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The flashcards below were created by user
medic11
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What are the three components of post intubation mgmt?
- Continued sedation
- Continued pain mgmt
- Continued tube security
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What is the path of blood flow through the heart?
SVC/IVC > RA > Tricuspid Valve > RV > Pulmonary semilunar valve > Pulmonary artery > Lungs > LA > Bicuspid > LV > Aortic semilunar > Aorta > Body
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The elec pathways of the heart follow what route?
SA node > Internodal > AV node > Bundle of His > R & L bundle branches > Purkinje Fibers
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What is Bachmans Bundle?
Conduction tract in the heart that originates @ SA node & conducts action potentials to the LA
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Class IA antidysrhythmics are ___ ___ ___ w/ the mechanism?
- Sodium Channel Blockers
- Slow conduction & decrease repolarization rate
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Prototype Sodium Channel Blockers (class ____) are what 3 drugs?
- IA
- Quinidine, Procainamide & Disopyramide
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Class IB (aka ___ ___ ___) include what 4 drugs?
- Sodium Channel Blockers
- Lidocaine (xylocaine)
- Phenytoin (Dilantin)
- Tocainide (Tonocard)
- Mexiletine (Mexitil)
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The mechanisms for Class IB Sodium Channel blockers are what?
- Increased rate of repolarization
- Reduced automaticity in ventricular cells
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Class IA Sodium Channel Blockers show on an ECG in the form of . . .
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Class IB Sodium Channel Blockers show on an ECG in the form of . . .
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Class IC sodium channel blockers include what 2 drugs/
- Flecainide (Tambocor)
- Propefenone (Rythmol)
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Actions of a class IC sodium channel blocker are . . .
- Decrease conduction velocity thru Atria, ventricles, bundle of His & purkinji network
- Delay ventricular repolarization
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What are the actions of moricizine (Ethmozine) (class ____)?
- Decreases conduction velocity
- Depresses myocardial contractility
- Blocks Na influx during fast potential depolarization
- Class I miscellaneous
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Class II drugs (___ ___) include what 3 drugs?
- Propranolol (Inderal)
- Acebutolol (Sectral)
- Esmolol (Brevibloc)
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The non selective beta blocker is ____ while acebutolol & Esmolol are selective for what?
- Propranalol
- Beta1 receptors in the heart
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Beta blockers are indicated in the treatment of what?
Tachycardias resulting fr excessive sympathetic stimulation
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How does a selective Beta blocker work?
Blocking Beta1 blocks Ca channels preventing gradual influx of Ca in phase 0 of slow potential
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K channel blockers (class ___) include what 2 drugs?
- Bretylium (bretylol)
- Amiodarone (Cordarone)
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The mechanism of action for Class III (aka ___ ___ ___) drugs is?
- K channel blockers
- Blocks efflux of K in fast channels
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K channel blockers are indicated for what?
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CCB�s or class __ drugs effects are almost identical to ____?
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What are the only 2 CCB�s that affect the heart?
- Verappamil (calan)
- Diltiazem (cardizem)
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CCB�s slow ____ ____of A fib & flutter & they can terminate ____ ____ originating fr a reentrant circuit.
- Ventricular conduction
- Superventricular tachycardias
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What are the 2 chief side effects of CCB�s?
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Adenosine is described as an & what does it act on?
- Endogenous nucleoside w/ a very short half life (about 10 secs)
- Both K & Ca channels; ^ K efflux & inhibiting Ca influx
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What are side effects of adenosine?
- Facial Flushing
- SOB
- Chest Pain
- Marked Bradycardia
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When should adenosine dosages be increased?
In pts taking adenosine blockers such as aminophylline or caffeine
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When should adenosine dosages be decreased?
In pts taking adenosine uptake inhibitors such as dypyridamole (Persantine) or Carbamazapine (Tegretol)
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What are the effects of digoxin on the heart?
- Decreases intrinsic firing rate in the SA node
- Decreases conduction velocity in the AV node
- ^ cardiac contractility
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What are the effects of digoxin on Purkinji Fibers & ventricular myocardial cells?
Dig causes a decrease in the effective refract period & ^ automaticity
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What are the side effects of digoxin (6)?
- Bradycardias
- AV blocks
- PVCs
- V Tach
- V Fib
- A Fib
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What is digoxin indicated for?
- A Fib w/ rapid ventricular conduction
- Chronic treatment of CHF
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What is Torsades de pointes?
A polymorphic V Tach
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What is the drug of choice for Torsades?
Magnesium
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What is the formula for BP?
BP=Cardiac output x peripheral vascular resistance
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What is cardiac output equal too?
Cardiac output = HR x Stroke Volume
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What is a diuretic?
Drug used to reduce circulating blood vol by ^ amt of urine
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What are the 3 main categories of diuretics?
