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75 Cards in this Set

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  • Back
What is the treatment of choice for an actively wheezing pt?
B agonist
What is the treatment of choice for prevention of asthma?
Inhaled corticosteroids
Where does adenosine work?
purinergic receptors
How do BBlockers work? (3 ways)
1. direct CNS suppression
2. direct cardiac depression: blocks beta 1 receptors
3. prevent renin release from kidneys
Why do bblockers prevent renin release from kidneys?
There are beta 1 receptors in kidneys
Why does esmolol have a short DOA?
metabolized by non specific esterases (RBC esterases) so short DOA
Nipride: arteria ldilator, venous dilator or both?
both
Nitroglycerin: arterial dilator, venous dilator or both?
venous
What is the major difference between labelotlol and esmolol?
esmolol has vasoconstrictive property, labetolol has vasodilator effect
How do direct agents work?
on smooth muscle of vascular wall
How is nipride metabolized?
by hgb
What is the cause of rebound HTN after stopping nipride infusion?
renin release
How do CCBs work to lower BP?
By blocking calcium entry into myocyt. Calcium is needed for cardiac muscle contraction, and CCBs block it from entering. Also has vasodilation effect.
What is step 1 of the 4 step asthma classification?
What is tx?
Mild intermittent
prn inhaled B agonist (albuterol)
What is step 2 on 4 step asthma classification scale? What is tx?
Mild persistant
inhaled steroid +/- singulair
What is step 3 on asthma classfication scale? What is tx?
moderate persistant
medium dose inhaled steroids +/- LABA
What is step 4 on asthma classification scale? What is tx?
high dose inhaled steroids, LABA, systemic steroids
Do you need to give stress dose of IV steroids to pt with daily inhaled steroids ?
No.
How do Class 1 antiarrythmic agents work? What kind of arrythmias are they best for?
Blocks Na channels
ventricular
What drugs are in Class 2 for antiarrythmic agents?
BBlockers
How do BBlockers work?
Examples of drugs?
decrease HR and contractility
metoproLOL, carvediLOL, esmoLOL, antenoLOL
How do class 3 antiarrythmics work?
blocks K channels
Examples of Class 1 antiarrythmics?
lido, Pronestyl, norpace,
What drugs are Class 4 antarrythmics? How do they work?
CCBs. Work by decreasing amt of Ca in cell, which decreases contractility.
Which antiarrythmic class is best for atrial arrythmias?
CCBs (or BBs)
Which agents are drugs of choice for SVT?
CCB's (or BB). Adenosine is too, but wouldnt use in anesthesia setting
Which drugs are tx of choice for ventricular dysrythmias?
lido or amio
What is tx of choice for Toursades de Points VT?
magnesium
What is JNC6 "normal BP"?
<120/<80
What is considered "prehypertension"?
120-139/80-89
What is considered stage 1 HTN?
140-159/90-99
What is considered stage 2 HTN?
>160/>100
Hypertensive urgency is
A. lower within 24 hours or pt could have event-oral agents could be OK
B. Lower within 1 hour
A
Hypertensive emergency is:
A. must lower within 24 hours or pt could have event. Oral agents might be OK
B. Needs lowered within 1 hour
B
Which of the following are drugs of choice for HTN in pregnant women?
A. atenolol
B. labetolol
C. hydralazine
D. nipride
B (according to Nag)
C (according to texts)
What is the MOA for ACE inhibitors?
prevents conversion of angiotenin 1 to angiotensin 2
What is the MOA for ARBs?
angiotensin 2 is made, but the receptor is blocked so cant bind
What is the MOA for DRIs?
angiotensinogen can'tbe made into angiotensin 1
What are the 3 MOA for beta blockers?
1. direct CNS depression'
2. direct cardiac depression by blocking beta 1 receptor
3. prevents renin release
Which of the following agents are vasodilators?
A. esmolol
B. labetolol
B
What is the only BBlocker with vasodilating properties?
labetolol
Which of the following are vasoconstricting?
A. labetolol
B. esmolol
B
How is esmolol metabolized?
hydrolyzed by RBC esterases-very short duration of action
Why does nipride cause hypoxia?
inhibits cytochrome oxidase inside the cell
How is nipride metabolized?
by hemoglobin
What is the Tx for nipride toxicity/cyanide poisoning?
1. Na nitrite
2. Na thiosulfate
3. Methylene blue
What is the cause of rebound HTN after d/c nipride?
renin release
What is the MOA of diuretics?
decreases preload and an additional unknown action
What does a BB with ISA activity mean?
intrinsic sympathomimetic activity.
Less efficacy, "weaker" bblockers
What special consideration is given to clonidine?
lots of rebound HTN.
Treatment of choice for acute angina?
nitrates
What is the MOA for nitrates?
decreases O2 demand by preload reduction
What class of agents is best for variant or Prinzmetals angina?
CCB
What is the MOA for ASA?
inhibits plt aggregation and endothelial COX.
What is the MOA for CCBs?
reduced preload, reduced afterload and vasodilation ( increase coronary flow)
What is the MOA for statins?
reduce thrombogenicity and antiplaque
AKA HMG-Co-A reductase inhibitors
What is the single biggest determinant of myocardial oxygen balance?
heart rate
Class 1 angina:
occurs with strenous activity but not normal activity
Class 2 angina:
slight limitation of ordinary activity
Class 3 angina:
marked limitation of ordinary activity
Class 4 angina:
pain present at rest or can't do any activity without angina
Which of the following agents is more of an arterial vasodilator?
A. nitroglycerin
B.. Nipride
C. hydralazine
D. labetolol
C
Which of the following agents is more of a venous vasodilator?
A. NTG
B. NIP
C. hydralazine
D. labetolol
A
Tx of choice for stable chronic angina?
BBlockers
Elective surgeries should be postponed how long for a pt with bare metal stents?
4-6 weeks
Elective surgeries should be postponed how long for pts with drug eluting stents?
12 months
Which of the following conditions represent the greatest anesthetic risk?
A. angina
B. CAD
C. CHF
D. HTN
C
Class 1 CHF:
can do normal physicl exercise without sx
Class 2 CHF:
slight limitation. sx with ordinary activity
Class 3 CHF:
marked limitation. sx with less than ordinary activity
Class 4 CHF:
symptoms at rest, cant carry out any activity
Why do PDE inhibitors ( milrinone) work?
blocks breakdown of cAMP
How does dig work?
blocks Na-K-ATPase pump. Since K and NA cant get back where they belong, Ca-Na pump takes over, which increase Ca inside cell. More ca=stronger contraction.
Is there a clear therapeutic range for dig?
No.
What does K level is inverse proportion to digitalis mean?
How well dig binds to Na-K-ATPase pump depends on serum K level. If K high, binds less, If K low, binds more.