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Pharmacology for Anesthesia > 09 - Autonomic Nervous System II - Adrenergic Agonists > Flashcards

09 - Autonomic Nervous System II - Adrenergic Agonists Flashcards

0
Q

The balance of adrenergic agonist activity can _____ at different doses

A

Shift

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1
Q

Adrenergic agonists have _____ selectivity/specificity for different adrenergic receptors. The activity can be

A

Varying

Overlapping

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2
Q

Phenylephrine (neosynephrine) is a predominantly

A

Direct a1 agonist (pure a)

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3
Q

The primary effect of phenylephrine is _______. It causes ______ venous return and stroke volume (preload)

A

Peripheral vasoconstriction

Increased

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4
Q

Cardiac output remains the same in most patients given phenylephrine because of

A

Reflex bradycardia (vagal reflex probably mediated through baroreceptors)

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5
Q

Phenylephrine causes _______ coronary blood flow

A

Increased

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6
Q

The vial concentration of phenylephrine?

A

1% (10 mg/ml)

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7
Q

What is the continuous infusion dose for phenylephrine? What can happen at higher doses?

A

0.25-1 mcg/kg/min (37.5-150 ml/hr)

Decreased renal perfusion at higher doses

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8
Q

T or F? Phenylephrine does not have tachyphylaxis.

A

False, phenylephrine requires upward titration of infusion but it is more common with ephedrine

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9
Q

Epinephrine is a ____________ that has variable peripheral effects in

A

Direct adrenergic agonist

a: skin, mucosa, kidney
b: skeletal muscle

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10
Q

Which receptors do epinephrine act on and what effects does it cause?

A

b1 - increased HR, contractility, and myocardial O2 demand, increased SBP
b2 - bronchodilation, skeletal muscle dilation (decreased DBP?)
a1 - decreased splanchnic/renal blood flow, increased coronary/cerebral blood flow

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11
Q

Epinephrine is used to treat?

A

Anaphylaxis

Ventricular fibrillation

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12
Q

Risks of epinephrine?

A

Cerebral hemorrhage
coronary ischemia
ventricular dysrhythmias

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13
Q

What should be used with caution in conjunction with epi? Why?

A

Volatile anesthetics, especially halothane

Potentiates dysrhythmias

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14
Q

What is the dose of epi for vfib?

A

1 mg = 1 ml of 1:1000

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15
Q

What is the dose of epi for anaphylaxis and shock?

A

50-100 mcg

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16
Q

What is the dose of epi for continuous infusion for improved contractility?

A

.01-.1 mcg/kg/min

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17
Q

Which adrenergic agonist can be applied topically or infiltration to decrease bleeding?

A

Epinephrine - causes vasoconstriction

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18
Q

How much epi is added to local anesthetic to prolong block?

A

1:200,000 - 1:600,000

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19
Q

Ephedrine is a ______ with similar effects to

A

Indirect (and direct) adrenergic agonist

Epinephrine

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20
Q

T or F. Ephedrine is a catecholamine that acts on a and b receptors.

A

False, ephedrine is a NONcatecholamine sympathomimetic

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21
Q

How does ephedrine cause tachyphylaxis?

A

It causes NE release, depleting the stores

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22
Q

How long does ephedrine last?

A

10x longer than epi

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23
Q

Ephedrine causes _____ venoconstriction than arteriolar constriction which redistributes _____ and _____ venous return (preload)

A

More
Centrally
Improves

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24
Q

Which adrenergic agonist may have anti emetic properties?

A

Ephedrine

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25
Q

What is the adrenergic agonist of choice in OB?

A

Ephedrine - thought to preserve uterine blood flow better than direct acting a agonists (evidence is lacking)
Phenylephrine - current data supports but consider reflex Brady in setting of sympathectomy

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26
Q

What is the dose of ephedrine?

A

5-10 mg IV

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27
Q

Norepinephrine (levophed) is a ______ without

A

Direct a1 agonist

b2 activity

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28
Q

Norepinephrine causes ______ BP due to intense arterial and venous

A

Increased

Vasoconstriction

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29
Q

Does norepinephrine cause reflex bradycardia?

A

Possible

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30
Q

Why isn’t norepinephrine a good first line treatment for cardio genic shock?

A

It causes decreased renal perfusion and increased myocardial O2 requirements
Ensure the pt has adequate volume resuscitation
Can see end organ ischemia/necrosis
Pulmonary vasoconstriction

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31
Q

What is the norepinephrine infusion dose and how is it administered?

A

.01-.1 mcg/kg/min

Central access only (extravasation->tissue necrosis)

32
Q

Which adrenergic agonist is a dose related agonist to all adrenergic receptors?

