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87 Cards in this Set
- Front
- Back
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How would you classify a patient with a BP > 180/110
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Stage 2 Hypertension
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What is the cause of rebound hypertension that may follow use of nitroprusside?
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Increased renin release
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Which of the drugs used perioperatively would have to be avoided or used with caution in asthmatic patients?
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Beta blockers obviously
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Which drugs cause histamine release?
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Phenanthrenes (Opioids), Atracurium, Sux
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Which would be the induction drug of choice in a patient that requires emergency surgery but has active asthmatic symptoms?
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Ketamine
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How does K+ influence digitalis intensity of effect? How about thiazide diuretics?
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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. |
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What is the main difference between esmolol and labetalol?
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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). |
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Which
is most likely to produce reflex tachycardia and orthostatic hypotension: Esmolol or labetalol? |
Labetalol
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In which patients should H2 antagonists and Beta-blockers be avoided?
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Asthmatics. (H2 blockers block the negative feedback mechanism and can result in bronchospasm)
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What cardiovascular effects would you expect esmolol to produce?
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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. |
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Which of the neuromuscular blockers have significant cardiovascular effects?
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pancuronium
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Which group of drugs are the DOC for variant angina?
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Calcium channel blockers
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What are the effects of calcium channel blockers on the heart?
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Decrease
everything …. Heart rate, force of contraction, conduction velocity, preload and afterload. |
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What is the most important effect of nitroglycerin in the treatment of angina?
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Decrease preload
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What is the most important effect of beta-blockers in the treatment of angina?
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Cardiac depression
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By what effects do the beta blockers reduce blood pressure?
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depress heart,
decrease renin production, central action to decrease sympathetic output, etc. |
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First choice drug for sinus tachycardia?
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Esmolol
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Which drug produces inotropic cardiac effects by inhibiting Na/K ATPase?
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digitalis (digoxin)
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Class 4 antiarrhythmic drugs appear to produce their therapeutic effects by
blocking which channel type? |
Calcium channels
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Which enzymes are involved in metabolizing esmolol?
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non-specific RBC
esterase |
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What is the DOC for an acute angina attack?
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nitroglycerin
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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
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What is hydralazine? In what sorts of patients would it be especially useful?
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Direct arterial vasodilator/hypertension with bradycardia
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Which type of drugs used to manage hypertension should be avoided in
diabetic patients? |
beta blockers (inhibit glucose release from liver)
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What is a common and troublesome side effect of many of the ACE
inhibitors? |
cough
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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 |
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What are the characteristics of someone classified as suffering Class 2 angina?
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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 |
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What is the mechanism of cyanide toxicity?
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Inhibits function of mitochondrial cytochrome oxidase. Tissues can’t use oxygen or generate ATP
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Which group of drugs are most effective in managing chronic asthma?
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Inhalation corticosteroids
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A patient classified as having Class II heart failure would exhibit what characteristics?
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Slight limitation of physical activity:comfortable at rest
but ordinary activity results in fatigue, palpitations or dyspnea |
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How long should elective surgery be postponed if your patient has a drug eluting stent (DES)?
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12 months
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What are the primary vascular beds affected by nitroglycerin? Hydralazine? Prazocin?
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Venous, Arterial, arterial and venous
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What effect would a drug have that dilates venous and arterial vessels (consider reflexes) ….. on heart rate?
Blood pressure? Preload? |
Increase
Decrease Decrease |
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Treatment of choice for PVC’s?
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a little complex but for purpose of the
exam go with lidocaine or amiodarone |
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Treatment of choice for sinus bradycardia?
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Atropine, pacemaker, dopamine, epinephrine
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Treatment of choice for Atrial fibrillation?
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Verapamil
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Treatment of choice for Ventricular fibrillation?
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Amiodarone
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What second messenger system is ALWAYS associated with beta receptor activation??
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cAMP
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What are the 4 different classifications of Asthma?
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Mild intermittent
Mild persistent Moderate persistent Severe persistent |
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What is the treatment for acute bronchoconstriction?
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Beta-2 agonists
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What is the preferred treatment for prophylaxis of chronic asthma?
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Inhaled steroids
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List the comparative effects of atropine vs. glycopyrrolate
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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 |
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What is the pneumonic for Atropine Poisoning?
