EXAM2-NE,Dop,Dobu,Iso,Phenyl, Amph Flashcards
1
Q
Caution of norepinephrine in patients with ________why?
Norepinephrine directs precursor to
A
- Right RV Failure; because increase in PVR and decrease in Venous return not well tolerated.
- Epinephrine
2
Q
Norepinephrine cause
A
Increased contractility and conduction velocity
3
Q
Norepinephrine vs. Epinephrine
A
As you titrate higher, REFLEX BRADYCARDIA even though it is a Beta 1 agonist.
4
Q
NE leads to _____ ______ due to activation of ______ reflex.
A
Reflex bradycardia due to activation of baroreceptor reflex.
5
Q
CYCLOPROPANE and HALOTHANE
A
Increases cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of IV epinephrine or norepinephrine.
6
Q
Epi cause intense ___________ and may cause Extravasation and sloughing treated with ________ which is ___ ____ -___antagonist
A
peripheral vasoconstriction; PHENTOLAMINE; non-selective alpha 1 and alpha 2 antagonist.
7
Q
Dopamine precursor to
A
Norepinephrine
8
Q
Main clinical effects (2)
Which receptor does it stimulate?
Is is lipid soluble or polar?
CNS activity
A
1.Direct acting effects at the receptor.
beta, alpha and dopamine (BAD)
2. causes release of NE from non-adrenergive nerve terminals.
POLAR- DOES NOT CROSS BBB
LOW CNS activity
9
Q
Endogenous work in the brain , dopamine
A
yes
10
Q
Given as a drug, dopamine works in the brain?
A
no
11
Q
Is dopamine administered orally?
A
NO
12
Q
Dopamine is metabolized by which 2 enzymes? and how is it excreted ?
A
MAO and COMT
Enzymes convert it to inactive metabolites and then excreted by kidneys
13
Q
Plasma half life of dopamine is _____Duration of action _____
A
2 minutes; less than 10 minutes
14
Q
In plasma, liver and kidney because of abundance of
______and ______enzymes
A
MAO and COMT
15
Q
Clinical uses of dopamine (MOHTS)
Positive _______in conditions such as
A
Positive inotrope in condition such as MI Open heart surgery Hemodynamic imbalances Trauma Septicemia
16
Q
****MEMORIZE Dopamine dosing scheme (DBA)
A
0.5 - 3 mg/kg/min (Dopamine)
17
Q
****MEMORIZE Dopamine dosing scheme (DBA)
A
0.5 - 3 mcg/kg/min (Dopamine dose)
3 - 10 mcg/kg/min (Beta dose
10> alpha dose
18
Q
What percentage of the dose of dopamine is taken up into specialized neuro-secretory vesicles?
A
25%
19
Q
The predominant effects of dopamine are dose -related
A
True
20
Q
Low dose is the _______dose
Less than _____
Stimulates ______ receptors and leading to ______ and ________ which increases _________ and _______blood flow.
A
dopamine dose : 3mcg/kg/min
vascular dopamine 1 and D2;
renal coronary and mesenteric arterial vasodilation;
Renal and splanchnic blood flow
21
Q
With low dose of dopamine, ______ and ____ are decreased
A
Prelaod and afterload
22
Q
Dopamine: Renal blood flow increases (with Low doses ) ___ ____ and ______
A
GFR; UO and excretion of sodium
23
Q
At low doses of dopamine is to ______ but do not use low dose of dopamine for _______ why?
A
PROMOTE RENAL BLOOD FLOW
renal protective effects; no evidence to support.
24
Q
Renal dose effects is antagonized by ___________ _______ such as ______, ______ , ______
A
Dopamine 2 blockers (antagonists)
Droperinol
Haloperinol
Metoclopramide
25
At beta dose, you are still stimulating ______ but the response is mediated by
Beta-1 receptors
26
Dopamine has little or no effect on
B2 adrenergic receptors
27
Lusitropic agent
myocardium relaxant
28
High dose Dopamine is the range of ________mcg/kg/min and the clinical effects include.? which effect predominates? but you can still see _____effects
10-20 ; Increases in MAP
CO
Alpha 1
beta 1
29
At very high rates of dopamine
Alpha 1 receptors stimulated
30
1st treatment of dopamine - STOP infusion
| 2nd treatment of Dopamine, administer -->
Phentolamine
31
Dopamine _____Prolactin, GH, thyroid hormones
Decreases
32
Prolonged infusion of dopamine can deplete
NE stores
33
Prolonged infusion of dopamine can deplete____
| Indirect effect going away, need direct effect of drugs.
