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87 Cards in this Set

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How would you classify a patient with a BP > 180/110
Stage 2 Hypertension
What is the cause of rebound hypertension that may follow use of nitroprusside?
Increased renin release
Which of the drugs used perioperatively would have to be avoided or used with caution in asthmatic patients?
Beta blockers obviously
Which drugs cause histamine release?
Phenanthrenes (Opioids), Atracurium, Sux
Which would be the induction drug of choice in a patient that requires emergency surgery but has active asthmatic symptoms?
Ketamine
How does K+ influence digitalis intensity of effect? How about thiazide diuretics?
K+ is like a competitive inhibitor with dig. Increases above normal will decrease dig effects. Decreases will enhance dig effect and
toxicity. Thiazides cause K+ loss.
What is the main difference between esmolol and labetalol?
Esmolol
duration is < labetalol but also esmolol is more selective for beta
receptors only whereas labetalol blocks both alpha and beta. Also differ
in how they are metabolized (esmolol non-specific RBC esterase).
Which
is most likely to produce reflex tachycardia and orthostatic hypotension: Esmolol or labetalol?
Labetalol
In which patients should H2 antagonists and Beta-blockers be avoided?
Asthmatics. (H2 blockers block the negative feedback mechanism and can result in bronchospasm)
What cardiovascular effects would you expect esmolol to produce?
Although esmolol is a relative beta1 selective blocker, at clinical doses used, most
of that selectivity will be lost and effects would those expected from any non-selective beta blockers such as bradycardia, etc. Advantages are often related to the brief action ….. so it can be used during surgery
to decrease bp and or slow the heart.
Which of the neuromuscular blockers have significant cardiovascular effects?
pancuronium
Which group of drugs are the DOC for variant angina?
Calcium channel blockers
What are the effects of calcium channel blockers on the heart?
Decrease
everything …. Heart rate, force of contraction, conduction velocity, preload and afterload.
What is the most important effect of nitroglycerin in the treatment of angina?
Decrease preload
What is the most important effect of beta-blockers in the treatment of angina?
Cardiac depression
By what effects do the beta blockers reduce blood pressure?
depress heart,
decrease renin production, central action to decrease sympathetic output, etc.
First choice drug for sinus tachycardia?
Esmolol
Which drug produces inotropic cardiac effects by inhibiting Na/K ATPase?
digitalis (digoxin)
Class 4 antiarrhythmic drugs appear to produce their therapeutic effects by
blocking which channel type?
Calcium channels
Which enzymes are involved in metabolizing esmolol?
non-specific RBC
esterase
What is the DOC for an acute angina attack?
nitroglycerin
Beta receptor blockers with ISA (intrinsic sympathomimetic activity) would
have what sort of activity at the beta receptor? Agonist? Antagonist? Partial agonist?
Partial agonist/antagonist
What is hydralazine? In what sorts of patients would it be especially useful?
Direct arterial vasodilator/hypertension with bradycardia
Which type of drugs used to manage hypertension should be avoided in
diabetic patients?
beta blockers (inhibit glucose release from liver)
What is a common and troublesome side effect of many of the ACE
inhibitors?
cough
What may happen if you abruptly terminate use of clonidine after it has
been used for a month or so to manage hypertension?
Withdrawal syndrome
resembling hypertensive crisis
What are the characteristics of someone classified as suffering Class 2 angina?
slight limitation of ordinary activity. Angina may occur with
walking or climbing stairs, after meals, in the cold, in the wind or under
emotional stress, walking up a hill, walking more than two blocks on level ground, etc
What is the mechanism of cyanide toxicity?
Inhibits function of mitochondrial cytochrome oxidase. Tissues can’t use oxygen or generate ATP
