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Pharm Unit 17,18,19
Pharmacology Exam 6
| Question | Answer |
|---|---|
| Peripheral Acting Drugs | Given by IV, Action is dose dependent, Interferes with N2 receptor |
| Non-Depolarizing Blocker | Act as anatagonist, Onset 3-5min, Duration 20-30min, often used for long-term paralysis, has antidote, frequently assess pt |
| Depolarizing Blocker | Stimulates N2 receptor then blocks it, no antidote, short acting, can cause malignant hyperthermia, spike in potassium levels & facial twitching |
| Train of Four | Used to assess degree of paralysis 4 twitches = <75% block 3 twitches = 90% block 2 twitches = 95% block 1 twitch = 98% block |
| What is Norcuron? | Non-depolarizing medication, has few cardiovascular effects |
| What is Zemuron? | non-depolarizing medication has low incidence of adverse cardiovascular effects, expensive |
| What is Tensilon? | Used to diagnose & treat myasthenia gravis, quick onset, ultra short acting |
| 3 medications used in maintenance Tx of myasthenia gravis | Prostigmin, Eserine, Mestinon |
| Antidote for non-depolarizing paralytics | Prostigmin |
| What is Pre-Load? | The amount of blood volume returning to the right heart. Increase in preload = Increase in Right heart work Decrease in preload = Decrease in Right heart work |
| What is After-Load? | Resistance to blood movement from the left ventricle at systole. Increase in SVR/Afterload = Increase in left heart work Decrease in SVR/Afterload = Decrease in Left heart work |
| Hypertension can result in _____ . | Stroke, kidney disease, & cardiac disease *Adversely alters organ function |
| Morphine Sulfate | Relaxes smooth muscle surrounding blood vessels w/ a resulting fall in BP, can vbe used to drop Pre & After Load in Tx of heart failure, Can cause nausea, constipation, apnea, bronchospasm, or hypotension. |
| Anti-hypertensive Medications | Sympathetic Blocker, ACE Inhibitor (Vasotec), Thiazides, Nipride, Nitrates |
| Inderal (propranolol) | Blocks sympathetic receptor, Beta blocker - can promote airway spasm w/ asthma, lowers BP |
| ACE Inhibitors | Given PO for Tx of hypertension, Act by interfering w/ angiotensin II = vasoconstriction is reduced resulting in lower BP |
| Vasotec | ACE Inhibitor used to lower BP, may cause swelling of tongue which can result in possible airway obstruction |
| Thiazides | A class of diuretics used to lower BP because they promote the loss of sodium which results in loss of sympathetic tone & so blood vessels dilate lowering BP |
| Nipride (sodium nitroprusside) | Rescue med used to Tx acute hypertension, IV drip, light sensitive, fast acting vasodilator, requires close pt monitoring |
| Nitrates | Promote vasodilation by limiting the availability of Ca+, reduces pre & after load, enhances myocardium perfusion |
| Levophed (norepinephrine) | Rescue med by IV drip, very strong acting vasoconstrictor, vasoconstriction is significant & can result in ischemia & tissue necrosis of the extremities, use of this med = dire situation |
| Vasopressin (pitressin) | Rescue med, anti-diuretic hormone, can be used as a vasopressor med by IV drip |
| Dopamine | Rescue med by IV drip, stimulates AlphaI receptor, requires higher doses to promote vasoconstriction |
| Moderate to High doses of Dopamine (intropin) | Catecholamine, dose dependent Low dose <5ug/kg/min not therapeutic Moderate dose <10ug/kg/min Beta1 increases force & rate of myocardium High dose >10ug/kg/min Alpha1 vasoconstriction |
| Cardiac Glycosides | Promotes availability of free Ca+ w/in myocardium which improves stroke volume |
| 3 Cardiac Gylcoside medications | Digitalis, Lanoxin, Digitoxin |
| Digitalis med | from foxglove plant, high K+ reduces effect, low K+ makes it toxic |
| Dobutamine (dobutrex) | Synthetic catecholamine, non-selective Beta agonist, Beta1 improves stroke volume, Beta2 vasodilation decreases systemic vascular resistance & can reduce BP & promote reflex tachycardia, indication is acute heart failure |
| Somatic Nervous System receptor & neurotransmitter | Nicotinic II & Ach |
| Acetylcholinesterase | Enzyme that terminates neuro message & allows for repolarization |
| Depolarization | contraction |
| Repolarization | resting state/relaxation |
| Indications for using nicotinic antagonists | Surgery, orthopedic procedures, intubation, mechanical ventilation, paralysis |
| Side-effects associated with peripheral acting nicotinic antagonists | Histamine release = bronchospasm Loss of sympathetic tone = hypotension Tachycardia, hypertension, arrhythmias Temp increase that is unstoppable |
| Compatibility of nicotinic agaonists | Poor compatibility with other drugs, pentiated by some: antibiotics, antiarrhythmics, diurectics |
| Non-depolarizing medications | Tubocurarine(tubarine), Pancuronium bromide(pavulon), Vercuronium bromide(norcuron), Rocuronium(zemuron), Gallamine(flaxedil) |
| Depolarizing medication | Anectine(succinylcholine chloride) |
| Anticholinesterase medications | Used in diagnosis & treatment of myasthenia gravis, potentiate Ach @ N2 receptor by inhibition of actylcholinesterase, antidote for non-depolarizing agents, promote skeletal muscle contraction |
| Vascular Tone | Smooth muscle surrounding the blood vessel alters the size of the blood vessel |
| Vascular Resistance | The amount of resistance to the movement of blood represents myocardium work |
| Ganglionic Blockers | Reduce hypertension through reduction of sympathetic tone, |
| Problems associated with Ganglionic Blockers | Loss of venous tone & resulting blood pooling in legs, Results in orthostatic hypotension, Constipation, Urinary retention |
| What is Shock? | The absence of adequate blood pressure is profound. Death follows quickly if intervention is not swift and appropriate. Metabolic Acidosis. |
| What is angina pectoris? | Intense chest pain secondary to lack of oxygen for the myocardium |
| Explain the use of calcium channel blockers | Vascular smooth muscle – requires free calcium for contraction – dilating/relaxing smooth muscle, Blocks the availability of free calcium, Negative Ionotropic effect |
| Explain the action of Procardia | Calcium channel blocker, reduces coronary artery spasm with resulting enhanced coronary perfusion |
| Glycosides | Are a positive inotropic medication, increases intracellular Ca+ which promotes contractility, increases myocardial contraction which increases stroke volume |
| Two actions of Glycosides | Reduces heart rate, lower AV conduction |
| Phosphodiesterase Inhibitors | Promote higher levels of free Ca+, Acts by increasing the level of cAMP through inhibition of phosphodiesterase, Higher levels of cAMP result in greater blood levels of free Ca+, Higher free levels of Ca+ promote enhance myocardial contraction |
| Inamrione and Amrinone | Phosphodiesterase inhibitors, used to treat severe congestive heart failure that does not respond to more conventional therapy |
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