chapter 21 - vasopressors and inotropes Flashcards
what are inotropes?
drugs that either increase or decrease heart contractility.
positive inotropes increase it.
negative inotropes decrease it.
what is a Chronotropic agent?
drug that will increase or decrease heart rate
give examples of catecholamines
5 examples
Norepinephrine Isoproterenol Dopamine Phenylephrine Vasopressin
what drugs can be used to treat torsades?
3 drugs
isuprel (isoproteronol), magnesium, or procainamide
Procainamide is the indicated treatment.
what effects does isoproteronol have?
has beta 1 positive inotropic and chronotropic effects and beta 2 vasodilation and bronchodialation.
what can you say about the effects of dopamine?
it is dose dependant.
lower doses can increase blood flow to the kidneys but not raise contractility too high.
higher doses are the reverse
what should you be aware of before giving dopamine to a patient.
It increases afterload and O2 demand in the heart.
Why is dopamine not a first choice drug for sepsis patients?
what drug is the better choice?
sepsis patients have trouble oxygenating their body.
dopamine increases heart O2 demand and makes this self defeating
what are some adverse effects of dopamine?
4 effects
Tachyarrhythmias, ectopic beat, palpitations, decreased perfusion
what are the effects of Phenylephrine?
purely an α-agonist
it causes vasoconstriction at most vascular beds and causes a rise in systolic BP
what does Phenylephrine have the potential to cause?
it can cause reflex bradycardia from aortic constriction.
when would you use vasopressin?
when a patient is hypotensive due to fluid loss because this drug is an antidiuretic drug.
what is an adverse effect to vasopressin?
may decrease splanchnic blood flow. which blood flow to the digestive system.
what is dobutamine used for?
short term treatment of heart failure secondary to decreased heart contractility.
Dobutamine is a right isomer to what drug?
dopamine
What are the effects of the isomer of dobutamine?
Positive inotropic and chronotropic effects and vasodilation
what is digoxin used for and what are its effects?
management of chronic heart failure and inhibits vagus nerve and slows HR.
Blocks AV node and prolongs refractory period
Give an example of a class I - A Antiarrhythmic drug?
Procainamide
What are 2 things that can cause irritations to the heart muscle?
Hypoxemia and Acidosis
Give an example of a Class I-B Antiarrhythmic drug?
Lidocaine
What might you use to treat a patient who has coughing reflex due to an ET tube placement?
Lidocaine dropped into ET tube to soothe out the Carina.
what is Lidocaine used to treat?
VENTRICULAR Arrhythmia
Soothes irritated portions of the heart and relaxes the heart.
But too much can slow the heart down too much.
Beta Blockers have what effect on the heart?
They are negative inotropes. they decrease contractility
what do can you use to treat patients with supraventricular tachycardia?
Adenosine.
Which stops the heart and due to 12 second half life, the heart should restart right away.
What is an alternative route of administration after IV?
intraosseous and ET Tube
WHat arethe durgs that can be adminstered through the ET tube?
Narcan/Naloxone Atropine Vasopressin Epinephrine Lidocane
What is a first line therapy for hypotensive episodes?
Fluids
Class I-A anti-arrhythythmics drugs are associated with what cardiac actions?
Pro arrhythmic properties like QT-interval prolongation
Procainamide belongs to what class of Antiarrhythmic drugs?
CLASS I-A
Class I-B anti-arrhythythmics drugs are associated with treating what cardiac conditions?
Ventricular arrhythmias
Lidocaine belongs to what class of Antiarrhythmic drugs?
CLASS I-B
CLASS I-C Antiarrhythmic drugs are commonly used to treat what?
Supra ventricular tachycardia (SVT)
But they can also have activity against ventricular arrhythmias as well
CLASS II Antiarrhythmic agents contain what kind of drugs? What conditions do they treat?
Beta blockers
Management of hypertension and post-myocardial infarction
Propranolol and metoprolol belong what what class of Antiarrhythmic drugs?
Beta blockers
Trick is they all end in “lol”
Beta blockers are commonly used for what type of effects on the heart?
Negative Dromotropic and negative chronotropic properties
What class of Antiarrhythmic drugs belong to CLASS IV?
Calcium channel blockers
Calcium channel blockers manage what?
SVT and ventricular rate control for AF
Verapamil and diltiazem belong to what class of drugs?
CLASS IV - calcium channel blockers
Adenosine is used to treat what?
SVT
