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DRUGS for CPB
CVSP 563
| Question | Answer |
|---|---|
| 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 |
| Novoseven | |
| 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
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