Which group of drugs are most effective in managing chronic asthma?
Inhalation corticosteroids
A patient classified as having Class II heart failure would exhibit what characteristics?
Slight limitation of physical activity:comfortable at rest
but ordinary activity results in fatigue, palpitations or dyspnea
How long should elective surgery be postponed if your patient has a drug eluting stent (DES)?
12 months
What are the primary vascular beds affected by nitroglycerin? Hydralazine? Prazocin?
Venous, Arterial, arterial and venous
What effect would a drug have that dilates venous and arterial vessels (consider reflexes) ….. on heart rate?
Blood pressure?
Preload?
Increase
Decrease
Decrease
Treatment of choice for PVC’s?
a little complex but for purpose of the
exam go with lidocaine or amiodarone
Treatment of choice for sinus bradycardia?
Atropine, pacemaker, dopamine, epinephrine
Treatment of choice for Atrial fibrillation?
Verapamil
Treatment of choice for Ventricular fibrillation?
Amiodarone
What second messenger system is ALWAYS associated with beta receptor activation??
cAMP
What are the 4 different classifications of Asthma?
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
What is the treatment for acute bronchoconstriction?
Beta-2 agonists
What is the preferred treatment for prophylaxis of chronic asthma?
Inhaled steroids
List the comparative effects of atropine vs. glycopyrrolate
Sedation: A>G
Antisialogogue: G>A
Increased HR: A>G
Relax smooth muscle: A=G
Mydriasis, Cycloplegia: A>G
Prevent Motion Sickness: A>G
Decrease Gastric H ions: A=G
What is the pneumonic for Atropine Poisoning?
Red as a Beet, Blind as a Bat, Dry as a Bone, Mad as a Hatter, Hot as a Hare
What are the effects of Beta-1 agonists?
Increased HR, increased contractility, headache, dizziness, nervousness, sweating, increased BP, increased blood lipid level, constipation, cardiac disturbances, inreased renin release
What are the effects of Beta-2 agonists?
Bronchodilation, Vasodilation, Tachycardia, tremor, relaxation of uterus, increased blood glucose levels and increased insulin secretion, restlessness and headache
What are the effects of Alpha-1 agonists?
Vasoconstriciton, pupil dilation, decreased gut motility and secretions, glycogen breakdown, urinary retention, contraction of uterus and vas deferens, sweating, goosebumps
Class 1 antiarrhythmic drugs mechanism of action =?
Block fast sodium channels (local anesthetic effect on the heart)
Class 2 antiarrhythmic drugs mechanism of action =?
Beta-adrenergic blockade
Class 3 antiarrhythmic drugs mechanism of action =?
Blockade of Potassium channels (slowed repolarization)
Class 4 antiarrhythmic drugs mechanism of action =?
Calcium channel blockade
Adenosine works on which type of receptors?
Purinergic receptors
What is the drug of choice for an atrial arrhythmia?
Verapamil
What is the drug of choice for a ventricular arrhythmia?
Lidocaine or AMIODARONE
What is the drug of choice for Heart Block/bradyarrhythmias?
Atropine, Pacers
What is the drug of choice for Torsades de Pointes?
Magnesium
What is the drug of choice for tachyarrhythmias?
Esmolol
Normal blood pressure is below ___ systolic and ___ diastolic
120 and 80
Prehypertension is a SBP between _____ or a DBP between _____
120-139 or 80-89
Stage 1 hypertension is a SBP between ______ or a DBP between ______
140-159 or 90-99
Stage 2 hypertension is a SBP greater than or equal to ______ or a DBP greater than or equal to ______
160 or 100
Describe how Nitroprusside is metabolized and the process of cyanide production/elimination/toxicity.
Nipride is metabolized by Hemoglobin in the plasma into 1 nitro group + 5 cyanides
Cyanide combines with Thiosulfate into Thiocyanate (via the enzyme Rhodanese) which is eliminated in the urine.
Too much cyanide inhibits cytochrome oxidase indefinitely which results in tissue hypoxia (cells can't use oxygen)
What are the 5 classes of antihypertensive drugs and how do they work?
Diuretics- unknown, mild diuresis...