Endogenous NE stores
34
Synthetic sympathomimetic amine same thing as
Synthetic catecholamines
35
Isoproterenol is a
synthetic catecholamines
36
Isoproteronol is a___________ and it stimulates both _____ and _____
non-selective B-adrenergic agonist that stimulates both B1 and b2
37
When being given IV isoproterenol? why
HAS TO BE PROTECTED FROM LIGHT, can start to degrate
38
Isoproterenol PREDOMINANTLY METABOLIZED BY ______, primarily in the _____
COMT ; liver
39
Clinical uses of ISOPROTERENOL
SYMPTOMATIC
40
General dose of ISOPROTERENOL
1-10 MCG/MIN continuous IV
41
Cardio-vascular effects of ISOPROTERENOL
Increase HR
increases cardiac automaticity
Increase MYOCARDIAL OXYGEN CONSUMPTION
Increase Myocardial contractictily
42
Isoproterenol will ________ coronary perfusion pressure due to
Decreases; vasodilation in renal, mesenteric and vascular bed.
43
CO is ______with isoproterenol due to positive _____and _______effects in the face of decreased PVR
Increases; Inotropic; chronotropic
44
MAP is _____ or _____ with isoproterenol? why ?
Unchanged or decrease; PVR and DBP decreased
45
Does compensatory baroreceptor reflex occur with ISOPROTERENOL ? Yes or NO and Why or why not?
No; because It does NOT INCREASE MAP
46
Avoid ISOPROTENROL when potent INHALATIONAL ANESTHETICS such as _______. If you must give, ______ the dose of isoproterenol
HALOTHANE; decrease
47
Preload and afterload should be _______ with ISOPROTERENOL
DECREASED
48
DOBUTAMINE is a ________ and a ______
| Recall the meaning of direct acting?
Synthetic catecholamine; direct acting inotropic agent
| Does not rely on endogenous store of NE
49
Dobutamine is a ______ mixture.
Racemic
50
Dobutamine is metabolized by _______meaning?
COMT; Need continuous infusion to maintain therapeutic level
51
When it comes to HR increases with is better DOB or ISO?
| DOB its better for ______
ISO
| INOTROPIC
52
Clinical use of dobutamine is even better if the patient has a high
HR and SVR
53
CV effects of Dobutamine are due to ____which is more potent_____and possess
BOTH StereoISOMERS (+ and -); (+); alpha 1 antagonist properties.
54
Mild to minimal effect on _____ and _____ with dobutamine
HR; BP
55
ISOPROTERENOL slightly higher risk with
cardiac arrhythmias
56
DRASTICALLY Increased with Dobutamine
Contractility
57
EPHEDRINE is a________
mixed synthetic non-catecholamines
58
The indirect acting effect of Ephedrine is _______
causes release of endogenous NE from pre-synaptic terminals
59
Ephedrine is a weak direct agonist on
alpha 1, 2, beta 1, beta 2
60
Non catecholamines is always ______than non-catecholamines agenst
WEAKER
61
response is reduced or BLUNTED by prior treatment with
RESERPINE and GUANETHIDINE
62
EPHEDRINE is a potent CNS ______
| Tell nerve endings to release
Stimulant; NE
63
Is ephedrine lipid soluble ? does it cross BBB and has CNS activity?
Yes; yes
64
EPHEDRINE IS metabolized SLOWLY by______enzyme and is not acted on by______. the slow metabolism allow
MAO ; COMT; oral absorption
65
Ephedrine half life is ______ and can be given _____but preferred route is _____
3-6 hours; IM; IV
66
Ephedrine can be eliminated _______
Unchanged.
67
Ephedrine use for
Low BLOOD PRESSURE (hypotension)
68
EPHEDRINE Resemble
EPINEPHRINE (weakened)
69
EPHEDRINE has similar effect but_____effects is less intense and last _____than epinephrine
Blood pressure; last 10X longer.
70
PRINCIPAL mechanism for CV effects of ephedrine.
Increase myocardial contractility due to activation of Beta 1
71
CLONIDINE is a________ agonist enhances :
alpha-2 ; Enhances the presser effects of EPHEDRINE in awake AND anesthetized
72
Another alpha -2 agonist used to enhance effects of EPHEDRINE
PRECEDEX.
73
If the patient is on CLONIDINE
Reduce ephedrine dose.
74
Patients taking beta blockers at home, lower dose of ephedrine why?
