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Pharm 2- Exam 3
Review
64
Nursing
Graduate
04/13/2015

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Term
Step 1: Mild intermittent asthma
Definition
S/Sx 2 x a week
Brief episodes
>80% of predicted value
Treat w/ short acting beta-2 agonists
Term
Step 2: Mild persistent asthma
Definition
o S/Sx > 2x a week
o FEV1 80% of predicted value
o Episodes impact activity
o Treat with: inhaled corticosteroid for long-term anti-inflammatory
Term
Step 3: Moderate persistent asthma
Definition
o S/Sx daily
o Use B-2 agonists daily
o FEV1 60-80% of predicted
o Treatment is Medium dose Inhaled corticosteroids, and Long-acting bronchodilator (b2-agonist or sustained release theophylline)
Term
Step 4: Severe persistent asthma
Definition
o S/Sx are continuous
o FEV1 60% of predicted
o Treatment includes High-dose inhaled corticosteroids and Long-acting bronchodilators
 Systemic corticosteroids
Term
What is the most effective treatment for acute asthma attacks?
Definition
Short acting beta-2 agonists
Term
What is the most effective treatment to prevent an asthma attack?
Definition
An inhaled corticosteroid
Term
How do you treat a bronchospasm?
Definition
DOBECA Mnemonic
• Deepen level of anesthesia
• 100% FiO2
• B2-agonists via an inhaler
• Epinephrine
• Corticosteroids
• Aminophylline
Term
Class 1 anti-arrhythmics
Definition
Sodium Channel Blockers, Depression of Phase 0 of Depolarization
o Lidocaine, procainamide, phenytoin, quinidine
Term
Class 2 anti-arrhythmics
Definition
Beta blockers
o Esmolol, propranolol, metoprolol, atenolol
Term
Class 3 anti-arrhythmics
Definition
Potassium channel blockers
o Amiodarone, sotalol, bretylium
Term
Class 4 anti-arrhythmics
Definition
Calcium channel blockers
o Verapamil, diltiazem
Term
Other anti-arrhythmics
Definition
o Adenosine, ATP, digoxin, atropine
Term
What receptor does adenosine work on?
Definition
o Purinergic receptors
Term
For atrial tachyarrhythmias under anesthesia the drug of choice would be?
Definition
o Calcium channel blockers
Term
o For SVT the drug of choice under anesthesia would be?
Definition
o Calcium channel blockers (because we wouldn’t give adenosine during a case)
Term
o What is the drug of choice for long term suppression of SVT?
Definition
o A beta-blocker
Term
o Anything with ventricular in the name of the arrhythmia would be treated by what drug?
Definition
amiodarone or lidocaine
Term
Torsade de pointe is treated with what medication?
Definition
Magnesium Sulfate
Term
Beta blockers, how do they make you blood pressure go down?
Definition
Through central depression, direct cardiac depression, renin suppression
Term
2Ace inhibitors, how do ace inhibitors make your blood pressure go down?
Definition
a. By blocking conversion of angiotensin 1 to angiotensin 2, therefore decreasing the amount of angiotensin 2, resulting in vasodilation
Term
Angiotensin receptor blockers, how do they make your blood pressure go down?
Definition
They block angiotensin 1 receptors (remember that angiotensin II is a very potent vasoconstrictor and it works on the angiotensin I receptor)
Term
Diuretics, how do they make blood pressure go down?
Definition
I think he said "volume control" and vasodilation
Term
Calcium channel blockers
Definition
Central depression, direct cardiac depression, vasodilation
Term
Normal BP is what?
Definition
SBP<120, DBP<80
Term
Prehypertension is what?
Definition
SBP 120-139, DBP 80-89 (no drugs indicated)
Term
Stage 1 HTN
Definition
SBP 140-159, DBP 90-99 (thiazide diuretics are most common, consider ACEI, ARB, B, CCB)
Term
Stage 2 HTN
Definition
SBP > or = 160, DBP > or = 100 (2 drug combo, usually thiazide diuretic and ACEI or ARB or BB or CCB)
Term
Where/how do renin blockers work?
Definition
block renin so you can’t convert angiotensinogen to angiotensin 1
Term
Where/how do ACE inhibitors work?
Definition
ACE inhibitors block the angiotensin converting enzyme so you can’t convert angiotensin 1 to angiotensin 2
Term
Where/how do Angiotensin receptor blockers (ARBs) work?
