Advanced Pharmacology - Vasopressors, Inotropes, Antiarrhythmic Agents
Terms in this set (86)
What are the 3 factors affecting blood pressure?
Systolic Blood pressure, diastolic blood pressure, and mean arterial pressure
______ = drives blood into tissues over the entire cardiac cycle.
What are the formulas for figuring MAP?
DBP x 2 + SPB / 3
MAP = Cardiac Output x SVR
MAP = SV x HR x SVR
_____ ______ = amount of blood leaving the heart with each contraction per unit of time.
What is the formula for cardiac output?
Stroke volume x heart rate
_____ = volume of blood filling the ventricles
_______ ________ is influenced mostly by preload.
_____ effect = increases the rate of contraction of the heart
_____ effect = increases contractility or force of the heart.
Vascular tone or ______ ______ _____ is regulated by the sympathetic nervous system and by circulating hormones. Resistance of flow that must be overcome to push blood through the peripheral circulation.
systemic vascular resistance
What are 2 determinants of MAP?
Cardiac Output and Systemic Vascular Resistance
_____ _____ - the amount of blood ejected from the heart during systole.
What is the normal value for Central Venous Pressure - CVP?
What is the normal value for Pulmonary Capillary Wedge Pressure - PCWP?
What is the normal value for Cardiac Output?
What is the normal value for Systemic Vascular Resistance - SVR?
800-1440 dynes/sec/cm 5
_____ = life threatening medical emergency characterized by organ hypoperfusion leading to decreased delivery of O2 and glucose and nutrients to tissues throughout the body.
What is the main job of the Cardiovascular System - CVS?
to pump blood to the body
What is the main job of the Central Nervous System - CNS?
To control vasomotortone
How to the CNS and the CVS communicate?
They communicate by hormones and neurotransmitters
______ = ventricular contraction; ejection of blood through the aorta
_______ = ventricular relaxation; blood filling
Map below 60 = ______ ______
ischemic organs; when this occurs, a bolus of fluid is given.
_____ ______ ______ = used to monitor patient response to vasoactive therapy. Used to determine cause of HYPOTENSIVE issues. Measures the amount of fluid returning to the heart.
pulmonary artery catheter
What is the first line therapy for hypotensive episodes?
Flow Directed Indwelling Pulmonary Artery Catheter is aka _____ ______ _____
Swan Ganz Catheter
For hypotensive episodes, what can we do to correct the problem?
1. increase blood volume with fluids
2. increase vasoconstriction with drugs such as vasopressors
3. increase heart rate with chronotropic agents - cardiac stimulants
4. increase force of contraction with inotropic agents - cardiac glycosides
What are the 5 types of shock?
cardiogenic, hypovolemic, septic, neurogenic or distributive, and anaphylactic
Cardiogenic shock = _____ ______
Hypoveolemic shock = _______ _____ ______
decreased blood volume
Septic shock = ______ ______
Neurogenic Shock = ______ _______ _______
massively decreased SVR
Anaphylactic shock = ______ ______
What are the 6 catecholamines used to treat/manage shock?
Norepi and epi are _______ catecholamines secreted by the adrenal _______.
Norepi and epi's net response is what?
vasoconstriction and tachycardia
What is Brand name for epinephrine?
What is the Brand name for norepinephrine?
Isoproterenol is a ______ catecholamine.
What is the brand name of Isoproterenol?
Isoproterenol is a very _____ drug and has limited use due to its effects on _______.
Use of this drug can cause rotting of the peripherals
Dopamine is an _______ catecholamine.
Dopamine has both ______ and _______ effects.
Must be careful giving Dopamine as it increases ______ and myocardial ______ demand. When wouldn't be a good time to use this drug?
Not the best choice of drug to use after MI
Dopamine increases chronotropic and inotropic effects and leads to increased _______ _______
What is the Brand name for Dopamine?
Phenylephrine is purely an ______ ______ drug.
Phenylephrine induces __________.
Phenylephrine has no significant ______ effects and increases _____ _______ and can cause rotting of the peripherals.
respiratory, heart rate
What is the Brand name for Phenylephrine?
