heart block, chest pain **SHORT half life 6 seconds |
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Magnesium
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Use:
1. Torsades de Pointes Side: -heart block, hypotension |
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Acute A-Fib
- Symptomatic |
1. Heparin
2. Cardioversion: amiodarone, sotalol, procainamide, propafenone, dronderone, flecainide 3. Anticoagulation: Warfarin - keep on if don't cardiovert to NSR |
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Acute A-Fib
- Asymptomatic |
1. Heparin
2. Block AV node: digoxin, CCB (verapamil, dilitazem) or BB 3. Anticoagulation: Warfarin &/or not 4. Echo followed by mechanical or chemical cardioversion: - Chemical: amiodarone, sotalol, procainamide, proprafenone, dronderone, flecainide |
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Warfarin
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Tx:
1. Acute symptomatic A-FIB - Short term if convert to NSR - Long term if don't convert to NSR 2. Acute asymptomatic A-FIB **Long term 3. Chronic asymp/symp A-FIB **Long term! - LONG TERM |
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Chronic or unknown asymptomatic A-Fib
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Tx:
1. Heparin with transition to warfarin for long term 2. AVN block: digoxin, CCB, BB |
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Chronic or unknown symptomatic A-FIB
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1. Heparin
2. Echo then cardioversion 3. Warfarin long term |
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What are the drugs used for chemical cardioversion?
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Cardioversion: amiodarone, sotalol, procainamide, propafenone, dronderone, flecainide
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Parkinson's Patient treatment?
|
catechol-o-methyltransferase (COMT) – possiblty Monoamine B
a. Breaks down epi/norepi allowing dopamine to survive longer |
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Treatment for depression patient?
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monamine B
a. Breaks down epi/norepi allowing dopamine to survive longer |
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Treatment for patient with glaucoma?
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bethanechol or pilocarpine (rarely used)
a. Direct cholinergic agonists; constrict pupil b. Cause diarrhea (make bowels more active), salivating |
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What can you use to diagnose asthma?
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Methacholine
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How do you treat dry mouth?
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Pilocarpine
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Myasthenia gravis
- how do you diagnose - how do you treat |
Dx w/ edrophonium, Tx w/ prydiostigmine
a. Indirect cholinergic agonists; short acting muscle contraction b. Cause tetany, GI & urinary prob in those w/o MG |
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How do you recover a patient faster from anesthesia?
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physostigmine
a. indirect cholinergic agonist; stops NM blocker |
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How do you treat a patient who is crashing (bradycardia)?
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Atropine
a. Cholinergic antagonist; raises HR |
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How do you minimize secretions?
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Atropine or scopolamine or glycopyrrolate
a. Cholinergic antagonists; dry up secretions b. Scop causes drowsiness; glyco is given procedurally b4 surgery 1 dose IV |
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How do you treat CNS adverse drug reactions?
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benztropine or trihexylphenidyl
a. Cholinergic antagonist; reverse drug rxn by controlling excess Ach in brain b. Causes dry mouth & elderly confusion |
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How do you treat IBS, GI distress/cramps?
|
dicyclomine
a. Cholinergic antagonist; slow/calms cramps b. Causes dry mouth, dysuria |
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How do you treat COPD with too much secretions?
|
ipratropium or tiotropium
a. Cholinergic antagonist; inhaled reduces secretion, relaxes airways b. Causes dry mouth |
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How do you treat urinary incontinence?
|
oxybutynin (ditropan), tolterodine (detrol), darifenacin (enablex), vesicare or sanctura
a. Cholinergic antagonists; relax urinary sphincter b. Cause dry mouth in 7-10% |
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How do you treat motion sickness?
|
scopolamine
a. Cholinergic antagonist; reduces secretion b. Causes drowsiness |
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How do you treat a hospice patient with secretions?
|
atropine or scopolamine
a. Cholinergic antagonist; drys up secretions |
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How do you reduce anesthetic induced nausea/vomitting?
|
Scopalmine
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How do you paralyze a patient before intubation?
