CVSP 563
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| Halothane | inhalation
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| Enflurane | inhalation
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| Isoflurane | inhalation
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| nitric oxide | inhalation
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| ether | inhalation
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| heparin | anticoagulant
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| coumadin | anticoagulant
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| ATIII | anticoagulant
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| hirudin | anticoagulant
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| CPD | anticoagulant
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| protamine sulfate | anticoagulant agonist
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| neutralase | anticoagulant agonist
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| aspirin | platelet active substance
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| streptokinase | fibrinolytic/thrombolytic
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| urokinase | fibrinolytic/thrombolytic
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| t-PA | fibrinolytic/thrombolytic
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| ReoPro | fibrinolytic/thrombolytic
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| DDAVP | fibrinolytic inhibitor
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| aminocaproic acid | fibrinolytic inhibitor
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| aprotinin | fibrinolytic inhibitor
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| quinidine | anti-arrhythmic
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| procainamide | anti-arrhythmic
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| lidocaine | anti-arrhythmic
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| bretylium | anti-arrhythmic
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| propranolol | anti-arrhythmic, anti-HTN (vasodilator)
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| isoproterenol | anti-arrhythmic
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| verapamil | anti-arrhythmic
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| diltiazem | anti-arrhythmic
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| esmolol | anti-arrhythmic
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| nifedipine | anti-arrhythmic
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| atropine | anti-arrhythmic, anesthesia adjunct
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| epinephrine | anti-arrhythmic, anti-hypotensive (vasoconstricor)
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| MgSO4 | anti-arrhythmic
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| Lasix | diuretics
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| ethacrynic acid | diuretic
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| mannitol | diuretic
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| sodium bicarbonate | agent for acidosis
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| THAM | agent for acidosis
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| insulin | hyperglycemia
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| glucagon | hypoglycemia
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| KCL | electrolyte
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| CaCL2 | electrolyte
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| NaCL | electrolyte
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| amrinone | inotrope
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| milrinone | inotrope
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| norepinephrine | anti-hypotensive (vasoconstrictor)
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| Phenylephrine | anti-hypotensive (vasoconstrictor)
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| ephedrine | anti-hypotensive (vasoconstrictor)
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| dobutamine | anti-hypotensive (vasoconstrictor)
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| dopamine | anti-hypotensive (vasoconstrictor)
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| vasopressin | anti-hypotensive (vasoconstrictor)
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| sodium nitroprusside | anti-HTN (vasodilator)
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| nitroglycerin | anti-HTN (vasodilator)
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| trimethaphan | anti-HTN (vasodilator)
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| hydralazine | anti-HTN (vasodilator)
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| nadolol | anti-HTN (vasodilator)
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| pancuronium | muscle relaxant
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| succinylcholine | muscle relaxant
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| vecuronium | muscle relaxant
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| tubocurarine | muscle relaxant
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| morphine | narcotic analgesic
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| meperidine | narcotic analgesic
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| fentanyl | narcotic analgesic, anesthesia adjunct
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| sufentanil | narcotic analgesic
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| prednisone | steroid
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| solu-medrol | steroid
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| dexamethasone | steroid
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| hydrocortisone | steroid
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| Novoseven |
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| pentothal | anesthesia adjunct
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| propofol | anesthesia adjunct
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| valium | anesthesia adjunct
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| versed | anesthesia adjunct
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| benadryl | anesthesia adjunct
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| pentobarbital | anesthesia adjunct
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| ketamine | anesthesia adjunct
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| scopalomine | anesthesia adjunct
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| dantolene | anesthesia adjunct
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| naloxone | anesthesia adjunct
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| prime constituents and drugs | balanced electrolyte solution (plasmalyte, LR), pump dose of heparing (10,000 IU), possibly add mannitol, sodium bicarb, magnesium, 5-25% albumin, aprotinin, steroids
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| drugs to add during circ arrest | steroids, pentobarbitol, mannitol
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| drugs to add prior to XC removal | lidocaine, mag sulfate, mannitol, steroids, turn off isoflurane
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| drug to add after XC removal | calcium chloride
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| what are the halogenated gases? | isoflurane, halothane, enflurane
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| MOA for isoflurane | not entirely clear, may increase threshold firing for CNS neurons, maybe by blocking ion channels by interacting with membrane lipids
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| why is isoflurane a good inhalation anti-hypertensive agent? | has low organ toxicity, causes less cardiac arrythmias and does not sensitize the heart to the action of epinephrine
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| how does isoflurane work so fast | has very LOW solubility in the blood, leading to rapid induction
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| what is the purpose of isoflurane? | it causes peripheral vasodilatation, therefore decrease BP
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| where is isoflurane administered? | into the oxygenator air supply (0-5%)
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| what is a danger of isoflurane? | must scavange gas out line, liquid form can melt plastics and destroy your circuit
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| Is heparin homogenous? | No, it is neither chemically or biologically homogeneous, the mucopolysaccharides vary in MW and ATIII binding activity
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| How does heparin work? | it potentiates ATIII by induces a conformation change that exposes ATIII active site, ATIII inactivates activated factors 9, 10, 11 and 12 and thrombin
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| what is the half life of heparin? | two hours
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| What is the danger of hemoconcentration and heparin? | hemoconcentration can remove the lower molecular weight heparins
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| what are the side effects of heparin? | bleeding, heparin rebound, HIT
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| what is heparin resistance? treatment? causes? | when a conventional dose of heparin (300-400 units/kg) produces a neglible effect. Can give 2 units FFP or recombinant ATIII, may be hereditary or from pre-operative heparin therapy
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| What is protamine sulfate? | LMW protein that reverses heparin by binding, give slowly to avoid increasing PAP and lowering MAP
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| dosing and timing of protamine | 1 mg per 100 units of heparin and turn off pump suckers!