Drug to drug interactions
| Because you WILL HAVE AN EXAGERRATED ALPHA RESPONSE because BETA receptors are blocked.
75
EPHEDRINE IS subject to _______meaning? solution is to ?
TACHYPHYLAXIS; smaller response to a given dose; switch to a direct acting sympatomimetic
76
Heart transplant patient ______won't work , why? you have to use ______Acting agent.
EPHEDRINE; DIRECT
77
Uterine blood flow is not greatly altered when ephedrine is used to restore BP to normal after production of sympathetic nervous system blockade, however it can cause a ______umbilical artery pH resulting in _______ _________ at delivery, which may suggest that even though it does not alter uterine blood flow, it may be NOT be the best agent to use in this clinical setting.
LOW ; FETAL ACIDOSIS.
78
EPHEDRINE cause in the eye
Mydriasis
79
Norepinephrine is a potent ____-agonist with modest ______agonism and has MINIMAL TO NO activity on ______ receptors
Alpha 1; Beta 1; B2
80
What is the main use of NE ? (PM)
Increased total PERIPHERAL VASCULAR RESISTANCE
| Increase MAP
81
An adjunct to tx of hypotension and cardiac arrest?
Norepinephrine.
82
What is the first line initial vasopressors agent of choice in the treatment of SEPTIC SHOCK?
Norepinephrine.
83
Dose of Norepinephrine is
0.01-3 mcg/kg/min
84
Norepinephrine produces intense arteriole and venous _________ in all vascular beds EXCEPT of _________arteries. Venous constriction lead to _______ and _______
Constriction
coronary.
Increasing venous return and augment SV
85
Use NE in caution for patient with _______ because PVR is ______with NE
Pulmonary HTN; Increased
86
What is increased in NE
MAP
SBP
DBP
PVR
87
NE: Excessive peripheral vasoconstriction lead to __________ which can cause 3 effects
decreased perfusion to renal splanchnic and vascular bed.
End-organ hypoperfusion
Tissue hypoxia
metabolic acidosis and ischemia
88
With NE the compensatory ____ ____ activity does what ? which overcomes the ____
Vagal reflex slows the HR which overcomes B1 stimulation.
89
What happens to CO with the administation of NE? why?
CO is typically unchanged or decreased slightly.
| Because the increase in afterload and vascular resistance may decrease CO and increase the work of the heart.
90
Is the Hyperglycemia seen in epi seen in NE? why or why not?
It is not seen unless large dose of NE is administered
| Because NE is not as effective as hormone as epi is
91
Why is the use of LEVOPHED during cyclopropane and Halothane anesthesia constraindicated?
because of the risk of producing VTach or Vfib.
92
NE drug interaction include the caution in patients taking_______, why? what is teh action of those drugs
MAOIs
tryptiline or imipramide types
Because it may lead to SEVERE HYPERTENSION.
MAOIs inhibit MAO which is one of the enzymes breaking down Catecholamines.
93
Dopamine is an endogenous neurotransmitter in both ___ and_____. And CNS is important in the ________
CNS and PNS ; regulation of movement.
94
Where are the effects of EXOGENOUSLY administered dopamine?
In the peripheral nervous system.
95
Why must dopamine always be given as a continuous infusion?
to maintain therapeutic concentration since its rapidly metabolized.
96
Special considerations with the handling of dopamine?
Do not add to alkaline solution (inactivates)
| PROTECT FROM LIGHT
97
What makes dopamine different among catecholamine agents? ( MURGS)
```
It simultaneously increases;
Myocardial contractility
Renal blood flow
GFR
Sodium excretion
Urine output
```
98
At low dose of dopamine you can see a _______ In SBP and DBP and preload and afterload are ________
Decreased; decreased.
99
Dopamine produces greater _____ and _________ than does dobutamine
diuresis and natriuresis
100
Moderate dose of Dopamine is _____mcg/kg/mi include stimulation of ______Receptors directly in the heart as well as some _______ in the peripheral vasculaturs, thus ___
3-10; beta 1; alpha 1
101
The low dose of dopamine stimulate the release of NE from
Non-adrenergic nerve endings.
102
The moderate of dopamine stimulate the release of NE from
Sympathetic nerve endings.
103
Dopamine, at moderate dose, HR and cardiac contractility ______ which will increase ____ and ______
Increases; CO and SV
104
At moderate doses , CO, HR, contractility and SV are________ those effects are mainly due to ________. will that release of NE be seen in patients with chronic cardiac failure? why or why not?
increased; direct stimulation of B1 receptors and the release of NE from sympathetic nerve endings
-no because neurotransmitters may be depleted.