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succinylcholine
a. Cholinergic antagonist – Depolarzing Neuromuscular blocker b. Causes malignant hyperthermia, only lasts 5-10min |
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How do you keep a patient paralyzed through surgery?
|
need non-depolarizing tubocurarine or panuronium
a. Cholinergic antagonist; non-depolarizing neuromuscular blocker b. Reduces twitch, keeps pt paralyzed longer |
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What is a local anasethic for muscles or cosmetic procedures?
|
botulinum toxin
a. Cholinergic antagonist; Chloride Channel Blocker keeps Ach out b. Not systemic, lasts 3-6mo |
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What do you give patients with nasal congestion?
|
ephedrine
a. Indirect adrenergic agonist; raises BP & HR |
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How do you treat a patient with severe ADD or someone who needs to lose weight?
|
amphetamine
a. Indirect adrenergic agonist; CNS & psycho stimulant |
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How do you treat a hypertrophic prostate patient with low BP ?
|
tamsulosin/flomax
a. Andrenergic A1 antagonist; vasodilates smooth m, but doesn’t lower HR |
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How do you treat a patient with a hypertrophic prostate?
|
doxazosin/cardura OR prazosin OR terazosin OR tamsulosin
a. Adrenergic A1 antagonist; lowers BP, vasodilates, relaxes smooth m. |
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How do you treat a heart failure patient with a adrenergic antagonist?
|
atenolol, metoprolol, esmolol, labetaolol, propanolol OR carvedilol
a. Beta-Blockers!; slows HR, antagonizes epi & norepi |
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Who do you treat a patient who needs a drug that vasodilates and slows HR?
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Labetolol
a. Adrenergic A1-B1-2 antagonist |
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Patient needs a B-1 selective drug to lower HR only?
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Atenolol, metoprolol, esmolol
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CHF patient needs three drugs?
|
3 goals of Tx
a. ACE (increase contractility) Lisinopril b. Diuretic (decrease fluid & preload) HCTZ c. Cardiac glycoside (decrease workload/afterload) digoxin |
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Decompensated HF patient with renal insufficiency?
|
dopamine
a. Inotrope (B1 agonist); increases contractility while preserving renal blood flow & fx |
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Decompensated HF treatment?
|
dobutamine or dopamine
a. Inotrope (B1 agonist); increases contractility w/o affected HR or BP |
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Patient with HF what is first drug you want to give them?
|
ACE: enalapril, captopril, lisinopril, fosinopril, quinapril
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How do you treat a pregnant patient with HTN?
|
Hydralazine
Apresoline - Vasodilator; primary arteriole dilator - Also used for patients on 3 - 4 drugs already! |
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Cardioversion for a chronic regimen to treat A-Fib?
|
Procainamide
Flecainide Propafenone Amiodarone |
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Primary prevention of HTN?
|
Under 140/80
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Secondary prevention of HTN?
|
Known CAD or DM target
under 130/80 |
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What are the complications associated with HTN?
|
CAD
Renal dysfunction Cerebrovascular disease Microvascular disease (eyes) |
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|
What is the number one treatment for diabetics with HTN?
|
ACE INHIBITORS!!!
- Protects renal function |
|
|
Methyldopa
|
SAFE TO USE IN PREGNANCY for HTN!
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How do you treat diabetic patients with HTN?
|
1st: ACE inhibitors
2nd: ARB (angiotensin II receptor blockers) Diuretics BB (if educate on hypglycemia) |
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How do you treat CHF patients for HTN?
|
ACE or ARB
Diuretic |
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How do you treat A.A for HTN?
|
BB
CCB - DON"T USE VERAPAMIL Diuretic (they have problem with water retention) |
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|
How do you treat hypertensive urgency?
|
Oral treatment NO damage to END ORGANS - kidneys, eyes, brain, heart
Greater than 180/110 -Clonidine -Labetalol -Captopril |
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How do you treat hypertensive emergency?
|
IV TREATMENT
End organ damage -Labetalol prn dose to target BP -Nitro IV -Enalapril IV prn |
