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CVSP 563

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