Peripheral Acting DrugsGiven by IV, Action is dose dependent, Interferes with N2 receptor
Non-Depolarizing BlockerAct as antagonist, Onset 3-5min, Duration 20-30min, often used for long-term paralysis, has antidote, frequently assess pt
Depolarizing BlockerStimulates N2 receptor then blocks it, no antidote, short acting, can cause malignant hyperthermia, spike in potassium levels & facial twitching
Train of FourUsed to assess degree of paralysis 4 twitches = <75% block 3 twitches = 90% block 2 twitches = 95% block 1 twitch = 98% block
What is Norcuron?Non-depolarizing medication, has few cardiovascular effects
What is Zemuron?non-depolarizing medication has low incidence of adverse cardiovascular effects, expensive
What is Tensilon?Used to diagnose & treat myasthenia gravis, quick onset, ultra short acting
3 medications used in maintenance Tx of myasthenia gravisProstigmin, Eserine, Mestinon
Antidote for non-depolarizing paralyticsProstigmin
What is Pre-Load?The amount of blood volume returning to the right heart. Increase in preload = Increase in Right heart work Decrease in preload = Decrease in Right heart work
What is After-Load?Resistance to blood movement from the left ventricle at systole. Increase in SVR/Afterload = Increase in left heart work Decrease in SVR/Afterload = Decrease in Left heart work
Hypertension can result in _____ .Stroke, kidney disease, & cardiac disease *Adversely alters organ function
Morphine SulfateRelaxes smooth muscle surrounding blood vessels w/ a resulting fall in BP, can vbe used to drop Pre & After Load in Tx of heart failure, Can cause nausea, constipation, apnea, bronchospasm, or hypotension.
Anti-hypertensive MedicationsSympathetic Blocker, ACE Inhibitor (Vasotec), Thiazides, Nipride, Nitrates
Inderal (propranolol)Blocks sympathetic receptor, Beta blocker – can promote airway spasm w/ asthma, lowers BP
ACE InhibitorsGiven PO for Tx of hypertension, Act by interfering w/ angiotensin II = vasoconstriction is reduced resulting in lower BP
VasotecACE Inhibitor used to lower BP, may cause swelling of tongue which can result in possible airway obstruction
ThiazidesA class of diuretics used to lower BP because they promote the loss of sodium which results in loss of sympathetic tone & so blood vessels dilate lowering BP
Nipride (sodium nitroprusside)Rescue med used to Tx acute hypertension, IV drip, light sensitive, fast acting vasodilator, requires close pt monitoring
NitratesPromote vasodilation by limiting the availability of Ca+, reduces pre & after load, enhances myocardium perfusion
Levophed (norepinephrine)Rescue med by IV drip, very strong acting vasoconstrictor, vasoconstriction is significant & can result in ischemia & tissue necrosis of the extremities, use of this med = dire situation
Vasopressin (pitressin)Rescue med, anti-diuretic hormone, can be used as a vasopressor med by IV drip
DopamineRescue med by IV drip, stimulates AlphaI receptor, requires higher doses to promote vasoconstriction
Moderate to High doses of Dopamine (intropin)Catecholamine, dose dependent Low dose <5ug/kg/min not therapeutic Moderate dose <10ug/kg/min Beta1 increases force & rate of myocardium High dose >10ug/kg/min Alpha1 vasoconstriction
Cardiac GlycosidesPromotes availability of free Ca+ w/in myocardium which improves stroke volume
3 Cardiac Gylcoside medicationsDigitalis, Lanoxin, Digitoxin
Digitalis medfrom foxglove plant, high K+ reduces effect, low K+ makes it toxic
Dobutamine (dobutrex)Synthetic catecholamine, non-selective Beta agonist, Beta1 improves stroke volume, Beta2 vasodilation decreases systemic vascular resistance & can reduce BP & promote reflex tachycardia, indication is acute heart failure
Somatic Nervous System receptor & neurotransmitterNicotinic II & Ach
AcetylcholinesteraseEnzyme that terminates neuro message & allows for repolarization
Repolarizationresting state/relaxation