105
Dopamine on Beta 2 receptors?
no effect on B2
106
Dopamine due to its beta 1 effect is considered a positive ____, _____, ____, _____ agent.
Chronotropi, inotropic, dromotrophic and lusitropic
107
At moderate dosing dopamine what are the renal effects?
renal effects still evident due to the combination of D1 mediated vasodilation increased CO and altered sodium tubular reaborption.
108
At high doses of dopamine stimulation of alpha 1 leads to __________leading to ________preload and afterload. And an increase in ________ and ______can attenuate further increases in CO. PVR is also ______. If SVR rises too much you may see ______
peripheral vasoconstriction ; increased; SVR and BP ; increased; Reflex braducard
109
Dopamine at very high doses, ________Mcg/kg/min, _____Predominates and vasoconstriction effect?
May compromise the circulation of the limbs and override the cardiac B1 effects.
110
Cardiovascular risks with DOPAMINE: can induce
tachyarrhythmia and MI
111
More than dobutamine and or epi, DOPAMINE is associated with ________ it can also decreased myocardial blood flow due to _________ and _______ and worsening _______in patients with ________
Sinus tachy and ventricular arrhythmia and other cardiac abnormalities; coronary VASOCONSTRICTION , vasospasm, increased wall tension; ischemia
112
Dopamin is not recommended in those cardia patients ?
R sided HF
113
Dopamine gastrointestinal effect? why?
N/V ; due to stimulation of D2 receptors
114
Dopamine GI In CRITICAL ILLNESS at low and high doses? why? What causes the MODS?
can lead to mesenteric ischemia;
it impairs GI motility in critical illness
Mucosal ischemia, and the translocation of bacteria and toxins..
115
Dopamine is a______ neurotransmitter at the carotid bodies. The result is _______of ventilation in patients who are treated with dopamine for increased ______________/ Dopamine decreases arterial oxygen saturation impairing ________. Monitor
Inhibitory; Myocardial contractility ;
| V/Q matching in the lungs; ABGs
116
Dopamine ENDOCRINE RESPONSE _____can occur. Decreases ____ _____ _____ _____ hormone secretion
Hyperglycemia can occur
| Prolactin, Growth hormone, thyroid hormone, pituitary.
117
Isoproterenol is a ___________ and a potent non selective ____ and _____ agonists
synthetic catecholamine; B1; B2
118
What is the most potent activator of all sympathomimetic at B1 and B2?
It lacks______agonism
Isoproterenol; alpha1
119
Must be protected form light? (2 drugs)
Dopamine
| Isoproterenol
120
3 clinical uses for isoproterenol for CV
Heart block
Adams-Stokes Attacks
Bronchospasm during anesthesia 0.01-0.02mg
121
This drug decreased PVR in patients with pulmonary HTN______
Isoproterenol
122
Isoproterenol and Epinephrine should not be given simultaneously, why?
Because they are both cardiac stimulants, and the combination can lead to serious arrhythmias.
123
Why is isoproterenol not desirable for patients with CAD? also a poor choice for treating?
It simultaneously decreased coronary artery perfusion, and increases myocardial oxygen requirements.
Septic Shock
124
Never use ISOPROTERENOL in patients with
Low BP
125
Dobutamine is a predominantly_____Agonist with mild to minimal ____ and ____activity
B1; beta 2 and alpha1
126
Is DOBUTAMINE a pure Beta1 adrenergic agonist?
Not
127
Onset of action of Dobutamine?
| when is steady state concentration achieved?
within 1-2 minutes ; within 10 minutes
128
Dopamine, Epinephrine and Dobutamine should all be dissolved in _____why?
D5W; to avoid inactivation of the catecholamine that may occur in alkaline solution.
129
Dobutamine may be combined with _______ to decrease after load and optimize_____in the presence of SVR.
Vasodilators; CO;
130
Dobutamine has ______prominent inotropic than chronotropic effects on the heart compared to isoproterenol
More
131
Dopamine vs dobutamine concerning NE store? SA node?
Does not cause the release of Endogenous NE as does dopamine
| Enhance conduction of SA node.
132
Dobutamine: Preload and Afterload are _______and contractility is ______ and HR is either ______or ______
Decreased; increased; same or increased.
133
Is renal flow increased with dobutamine? why?
Yes ; because CO is increased
134
As with any inotropic agents, Dobutamine may potentially?
