CCP 109 - Pharmacology Flashcards
Name the 3 inoconstrictors
Norepinephrine
Epinephrine
Dopamine
Name the 2 vasoconstrictors
Phenylephrine
Vasopressin
Name the 2 inodilators
Dobutamine
Milrinone
Name the 3 vasodilators
Nitroglycerin
Nitroprusside
Nesiritide
What is the difference between a vasopressor and an inotrope?
A vasopressor is a drug that regulates vascular tone in the form of vasoconstriction and an inotrope is a drug that increases the heart’s contractility
Epinephrine
1. class
2. dosing range for infusions
3. route
4. brief MOA (which receptors does it act on?)
- Sympathomimetic, Inoconstrictor
- 2-20 mcg/min (source: Rico)
- IV/IO infusion. Central line preferred.
- Acts on alpha and beta adrenergic receptors.
Norepinephrine
1. class
2. dosing range for infusions
3. route
4. brief MOA (which receptors does it act on?)
- Sympathomimetic, Inoconstrictor
- 2-20 mcg/min (source: Rico)
- continuous IV infusion, central line preferred.
- Predominantly acts on alpha1 receptors, but also some beta1 at higher doses.
Dopamine
1. class
2. dosing range for infusions
3. route
4. brief MOA (which receptors does it act on?)
- Sympathomimetic, Inotrope
- 2-20 mcg/min (source: Rico)
- IV infusion
- Acts on dopaminergic, beta1 and alpha adrenergic receptors.
Milrinone
1. class
2. dosing range for infusions
3. route
4. brief MOA (which receptors does it act on?)
- Phosphodiesterase inhibitor, Inodilator
- 0.125–0.75mcg/kg/min (source: Chris’s slides)
- Continuous IV infusion
- Selective phosphodiesterase inhibitor resulting in vasodilation and inotropy with very little chronotropy.
Phenylephrine
1. class
2. dosing range for infusions
3. route
4. brief MOA (which receptors does it act on?)
- Sympathomimetic
- 50-200 mg IVP or 100-180 mcg/min continuous infusion, when B/P is stabilized, drop to 40-60 mcg/min. (source: Chris’s slides)
- IV push or continuous IV infusion
- Pure alpha 1 agonist
Vasopressin
1. class
2. dosing range for infusions
3. route
4. brief MOA (which receptors does it act on?)
- ADH analogue, hormone, vasoconstrictor
- 0.03-0.04 units/min (source: Rico)
- continuous IV infusion
- acts on V1 receptor to increase SVR and B/P, may decrease HR and cardiac output. Acts on V2 receptor to increase cAMP which increases osmolality at renal tubule and decreases urine production. (source: UpToDate)
List 5 non-depolarizing neuromuscular blocking agents
- Rocuronium
- Pancuronium
- Vecuronium
- Atracurium
- Cisatricurium (Nimbex)
Name 1 depolarizing neuromuscular blocking agent
Succinylcholine
Describe the mechanism of action of Rocuronium
Occupies (competitive antagonist) post-synaptic nicotinic acetylcholine receptors on muscles
Mimics the effect of acetylcholine in the synaptic cleft, occupies the receptor site and prevents transmission of the signal and prevents depolarization of the muscle resulting in paralysis
What is the dose of Rocuronium for RSI?
1 mg/kg
Describe the mechanism of action of Succinylcholine
-Agonist at nicotinic ACh receptors in skeletal muscles
-Generates action potential
-Not affected by synaptic acetylcholinesterase (unlike ACH)
-Continuous end plate depolarization
-Inactivation of sodium channels
-Prevention of repolarization and additional action potentials
-Skeletal muscle paralysis
What is the dose for Succinylcholine for RSI?
1.5 mg/kg
Ketamine
1. class
2. dose for induction and maintenance of sedation
3. route
4. brief MOA
- Anesthetic/analgesic/sedative
- 1-2 mg/kg depending on shock index, half of induction dose for maintenance.
- IV, IO, IM, IN, PO,
- NMDA receptor antagonist - impairs glutamate release leading to dissociative anesthesia
- Weak opioid receptor agonist - sedation and analgesia
- Muscarinic receptor antagonist - impairs cholinergic transmission leading to bronchodilation and increased salivation
- Enhances central/peripheral monoaminergic transmission
- NMDA receptor antagonist - impairs glutamate release leading to dissociative anesthesia
Propofol
1. class
2. dose for induction and maintenance of sedation
3. route
4. brief MOA
- General anesthetic
- 1-2 mg/kg for stable patients
0.5-1 mg/kg for unstable patients
25-100 mcg/kg/min for maintenance - IV push, IV infusion
- Allosterically increases binding affinity of inhibitory neurotransmitter GABA for GABA-A receptor
Prolonged opening of chloride channel
Hyperpolarization of nerve membrane