Indications for using nicotinic antagonistsSurgery, orthopedic procedures, intubation, mechanical ventilation, paralysis
Side-effects associated with peripheral acting nicotinic antagonistsHistamine release = bronchospasm Loss of sympathetic tone = hypotension Tachycardia, hypertension, arrhythmias Temp increase that is unstoppable
Compatibility of nicotinic agaonistsPoor compatibility with other drugs, pentiated by some: antibiotics, antiarrhythmics, diurectics
Non-depolarizing medicationsTubocurarine(tubarine), Pancuronium bromide(pavulon), Vercuronium bromide(norcuron), Rocuronium(zemuron), Gallamine(flaxedil)
Depolarizing medicationAnectine(succinylcholine chloride)
Anticholinesterase medicationsUsed in diagnosis & treatment of myasthenia gravis, potentiate Ach @ N2 receptor by inhibition of actylcholinesterase, antidote for non-depolarizing agents, promote skeletal muscle contraction
Vascular ToneSmooth muscle surrounding the blood vessel alters the size of the blood vessel
Vascular ResistanceThe amount of resistance to the movement of blood represents myocardium work
Ganglionic BlockersReduce hypertension through reduction of sympathetic tone,
Problems associated with Ganglionic BlockersLoss of venous tone & resulting blood pooling in legs, Results in orthostatic hypotension, Constipation, Urinary retention
What is Shock?The absence of adequate blood pressure is profound. Death follows quickly if intervention is not swift and appropriate. Metabolic Acidosis.
What is angina pectoris?Intense chest pain secondary to lack of oxygen for the myocardium
Explain the use of calcium channel blockersVascular smooth muscle – requires free calcium for contraction – dilating/relaxing smooth muscle, Blocks the availability of free calcium, Negative Ionotropic effect
Explain the action of ProcardiaCalcium channel blocker, reduces coronary artery spasm with resulting enhanced coronary perfusion
GlycosidesAre a positive inotropic medication, increases intracellular Ca+ which promotes contractility, increases myocardial contraction which increases stroke volume
Two actions of GlycosidesReduces heart rate, lower AV conduction
Phosphodiesterase InhibitorsPromote higher levels of free Ca+, Acts by increasing the level of cAMP through inhibition of phosphodiesterase, Higher levels of cAMP result in greater blood levels of free Ca+, Higher free levels of Ca+ promote enhance myocardial contraction
Inamrione and AmrinonePhosphodiesterase inhibitors, used to treat severe congestive heart failure that does not respond to more conventional therapy

PreloadAmount of blood returning to Right Heart. Lower preload = lower work load for Right Heart. Higher = higher work load
AfterloadResistance to blood movement from Left Ventricle at systole. If Systemic Vascular Resistance(SVR) is low = low work for Left Heart. Higher SVR = higher work for Left Heart
Hypertension adversely alters what? Can result in?Alters organ function. Can result in stroke.
Inderal (propranolo)Sympathetic(Epi, NE, and Dopa) Blocker = Lowers BP. Anti-hypertensive
ACE inhibitorsgiven PO, act by interfering with angiotension II(strong vasoconstrictor)resulting in Lower BP. Anti-hypertensive
VasotecACE inhibitor for Lowering BP. Swelling of the tongue = possible airway problem. Anti-hypertensive
ThiazidesDiuretic. Lowers BP by promoting sodium (NA+) loss = loss of sympathetic tone = blood vessels dilate Lowering BP. Anti-hypertensive
Nipride (sodium nitroprusside)light sensitive, fast acting , rescue med for acute rise in BP. Given IV drip and require close monitor. Anti-hypertensive
ACE inhibitors do what to afterload?Reduces = lower BP
Morphine sulfateDrops preload AND afterload in tx of Left sided heart failure(MI). Relaxes smooth muscle surrounding blood vessels = Lower BP and hypotension. Anti-hypertensive
What are the Anti-hypertentive (BP Lowering)Meds?Morphine sulfate, ACE inhibitors, Inderal, Nipride, Thiazides, Vasotec or M.A.I.N.T.V.
