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cardiovascular > CV118 ANS inotropes and vasopressors > Flashcards

CV118 ANS inotropes and vasopressors Flashcards

1
Q

What type of sympathetic receptors are found in the SA and AV node of the heart?

A

Beta - 1

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2
Q

What type of parasympathetic receptors are found in the SA and AV node?

A

muscarinic

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3
Q

What do beta-1 receptors do?

A

1) increase chronotropy (rate)

2) increase inotropy (strength)

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4
Q

What do beta-2 receptors do?

A

1) dilates veins and arteries

2) increases renin release

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5
Q

what do alpha-1 receptors do?

A

constrict veins and arteries

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6
Q

what do D1 receptors do?

A

Dopamine D1 receptors dilate renal, splanchnic, coronary and cerebrovascular beds

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7
Q

what do activating alpha 1 receptors do to the preload?

A

increase it.

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8
Q

what do activating beta 2 receptors do the preload?

A

decrease it

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9
Q

what do activating alpha 1 receptors do the after load?

A

increase it

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10
Q

what do activating beta 2 receptors do to the after load?

A

decrease it

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11
Q

what do activating D1 receptors do to the after load?

A

decrease it

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12
Q

what is afterload?

A

outflow resistance. Pressure in the wall of the [left ventricle] during ejection

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13
Q

hypovolemia

A

decreased blood volume of blood circulating in the body

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14
Q

What are the 3 major compensatory mechanisms that occur in response to a decrease in BP?

A

1) increase in Na retention (slow)
2) increase in renin release and subsequent increase in angiotensin II
3) increased SNA (sympathetic nervous activation)

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15
Q

Where are the baroreceptors located?

A

aortic arch and carotid artery

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16
Q

what is the mechanism behind how the baroreceptors respond to changing blood pressures?

A

during a decrease in blood pressure, the baroreceptors in the aortic arch and carotid artery respond by activating the sympathetic nervous system and inactivating the parasympathetic nervous system to increase BP. Also responds by increasing fluid retention.

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17
Q

What is the formula for BP?

A

BP = CO x TPR

Blood pressure = cardiac output x total peripheral resistance

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18
Q

When would one use vasopressors?

A

used in hypotension or shock to increase blood pressure

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19
Q

when treating shock, what is the first step?

A

correcting for intravascular volume (replacing fluids) f

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20
Q

What receptors does phenylephrine act on?

A

alpha- 1 adrenergic receptors

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21
Q

What are the effects of phenylephrine?

A

it is an alpha-1-receptor agonist

1) mydriatic - increases pupil size by constricting iris muscles
2) decrease blood flow in nasal turbinates (for nasal congestion
3) reflex slowing of the heart
4) used for hypotension to increase total peripheral resistance

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22
Q

Where does NE work?

A

alpha 1, alpha 2 and beta 1

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23
Q

what is the route of administration for NE?

A

IV

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24
Q

What is the action of NE when given IV?

A

works at alpha 1 receptors (agonist) to constrict vessels.

25
Q

When is NE used?

A

used in emergency situations where it is given by IV when the blood pressure becomes dangerously low such as in heart failure and shock.

26
Q

What is the proper order to treat shock?

A

1) first give fluids
2) then give vasopressors
3) identify infection
4) then treatment

*only give vasopressin if fluids alone fail

27
Q

why is dopamine falling out of favour?

A

because it is likely to produce dysrhythmia

28
Q

What is another term used to describe total peripheral resistance?

A

systemic vascular resistance

29
Q

what is cardiac index?

A

cardiac output/ body surface area

30
Q

what is the best type of receptor agonist that should be used to treat warm sepsis?

A

alpha 1 agonist such as NE or phenylephrine

31
Q

What are the characteristics of warm sepsis?

A

1) hyperdynamic shock so decrease in systemic vascular resistance
2) decrease in BP, decrease in SVR, and increase in Cardiac index

32
Q

What is cold sepsis?

A

1) hypodynamic shock - SVR and CI are low

2) decrease BP, decrease SVR, decreased CI

33
Q

what is the best type of receptor agonist that should be used to treat cold sepsis?

A

an alpha 1 and beta 1 agonist which would increase vasoconstriction as well as isotropy. Use NE but add epinephrine or dobutamine as inotrope if beta 1 agonist activity is required.

34
Q

in what ways are epinephrine administered?

A

topically, subcutaneously, and intravenously

35
Q

on which receptors does epinephrine work?

A

beta 1, then alpha 1 and beta 2

36
Q

Explain how epinephrine’s effects are dose dependent

A

at low doses, it is predominantly a b1-agonist and at high doses, it is predominantly an alpha1 agonist

37
Q

What drug is used as a topical hemostatic agent?

A

epinephrine. Works by means of alpha receptors which cause local constriction of blood vessels and causes decreased bleeding.

38
Q

What is the first drug choice for anaphylaxis?

A

epinephrine

39
Q

During shock, what is the best agent to use if norepinephrine fails?

A

epinephrine

40
Q

How does dopamine work at low doses?

A

works at D1 receptors to dilate vessels.

41
Q

How does dopamine work at a medium dose?

A

works at D1 and beta-1 adrenergic receptors. Cardiac effects

42
Q

how does dopamine work at high doses?

A

mostly affects alpha 1. used for hypotension due to sepsis or cardiac failure

43
Q

what is another name for vasopressin?

A

antidiuretic hormone

44
Q

hypoantremia

A

low sodium concentration in the blood

45
Q

How do inotropes work?

A

they increase intracellular calcium which then increases contractility

46
Q

What type of drug is digoxin?

A

cardiac glycoside

47
Q

What are the 2 major actions of digoxin?

A
  1. increases contractility

2. stimulates the vagus nerve - decreases conduction.

48
Q

How does digoxin work?

A

it blocks Na/K ATPase causing increased intracellular sodium. This decreases the driving force of the Na/Ca exchanger so there is a decreased extrusion of Ca into the extracellular space

49
Q

Does digoxin improve mortality ?

A

no, but it improves quality of life

50
Q

When is digoxin used?

A

used late in heart failure when appropriate treament fails to improve

51
Q

what receptors does dobutamine act on?

A

mainly beta 1 but also alpha 1 and beta 2

52
Q

what is dobutamine used for?

A

mainly for beta 1 inotropic effect

53
Q

How can dobutamine’s Beta 2 effects be both useful and detrimental?

A

useful in heart failure because beta 2 causes vasodilation which decreases afterload (which is increased in heart failure); detrimental in sepsis or cardiogenic shock because lowers SVR

54
Q

how is dobutamine administered?

A

by infusion

55
Q

what is the half-life of dobutamine?

A

2 min

56
Q

What kind of drug is milrinone?

A

It is a phosphodiesterase (PDE) - 3 inhibitor

57
Q

How do PDE-3 inhibitors work?

A

they decrease cAMP breakdown

58
Q

What is milrinone used for?

A

short-term use in advanced congestive heart failure

59
Q

how is milirinone administered?

A

intravenously

cardiovascular (6 decks)

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