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Oral Boards J > Catecholamines > Flashcards

Catecholamines Flashcards

1
Q

Epinephrine Class

A

endogenous catecholamine, adrenergic agonist

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2
Q

Epinephrine Use

A

Hypotension, cardiac arrest, anaphylaxis, mixed with local anesthetics

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3
Q

Epinephrine MOA

A

Agonizes B1, B2, A1, A2 receptors, triggering a G-protein response → increases cAMP → increases Ca → results in increased BP, CO, bronchial relaxation, & stabilization of mast cells

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4
Q

Epinephrine Dose

A
  • Cardiac arrest, shock: 1 mg
  • Anaphylaxis: 100-500 mg
  • Infusion: 2-20 mcg/min

Low dose infusion: BETA agonism
Medium dose infusion: equal beta + alpha
High dose infusion: ALPHA agonism

Mixed with LA to decrease systemic absorption, 1:200,000 (5mcg/mL of epi) - induces vasoconstriction to promote longer DOA

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5
Q

Epinephrine Pharmacokinetics

A

Onset: 1 minutes
DOA: 5 - 10 minutes
Metabolism: MAO, COMT
Elimination: kidneys

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6
Q

Epinephrine Contraindications

A

Peripheral nerve blocks (digits)

Caution: CAD, hyperthyroidism, pheochromocytoma (tachycardia)

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7
Q

Epinephrine Considerations

A

Tachycardia, arrhythmias, angina, HTN, decreased perfusion to splanchnic organs/uterus, gangrene in digits

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8
Q

Norepinephrine Class

A

Endogenous catecholamine, adrenergic agonist

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9
Q

Norepinephrine Use

A

First-line vasopressor for septic shock

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10
Q

Norepinephrine MOA

A

Agonizes A1, A2, weakly B1 by triggering a G-protein response → increases cAMP → increases Ca → increases BP, decreases perfusion to splanchnic organs

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11
Q

Norepinephrine Dose

A

Infusion: 1 - 20 mcg/min

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12
Q

Norepinephrine Pharmacokinetics

A

Onset: 1 minutes
DOA: 2 - 10 minutes
Metabolism: MAO, COMT
Elimination: Kidneys

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13
Q

Norepinephrine Contraindications

A

Peripheral nerve blocks

Caution: hyperthyroidism, pheochromocytoma

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14
Q

Norepinephrine Considerations

A

Requires central access→ vesicant

Bradycardia (2/2 baroreceptor reflex), HTN, profound decrease in perfusion to splanchnic organs/uterus

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15
Q

Ephedrine Class

A

Synthetic noncatecholamine, indirect + direct acting

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16
Q

Ephedrine Use

A

Treat hypotension with bradycardia
Used in GA or SNS blockade to increase BP
Bradycardia after spinal
Similar to epinephrine, but weaker & lasts 10x longer

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17
Q

Ephedrine MOA

A

Directly stimulates both alpha + beta receptors.

Indirectly causes release of endogenous catecholamines, leading to multiple MOAs (central + peripheral)

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18
Q

Ephedrine Dose

A

Small bolus: 5 - 10 mg

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19
Q

Ephedrine Pharmacokinetics

A

Onset: 1 min
DOA: 10-60 minute (variable)
Metabolism: Resistant to MAO, liver
Elimination: Kidney (40% unchanged)

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20
Q

Ephedrine Contraindications

A

Caution: MAOIs, TCAs, cocaine (arrhythmias), CAD, tachycardia, HTN

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21
Q

Ephedrine Considerations

A

Trauma patients → requires increasing subsequent doses to offset the development of tachyphylaxis, likely due to depletion of NE stores
Available in 1-mL ampules containing 25-50 mg - must be diluted

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22
Q

Phenylephrine Class

A

Alpha 1 adrenergic agonist

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23
Q

Phenylephrine Use

A

Vasodilatory shock, hypertension (w/ normal HR), s/p spinal anesthesia

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24
Q

Phenylephrine MOA

A

Binds to alpha 1 activating IP3 increasing Ca

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25
Q

Phenylephrine Dose

A

Small boluses: 40 - 80 mcg

Infusion: 20 - 50 mcg/min

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26
Q

Phenylephrine Pharmacokinetics

A

Onset: 1 minute
DOA: 15 - 20 minutes
Metabolism: MAO
Elimination: Kidneys

27
Q

Phenylephrine Contraindications

A

Caution: bradycardia, hyperthyroidism, pheochromocytoma

28
Q

Phenylephrine Considerations

A

Reflex bradycardia + reduced CO
Must be diluted form a 1% solution (10mg/1mL ampule) to 100 mcg/mL solution
*Best for hypotension with tachycardia/normal HR
*Ephedrine best for hypotension w/ bradycardia

