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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
Phenylephrine Dose
Small boluses: 40 - 80 mcg | Infusion: 20 - 50 mcg/min
26
Phenylephrine Pharmacokinetics
Onset: 1 minute DOA: 15 - 20 minutes Metabolism: MAO Elimination: Kidneys
27
Phenylephrine Contraindications
Caution: bradycardia, hyperthyroidism, pheochromocytoma
28
Phenylephrine Considerations
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
Dobutamine Class
Synthetic catecholamine, selective B1 adrenergic agonist
30
Dobutamine Use
Cardiogenic & septic shock, mild CHF, cardiac stress tests
31
Dobutamine MOA
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
Dobutamine Dose
Infusion: 2-20 mcg/kg/min
33
Dobutamine Pharmacokinetics
Onset: 1 minute DOA: 10 minutes Metabolism: MAO/COMT Elimination: kidneys
34
Dobutamine Contraindications
Caution: tachycardia, CAD, hypertrophic cardiomyopathy
35
Dobutamine Considerations
Decreases SVR (BP), platelet inhibition
36
Dopamine Class
Endogenous nonselective adrenergic + dopaminergic agonist (direct + indirect acting)
37
Dopamine Use
Hemodynamic support adjunct: Cardiogenic and septic shock, advanced heart failure Renal dosing → increases UOP, but long-term morbidity & mortality are not changed
38
Dopamine MOA
Stimulates D receptors, B receptors, alpha receptors, in a dose-dependent manner because of differing affinity for receptor sites
39
Dopamine Dose
D receptors: 2 mcg/kg/min B receptors: 2-5 mcg/kg/min A receptors: >10 mcg/kg/min
40
Dopamine Pharmacokinetics
Onset: 2 - 4 minutes DOA: 10 minutes Metabolism: MOA/COMT - 75% inactive, 25% NE Elimination: kidneys
41
Dopamine Contraindications
Caution: MAOI/TCA, tachycardia, arrhythmias
42
Dopamine Considerations
Inhibits aldosterone, resulting in increase in sodium excretion & UOP R/F extravasation
43
Vasopressin Class
Exogenous antidiuretic peptide & vasopressor
44
Vasopressin Use
Septic shock, post-CPB shock state | ACE inhibitor-related hypotension
45
Vasopressin MOA
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
Vasopressin Dose
Bolus: 1 unit Infusion: 0.01 - 0.04 units/minute
47
Vasopressin Pharmacokinetics
Onset: 1 - 5 minutes DOA: 10 - 30 minutes Metabolism: Tissue peptidase Elimination: Kidneys
48
Vasopressin Contrainidications
Cardiac ischemia and CHF
49
Vasopressin Considerations
Complications: GI ischemia, decreased CO, skin/digit necrosis, cardiac arrest
50
Milrinone Class
Phosphodiesterase 3 inhibitor
51
Milrinone Use
Cardiogenic shock, right HF, pulmonary HTN (dilates pulmonary artery) Inotropy in setting of beta blockade
52
Milrinone MOA
- PDE III degrades cAMP→milrinone inhibits - Myocardium: increases cAMP → increased intracellular Ca→ increases contractility - Vascular SM: increases cAMP → vasodilation & decreased PVR
53
Milrinone Dose
Loading dose: 50 mcg/kg over 10 minutes | Infusion: 0.375-0.75 mcg/kg/min
54
Milrinone Pharmacokinetics
Onset: 5 - 15 minutes DOA: 3 - 6 hours Metabolism: hepatic Elimination: Kidneys (80% unchanged)
55
Milrinone Contraindications
hypotension, renal failure , recent MI
56
Milrinone Considerations
Side effects: arrhythmias, hypotension
57
Albuterol Class
Selective B2 agonist
58
Albuterol Use
Bronchodilation
59
Albuterol MOA
Acts directly on B2 receptors - coupled to G protein, activates adenylyl cycle, increasing cAMP → decreases Ca, increases K → SM relaxation & bronchodilation
60
Albuterol Dose
90 mcg per puff
61
Albuterol Pharmacokinetics
Onset: 5 minutes DOA: 4 hours Metabolism: MAO Elimination: Kidneys (30% unchanged)
62
Albuterol Contraindications
Hypersensitivity to milk protein and albuterol
63
Albuterol Considerations
Side effects: tremors, tachycardia, hypokalemia

Oral Boards J (11 decks)

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