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