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Oral Boards Study Guide > Endogenous & Synthetic Catecholamines > Flashcards

Endogenous & Synthetic Catecholamines Flashcards

1
Q

Epinephrine: Class

A

Endogenous Catecholamine
Adrenergic Agonist

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2
Q

Epinephrine: Use

A

Cardiac Arrest
Hypotension
Allergic Reaction
mixed with Local Anesthetics

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3
Q

Epinephrine: Mechanism of Action

A

Agonist of Beta 1, Beta 2, Alpha 1 and Alpha 2 receptors

-> Increases cAMP -> Increasing Calcium

Increases BP, CO, Bronchial relaxation, stabilizes mast cells

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4
Q

Epinephrine: Dose

A

Cardiac Arrest: 1 mg

Anaphylaxis: 100-500 mcg

Infusion: 2-20 mcg/min

LA Mix: 1 : 200,000 (5mcg/mL)

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5
Q

Epinephrine: Pharmacokinetics

A

Absorption: IV, IM, Inhalation

Onset: 1 minute
Duration of Action: 5 minutes

Metabolism: MAO, COMT

Elimination: Renal

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6
Q

Epinephrine: Contraindications

A

AVOID in peripheral nerve blocks

Caution in:
CAD
Hyperthyroidism
Pheochromocytoma

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7
Q

Epinephrine: Considerations

A

Tachycardia
Arrythmias
Angina
HTN
Decrease perfusion to splanchnic organs/uterus
gangrene in digits

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8
Q

Norepinephrine: Class

A

Endogenous Catecholamine
Adrenergic agonist

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9
Q

Norepinephrine: Use

A

Treatment of Hypotension

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10
Q

Norepinephrine: Mechanism of Action

A

Agonist of Alpha 1, Alpha 2, and weakly Beta 1 receptors

-> Increases cAMP -> Increases Calcium

Results in increased BP

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11
Q

Norepinephrine: Dose

A

1-20 mcg/min

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12
Q

Norepinephrine: Pharmacokinetics

A

Absorption: IV

Onset: 1 minute
Duration of Action: 2 minutes

Metabolism: MAO, COMT

Elimination: Renally

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13
Q

Norepinephrine: Contraindications

A

Avoid in Peripheral nerve blocks
Caution with:
Hyperthyroidism
Pheochromocytoma

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14
Q

Norepinephrine: Considerations

A

May cause Bradycardia (Baroreceptor reflex)
HTN
Profound decrease in perfusion to splanchnic organs and uterus
Prefer Central access d/t extravasation

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15
Q

Ephedrine: Class

A

Synthetic Catecholamine

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16
Q

Ephedrine: Use

A

Treatment of Hypotension WITH bradycardia
With GA/Spinal blockade to treat hypotension/bradycardia

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17
Q

Ephedrine: Mechanism of Action

A

Stimulates both Alpha and Beta Receptors directly

Indirectly causes release of endogenous catecholamines

Both Central and peripheral actions

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18
Q

Ephedrine: Dose

A

5 mg Bolus

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19
Q

Ephedrine: Pharmacokinetics

A

Absorption: IV, IM

Onset: 1 minute
Duration of Action: 10-60 minutes

Metabolism: into Norephedrine

Elimination: Renal

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20
Q

Ephedrine: Contraindications

A

Patient taking MAOIs, TCAs, COCAINE

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21
Q

Ephedrine: Considerations

A

Long 1/2 life
Subsequent doses need to be increased
Caution with:
CAD
Tachycardia
HTN

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22
Q

Phenylephrine: Class

A

Alpha 1 adrenergic agonist

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23
Q

Phenylephrine: Use

A

Treatment of Hypotension

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24
Q

Phenylephrine: Mechanism of Action

A

Agonist of Alpha1 receptor

-> cAMP -> Calcium levels

Results in constriction of smooth muscle around vasculature = Increased BP

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25
Q

Phenylephrine: Dose
Infusion + Bolus

A

Small Boluses: 40 - 80 mcg
Infusion: 20 - 50 mcg/min

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26
Q

Phenylephrine: Pharmacokinetics

A

Absorption: IV, Intranasal, Occular

Onset: 1 minute
Duration of Action: 15 minutes

Metabolism: MAO

Elimination: Renal

27
Q

Phenylephrine: Contraindications

A

Caution in patients with BRADYcardia
Hyperthyroidism
Pheochromocytoma

28
Q

Phenylephrine: Considerations

A

Can cause reflex bradycardia from vagus nerve leading to reduced cardiac output
Best for Hypotension with Normal HR

