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Certified Registered Nurse Anesthetist (CRNA) /

interview



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Jan 12, 2004 10:47 PM

interview

by tcrn

Ok, I interviewed today and got a question about your post op heart on nipride and neo... My first question ... what is the neo doing here??? I understand that nipride is decreasing the preload and afterload.. ... does nipride help increase the afterload in this situation?? No matter what the outcome of this interview.. inquiring minds need to know.. or is it a trick?

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7 Comments
No. 1
from smiling_ru
Old Jan 13, 2004, 07:46 PM

Well, the only thing I can come up with is that the nipride was there to prevent or treat myocardial ischemia/coronary spasms (arterial dilator). And the Neo was there to counteract the hypotension.
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No. 2
from CougRN
Old Jan 14, 2004, 02:37 AM

well i was hoping for more input on your question. i would like to know the thought process behind this question too.
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No. 3
from Elenaster
Old Jan 14, 2004, 07:07 AM

I thought about this for awhile, and basically came up with the same thing as smiling. Since neo only works on alpha receptors, it's a more "heart friendly" way to keep the BP up and improve perfusion. We often use neo instead of Dopamine in patient's who need a pressor to keep their MAP up for cerebral perfusion, but can't tolerate the cardiac effects of dopamine.
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No. 4
from London88
Old Jan 14, 2004, 03:23 PM

I am inclined to agree with smiling_ru in that the neo is to counteract the effects of the nipride. I am assuming that there there is decreased pump function hence the need to decrease preload to prevent CHF using nipride. However there is a delicate blance with using neo, as neo increases afterload by increasing SVR, and this is not always in the best interest of a heart with weak left vent. function as you increase the work of the heart by making it pump against greater resistance.
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No. 5
from javajunkie
Old Jan 14, 2004, 05:36 PM

LOL, I know every CT surgeon is different. All I know is that if I ever feel the need to make one of ours cringe, I say the word "Neo." They hate it. Get out the dobutamine and nitro.

However, I do believe in your question, the neo is used to maintain MAP against the nipride.

Where did you interview?
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No. 6
from tcrn
Old Jan 15, 2004, 07:50 AM

At Newman in wichita... My answer was basically to state that the nipride would decrease preload and afterload.... and that neo is a vasoconstrictor... Also that I was not sure exactly why one would run the two together... That is the reason I posted the question... to find out why. What do you think of the response that I gave?
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No. 7
from CougRN
Old Jan 15, 2004, 05:16 PM

i think your response was a good one. you were able to state what each drug does and also let them know you weren't afraid to say you didn't know the reasoning behind it. hope that works out for you.
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