- Loop or High ceiling diuretics
- Thiazides
- K sparing diuretics
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What is the prototype loop diuretic?
Lasix
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Loop diuretics are one of the primary tools in treating what?
Left ventricular heart failure (CHF)
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How does Furosemide (aka____) work?
- Lasix
- By blocking Na reabsorption in the ascending loop of Henle decreasing the pull of H2O fr the tubule & into the capillary bed
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What are furosemides main side effects?
- Hyponatremia
- Hypovolemia
- Hypokalemia
- Dehydration
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What is the difference between loop diuretics & thiazides?
Thiazides mechanism affects the early part of distal convoluted tubule & therefore cannot block as much Na fr reabsorption
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What is the prototype thiazide?
Hydrochlorothiazide
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What is the 1 important thing that distinguishes thiazides?
They depend on glomerular filtration rate
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How do K sparing diuretics work?
Na absorption is affected be inhibiting the effects of aldosterone on the distal tubules or the specific Na/K exchange mechanism
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What is the prototype K sparing diuretic?
Spironolactone (Aldactone)
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What are the 5 types of adrenergic inhibiting agents?
- Beta adrenergic antagonists
- Centrally acting adrenergic inhibitors
- Peripheral adrenergic neuron blocking agents
- Alpha1 antagonists
- Combined Alpha/Beta antagonists
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What is the prototype Selective Beta1 Blocker?
Metoprolol (Lopressor)
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What is the prototype non-selective Beta1 Blocker?
Propranolol (Inderal)
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Of the Centrally Acting Adrenergic Inhibitors, the prototype is ____ (aka ____) w/ side effects of ____ & ____.
- Clonidine aka Catepres
- Drowsiness & Dry Mouth
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The prototype Peripheral Adrenergic Neuron Blocking Agent is what?
Reserpine aka Serpalan
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What is the prototype Alpha1 antagonist?
Prazosin aka Minipress
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How does an Alpha1 antagonist work?
Competitively blocks Alpha1 receptors inhibiting sympathetically mediated increases in peripheral vascular resistance
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Alpha/Beta antagonists act by . . . .
Decreasing Alpha mediated vasoconstriction & the Beta1 blockade decreases HR, contractility & rennin release fr kidneys
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2 Alpha/beta antagonist drugs are ____ & ___.
- Labetalol (normodyne)
- Carvedilol (Coreg)
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What do ACE inhibitors do?
Interrupt the rennin-angiotensin-aldosterone-sys by preventing the conversion of angiotensin1 to angiotensin2 leading to a decrease in peripheral vascular resistance
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What is the prototype ACE inhibitor?
Catopril (Capoten)
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Name 2 common ACE inhibitors other than the prototype which is___.
- Enalapril (Vasotec) & Lisinipril (Zestril)
- Catopril (Capoten)
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1 category for CCBs is antidysrhythmic. What is the other & what is the prototype?
- Dihydropiridines
- Nifedipine (Procardia, Adalat)
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What is Stoke-Adams Syndrome?
Heart condition characterized by fainting, blackouts & fainting while sitting
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What is the prototype for selective arteriole dilators?
Hydralazine (Apresoline)
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How does Hydralazine work?
It decreases peripheral vascular resistance & afterload therefore BP.
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Alpha 1 receptors cause what response where?
- Constriction � Arterioles & veins
- Mydriasis � eye
- Ejaculation � penis
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Alpha2 receptors cause what response where?
Inhibits release of norepi in presynaptic terminals
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Beta 1 receptors cause what response where?
- ^ HR, conductivity, automaticity, contractility � heart
- Renin release � kidneys
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Beta 2 receptors cause what response where?
- Bronchodilation � lungs
- Dilation � arterioles
- Inhibition of contractions � uterus
- Tremors � skeletal muscle
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Beta 3 receptors cause what response where?
Lipolysis � adipose tissue
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Dopaminergic receptors cause what response where?
Vasodilation � kidney
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All antidysrhythmics have arythmogenic properties. This means?
All antidysrhythmics have the ability to cause dysrhythmias
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What are the 2 cardiac glycosides?
- Digoxin (Lanoxin)
- Digitoxin (Crystodigin)
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How does digoxin reduce symptoms of CHF?
By ^ myocardial contractility & cardiac output
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What are side effects of digoxin?
- Fatigue
- Anorexia
- Nausea
- Vomiting
- Blurred vision w/a yellowish haze & halos around dark objects
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Name the 2 bronchodilators that are non-specific agonists.
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What are the 4 Beta2 specific agonists that are short acting?
- Albuterol (Ventolin, proventil)
- Metaproterenol (Alupent)
- Terbutaline (Brethine)
- Levalbuterol (Xopenex)
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What is the Beta 2 specific agonist that is long acting?