Can be given to prevent nose bleeds

29
Q

Dobutamine: Class

A

Synthetic Catecholamine, selective Beta1 adrenergic agonist

30
Q

Dobutamine: Use

A

Chemical Stress Test
Increase Cardiac Output (In sepsis, cardiogenic shock)

31
Q

Dobutamine: Mechanism of Action

A

Acts on Beta1 to increase cAMP causing Increase in Calcium levels
= Increase in Contractility and Cardiac Output

32
Q

Dobutamine: Dose

A

2 - 20 mcg/kg/min

33
Q

Dobutamine: Pharmacokinetics

A

Absorption: IV

Onset: 1 minute
Duration of Action: 10 minutes

Metabolism: MAO, COMT

Elimination: Renal

34
Q

Dobutamine: Contraindications

A

Tachycardia
CAD
Hypertrophic Cardiomyopathy

35
Q

Dobutamine: Considerations

A

Increases HR
Decreases SVR
Inhibits PLTs

36
Q

Dopamine: Class

A

Endogenous nonselective adrenergic and dopaminergic agonist

37
Q

Dopamine: Use

A

Increase BP and HR

38
Q

Dopamine: Mechanism of Action

A

Stimulates Dopamine receptors, Beta and Alpha receptors in a dose dependent manner

39
Q

Dopamine: Dose

A

Dopamine receptors: 2 mcg/kg/min
Beta receptors: 2 - 5 mcg/kg/min
Alpha receptors: >10 mcg/kg/min

40
Q

Dopamine: Pharmacokinetics

A

Absorption: IV

Onset: 2 minutes
Duration of Action: 10 minutes

Metabolism: MAO and COMT
25% metabolism into Norepinephrine

Excretion: Renal

41
Q

Dopamine: Contraindications

A

Hypernatremia
Pt taking MAOI, TCAs
Tachycardia/arrythmias

42
Q

Dopamine: Considerations

A

Active metabolite: Norepinephrine

Increases urine output and Na levels

Risk for extravasation

43
Q

Vasopressin: Class

A

Exogenous antidiuretic peptide & vasopressor

44
Q

Vasopressin: Use

A

Septic Shock
ACE inhibitor related hypotension

45
Q

Vasopressin: Mechanism of Action

A

Stimulates V1 receptors on vascular smooth muscle, glomerular mesangial cells and vasa recta
ADH (activates V2 receptors)

46
Q

Vasopressin: Dose

Infusion +Bolus

A

Bolus: 1 unit
Infusion: 0.01- 0.08 units/min

47
Q

Vasopressin: Pharmacokinetics

A

Absorption: IV

Onset: 1 minute
Duration of Action: 10 minutes

Metabolism: Tissue peptidase

Elimination: Renal

48
Q

Vasopressin: Contraindications

A

Hypersensitivity

49
Q

Vasopressin: Considerations

A

Gastrointestinal ischemia
Decreased Cardiac Output
Skin/Digit necrosis
Cardiac Arrest

50
Q

Milrinone: Class

A

Phosphodiesterase 3 Inhibitor

51
Q

Milrinone: Use

A

Cardiogenic shock
Right sided Heart Failure
Inotropy in the setting of Beta Blockade

52
Q

Milrinone: Mechanism of Action

A

Inhibits PDE
(usually breaks down cAMP and cGMP)

More cAMP and cGMP in myocardium and smooth muscle

Myocardium: More cAMP -> Increase in Calcium levels = Increased Contractility

Smooth Muscle: More cGMP causes vasodilation = lowering PVR

53
Q

Milrinone: Dose

A

Loading Dose: 50 mcg/kg over 10 minutes

Infusion: 0.375- 0.75 mcg/kg/min

54
Q

Milrinone: Pharmacokinetics

A

Absorption: IV

Onset: 5 minutes
Duration of Action: 6 hours

Metabolism: Hepatic

Elimination: Renal

55
Q

Milrinone: Contraindications

A

Hypotension
Renal Failure

56
Q

Milrinone: Considerations

A

Arrythmias

57
Q

Albuterol: Class

A

Selective Beta2 Agonist

58
Q

Albuterol: Use

A

Bronchodilation

59
Q

Albuterol: Mechanism of Action

A

Acts directly on Beta 2 receptors

activates adenylyl cyclase which increases cAMP and decreases Calcium causing smooth muscle relaxation and bronchodilation

60
Q

Albuterol: Dose

A

90 mcg / puff

61
Q

Albuterol: Pharmacokinetics

A

Absorption: Inhalation

Onset: 5 minutes
Duration of Action: 4 hours

Metabolism: MAO

Elimination: Renal

62
Q

Albuterol: Contraindications

A

Allergy

63
Q

Albuterol: Considerations

A

Tremors
Tachycardia
Hypokalemia

Oral Boards Study Guide (15 decks)

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