Increase the size of an MI by increasing Myocardial O2 demand
135
The majority of EPHEDRINE's effect is via the _______ action which
Displaced endogenous NE from the pre-synaptic sympathetic nerve which increased NE release from the nerve endings.
136
What is the 2nd action of Ephedrine ?_______what results in a loss of direct sympathomimetic effect ?
weak direct agonist on alpha 1 and 2 and Beta 1 and 2
| Loss of polar 3- & 4 OH group
137
Ephedrine use to treat hypotension associated with_______ and ________why?
Regional anesthesia
Injected/inhaled anesthetics
Because the hypotension is cause by sympathetic NS blockade.
138
Used as a nasal decongestant and has antiemetic effect similar to that of droperinol with less sedation?
EPHEDRINE
139
What is the usual dose of EPHEDRINE?
| IV and IM
2.5mg to 25mg IV
| 25mg to 50mg IM
140
2 conditions in which ephedrine may not work as well?
```
sepsis (endogenous NE depleted)
Heart transplant (endogenous NE absent)
```
141
Ephedrine and hyperglycemia
Does not produce
142
Epinephrine should NOT BE administered during or within 14 days following the administration of ______
MAO inhibitors.
143
Phenylephrine is a
Direct acting synthetic non-catecholamines
144
Use of Phenylephrine
Hypotension- regional and epidural Hypotension- women in labor
145
Typical phenylephrine dose
50-200mcg/IVP
146
What effect can phenylephrine may have?
Reflex Bradycardia
147
Other clinical use of Phenylephrine
| Topical?
Can prolong the duration of spinal anesthesia when local anesthetics.
nasal decongestants
148
Phenylephrine can be use to relieve
Drugs induced Priaprism
149
Phenylephrine has a ______onset and _______duration
Rapid; short
150
MAP is increased and CPP is with Phenylephrine
increased
151
Phenylephrine: CO is ________ may reflect an increase in __________ but are
Decreased: afterload; Baro-receptor mediated reflex.
152
Premedication with _______Will augment pressure response to
Oral CLONIDINE
153
Clonidine is a _____ (class) ; If the patient is on clonidine at home?
alpha 2 agonist. decrease the dose of phenylephrine
154
Phenylephrine stimulation of _________Receptors in the heart. ____Constriction greater than _____constriction
Alpha 1 receptors ; venous; arterial
155
Halothane does what to the myocardium ?
Sensitize myocardium to catecholamines
156
Phenylephrine ________ afterload ; Contractility ________; MAP is _________
Increase; unaffected; increased; may help with reflex bradycardia.
157
Phenylephrine :Uterine effect in the Uterus
Uterine blood flow slightly decreseHIGHER UMBILICAL artery pH
158
Drug of choice for parturients patient
Phenylephrine better than ephedrine
159
Amphetamine is _____agent
indirect-acting synthetic noncatecholamine agentt
160
Mechanism of action of AMPHETAMINE
indirectly tell nerve to release norepinephrine, dopamine and (serotonin) 5HT from their storage sites, work in the CNS
161
Amphetamine does /doesnt cross BBB? what is the MAIN MECHANISM OF ACTION?
Does; in the CNS
162
What is common with amphetamine? _______and drug dependence is
Tachyphylaxis; high
163
Amphetamine are all______
Weak bases
164
Amphetamine on heart? BP and CO?
Increase SBP and DBP
| Does not increase CO
165
****CNS effects of amphetamine
Appetite suppression
******Enhance analgesia produced by opioids
Stimulate Respiratory center
****Additive drug to drug interaction
Feeling of wakefulness, alertness, agitation, dizziness, restlessness.
166
Dose of phenylephrine?
50-200 mcg IV
167
Phenylephrine better for when ______Constriction is needed and CO is ______ and for the hypotension in patients with ______and ________ to increase _______without ______Side effects?
Peripheral; adequate; CAD and Aortic stenosis; Coronary Perfusion Pressure ; chronotropic effects.
168
Phenylephrine acts on _______of alpha ___receptors in the heart and my contribute to arrhythmia with
small number
| halothane.
169
Explain the effect of phenyelphrine on the heart?
It is a potent alpha 1 agonists which produces systemic vasoconstriction increases the work of the heart. so if the coronary circulation is impaired, the decrease in myocardial oxygen supply/demand may precipitate angina.
170
Phenylephrine reflex bradycardia is due to
rapid increase in SBP and DBP
171
What is the treatment of amphetamine OVERDOSE?
Is the acidification of the urine to eliminate through the kidneys.