Angiotension Converting Enzyme Inhibitors (ACE-Inhibitors) Block the conversion of angiotensin I into angiotensin II

Angiotensin Receptor Blockers (ARBs)- Block the site of action for Angiotensin II

Beta Blockers- Block adrenergic receptor activation, decreased renin release, central sympathetic outflow depression

Calcium Channel Blockers- Block calcium channels, vasodilate the periphery, cardiac depression, central depression as well
What are the 5 mechanisms to reduce blood pressure?
Central depression
Cardiac depression
Hormonal depression
Baroreceptor depression
Direct vasodilation
Beta blockers should be given with caution to which patients?
Asthmatics (Bronchoconstriction)

Diabetics (Hypoglycemia)

Those with Vascular disorders (Vasoconstriction)
What are the two ways to treat angina?
Increase coronary blood supply
Decrease myocardial oxygen demand
What classification of Angina Pectoris might the following patient fall under: Angina only occurs with strenuous, rapid or prolonged exertion?
Class 1
Which category of Angina Pectoris might the following patient fall under: Angina may occur with ordinary physical activity (stairs, stress, walking more than two blocks)?
Class 2
Which category of Angina Pectoris might the following patient fall under: Angina may occur with minimal physical activity (one flight of stairs, walking one or two blocks)?
Class 3
Which category of Angina Pectoris might the following patient fall under: Inability to carry on any physical activity without discomfort (Angina @ rest)
Class 4
Hydralazine works by decreasing?
Afterload
Nitroglycerin works by decreasing?
Preload
How do Beta-blockers work as antianginals?
They decrease myocardial oxygen demand
How do Calcium channel blockers work as antianginals?
They decrease myocardial oxygen demand and increase coronary blood supply
How does Nitroglycerin work as an antianginal?
It decreases preload and mildly dilates coronary arteries
If your patient has a bare metal stent, how long must they wait for elective surgery?
4-6 weeks
Which of the following is a second messenger for adrenergic beta receptors?
cAMP
Calcium
cGMP
Triphosphate
Prostaglandin
cAMP
An antiarrhythmic drug which blocks sodium channels is classified as?
Class 1
An antiarrhythmic drug which blocks calcium channels is classified as?
Class 4
Esmolol is a potent blocker of beta adrenergic sympathetic activity. It may be detrimental however, in patients with?
Bronchial asthma
In an ASA intolerant asthmatic patient, which of the following could be used safely to manage pain?
a- acetaminophen
b- aspirin
c- toradol
d- naproxen
a- acetaminophen
As you read the chart for your next surgical patient, you observe they are on the following drug protocol: High dose flucanasole as well as oral prednisone along with salmeterol and an albuterol inhaler. You would conclude that this patient suffers from?
a- mild intermittent asthma
b- mild persistent asthma
c- moderate persistent asthma
d- severe persistent asthma
d- severe persistent asthma
Which two of the following drugs would it be best to avoid in a patient with severe persistent asthma?
a- fentanyl
b- ketamine
c- labetalol
d- propofol
e- morphine
c- labetalol
e- morphine
In the patient that develops atrial fibrillation, the drug of choice for acute management would be?
Verapamil (IV)
The mechanism of cyanide toxicity with nipride relates to the ability of cyanide to?
Inhibit mitochondrial cytochrome oxydase
Which one of the following is verapamil least likely to produce?
a- AV nodal block
b- hypotension
c- positive inotropic effects
d- slow ventricular response
c- positive inotropic effects
Which one of the following is nitroglycerin least likely to produce?
a- bronchoconstriction
b- decreased blood pressure
c- decreased cardiac demand
d- headache
e- reflex tachycardia
a- bronchoconstriction
Labetalol would be expected to produce?
a- bronchodilation
b- nasal decongestion
c- tachycardia
d- vasodilation
d- vasodilation