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Red as a Beet, Blind as a Bat, Dry as a Bone, Mad as a Hatter, Hot as a Hare
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What are the effects of Beta-1 agonists?
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Increased HR, increased contractility, headache, dizziness, nervousness, sweating, increased BP, increased blood lipid level, constipation, cardiac disturbances, inreased renin release
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What are the effects of Beta-2 agonists?
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Bronchodilation, Vasodilation, Tachycardia, tremor, relaxation of uterus, increased blood glucose levels and increased insulin secretion, restlessness and headache
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What are the effects of Alpha-1 agonists?
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Vasoconstriciton, pupil dilation, decreased gut motility and secretions, glycogen breakdown, urinary retention, contraction of uterus and vas deferens, sweating, goosebumps
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Class 1 antiarrhythmic drugs mechanism of action =?
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Block fast sodium channels (local anesthetic effect on the heart)
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Class 2 antiarrhythmic drugs mechanism of action =?
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Beta-adrenergic blockade
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Class 3 antiarrhythmic drugs mechanism of action =?
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Blockade of Potassium channels (slowed repolarization)
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Class 4 antiarrhythmic drugs mechanism of action =?
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Calcium channel blockade
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Adenosine works on which type of receptors?
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Purinergic receptors
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What is the drug of choice for an atrial arrhythmia?
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Verapamil
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What is the drug of choice for a ventricular arrhythmia?
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Lidocaine or AMIODARONE
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What is the drug of choice for Heart Block/bradyarrhythmias?
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Atropine, Pacers
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What is the drug of choice for Torsades de Pointes?
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Magnesium
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What is the drug of choice for tachyarrhythmias?
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Esmolol
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Normal blood pressure is below ___ systolic and ___ diastolic
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120 and 80
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Prehypertension is a SBP between _____ or a DBP between _____
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120-139 or 80-89
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Stage 1 hypertension is a SBP between ______ or a DBP between ______
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140-159 or 90-99
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Stage 2 hypertension is a SBP greater than or equal to ______ or a DBP greater than or equal to ______
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160 or 100
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Describe how Nitroprusside is metabolized and the process of cyanide production/elimination/toxicity.
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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) |
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What are the 5 classes of antihypertensive drugs and how do they work?
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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 |
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What are the 5 mechanisms to reduce blood pressure?
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Central depression
Cardiac depression Hormonal depression Baroreceptor depression Direct vasodilation |
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Beta blockers should be given with caution to which patients?
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Asthmatics (Bronchoconstriction)
Diabetics (Hypoglycemia) Those with Vascular disorders (Vasoconstriction) |
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What are the two ways to treat angina?
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Increase coronary blood supply
Decrease myocardial oxygen demand |
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What classification of Angina Pectoris might the following patient fall under: Angina only occurs with strenuous, rapid or prolonged exertion?
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Class 1
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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)?
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Class 2
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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)?
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Class 3
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Which category of Angina Pectoris might the following patient fall under: Inability to carry on any physical activity without discomfort (Angina @ rest)
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Class 4
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Hydralazine works by decreasing?
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Afterload
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Nitroglycerin works by decreasing?
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Preload
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How do Beta-blockers work as antianginals?
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They decrease myocardial oxygen demand
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How do Calcium channel blockers work as antianginals?
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They decrease myocardial oxygen demand and increase coronary blood supply
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How does Nitroglycerin work as an antianginal?
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It decreases preload and mildly dilates coronary arteries
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If your patient has a bare metal stent, how long must they wait for elective surgery?
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4-6 weeks
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Which of the following is a second messenger for adrenergic beta receptors?
cAMP Calcium cGMP Triphosphate Prostaglandin |
cAMP
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An antiarrhythmic drug which blocks sodium channels is classified as?
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Class 1
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An antiarrhythmic drug which blocks calcium channels is classified as?
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Class 4
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Esmolol is a potent blocker of beta adrenergic sympathetic activity. It may be detrimental however, in patients with?
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Bronchial asthma
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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
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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
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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 |
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In the patient that develops atrial fibrillation, the drug of choice for acute management would be?
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Verapamil (IV)
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The mechanism of cyanide toxicity with nipride relates to the ability of cyanide to?
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Inhibit mitochondrial cytochrome oxydase
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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
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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
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Labetalol would be expected to produce?
a- bronchodilation b- nasal decongestion c- tachycardia d- vasodilation |
d- vasodilation
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