Saslmeterol (Serevent)
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What are methylxanthines & what 2 drugs are in this category?
- CNS stimulants w/ additional bronchodilatory properties
- Theophylline & Aminophylline
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What are the 2 anticholinergics used to treat asthma?
- Atropine
- Ipratropium (Atrovent)
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What are the 3 inhaled glucocorticoid anti-inflammatory agents for treating asthma?
- Beclomethasone (Beclovent)
- Flucticasone (Flovent)
- Triamcinolone (Azmacort)
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What is the oral glucocorticoid anti-inflammatory agents for treating asthma?
Prednisone (deltasone)
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What are 2 injected glucocorticoid anti-inflammatory agents for treating asthma?
- Methyprednisolone (solu-medrol)
- Dexamethasone (Decadron)
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What are the 2 leukotriene Antagonists for treating asthma?
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
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What is the 1 Mast-cell membrane stabilizer used in treating asthma?
Cromolyn (Intal)
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What are the 2 basic components of the pathophysiology of asthma?
Bronchoconstriction & Inflammation
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Common causes of asthma are ?
Pet dander, mold, dust etc.
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True or false. . . .All that wheezes is asthma.
False
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For asthma, what is the first line mechanism for treatment especially for daily use?
Beta2 specific agents
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How do beta2 specific agents work in asthma?
Relax bronchial smooth muscle resulting in bronchodilation & relief fr bronchospasm
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What is the prototype beta 2 specific agent for daily use in asthma?
Albuterol
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What is rhinitis & what are some symptoms?
Inflammation of nasal lining w/ symptoms nasal congestion, itching, redness, sneezing & rhinorrhea (runny nose)
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What is the main pharmacological classification for nasal decongestants?
Alpha 1 agonists including phenylephrine, pseudoephedrine, phenylpropanolamine
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What is rebound congestion?
A form of tolerance that is caused by long term use of nasal decongestants.
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What are antihistamines?
Med that arrests the effects of histamine by blocking its receptors
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What is a histamine?
An endogenous substance that affects a wide variety of organ systems.
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Name 5 antihistamines.
- Benadryl
- Seldane
- Claritin
- Zyrtec
- Allegro
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What is the chief side effect of antihistamines?
Sedation
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Why do second generation antihistamines not cause sedation?
B/c they do not cross the blood brain barrier
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Why should I not give an antihistamine to my asthma pt?
B/c they can thicken bronchial secretions
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If my pt has a productive cough should I treat it? Why or why not?
No b/c it is performing a useful function
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If a nasal decongestant is overused it can cause an elevation in what?
Pulse Rate & BP
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An antitussive is defined as what?
Med that suppresses a stimulus to cough in the CNS
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What is an expectorant?
Med intended to ^ the productivity of a cough
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What is a mucolytic?
Med intended to make mucus more watery
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What are the 4 main indications for gastrointestinal drug therapy?
- Peptic ulcers
- Constipation
- Diarrhea & emesis
- Digestion
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Peptic ulcer disease is characterized by. . . .
An imbalance between factors in the gastrointestinal sys that ^ acidity & those that protect against acidity
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What is the most common cause of peptic ulcer disease?
- Helicobacter pylori bacterium infestation in the space between the endothelial cells & the mucus lining of the stomach & duodenum
- Often found in pts w/ failing gall bladders
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4 H2 receptor antagonists for treating PUD are?
- Cimetidine (Tagamet)
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Nizatidine (axid,pulvulex)
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Proton pump inhibitors used to treat PUD are?
- Omeprazole (prilosec)
- Lansoprazole (prevacid)
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5 treatment modalities for treating PUD are?
- H2 receptor antagonists
- Proton pump inhibitors
- Antacids
- Aluminum, Magnesium or Na compounds
- Anticholinergics
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What is the anticholinergic used for treating PUD?
Pirenzepine (gastrozepine)
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What are the 4 categories of laxatives?
- Bulk forming
- Stimulant
- Osmotic
- Surfactant
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What is a laxative?
Med used to decrease a stools firmness & ^ its water content
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What is surfactant?
Substance that decreases surface tension
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What are 2 examples of bulk forming laxatives?
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What are 2 examples of a stimulant laxative?
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What is an example of an osmotic laxative?
Milk of magnesia
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What is an example of a surfactant laxative?
Colace
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What are the 4 categories of drugs for treating emesis?
- Anticholinergic
- Serotonin antagonists
- Dopamine antagonists
- Cannabinoids
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What is 1 example of a serotonin antagonist?
Ondansetron (zofran)
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Give 4 examples of dopamine antagonists for emesis?
- Compazine
- Phenergan
- Inapsine
- Reglan
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What are 2 examples of cannabinoids used for emesis?
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