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ICU > Hemodynamic Drugs > Flashcards

Hemodynamic Drugs Flashcards

1
Q

What do beta 1 receptors do?

A

Cardio acceleration
Increase contractile they
Lipgloss

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2
Q

What do beta 2 receptors do?

A

Vasodilation
Bronchodilator
Increased glycolysis
Uterine relaxation

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3
Q

What receptors does dobutamine act on?

A

Beta 1>beta 2

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4
Q

What happens to systemic vascular resistance when you use dobutamine?

A

It decreases due to weak beta 2 activity

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5
Q

What happens to cardiac output when you use dobutamine?

A

Increases

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6
Q

What condition is dobutamine used for?

A

Myocardial depression after septic shock

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7
Q

What is the infusion rate of dobutamine?

A

3-5 micrograms/kg/min

Increase in increments of 3-5 micrograms/kg/min

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8
Q

In what heart condition is dobutamine contraindicated?

A

Hypertrophic cardiomyopathy

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9
Q

What receptors does dopamine act on in moderate dose?

A

Beta 1 and 2

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10
Q

What receptors does dopamine act on in high doses?

A

Alpha and beta 1/2

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11
Q

What is the low infusion rates of dopamine?

A

3 micrograms/kg/min

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12
Q

Which organ circulations does dopamine act on at low rates?

A

Renal and splanchnic

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13
Q

What is the effect of low infusion dopamine on renal and splanchnic circulation?

A

Increased sodium excretion

Increases blood flor to these regions

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14
Q

What organs are affected with moderate infusion of dopamine?

A

Beta 1 in the heart and beta 2 in the periphery causing increase heart rate and contractility with vasodilation

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15
Q

What is a moderate infusion rate of dopamine?

A

3-10 micrograms/kg/min

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16
Q

What is a high dopamine infusion rate?

A

Greater than 10

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17
Q

What are the effects of a high dopamine rate?

A

Alpha - vasoconstriction

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18
Q

Why does dopamine have to be administered into a large central vein?

A

Because extravasation from a peripheral vessel cause extensive tissue necrosis

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19
Q

What are the adverse effects of dopamine?

A
  1. Sinus tachycardia and afib (25%) of patients
  2. Increased intraocular pressure
  3. Splanchnic hypoperfusion
  4. Delayed gastric emptying
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20
Q

What drug should you inject if you get extravasation of a vasoconstrictor?

A

Phentolamine - alpha antagonist

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21
Q

What organ releases epinephrine?

A

Adrenal medulla

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22
Q

What drug is a more potent beta 1 agonist than dopamine?

A

Epinephrine

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23
Q

What receptors does epinephrine act on?

A

All of them

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24
Q

What is epinephrine used for?

A

Cardiac arrest

Postop cabg

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25
Q

What is the infusion of epinephrine started at?

A

1-2 micrograms/kg/min

26
Q

What is the usual dose range for epinephrine for augmenting cardiac output or correcting hypotension?

A

5-15 micrograms/kg/min

27
Q

What are the other effects of epinephrine?

A
  1. Hyperglycemia
  2. Increased metabolic rate
  3. Splanchnic vasoconstriction
  4. Increased lactate (because increases the rate of glycolysis thru beta 2 effects)
28
Q

What is the preferred drug for septic shock and why?

A

Norepinephrine because it has fewer side effects than dopamine or epinephrine

29
Q

What are norepinephrine infusions usually started at?

A

8-10 micrograms/min

30
Q

What receptors does norepinephrine work on?

A 
Alpha 1 
Beta 1 (weak)
31
Q

What are the effects of using norepinephrine in a patient with septic shock?

A

Increased renal and splanchnic blood flow (paradoxical)

32
Q

What phenylephrine cause?

A

Systemic vasoconstriction with reflex bradycardia

33
Q

What is the principal use of phenylephrine?

A

Reversal of severe hypotension produced by spinal anesthesia

34
Q

How much phenylephrine do you initially give someone?

A

0.2 mg

35
Q

What is the max dose of phenylephrine?

A

0.5 mg

36
Q

What does vasopressin do?

A

V1 - causes vasoconstriction in the skin, skeletal muscle and splanchnics
V2 - increases water resorption in the distal renal tubules
V3 - causes ACTH release by anterior pituitary

37
Q

What is vasopressin used in?

A

In cardiac arrest (40 units)
Septic shock that is refractory to norepinephrine or dopamine to raise bp and reduce the catecholamine requirement
In cases of hemorrhagic get varices to promote splanchnic constriction

38
Q

What is the half life of vasopressin?

A

5-20 minutes

39
Q

What is the infusion rat of vasopressin?

A

0.03 units/he

40
Q

What is terlipressin?

A

Vasopressin analogue that is V1 receptor selective and has a longer duration of action

41
Q

What is the duration of action of terlipressin?

A

5 hours

42
Q

What is the danger of terlipressin?

A

Splanchnic ischemia

43
Q

What does nitroglycerin do?

A

Binds to the surface of endothelial cells and releases inorganic nitrite which is converted to NO which promotes cGMP and cause muscle relaxation

  • venodilation at lower infusion rates

It also inhibits platelet aggregation

44
Q

Why does nitroglycerin have to be in a glass bottle of PET tubing?

A

Because it binds to polyvinylchloride plastics

45
Q

What is the initial infusion rate of nitroglycerin?

A

5-10 micrograms/min

46
Q

What are the adverse effects of nitroglycerin?

A

Right heart infarction
Increased cerebral blood flow –> increased ICP
Increased pulmonary blood flow –> physiologic shunt
Methemoglobinemia
Solvent toxicity

47
Q

What solvents must be used to keep nitroglycerin dissolved?

A

Ethanol

Propylene glycol

48
Q

How can you prevent nitrate tolerance?

A

6 hours a day drug free

49
Q

How does nitroprusside work?

A

It releases NO when it enters the blood

50
Q

What is nitroprusside better at?

A

Arterial dilation

51
Q

What is nitroprusside used for?

A

Hypertensive emergency

Decompensated heart failure

52
Q

How is cyanide cleared from the body?

A

Thiosulfate gives a sulfur group to cyanide and then this thiocyanate is cleared by the kidneys

Cyanide binds to the oxidized iron in methemoglobin

53
Q

How much thiosulfate should be given for 50 mg of nitroprusside?

A

500 mg

54
Q

What is the first sign of cyanide toxicity in nitroprusside infusion?

A

Increasing nitroprusside requirement

55
Q

What are the signs of thiocyanate toxicity?

A

Anxiety, confusion, seizure, miosis, tinnitus, hallucinations, hypothyroidism

56
Q

What is the diagnostic level for thiocyanate toxicity?

A

Above 100

57
Q

What is the treatment for thiocyanate toxicity?

A

Dialysis

58
Q

What do alpha receptors do?

A
  1. Vasoconstriction
  2. Iris dilatation
  3. Piloerection
59
Q

What does dopamine do to TSH?

A

Inhibits its release from the pituitary

60
Q

What does dopamine do to T cell function?

A

Inhibits their function

61
Q

What is the MOA of methylene blue?

A

Inhibits nitric oxide synthase and cGMP counteracting refractory hypotension from vasoplegia from endothelial dysfunction

ICU (17 decks)

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