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| what is aprotinin? | a fibrinolytic inhibitor, it inhibits the conversion of plasminogen to plasmin. It also protects the platelet adhesion glycoproteins, making them more resistant to damage and activation
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| aprotinin test dosing? | test dose, 1 mL given 10 minutes before systemic dose to check for allergic reaction
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| what is full dose aprotinin regimen? | Regimen A. Loading 200 mL IV over 20-30 min prior to sternotomy. Constant infusion of 50 mL/hour during surgery up to 4hrs and a pump dose of 200 ml to prime after negative test
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| What is half dose aprotinin regimen? | Regimen B, half of A levels
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| What type of ACT do you have to use with aprotinin? | must use Kaolin activator, if celite is used the ACT is artifically prolonged and you should shoot for >750 seconds
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| what is the incidence of hypersensitivity reactions to aprotinin? | no prior <0.1%, 6 month 5%, reexposure after 6 months, 0.9%
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| What are the two major anti-arrhythmics after cross clamp removal? | lidocaine and magnesium sulfate
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| How is lidocaine given? | 50-300 mg directly into ECC
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| what is the MOA of lidocaine? | it is a mild Na+ channel blocker, decreases pacemaker activity
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| what can happen with too high doses of lidocaine? | seizures
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| what is the half life of lidocaine? | 8 minutes
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| what is the dosing for MgSO4 | 1-4 gm dose into ECC
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| what is the MOA of MgSO4? | controls transmembrane electrolytes, energy metabolism and enzyme systems
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| what can happen if magnesium levels are too low? | cardiac arrhythmias
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| What effect does magnesium have on calcium utilization? on patient post-op pain | a synergistic effect, it decreases it
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| What is the MOA of mannitol, use? | freely filtered at kidney, therefore takes water with it because it increase extracellular osmotic pressure. Used as a diuretic. Used to reduce cerebral edema during circ arrest
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| what cautions are used for mannitol? | caution with severe pulmonary congestion, end stage renal disease
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| what can mannitol do at room temperatuer | supersaturated solution precipitates out of solution and crystallizes
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| how does sodium bicard treat acidosis? | buffers extra hydrogen ions to water and carbon dioxide
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| what is the formula for determined bicarb dosing? | base deficit time body weight/3 times 0.5 is the dose in mL
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| what is the 3 in the bicarb formula | one-third of the body is extracellular
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| what is base deficit? | a measure used to describe the degree of acidosis
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| what is THAM? | tris-(hydromethyl)aminomethane, it is an alkalinizing agent that scavanges excess H+
$$$$$$
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| what is the dosing for THAM? | bicarb level (mEq/L) x kg=ml of 0.3M THAM required
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| potassium, normal function | major intracellular ion, necessary for normal cardiac muscle contractions
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| what symptoms of hyperkalemia? | irregular cardiac contractions and arrest
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| how to treat hyperkalemia? | insulin and glucose, increase urine production and hemoconcentration
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| calcium normal function? | myocardial contractility, blood clotting, muscle contraction
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| affect of Ca+ on contractility? | positive iontrope
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| why do give Ca2+ if multiple units transfused? | anti-coagulants bind up calcium
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| what is the role of sodium? | major extracellular ion, determines fluid location
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| what is phenylephrine? | an anti-hypotensive agent
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| where does phenylephrine act? | strong alpha-1 agonist, therefore a vasoconstrictor, used to raise BP during CPB by increasing peripheral vascular resistance
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| dosing/location of phenylephrine? | 40-200 mcg/mL by IV or circcuit
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| what is a danger of too large of a dose of phenylephrine? | can cause visceral/ischemic injury
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| what drugs when given too quickly and in large enough concentration will cause vasodilation and decrease BP? | most drugs
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