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) |
|
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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 |
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|
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
|
Definition
Sodium Channel Blockers, Depression of Phase 0 of Depolarization
o Lidocaine, procainamide, phenytoin, quinidine |
|
|
Term
|
Definition
Beta blockers
o Esmolol, propranolol, metoprolol, atenolol |
|
|
Term
|
Definition
Potassium channel blockers
o Amiodarone, sotalol, bretylium |
|
|
Term
|
Definition
Calcium channel blockers
o Verapamil, diltiazem |
|
|
Term
|
Definition
| o Adenosine, ATP, digoxin, atropine |
|
|
Term
| What receptor does adenosine work on? |
|
Definition
|
|
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
|
|
Term
| o Anything with ventricular in the name of the arrhythmia would be treated by what drug? |
|
Definition
|
|
Term
| Torsade de pointe is treated with what medication? |
|
Definition
|
|
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
|
Definition
| Central depression, direct cardiac depression, vasodilation |
|
|
Term
|
Definition
|
|
Term
|
Definition
| SBP 120-139, DBP 80-89 (no drugs indicated) |
|
|
Term
|
Definition
| SBP 140-159, DBP 90-99 (thiazide diuretics are most common, consider ACEI, ARB, B, CCB) |
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
Definition
| Angina doesn’t happen with normal activity, only with strenuous activity |
|
|
Term
|
Definition
| Angina may happen with normal activity, causing slight limitation |
|
|
Term
|
Definition
| Angina occurs with normal activity and causing marked limitation |
|
|
Term
|
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
|
|
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
|
|
Term
| Nitroglycerin is what kind of vasodilator |
|
Definition
|
|
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
|
|
Term
| The 3 herbal medications that can affect coagulation |
|
Definition
1. Garlic
2. Ginger
3. Gingko |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Slight physical limitation, ordinary activity causes fatigue |
|
|
Term
|
Definition
| marked physical limitation, Less than ordinary activity causes symptoms |
|
|
Term
|
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
|
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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|
