Pima Advanced Pharm Chp 19 Inotropes,& Antiarrhythmic Agents

1.) What is BP determined by. - C.O. (Pump) - Vascular Vol. - Condition of Vessels - Vascular Resistance 2.) What do you do for decreased BP? - Give Vol./Fluids Stroke Vol x HR= CO Normal C.O. = 5-7 L/min

3.) What drugs do you use to Tx Increase BP? - Catecholamines /Epi/NE/Levophed/Adrenalin ( HR & contractibility) - Metabolized by MOA COMT & Short acting - Vassopressors (constricts blood vessels) - Isoproterenol Synthetic Catecholamines (B2 agaonists) - Dopamine (inotropin) IV 5 to 20 ug/kg/min - Has Chronotropic & Inotropic effects - Motabolized into NE/Most Common Used - Vascular Resistance B1 + Systemic Resistance - Phenylephrine (Neo-Synephrine) Rare (Pts with major HR issues) - Nasal spray with only Alpha effect - Vassopressin (Pitressin) ADH-Anti-Diuretic Hormone - Very Common/Pt with Septic Shock & usually have a ADH

4.) Define Inotropic Agents.

-Inotropic Agents ( Contractability) - Dohutamine (Dobutrex) a catecholamine - Not Metabolized into NE - Contractibility (some B1 & Vascular) - Problem = Taxaphylaxis (rapid tolerance) 72 hrs - Phosphodiesterase Inhibitors (PDIs) - Milrinone, (Primcor) - Inamrione (Inocor) - Kills cAMP - Acts as a vasodilator - Used to Tx Pulm. Hypertension (PPH) or - Ithiopathic Pulm. hypertension (IPH)

5.) What are Cardiac Glycosides? - They inhibit the K+ & Na in the ATPase pump in the heart - They are a Positive Inotrope - Digitalis, Digoxin (Lanoxin) - Used to Tx Chronic CHF/Very toxic - Helps to remove fluids

6.) What is WPWS (Wolfe Parkinson white syndrome)? - Causes a very high HR that is uncontrollable - Conduction defect causes BP, so must bring it down - Tx is ablation of the bad pathways

7.) What are the drugs to treat BP? - Anti-hypertensives - Angeotensin converting enzyme (ACEI) Inhibitors - Angeotensin Receptor Blockers (ARBS) - This is a common class to Tx

8.) How does an ACEI work? - Renin is released when the BP drops This causes a release of Angeotenisin I It is then converted into Angeotenisin II (very potent Vasoconstrictor) - ACEIs inhibits Angeotenisin I from being released so it cannot do the conversion - 1/3 Pts develop an ACE cough and it is best treated with Spiriva

9.) How does an ARB work? - It Blocks the receptors so Angeotenisin II cannot do its thing - Very expensive

10.) What are the 4 classes of Antiarrhythmics? - Class I (Lidocaine) drip - Tx for Irritable heart (PVCs) - Class II (Beta Blocker) all end in (OLOLS) - Slows the heart down (Blocks 1 & 2) - Used to Tx hyperstnsion (Htn) *Never give to Asthmatics* - Class III (Amiodarone) - Used for Tx of A- Flutter, A & V-Fib, V-Tach - Toxic - Can get Amiodarone lung (Fibrotic changes) - Calcium Channel Blocker - Verapamil & Ditliazem - Works by slowing the AV node (conduction)