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Pharmacology Drug Flashcards > Drug Flaschards 13.08.26 Epi and Norepi > Flashcards

Drug Flaschards 13.08.26 Epi and Norepi Flashcards

1
Q

Norepi Other Names?

A

noradrenaline, Levophed

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2
Q

Norepi Drug Class…
Pharmacologic Class?
Therapeutic Class?

A
  • pharmacologic class—direct-acting adrenergic agonist

* therapeutic class—vasopressor, vasoconstrictor

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3
Q

Norepi Pharmacodynamics?
What is the major action?
What is the minor action?
What are the main effects?

A
  • Major action is to stimulate peripheral alpha-1 adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload).
  • This increases CO, SVR, and MAP, but decreases blood flow to vulnerable tissues like skin, muscle, and kidney.
  • Minor action stimulates beta-1 receptors in the heart, increasing HR and contractility
  • Main effects are vasoconstriction and cardiac stimulation.
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4
Q

Norepi stimulates peripheral _____ receptors which leads to increases CO, SVR, and MAP.
Norepi stimulates heart _____ receptors which increases HR and Contractility

A

Alpha-1

Beta-1

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5
Q

Norepi Pharmacokinetics?
What is F %?
How is it administered?
What enzyme metabolizes Norepi and in what organ?
Where are metabolites of Norepi excreted?
What is the half-life of Norepi?
What Blood-Tissue barriers can Norepi cross and not cross?

A
  • F ~100%.
  • Given IV only.
  • Metabolized by COMT and MAO, mostly in liver.
  • Metabolites are excreted in urine.
  • Half-life 1-2 minutes (e.g. can be titrated quickly IV).
  • Can cross the placenta, but not the blood/brain barrier.
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6
Q

Norepi…
What is F%?
How is it administered?

A
  • F ~100%.

* Given IV only

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7
Q

Norepi…
What enzymes metabolizes Norepi and in what organ?
How are the metabolites excreted?

A
  • Metabolized by COMT and MAO, mostly in liver.

* Metabolites are excreted in urine.

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8
Q

What is the Half-Life of Norepi?

A
  • Half-life 1-2 minutes (e.g. can be titrated quickly IV)
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9
Q

What Blood-Tissue barriers can Norepit cross and not cross?

A
  • Can cross the placenta, but not the blood/brain barrier.
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10
Q

Norepi Toxicity

What physiologic events occur with Norepi Toxicity?

A
  • excessive vasoconstriction in mesenteric vessels
  • peripheral arterioles causing ischemia, infarction, and gangrene
  • reflex bradycardia
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11
Q

Norepi…

Which drug interactions are a concern?

A 
MAO inhibitors (phenelzine) [use lower doses of norepi]
Propranolol [risk of causing hypertension]
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12
Q

Norepi…

What special considerations are there?

A
  • correct volume depletion with IV fluids BEFORE giving NE infusion
  • select infusion site carefully—extravasation is a major problem
  • monitor patient and BP continuously in ICU setting
  • use cautiously in pediatric and geriatric patients
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13
Q

Norepi…

What are indications and dose/route?

A
  • for adults with acute hypotension and shock (related to low SVR)
  • infuse 2-12 mcg/min
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14
Q

Norepi…

How should the patient be monitored if given norepi?

A

BP, HR, infusion site, evidence of extravasation

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15
Q

Epi…

Other names?

A

Adrenaline

EpiPen

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16
Q

Epi…
Pharmacologic class?
Therapeutic Class?

A
  • pharmacologic class—direct-acting adrenergic agonist
  • therapeutic class—vasopressor, cardiac stimulant, bronchodilator, adjunct to local anesthetics, treatment for anaphylaxis
17
Q

Epi…
What are the pharmacodynamics…
Major actions (3)?
(Comprehensive flashcard)

A
  • major action is to stimulate peripheral alpha-1 adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload)
  • beta-1 receptors leading to tachycardia and increased contractility
  • beta-2 receptors leading to bronchodilation these actions are also helpful in severe allergic reactions (e.g. anaphylaxis) by stabilizing mast cells
18
Q

Epi… which receptors?

  • major action is to stimulate peripheral ____ adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload)
  • ____ receptors leading to tachycardia and increased contractility
  • ____ receptors leading to bronchodilation these actions are also helpful in severe allergic reactions (e.g. anaphylaxis) by stabilizing mast cells
A

Alpha-1
Beta-1
Beta-2

19
Q

Epi again…
What do Alpha-1 receptors do in peripheral vessels?
What do Beta-1 receptors do to the heart?
What do Beta-2 receptors do to the lungs and to mast cells?

A
  • peripheral alpha-1 adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload)
  • beta-1 receptors leading to tachycardia and increased contractility
  • beta-2 receptors leading to bronchodilation these actions are also helpful in severe allergic reactions (e.g. anaphylaxis) by stabilizing mast cells
20
Q

Epi Pharmacokinetics…
What are routes of administration?
What enzyme metabolizes epi?
How are the metabolites excreted?

A

can be given iv (immediate), IM (variable), SC 5-15 min), inhalation (1-5 min onset), ophthalmic topical

metabolized by COMT and then renally excreted

21
Q

Epi…

What are syptoms of toxicity?

A

excessive vasoconstriction, HTN, hemorrhagic stroke, angina, arrhythmias

22
Q

Epi…

What are special considerations (ie, when is it used)?

A
  • utility with local anesthetics

* drug of choice in severe anaphylactic reactions (along with others)

23
Q

Epi…

What are indications for use?

A

Anaphylaxis

Cardiac arrest

24
Q 
Epi...
What are the dosages and route of administration for
Anaphylaxis?
Cardiac Arrest?
Infusion of epi?
A

anaphylaxis, 0.1-0.5 mg SC or IM
cardiac arrest, 1-5 mg IV push
infusion, 1-4 mcg/min

25
Q

Epi…

What patient symptoms should be monitored?

A

BP, HR, rhythm, infusion site, evidence of extravasation

Pharmacology Drug Flashcards (4 decks)

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