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Anesthesia > Autonomic Physio And Pharm > Flashcards

Autonomic Physio And Pharm Flashcards

0
Q

Alpha 1 blood vessel effect, major site

A

Arteries- vasoconstrict

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1
Q

Beta 1 Heart Effect

A

Increase rate/force of contraction

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2
Q

Beta 2 blood vessel effect, major site

A

Skeletal muscle, vasodilation

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3
Q

Alpha 2 major blood vessel effect, site

A

Veins, vasoconstrict

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4
Q

Beta 2 bronchial tree effect

A

Bronchodilate

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5
Q

Alpha 1 eye effect

A

Mydriasis

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6
Q

Beta 1 kidney effect

A

Renin secretion

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7
Q

Alpha 2 pancreas effect

A

Decrease insulin release

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8
Q

Beta 1 major targets

A

Heart, eye, kidney

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9
Q

Beta 2 major targets

A

Skeletal muscle vasculature, bronchial tree

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10
Q

Alpha 1 major targets

A

Arteries, gI, eye, sweat/salivary

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11
Q

Alpha 2 major targets

A

Veins, gI tract pancreas

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12
Q

Dopamine effects

A
    • MAP, HR, SVR, dysthymia

2. +++ CO, renal blood flow

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13
Q

Prep and IV dose of dopamine

A

Prep- 200mg/250ml (800 ug/mL)

Dose- 2-20 ug/kg/min

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14
Q

Norepinephrine effects

A
    • cardiac dysthymia
  2. +++ MAP, SVR
    • HR, CO
  4. — renal blood flow
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15
Q

Norepinephrine prep and IV dose

A

Prep- 4mg/250ml (16ug/ml)

Dose - 0.01-0.1 ug/kg/min

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16
Q

Epinephrine effects

A
    • MAP
  2. ++ HR, CO, SVR
  3. +++ cardiac dysthymia
  4. – renal blood flow
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17
Q

Epinephrine prep and IV dosage

A

Prep- 1mg/250ml (4ug/ml)

Dose- .03-0.15 ug/kg/min

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18
Q

Isoproterenol effects

A

IsoP effects 1-B

  1. +++ HR, CO
    • MAP, renal blood flow
  3. – SVR
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19
Q

Isoproternol preparation and IV dosage

A

Prep- 1mg/250ml (4ug/ml)

Dose - 0.03-0.15 ug/kg/min

Same as epi

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20
Q

Dobutamine effects

A
    • MAP, HR
  2. ++ renal blood flow
  3. +++ CO
    • SVR, dysthymia
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21
Q

Dobutamine preparation and IV dosage

A

250mg/ml (800ug/ml)

Dose 2-20ug/kg/ml

Same as dopamine

22
Q

Norepinephrine half life, typical infusion rate

A

2.5 min

3ug/min, titrate to effect (recall: typical dosage is 0.01-0.1 ug/kg/min)

23
Q

Pitfall of norepinephrine infusions

A

decreased organ blood flow (Pulm, renal, med enteric) and limb ischemia

24
Epi dose in cardiovascular collapse, a systole, v fib, anaphylaxis
1 mg IV
25
Epi titration curve effects
1-2 ug/min - B2 (decrease airway resistance and vasculature) 2-10ug/min - increase hr, co, and AV conduction >10ug/min - sognificant vasoconstrict (alpha 1) . Can cause reflex brady
26
Dopamine infusion curve
0.5-2ug/kg/min - mostlyD1 effects (splanch) decrease BP 2-10ug/kg/min- B1 receptors ( increase CO) >10ug/kg/min - alpha1 (constrict vasc)
27
Ephedrine Effect Which situation is it best used in
Increase arterial BP + ionotropy Moderate hypotension accompanied by bradycardia (due to B1 stim effects)
28
Typical dose of Ephedrine
2.5-25mg IV
29
Phenylephrine site of effect
alpha 1 agonist, peripheral vasoconstriction in setting of adequate CO--> i.e. neuroaxial anesthesia
30
Typical patient phenylephrine used in
Afterload maintenance in patients with AS and coronary perfusion issues in setting of normal/decreased SVR
31
Half life of phenylephrine
5-10 min, rapid onset
32
Dosing of phenylephrine
Bolus- 40-100ug IV (> 1mg dose = slow SVT via reflex brady) Infusion- 10-20ug/min
33
Major effect of alpha-2 agonist
sympatholytic reduce peripheral NE release by stimulation of presynatptic inhib alpha2 receptor
34
Antihypertensive used to treat clonidine withdrawl htn
Labetelol
35
Dexmedetomidine receptor, half life
alpha 2 agonist half life 2.3 hrs, clinical effect is short though due to distribution half life 5 min
36
Dexmedetomidine dosing
Infusion- 0.3-0.7ug/kg/hr +/- LD 1ug/kg over 10 min
37
Major effect of Dexmedetomidine
Increases sedation, analgesia, and amnesia Decrease HR, CO, and circulating catecholamine minimal if any respiratory depression (good for awake fiberoptic intub) MAC sparing sedative/analgesic effects
38
Major side effects of alpha-1 antagonist
orthostatic hypotension, fluid retention
39
Phenoxybenzamine site of action, and effect
alpha-1 antagonist (some alpha2 effects as well) decrease PVR, increases CO
40
Most common use for phenoxybenzamine
pre-treatment of pheochromocytoma (chemical sympathectomy preop) = less lability of BP during surgical resection
41
Antidote for phenoxybenzamine OD
norepinephrine (acts on remaining free alpha-1 receptors)
42
Major B-blockers used in anesthesia
labetelol, propranolol, metoprolol, and esmolol
43
Metoprolol dosing
2.5-5mg IV q2-5 min, up to total dose of 15mg IV Titrate based on HR and BP
44
Labetelol dosing
5-10mg IV q5 min Infusion- 2mg/min (max)
45
Why may labetelol be useful in post-cardiac surgery pts?
Vasodilation (decrease BP) w/out reflex tachycardia (works on alpha 1 as well as Beta 1)
46
What makes esmolol unique?
hydrolyzed by esterases, short half life of 9-10min makes useful in anesthesia, critically ill patients,
47
Esmolol timing, dosing
peak 5-10min, diminished 20-30min Dose- 0.5mg/kg IV bolus
48
Side effects of anticholinergic drugs (muscarinic antagonists)
tachycardia, sedation, dry mouth
49
Which anticholinergic can cross the BBB?
atropine
50
When would you use glycopyrrolate?
to blunt the muscarinic effects (bradycardia, etc) that occur when anticholinesterases (pyridostigmine, neostigmine, etc) are given to reverse neuromuscular blockade
51
Antidote for CNS effects (mentation disorders) from atropine/scopolamine
physostigmine (anticholinesterase that crosses BBB)
52
What are cholinesterase inhibitors (anticholinesterases) used for?
reverse NMJ blockade and treat MG
53
Major side effect of cholinesterase inhibs?
bradycardia

Anesthesia (9 decks)

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