Vasopressin is aka ______ _______
Vasopressin has both _________ and water ________ effects
Vasopressin in not a good _____ choice and is not to be used as a _____ agent.
What is the Brand name for Vasopressin?
Vasopressin can be used for _______ shock
Dobutamine is an ______ agent used for short term treatment of heart failure secondary to depressed contractility.
Dobutamine is an R isomer than causes positive _____ and ________ effects and __________ effects.
inotropic, chronotropic, vasodilatory
What is the Brand name for Dobutamine?
Inamrinone and and milrinone are ___________ inhibitors with inotropic vasodilator agents.
Inamrinone brand name = __________
Milrinone brand name = _________
The only drug in the cardiac class used in the management of chronic heart failure is _______
1. Top prescribed drug for _______
2. Very ______ dosage window of _____ - _______
3. It's important to drink a lot of ______ while on this drug
2. narrow, 0.5 - 2 mg/ml
What is the Brand name for Digoxin?
Physiology of Myocardium:
1. ______ _______ initiates electrical activity; generates action potential; depolarized atria
2. _____ _______ links activity of the atria and ventricle; potential travels to bundle of His, bundle branches, and purkinje fibers.
1. SA Node
2. AV Node
List the order of the 5 major components of the heart's conduction system.
1. SA Node
2. AV Node
3. Bundle of His
4. Ventricular Bundle Branches
5. Purkinje Fibers
Polarization = ______
What happens during polarization?
K+ concentration is greater inside the cell. Na+ is greater outside the cell. The inside of the cell is negative relative to the outside of the cell.
________ = trigger for myocardial contraction.
______ = return of the cell's membrane potential to resting potential.
1. ______ ______ = trigger for myocardial contraction, depolarization, sodium ions rapidly diffuse into the cell.
2. ______ ______ = beginning of repolarization; potassium flows out of the cell
3. _____ ______ = Seen as plateau on action potential, slow inward flow of Ca++ which slows the outflow of potassium; prolongs the contraction
4. ______ _______ = Inward flow of Ca++ stops and potassium is then accelerated out of the cell.
5. _____ ______ = ion channels return to their resting state
1. Phase 0
2. Phase 1
3. Phase 2
4. Phase 3
5. Phase 4
_____ = application w/radiofrequency current to part of the heart causing arrhythmia via catheter; effective with AFib
_____ ______ ______ = used to cardiovert, terminate VT, and pace bradycardia; indicated for cardiac arrest secondary to VT or VF that is not reversible.
Implantable Cardioverter Defibrillator (ICD)
Arrhythmias are classified according to _______ ___ _____.
mechanisms of action
Class _____ = blocks fast Na channels in the atrium and block repolarizing K currents; knocks out overstimulation in the atria; Quinidine; Procainamide. In the BETTER USE IT CLASS!
Class _____ frequently used to treat VA during cardiac surgery or after MI; MAYBE USE CLASS!!
Class ______ = Beta Blockers; used for management of hypertension and post MI.
Class _____ = agents that are used to treat SVT and VA's; Amiodarone
Class _____ = calcium channel blockers; used in the management of SVT and ventricular rate control; if heart is beating too fast, it slows down the calcium.
______ is the drug that prolongs the relative refractory period; used as a maintenance drug
______ = used to terminate SVT; pushed rapidly by IV - brachial or central - followed by saline bolus and raising of the arm. Results in cardiac standstill.
____ _____ ______ = Leading cause of death in the U.S.; VFib, Pulseless VTach, PEA, or Asystole.
Sudden Cardiac Death
_____ = very potent and most common drug given during a CODE; 1 mg ampules given during CODE.
______ = given along with Epi and Vasopressin for ACLS; given for Asystole or PEA.
____ _____ - given for acidosis to balance pH to restart heart; ACLS drug; used for status asthmaticus; patient must be well ventilated.
_____ ______ = Used for torsades de pointes.
ETT Route during CODE:
1. NAVEL = ____ _____ ____ ____ ____
2. _____ dose and dilute with ______ mL saline
3. Follow with ___ - _____ rapid ventilations
1. Narcan, Atropine, Vasopressin, Epinephrine, Lidocaine
2. Double, 10