VasopressorsUsed to treat systemic hypotension or raise BP
Low blood pressure results in?Lack of prefusion = death as absence of O2 and build up of acids take toll on cellular function
Dopamine (Intropine)sympathomimetic to tx hypotension. In low dose promotes renal vasodilation and diuresis. In high doses stimulates Alpha1 receptors = vasoconstriction. Vasopressor
Levophed (norepinephrine)very strong vasoconstrictor used ONLY when Dopamine fails to increase BP. Vasoconstriction so significant can result in ischemia and tissue necrosis. Vasopressor
Dopamine can be used to treat?Heart failure (MI), by acting as a cardiac stimulant in moderate doses. Beta1 agonist promoting + inotropic and chronotropic.
Cardiac Glycosidespromote availibility of free Ca+ within myocardium = improved stroke volume. Vasopressor
Digitalis, Lanoxin, and DigitoxinAll cardiac glycosides used to tx heart failure. Efficacy and toxicity are associated with levels of potassium (K+). Higher K+ levels = lower efficacy, Lower K+ = Toxic
Digitalis Toxicitycaused by high levels of digitalis or decrease tolerance. Pts with decrease tol. may have normal levels. Cause from single exposure or chronic overmed. Risks = taking w/quinidine, verapamil, amiodarone. MI commonly given diuretics w/digoxin. Diuretics cau
Dobutrex (dobutamine)sympathomimietic w/good Beta1 agonist effects to tx heart failure by improving stroke volume and vasodilation = lower workload on heart
What are the Vasopressor Meds? (BP rising)…thinks D w/LLC (D -press)Dopamine, Levophed, Dobutrex, Cardiac glycosides, digitalis, digitoxin, Lanoxin), Dobutrex
What are the Anti-arrythmic Meds? C.C.A.A.A.L.I.E.Cardizem, Calan, Amiodarone, Atropine sulfate, Adenocard, Lidocaine, Inderal, Epinephrine
Adeoncard (adenosine)drug of choice to tx Paroxysmal Supraventricular Tachycardia (PSVT. Anti-arrythmic
Atropine sulfateTx of sinus bradycardia(slow heart rate) and other arrythmias. Anti-arrythmic
Cardizem (diltazem)Ca+ channel blocker used to tx atrial fibrillation but can cause side effects of heart block. Anti-arrythmic
Calan (verapamil)Ca+ channel blocker used to tx atrial arrythmias. Anti-arrythmic
LidocaineTx of Premature Ventricular Contractions(PVCs) and othe ventticular arrythmias. Action by reducing sodium influx. Increases resting potential slowing nerve impulse conduction. Higher dose = production of Methemoglobin and seizure. Met reduces availability
Inderal ( propranolo)Beta blocker tx of tachy arrythmias. Reduces hear rate but can cause bronchospasm. Anti-arrythmia
EpinephrineRescue sympathomimetic. Fast acting agonist to both Alpha and Beta receptors = stimulation of sympathomimetic recptors. Given during cardiac arrest to treat asystole. Anti-arrythmia
Nitrates and vasodilators to treat CHF. How?Reduce preload, afterload, and corornary artery vasodilation from limiting free Ca+.
What do long term use of steroids do to pH?Promotes retention of HCO3 and development of METABOLIC ALKALOSIS. Noted in COPD
What receptors does Racemic Epinephrine stimulate?Alpha1 , Beta1 and Beta2
Benefits of Methyxanthines?1. Enhance bronchodilation 2. Reduces PVR 3. Enhances the contraction and endurance of the Diaphragm 4. Improve Resp. drive 5. Positive ino and chrono 6. Improve stroke volume 7. Downgrade of inflammatory cells 8. Slows histamine, luekotrienes, and cytoki
What us DuoNeb?SVN solution – .5mg ipratropium(atrovent) and 3mg albuterol sulfate