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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
Q

Epi dose in cardiovascular collapse, a systole, v fib, anaphylaxis

A

1 mg IV

25
Q

Epi titration curve effects

A

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
Q

Dopamine infusion curve

A

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
Q

Ephedrine Effect

Which situation is it best used in

A

Increase arterial BP
+ ionotropy

Moderate hypotension accompanied by bradycardia (due to B1 stim effects)

28
Q

Typical dose of Ephedrine

A

2.5-25mg IV

29
Q

Phenylephrine site of effect

A

alpha 1 agonist, peripheral vasoconstriction in setting of adequate CO–> i.e. neuroaxial anesthesia

30
Q

Typical patient phenylephrine used in

A

Afterload maintenance in patients with AS and coronary perfusion issues in setting of normal/decreased SVR

31
Q

Half life of phenylephrine

A

5-10 min, rapid onset

32
Q

Dosing of phenylephrine

A

Bolus- 40-100ug IV (> 1mg dose = slow SVT via reflex brady)

Infusion- 10-20ug/min

33
Q

Major effect of alpha-2 agonist

A

sympatholytic

reduce peripheral NE release by stimulation of presynatptic inhib alpha2 receptor

34
Q

Antihypertensive used to treat clonidine withdrawl htn

A

Labetelol

35
Q

Dexmedetomidine receptor, half life

A

alpha 2 agonist

half life 2.3 hrs, clinical effect is short though due to distribution half life 5 min

36
Q

Dexmedetomidine dosing

A

Infusion- 0.3-0.7ug/kg/hr +/- LD 1ug/kg over 10 min

37
Q

Major effect of Dexmedetomidine

A

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
Q

Major side effects of alpha-1 antagonist

A

orthostatic hypotension, fluid retention

39
Q

Phenoxybenzamine site of action, and effect

A

alpha-1 antagonist (some alpha2 effects as well)

decrease PVR, increases CO

40
Q

Most common use for phenoxybenzamine

A

pre-treatment of pheochromocytoma (chemical sympathectomy preop) = less lability of BP during surgical resection

41
Q

Antidote for phenoxybenzamine OD

A

norepinephrine (acts on remaining free alpha-1 receptors)

42
Q

Major B-blockers used in anesthesia

A

labetelol, propranolol, metoprolol, and esmolol

43
Q

Metoprolol dosing

A

2.5-5mg IV q2-5 min, up to total dose of 15mg IV

Titrate based on HR and BP

44
Q

Labetelol dosing

A

5-10mg IV q5 min

Infusion- 2mg/min (max)

45
Q

Why may labetelol be useful in post-cardiac surgery pts?

A

Vasodilation (decrease BP) w/out reflex tachycardia (works on alpha 1 as well as Beta 1)

46
Q

What makes esmolol unique?

A

hydrolyzed by esterases, short half life of 9-10min

makes useful in anesthesia, critically ill patients,

47
Q

Esmolol timing, dosing

A

peak 5-10min, diminished 20-30min

Dose- 0.5mg/kg IV bolus

48
Q

Side effects of anticholinergic drugs (muscarinic antagonists)

A

tachycardia, sedation, dry mouth

49
Q

Which anticholinergic can cross the BBB?

A

atropine

50
Q

When would you use glycopyrrolate?

A

to blunt the muscarinic effects (bradycardia, etc) that occur when anticholinesterases (pyridostigmine, neostigmine, etc) are given to reverse neuromuscular blockade

51
Q

Antidote for CNS effects (mentation disorders) from atropine/scopolamine

A

physostigmine (anticholinesterase that crosses BBB)

52
Q

What are cholinesterase inhibitors (anticholinesterases) used for?

A

reverse NMJ blockade and treat MG

53
Q

Major side effect of cholinesterase inhibs?

A

bradycardia

Anesthesia (9 decks)

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