Cardiac Pharmacology
3 classes of antiplatelet drugs - questions and answers-Block cyclooxygenase: ASA
ADP receptor antagonist: clopidrogrel
Glycoprootein 2 B 3 A: integrillin, in stents
ACE inhibitors - questions and answers-All end in "PRIL"
MOA: block renin release, vasodilate pg 179
*Makes people cough because it inhibits breakdown of bradykinin.
Amiodorone affects potassium channels, what types of arrythmias is it used in? -
questions and answers-All arrythmias (but can affect repolarization)
Angina - questions and answers-4 Classes
First symptoms:
pressure, heartburn, diffuse pain, substernal, goes down arm into jaw, lasts 1-15minutes
(longer than 15 minutes, MI), precipitated by exertion, relieved by rest
Tachycardia: decreases oxygen supply
Anesthesia: will see ECG changes first
ARB: Angiotensin Receptor Blockers - questions and answers-All end in "ARTAN"
Used when people can't tolerate ACE inhibitor
Angiotensin 2 can't get on angiotensin receptor since ARB has blocked it. These drugs
do not affect bradykinin, no cough.
MOA: block angiotensin 1 receptors and angiotensin 2, angiotensin can't vasoconstrict
causing vasodilation
Atropine posioning mnemonic - questions and answers-Red as a beet, blind as a bat,
dry as a bone, mad as a hatter, hot as a hare.
Atropine vs. Robinul - questions and answers-Atropine: crosses BBB, better for ↑ HR,
sedative
Robinul: better drying drug,
B1 in the heart does what? - questions and answers-Stimulation: tachycardia, increased
Block: bradycardia, decreased contraction
Betablocker - questions and answers-Most end in "OLOL"
Ensure no missed dose (up-regulated) tremendous rebound HTN
, MOA: central depression in medulla, cardiac depression, block renin release in the
kidneys
ISA: partial agonist, weaker beta blocker
Alpha blocking properties: labetolol, coreg, also vasodilates due to alpha block
Disadvantages: bronchoconstriction, vasoconstriction and hypoglycemia
Blocking calcium channels in the heart has what effect? - questions and answers-↓
demand ↑ O₂ supply
Any time calcium is less in muscle it will decrease contraction. Decreases afterload and
preload also. Very effective at preventing vasospasm in coronary arteries (variant
angina)
BP classification: Normal - questions and answers-<120/ <80
CAD and Anesthesia - questions and answers-Prevent tachycardia (induction &
emergence)
Maintain HR at pre-op values reduces ischemia.
If HR <120 under anesthesia, reduced risk of ischemia.
Inject esmolol during induction to keep BP/HR low during induction & emergence.
Calcium channel blockers - questions and answers-Most end in "DIPINE" also
verapamil, diltiazem
MOA: CNS effect, cardiac depression, vasodilate
Can patient have regional anesthesia when on anti-ccoagulants? - questions and
answers-ASA: fine
Plavix: DC 7 days prior to block
GPD23A: DC 8-48 hours prior
(About 48 hours for each drug is probably safe)
Heparin: may resume 1 hour post block
Digitalis & anesthesia - questions and answers-Why are they on dig? atrial tachycardia
or CHF
What is digitalis level?
What is their serum potassium?
How effective is the digoxin? Assessment.
3 classes of antiplatelet drugs - questions and answers-Block cyclooxygenase: ASA
ADP receptor antagonist: clopidrogrel
Glycoprootein 2 B 3 A: integrillin, in stents
ACE inhibitors - questions and answers-All end in "PRIL"
MOA: block renin release, vasodilate pg 179
*Makes people cough because it inhibits breakdown of bradykinin.
Amiodorone affects potassium channels, what types of arrythmias is it used in? -
questions and answers-All arrythmias (but can affect repolarization)
Angina - questions and answers-4 Classes
First symptoms:
pressure, heartburn, diffuse pain, substernal, goes down arm into jaw, lasts 1-15minutes
(longer than 15 minutes, MI), precipitated by exertion, relieved by rest
Tachycardia: decreases oxygen supply
Anesthesia: will see ECG changes first
ARB: Angiotensin Receptor Blockers - questions and answers-All end in "ARTAN"
Used when people can't tolerate ACE inhibitor
Angiotensin 2 can't get on angiotensin receptor since ARB has blocked it. These drugs
do not affect bradykinin, no cough.
MOA: block angiotensin 1 receptors and angiotensin 2, angiotensin can't vasoconstrict
causing vasodilation
Atropine posioning mnemonic - questions and answers-Red as a beet, blind as a bat,
dry as a bone, mad as a hatter, hot as a hare.
Atropine vs. Robinul - questions and answers-Atropine: crosses BBB, better for ↑ HR,
sedative
Robinul: better drying drug,
B1 in the heart does what? - questions and answers-Stimulation: tachycardia, increased
Block: bradycardia, decreased contraction
Betablocker - questions and answers-Most end in "OLOL"
Ensure no missed dose (up-regulated) tremendous rebound HTN
, MOA: central depression in medulla, cardiac depression, block renin release in the
kidneys
ISA: partial agonist, weaker beta blocker
Alpha blocking properties: labetolol, coreg, also vasodilates due to alpha block
Disadvantages: bronchoconstriction, vasoconstriction and hypoglycemia
Blocking calcium channels in the heart has what effect? - questions and answers-↓
demand ↑ O₂ supply
Any time calcium is less in muscle it will decrease contraction. Decreases afterload and
preload also. Very effective at preventing vasospasm in coronary arteries (variant
angina)
BP classification: Normal - questions and answers-<120/ <80
CAD and Anesthesia - questions and answers-Prevent tachycardia (induction &
emergence)
Maintain HR at pre-op values reduces ischemia.
If HR <120 under anesthesia, reduced risk of ischemia.
Inject esmolol during induction to keep BP/HR low during induction & emergence.
Calcium channel blockers - questions and answers-Most end in "DIPINE" also
verapamil, diltiazem
MOA: CNS effect, cardiac depression, vasodilate
Can patient have regional anesthesia when on anti-ccoagulants? - questions and
answers-ASA: fine
Plavix: DC 7 days prior to block
GPD23A: DC 8-48 hours prior
(About 48 hours for each drug is probably safe)
Heparin: may resume 1 hour post block
Digitalis & anesthesia - questions and answers-Why are they on dig? atrial tachycardia
or CHF
What is digitalis level?
What is their serum potassium?
How effective is the digoxin? Assessment.
