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Pharm 2 > Class 6 Deck 1 > Flashcards

Class 6 Deck 1 Flashcards

1
Q

What are the 2 types of positive inotropes?

A
  • cAMP Dependent

- cAmp Independent

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2
Q

What are the 3 cAMP dependent positive inotropes?

A
  • Beta agonists
  • Dopaminergic agonists
  • Phosphodisterase inhibitors
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3
Q

What are the 2 cAMP independent (direct acting) positive inotropes? and what do they do?

A
  • Cardiac glycosides (digoxin) = Inhibits Na-K ATPase

- Calcium = ↑Ca gradient

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4
Q

How do cAMP dependent phosphodisterase inhibitors work?

A
  • Inhibit metabolism of cAMP
  • Increase Ca sensitivity of contractile proteins
  • Increase Ca influx
  • Antagonize adenosine
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5
Q

What are the pure Beta 1 agonists?

A
  • Dobutamine

- Isoproterenol

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6
Q

What are the hemodynamic effects of pure Beta-1 agonists?

A
  • Increased HR
  • Increased A-V conduction
  • Decreased SVR and PVR (Beta 2 effect)
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7
Q

What are the mixed alpha/beta agonists?

A

-NorEpi, Epi, Dopamine

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8
Q

What are the hemodynamic effects of mixed alpha/beta agonists?

A
  • Increased vascular resistance
  • Increase myocardial O2 consumption
  • increased HR
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9
Q

When are the effects of inotropes more pronounced?

A

-Failing heart

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10
Q

when are direct acting positive inotropes used?

A

-To increase SV in low flow states when myocardial contractility is depressed

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11
Q

What 3 direct acting inotropes drugs can worsen tachyarrhythmias?

A
  • Isoproterenol
  • Dopamine
  • Dobutamine
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12
Q

What 2 inotrope drugs will may decrease tissue perfusion and lead to renal failure in low CO states?

A

-NorEpi and Epi

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13
Q

Digoxin should be used cautiously in what 3 patient types for fear of digoxin toxicity?

A
  • Hypokalemia
  • Renal failure
  • Preop digoxin administration
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14
Q

From lowest to greatest, list the positive inotropes arrhythmogenic potential.

A

-Dobutamine<Isoproterenol

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15
Q

What is the prototypical catecholamine? and what receptors does it stimulate?

A
  • Epinipherine

- Alpha 1, Beta 1 & 2

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16
Q

What is the most potent activator of Alpha 1 receptors?

A

-Epinepherine

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17
Q

What is the low dose of EPI and what does it do?

A
  • 1-2 mcg/min (BETA 2)
  • Essentially a vasodilator
  • Decrease SVR
  • Increased blood to skeletal muscle
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18
Q

What is the intermediate dose of EPI and what does it do?

A
  • 4 mcg/min (BETA 1)
  • Increases in HR, Contractility, CO and automaticity
  • Inotrope
19
Q

What is the high dose of EPI and what does it do?

A
  • > 10 mcg/min (ALPHA 1)
  • Vasoconstrictor
  • Most potent activator of Alpha 1 receptors
  • Maintain myocardial and cerebral perfusion
  • Possible reflex brady
20
Q

Continuous epinepherine IV infusion is used to treat what?

A

-Decreased myocardial contractility

21
Q

NorEpi is also known as what? and is primarily a what?

A
  • Levophed

- Alpha 1 agonist

22
Q

NorEpi (Levophed) is used to treat what?

A

-Refractory hypotension (titrate to flow not BP)

23
Q

What doe NorEpi (levophed) do to CO?

A
  • Increase at low doses (2mcg/min) Beta stimulation

- Decrease at higher doses (>3mcg/min) Alpha 1 = peripheral vasoconstriction

24
Q

What drug is a better inotrope, Epi or NorEpi? and Why?

A
  • Epi

- Produces greater CO

25
Q

NorEpi can be used as a Beta 1 agonist when combined with what alpha blocking drug?

A

-Phentolamine

26
Q

What does dobutamine do?

A
  • Beta 1 Receptor
  • Dilates coronaries
  • Increases CO/HR
  • Decreases filling pressure
  • Inotropic properties w/o dysrhythmias
27
Q

Dopamine and dobutamine need to mixed what solution?

A

-D5W

28
Q

Dobutamine can be combined with what drug to increase SVR and Urine output.

A

-Dopamine

29
Q

Isoproterenol works on what 2 receptors?

A

-Beta 1 and 2

30
Q

Isoproterenol increases what 4 things?

A
  • HR
  • Contractility
  • systolic BP
  • Automaticity
31
Q

What is the net effect of Isoproterenol?

A
  • Increased CO
  • Decreased MAP
  • Bronchodilator
32
Q

What are 4 problems with Isoproterenol

A
  • Tachycardia
  • Diastolic hypotension
  • ↑ MVO2
  • ↑ dysrhythmias
33
Q

What are the uses for Isoproterenol?

A
  • Chemical pacemaker

- Decrease PVR in pulmonary HTN and RV failure

34
Q

What clinical situations is dopamine used?

A
  • Decreased CO
  • Decreased systemic BP
  • Increased LVEDP
35
Q

What are the problems associated with dopamine?

A
  • Vent response to hypoxemia
  • Inhibit insulin (hyperglycemia)
  • Extravisation causes vasoconstriction
36
Q

What receptors does dopexamine work on?

A
  • Beta 2 and DA1

- Inhibits presynaptic uptake of NE

37
Q

How does Dopaximine compare to Dopamine?

A

-As effective at increasing CO, but tachycardia is more common

38
Q

When is dopaximine used?

A

-CHF with high SVR

39
Q

Fenoldopam works on what receptor?

A
  • Selective D1 agonist

- Moderate affinity for Alpha 2

40
Q

What does fenoldopam do?

A

-Decrease SVR and renal resistance = decreased BP and increased LVEF and RBF

41
Q

How does fenoldopam compare with SNP?

A
  • As effective in controlling BP with benefit of increased renal blood flow
  • Slower on/off than SNP
42
Q

8 Advantages of fenoldopam?

A
  • Rapid on/off
  • No fall in BP
  • No coronary steal
  • No negative ino/chronotropic
  • No invasive monitoring
  • No interactions
  • Easy titrate
  • Preserve renal function
43
Q

What are the 6 disadvantages of fenoldopam?

A
  • Reflex tach
  • ECG changes
  • Tolerance
  • Hypokalemia
  • Increase in IOP
  • Cost

Pharm 2 (23 decks)

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