A

Dopamine

33
Q

The low dose of dopamine is _____ and stimulates ______

A

<2 mcg/kg/min

DA receptor

34
Q

_________ of dopamine is considered outdated

A

Neal dose

35
Q

The low does of dopamine causes

A

Renal vasodilation, diuresis

Inhibits renal/splanchnic NE release

36
Q

The medium dose of dopamine is ______ and stimulates the

A

2-10 mcg/kg/min

b1 receptor

37
Q

The medium dose of dopamine causes

A

Increased contractility, HR, CO

Myocardial O2 demand > O2 supply

38
Q

High dose of dopamine is _____ and stimulates

A

10-20 mcg/kg/min

a1 receptor

39
Q

What does of dopamine causes risk for dysrhythmias?

A

High

40
Q

High doses of dopamine cause

A

Increased PVR, decreased renal perfusion
Coronary/pulm vasoconstriction
Increased PA pressures

41
Q

Isoproterenol is a highly potent _______ with no

A

b1 and b2 agonist

No a activity

42
Q

Isoproterenol was used as an ______ because it _______ HR and contractility

A

Inotrope
Increases
Risk for arrhythmia

Has been replaced by b1 specific agonist (dobutamine)

43
Q

Used to increase HR in presence of a heart block until a place maker can be placed

A

Dobutamine

44
Q

Which adrenergic agonists increase myocardial O2 demand?

A 
Epinephrine
Norepinephrine
Dopamine (medium dose)
Isoproterenol
Dobutamine
45
Q

Isoproterenol causes _______ which can lead to coronary steal

A

Coronary artery dilation

46
Q

Isoproterenol was used as a _____ but has been replaced by b2 specific agonists

A

Bronchodilator

47
Q

Used for bronchodilation and as an inotrope but has been replaced by more selective agonists

A

Isoproterenol

48
Q

Isoproterenol decreases _____ due to peripheral vasodilation. The overall effect is increased ___ and decreased

A

SVR
SBP
DBP

49
Q

Dobutamine is a _____ that increases CO due to contractility. It is also a weak

A

Selective b1 agonist
INOTROPE
Coronary vasodilation

50
Q

Dobutamine has ____ b2 activity

A

Selective
Slightly increased and
Potential arrhythmias, esp at higher doses
Some pulmonary vasodilation
Systemic vasodilation -> decreased SVR (hypotension)

51
Q

Dobutamine has some ____ activity that is unmasked when _____ leading to

A

a1
Beta blocker is given
Hypertension

52
Q

What dose of dobutamine potentially causes arrhythmias?

A

> 10 mcg/kg/min

53
Q

Dose of dobutamine?

A

2-20 mcg/kg/min

54
Q

Fast onset and short acting adrenergic agonist?

A

Dobutamine

55
Q

This adrenergic agonist is a selective phosphodiesterase (PDE) inhibitor

A

Milrinone (primacor)

56
Q

How do PDE inhibitors facilitate the inward movement of calcium?

A

Inhibit PDE III -> increased myocardial cAMP, leading to influx of calcium

57
Q

Which adrenergic agonist is an inodilator?

A

Mirinone

Positive inotropic effect + vascular/airway smooth muscle relaxation + pulmonary vasodilator

58
Q

Milrinone has a ______ effect on SVR

A

Significant

Leads to hypotension

59
Q

Dose of Milrinone

A

50 mcg/kg over ten min followed by .5 mcg/kg/min infusion

60
Q

What is the onset of milrinone?

A

5-15 min

Slower onset and offset

61
Q

What is the elimination half time of milrinone?

A

2.7 hr

62
Q

Which adrenergic agonist should be used with caution in severe renal disease?

A

Milrinone

63
Q

Clonidine is used to treat ______ because it is a

A

Hypertension

Selective a2 agonist (a2:a1 = 220:1)

64
Q

Clonidine is not commonly administered by

A

IV

Administered PO, TD patch, IM

65
Q

Side effects of clonidine

A

Brady
Hypotension
Dry mouth

66
Q

Used as an adjunct for analgesia: added to local anesthetic or opioids for epidural/spinal/nerve block

A

Clonidine

67
Q

Effective against post operative shivering? Dose?

A

Clonidine

.5-1 mcg/kg

68
Q

Used as a sedative. What are the effects?

A

Clonidine

Anxiolytics, sedation, decreases MAC

69
Q

Highly selective a2 agonist?

A

Dexmedetomidine

70
Q

ADH is secreted from the

A

Pituitary gland

71
Q

Non adrenergic sympathomimetic that activates smooth muscle V1 receptors

A

Vasopressin

72
Q

Vasopressin is an _____ version of ADH

A

Exogenous

73
Q

Used in the treatment of diabetes insipidus

A

Vasopressin

Because pt with DI lack ADH secretion

74
Q

How is vasopressin used to support BP?

A

Induces re absorption of water from renal collecting ducts

Vasoconstriction

75
Q

Ackles dose of vasopressin

A

40 units

76
Q

Lactic acidosis may develop from use of

A

Vasopressin

77
Q

Which adrenergic agonists have potential to cause arrhythmias?

A

Epinephrine, especially with halothane
High doses of dopamine
Dobutamine, more liekly with higher dose
Isoproterenol

Pharmacology for Anesthesia (9 decks)

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