Class 4 Deck 2

Question 1

What does NTG do to non cardiac vasculature?

Answer 1

• Dilates meningeal vessels (Cautious w/ ↑ ICP)
• Decrease renal blood flow
• Dilates pulmonary vessels (↓ PVR)

Question 2

What are the indication for NTG?

Answer 2

• Ventricular failure
• HTN
• Ischemic heart disease

Question 3

How is NTG used in OB?

Answer 3

-To help relax the uterus

Question 4

NTG adverse effects

Answer 4

• Postural HTN
• Tachy
• Headache
• Dizzy
• Weakness
• Methemoglobin

Question 5

What patients need to avoid NTG?

Answer 5

• PDE5 inhibitors (Viagra)
• Glaucoma
• Head injury
• Anemia
• Hypotension

Question 6

What are the advantages of NTG

Answer 6

• Rapid onset / Short duration
• Coronary vasodilator
• ↓ myocardial O2 consumption
• no toxicity / no steal
• ↓ PVR

Question 7

What is hydralazine?

Answer 7

-Direct acting vascular smooth muscle dilator. (interferes with calcium ion transport)

Question 8

What does hydralazine increase?

Answer 8

• CO
• HR
• SV
• Sympathetic output (baroreceptor reflex)
• contractility
• Renin

Question 9

What does hydralazine decrease?

Answer 9

• SVR

- diastolic BP more than systolic

Question 10

Hydralazine has a greater effects on _______ than _____?

Answer 10

Arterioles / Veins

Question 11

What are the advantages of hydralazine

Answer 11

• Maintains cerebral blood flow

- Increases CO and SV

Question 12

What are the disadvantages of hydralazine?

Answer 12

• Reflex tach
• reduced response to ephedrine
• sodium and water retention
• longer duration of action
• Increase myocardial O2 demands

Question 13

What type of patients should hydralizine be avoided?

Answer 13

• CAD
• ↑ ICP
• Lupus

Question 14

What are the side effects of hydralazine?

Answer 14

• Sodium and water retention

- Vertigo, Nausea, diaphoresis

Question 15

What is the drawback of hydralizine in anesthesia?

Answer 15

-Long onset time

Question 16

Name 3 alpha antagonists

Answer 16

• Phentolamine
• Phenoxybenzamine
• Prozosin

Question 17

How does phentolamine work?

Answer 17

• Alpha adrenergic blocker
• Direct acting vasodilator
• Greater arterial than venous

Question 18

What does phentolamine do?

Answer 18

• ↓ afterload and preload
• Promote EF and CO
• Decrease PVR

Question 19

When is phentolamine used

Answer 19

• HTN from pheochromacytoma
• Clonidine withdrawl
• ED
• Extravisation of catecholamines
• improves asthma symptoms

Question 20

What is phenoxybenzamine? what does is bind to?

Answer 20

• Prototype alpha 1 antagonist

- irreversibly binds to receptor

Question 21

When is phenoxybenzamine used?

Answer 21

• Long term treatment of pheochromacytoma
• Ischemic PVD
• BPH

Question 22

phenoxybenzamine can cause what effects?

Answer 22

• ↓ PVR to ↓ BP
• ↑ in NorEpi
• Crosses BBB

Question 23

What is prazosin? What does it do?

Answer 23

• Oral selective alpha 1 antagonist
• Peripheral vasodilator (arteries more than veins)
• ↑ HR
• Improves urinary flow

Question 24

Clonidine is what type of drug?

Answer 24

Alpha 2 agonist (decreases release of sympathetic neurotransmitters)

Question 25

What are the uses for alpha 2 agonists (clonidine)

Answer 25

- Sedation - Anesthesia sparing effect - Peripheral nerve block - Analgesia (postop, labor, chronic) - Post op shivering - Drug withdrawl

Question 26

How does clonidine effect anesthesia?

Answer 26

- Reduce need for propofol and thiopental - Alternative to N2O for shortening induction time - Decrease adrenergic response to intubation - Supplement regional blocks

Question 27

What are the actions of clonidine?

Answer 27

- Decrease HR,BP, CO, SVR | - Baroreceptors reflex preserved (no orthostatic hypotension)

Question 28

What happens if clonidine is stopped abruptly? How quickly can it be seen?

Answer 28

- Rebound HTN | - can happen after 6 days on med

Question 29

How does alpha-Methyldopa work?

Answer 29

-In CNS it is metabolized to alpha-methylepinepherine which acts on alpha 2 receptors to decrease sympathetic outflow

Question 30

When is alpha-Methyldopa used?

Answer 30

-Treat HTN during pregnancy, usually 3rd trimester

Question 31

What is Dexmedetomidine (Precedex) do?

Answer 31

- Alpha 2 agonist for IV sedation (<24hr) in the ICU - Maintain respiratory stability - Light analgesia, no amnestic effects - Pts are arousable (sleep like state) safer for non-anesthesia personal

Question 32

What 3 drugs can reduce post op shivering?

Answer 32

- Demerol - Clonidine - Precedex

Question 33

When is precedex used?

Answer 33

- Procedural sedation (Fiber optic intubation, regional anesthesia) - Children who failed sedation by other techniques

Question 34

Precedex must be used with caution in what patients and why?

Answer 34

- Heart Block (brady) | - Ventricular dysfunction (sinus arrest)

Question 35

ACE inhibitors are recommended for what types of patients?

Answer 35

- Those that cant take beta blockers - Bronchospasms - DM (beta blockers decrease insulin)

Question 36

When are ACE inhibitors used?

Answer 36

- Treat CHF and MR by afterload reduction | - Increase CO w/o decrease in preload

Question 37

Why are ACE inhibitors not used in anesthesia?

Answer 37

-Risk of acute renal failure

Question 38

How does and ACE inhibitor affect renal function of a hypertensive patient? Normotensive?

Answer 38

- Hypertensive = improves RBF and GFR | - Normo = renal function may decrease

Question 39

Advantages of ACE inhibitors

Answer 39

- Minimal side effects | - No problems with abrupt withdrawl

Question 40

Most serious side effects with ACE inhibitors

Answer 40

-Angio edema

Question 41

ACE are not for use in what patients?

Answer 41

- Renal patients | - Pregnant

Question 42

Why choose and ARB over an ACE inhibitor?

Answer 42

- Same hemodynamic effects - Less cough and angioedema - Can combine with diuretic / CCB

Question 43

What is fenoldopam? When is it used?

Answer 43

- DA1 agonist - Short term management of severe HTN - Preserve RBF

Question 44

Problems with fenoldpam?

Answer 44

- Tachycardia - Hypokalemia - Not renal protective - expensive