29
Q

Dobutamine Class

A

Synthetic catecholamine, selective B1 adrenergic agonist

30
Q

Dobutamine Use

A

Cardiogenic & septic shock, mild CHF, cardiac stress tests

31
Q

Dobutamine MOA

A

Synthetic analog of isoproterenol
Acts on B1, G-proteins to increase cAMP, increase influx of Ca, causing increased contractility & CO
Some B2 - vasodilation, decrease SVR, minimal A1

32
Q

Dobutamine Dose

A

Infusion: 2-20 mcg/kg/min

33
Q

Dobutamine Pharmacokinetics

A

Onset: 1 minute
DOA: 10 minutes
Metabolism: MAO/COMT
Elimination: kidneys

34
Q

Dobutamine Contraindications

A

Caution: tachycardia, CAD, hypertrophic cardiomyopathy

35
Q

Dobutamine Considerations

A

Decreases SVR (BP), platelet inhibition

36
Q

Dopamine Class

A

Endogenous nonselective adrenergic + dopaminergic agonist (direct + indirect acting)

37
Q

Dopamine Use

A

Hemodynamic support adjunct: Cardiogenic and septic shock, advanced heart failure

Renal dosing → increases UOP, but long-term morbidity & mortality are not changed

38
Q

Dopamine MOA

A

Stimulates D receptors, B receptors, alpha receptors, in a dose-dependent manner because of differing affinity for receptor sites

39
Q

Dopamine Dose

A

D receptors: 2 mcg/kg/min
B receptors: 2-5 mcg/kg/min
A receptors: >10 mcg/kg/min

40
Q

Dopamine Pharmacokinetics

A

Onset: 2 - 4 minutes
DOA: 10 minutes
Metabolism: MOA/COMT - 75% inactive, 25% NE
Elimination: kidneys

41
Q

Dopamine Contraindications

A

Caution: MAOI/TCA, tachycardia, arrhythmias

42
Q

Dopamine Considerations

A

Inhibits aldosterone, resulting in increase in sodium excretion & UOP
R/F extravasation

43
Q

Vasopressin Class

A

Exogenous antidiuretic peptide & vasopressor

44
Q

Vasopressin Use

A

Septic shock, post-CPB shock state

ACE inhibitor-related hypotension

45
Q

Vasopressin MOA

A

Vasoconstriction: stimulates V1 receptors on vascular smooth muscle, glomerular mesangial cells, & vasa recta

V2 activation: found on collecting duct of nephron & acts as ADH

46
Q

Vasopressin Dose

A

Bolus: 1 unit
Infusion: 0.01 - 0.04 units/minute

47
Q

Vasopressin Pharmacokinetics

A

Onset: 1 - 5 minutes
DOA: 10 - 30 minutes
Metabolism: Tissue peptidase
Elimination: Kidneys

48
Q

Vasopressin Contrainidications

A

Cardiac ischemia and CHF

49
Q

Vasopressin Considerations

A

Complications: GI ischemia, decreased CO, skin/digit necrosis, cardiac arrest

50
Q

Milrinone Class

A

Phosphodiesterase 3 inhibitor

51
Q

Milrinone Use

A

Cardiogenic shock, right HF, pulmonary HTN (dilates pulmonary artery)
Inotropy in setting of beta blockade

52
Q

Milrinone MOA

A
  • PDE III degrades cAMP→milrinone inhibits
  • Myocardium: increases cAMP → increased intracellular Ca→ increases contractility
  • Vascular SM: increases cAMP → vasodilation & decreased PVR
53
Q

Milrinone Dose

A

Loading dose: 50 mcg/kg over 10 minutes

Infusion: 0.375-0.75 mcg/kg/min

54
Q

Milrinone Pharmacokinetics

A

Onset: 5 - 15 minutes
DOA: 3 - 6 hours
Metabolism: hepatic
Elimination: Kidneys (80% unchanged)

55
Q

Milrinone Contraindications

A

hypotension, renal failure , recent MI

56
Q

Milrinone Considerations

A

Side effects: arrhythmias, hypotension

57
Q

Albuterol Class

A

Selective B2 agonist

58
Q

Albuterol Use

A

Bronchodilation

59
Q

Albuterol MOA

A

Acts directly on B2 receptors - coupled to G protein, activates adenylyl cycle, increasing cAMP → decreases Ca, increases K → SM relaxation & bronchodilation

60
Q

Albuterol Dose

A

90 mcg per puff

61
Q

Albuterol Pharmacokinetics

A

Onset: 5 minutes
DOA: 4 hours
Metabolism: MAO
Elimination: Kidneys (30% unchanged)

62
Q

Albuterol Contraindications

A

Hypersensitivity to milk protein and albuterol

63
Q

Albuterol Considerations

A

Side effects: tremors, tachycardia, hypokalemia

Oral Boards J (11 decks)

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