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Describe Mild Intermitent Asthma? Tx?  
Step 1
1. S &S less than twice per week
2. Short acting bronchodilator
Describe Mild Persistent Ashtma? Tx?
Step 2
1. S&S > 2 times per week, but < once per day
2. Tx: Short acting bronchilator, low dose inhalation corticosteroid
Describe Moderate Persistent Ashtma? Tx?
Step 3
1. S&S daily
2. Daily use of bronchodilator
3. Medium-dose inhaled corticosteroids
4. long acting b-agonist and low to med dose inhaled corticosteroid
Describe Severe Persistent Asthma? Tx?
Continous signs and symptoms, frequently exacerbated
2. High-dose inhaled corticosteroids with long-acting bronchodilators
What drugs/preservatives common in anesthesia may trigger asthma attack?
1. Aspirin
3. Sulfites (generic propofol)
4. B-blocker
5. H2 blocker
What is the best treatment for acute asthma issue?
Beta2 agonist
What is the treatment for chronic asthma?
inhaled corticosteroids
Which route of administration of corticosteroid treatment for asthma has least side effects?
inhalation route
What type of asthma is inhaled corticosteroid appropriate in?
mild, mod, sever persistent asthma
What are 3 considerations for pt on high-dose inhaled corticosteroid?
1. osteoperosis
2. cataract
3. hypothalamic-pituitary-adrenal axis function suppression
T/F if a pt takes short-acting beta2 agonist for long time is there a risk of tolerance?
T. it is d/t down regulation of beta receptors
what is risk of pt using long-acting beta2 agonist for asthma?
Cause down regulation of beta2 receptors with loss of bronchoprotective effect from rescue therapy with short-acting beta2
What narcotic is appropriate to use in asthma pt?
Phenylpiperidine, they don''t cause histamine release
What is the consideration of giving H2 blocker to pt with asthma?
1. unopposed H1 receptor
2. blocking of histamine autoreceptors, so there is no inhibition signal to decrease release of histamine
What is the treatment of periop bronchospasm?
1. deepen level of anesthesia
2. administer 100% oxygen
3. administer beta-2 agonist
4. give subq or iv epi, in severe cases
5. IV steroids
What is the goal for the CRNA if a pt deveolps a dysrhythmia periop?
treat immediate HD problems and prevent progression of serious dysrhythmias
What 5 things need to be evaluated before antidysrhthmic is used periop?
1. verify ventilation
2. verify depth of anesthesia
3. verify acid-base balance
4. verify fluid status
5. verify electrolytes
Supraventricular arrhthmias occur where? tx?
above the ventricles so include the SA and AV node. treat with calcium channel blocker
What is treatment for SA and AV node tachydysrhythmias? y?
1. treat with calcium channel blocker
2. CCB slow heart rate by slowing phase 4 depolarization of the SA node action potential, this prolongs depolarization of SA node
What are the different classes of antidysrhythmics? I, II, III, IV, V
I. Na channel blocker
2. beta blocker
3. Potassium channel blocker
4. Calcium channel blocker
5. other
what are the 3 subclasses of Class I antidysrhythmics?
IA- mod depression, prolongs repolarization. Ex. Procainamide
IB- weak depression, shortens repolarization. Ex. Lidocaine
How do class III antidysrhythmics work?
1. voltage gated K channel blocker, this causes a prolongation of repolarization (K can't leave the cell)
2. Prolonging repolarization makes cell less irritable
What class of receptor is adenosine?
a purine receptor
What is are the subtypes of purinergic (P1) receptors? effect?
A1- inhibit adenyl cyclase
A2- activate adenyl cyclase
What is adenosine used to treat?
SVT, don't use for atrial tachydysrhytmias
What is the treatment for Afib intraop?
Verapamil (CCB)
Beta blocker
What is considered rate control for Afib with RVR?
HR <120bpm
What is the treatment for Vtach?
What is a contraindication for antiarrhythmic administration?
patient with a heart block
Drug of choice for SVT or Atrial tachycardia?
Drug of choice for ventricular dysrhythmia?
Amiodarone or Lidocaine
Drug of choice for Torsades?
Drug of choice for brady arrhythmias?
atropine (above AV node) or cardiac pacing (below AV node)
Drug of choice for ST?
How do u treat Digoxin toxicity?
What are the classifications of HTN? normal, preHTN, Stage 1, Stage 2
Normal: <120/ <80
preHTN: 120-139/80-89
Stage 1 HTN: 140-159/ 90-99
Stage 2 HTN: >160/ >100
How do ACE inhibitors work?
ACE inhibitors prevent the conversion of angiotensin I to angitotensin II
How do direct Renin-blockers work?
They bind directly to renin and prevent it from cleaving angiotensin 1 from angiotensinogen. Ex. Aliskiren
What causes coughing d/t ACE inhibitor?
ACE is normally degrades bradykinin to inactive compounds in the lungs, when blocked bradykinin acts as an irritant
What is the only IV ACE inhibitor?
Enalapril, undergoes hepatic metabolism to active form, enalaprilat
What pt population may not receive ACE inhibitors/ARBs? caution in?
1. not used in OB
2. pt with renal compromise may have prolonged elimination
What is the mechansim of angiotensin receptor blockers (ARB)?
These drugs bind directly to Angiotensin II receptors and prevent vasoconstriction
What are the 3 mechanisms on how beta-blockers decrease BP?
1. CNS depression (vasomotor center)
2. Direct cardiac depression
3. Blocking of Renin release by kidneys (B1 receptors)
What are the 3 contraindicators for B-blocker use?
1. Asthma- cause bronchoconstriction
2. Diabetics- decrease blood sugar by blocking SNS to liver
3. Vascular Disease- blocking B2 receptors causes peripheral vasoconstriction that can worsen peripheral vascular disease
What must be considered if administering Beta-blockers IV?
They all lose cardioselectivity, so caution in use of pt with asthma or diabetes
What are the benefits of using Intrinsic Sympatomimetic Activity (ISA) beta-blockers?
1. partial agonist drugs
2.less bronchoconstriction, hypoglycemia, vasoconstriction
3. competitively antagonize full agonists to acitivity level of its partial agonist component
What is the benefit of using a beta-blocker with alpha-blocker properties? examples?
1. cause vasodilation by blocking alpha receptors
2. Labetolol, Carvedilol
What is the MOA for CCB to decrease bloodpressure? 2
1. cardiac depression
2. vasodilation
What are the 3 commonly used Ca blockers in anesthesia?
1. nicardipine- control of BP
2. nimodipine- treatment of cerebral vasospasm
3. verapamil- control of atrial tachyarrhythmias, and ventricular response to afib and aflutter
how do CCB cause negative inotropy?
They block the entry of Ca into the cardiac muscle during phase 2 depolarization (slow Ca channels) of ventricular depolarization. This prevents the movement of troponin from blocking the binding sites of actin to myosin heads, which would cause a contraction
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