Definition
Angiotensin receptor blockers (ARBs) block the angiontensin 1 receptor which prevents angiotensin 2 (a very potent vasoconstrictor) from occupying the angiontensin 1 receptor
Term
What are the 3 beta blockers we can use?
Definition
Labetalol, esmolol and metoprolol
Term
Which one of the beta blockers is different than the others and how so?
Definition
Labetalol is also an alpha blocker so it vasodilates. Esmolol and metoprolol have no alpha blocking effect so they cause vasoconstriction
Term
How is Esmolol broken down?
Definition
Non-specific esterase enzymes, or RBC esterases to be specific
Term
Why is esmolol so short acting?
Definition
Because it is broken down in the plasma by RBC esterases.
Term
What is the problem with nitroprusside?
Definition
Cyanide toxicity
Term
How do you get cyanide toxicity?
Definition
Because a build up of CN blocks cytochrome oxidase in the cells.
Term
How do you treat cyanide toxicity?
Definition
Thiosulfate, sodium nitrate
Term
What is the enzyme that detoxifies cyanide in the body usually?
Definition
Rhodanese
Term
Treatment of CN toxicity?
Definition
Mnemonic: SOMe B Needs That Hat
o Stop Nipride infusion
o 100% FiO2
o Mechanical Ventilation PRN
o Sodium Bicarb to correct metabolic acidosis
o Sodium Nitrate 3% 4-6mg/kg IV
o Sodium thiosulfate 150-200mg/kg IV
o Hydroxocobalamin (vitamin B12) 25 mg/ht
Term
Why do you get rebound hypertension when you turn off nipride?
Definition
Due to renin release.
Term
What are the drugs of choice for the treatment of angina?
Definition
o Nitrates
o Beta Blockers
o Calcium Channel Blockers
o Antiplatelet drugs
o Statins
o ACE inhibitors
o Ranexa
Term
Class 1 Angina
Definition
Angina doesn’t happen with normal activity, only with strenuous activity
Term
Class 2 Angina
Definition
Angina may happen with normal activity, causing slight limitation
Term
Class 3 Angina
Definition
Angina occurs with normal activity and causing marked limitation
Term
Class 4 Angina
Definition
Angina at rest, angina occurs with all physical activity
Term
Treatment for Stable Angina
Definition
beta blocker, Ca channel blocker, nitrates, antiplatelet drugs, statins, ACE inhibitors
Term
Treatment for Unstable Angina
Definition
"every drug in the drawer"
Term
Treatment for Variant Angina
Definition
Calcium Channel Blockers
Term
How does nitroglycerin help with angina?
Definition
o It reduces preload, therefore reducing cardiac demand, possibly some coronary dilation
Term
With beta blockers, what is the issue?
Definition
You want to block beta 1 receptors but you don’t want to block beta 2. If you block beta 2 you get bronchoconstriction affecting asthmatics, and you get hypoglycemia affecting diabetics, and you get vasoconstriction therefore people with claudication are affected.
Term
Selective or non-selective beta blockers means what?
Definition
Non-selective blocks beta 1 and beta 2, selective blocks primarily one receptor
Term
What about somebody who takes beta blockers and coming to surgery?
Definition
Anybody who is on one, keep them on it.
If you want to start someone on one, start a week before surgery and titrate to heart rate of 55 if possible
Term
Hydralazine is what kind of vasodilator
Definition
arterial
Term
Nitroglycerin is what kind of vasodilator
Definition
venous
Term
All other vasodilators (other than nitroglycerin and hydralazine) vasodilate how?
Definition
arterial and venous vasodilation
Term
The drug of choice for variant angina:
Definition
calcium channel blocker
Term
The 3 herbal medications that can affect coagulation
Definition
1. Garlic
2. Ginger
3. Gingko
Term
Class 1 CHF
Definition
no physical limitation
Term
Class 2 CHF
Definition
Slight physical limitation, ordinary activity causes fatigue
Term
Class 3 CHF
Definition
marked physical limitation, Less than ordinary activity causes symptoms
Term
Class 4 CHF
Definition
unable to do any activity without symptoms or discomfort
Term
What are the drugs to treat CHF?
Definition
Everyone gets an ACE inhibitor and a beta blocker, and depending on severity you can also be given a diuretic, digitalis, or vasodilators
Term
How does digoxin work?
Definition
It blocks the sodium pump, which results in a build up of calcium within the cell causing increased inotropy.
Term
The signs of dig toxicity:
Definition
GI, neuro, visual and cardiac arrhythmias
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