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CT surgery March 2022 > ICU meds > Flashcards

ICU meds Flashcards

1
Q

Calcium chloride: hemodynamic effects. 3

A
  1. Transient improvement in systolic function
  2. Increases the SVR and the MAP
  3. Little effect on HR
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2
Q

Calcium chloride: indications

A
  1. Termination of Cardiopulmonary Bypass
  2. Myocardial function support
  3. Hyperkalemia
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3
Q

Epinephrine: Hemodynamic Effects
3

A
  1. Increases cardiac output by ↑ HR and contractility
  2. Also has strong B2 properties that produces bronchodilatation
  3. Higher doses also cause vasoconstriction
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4
Q

Epinephrine: Indications 5

A
  1. Low Cardiac Output
  2. Stimulates sinus node: useful if pacing
  3. Bronchospasm/Croup
  4. Anaphylaxis (protamine reaction)
  5. ACLS (VT/VF, PEA, etc)
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5
Q

Epinephrine: Adverse reactions? 2

A

Beware of possible 1. hyperglycemia & 2. acidosis with epinephrine

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6
Q

Vasoconstricting Ionotropes? 2

A

Epi (higher doses)
Levo

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7
Q

Norepinephrine (Levophed): Hemodynamic effects? 2.5

A

Very powerful catecholamine
1. Alpha: Increases SVR and BP (MAP)
1.5. Beta 1: Increases both contractility and HR
2. Increasing of myocardial oxygen demand (bad)

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8
Q

Levophed: Indications 2

A

Low cardiac output with low SVR

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9
Q

Levo: concern at higher doses?

A

Higher doses may cause significant acidosis

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10
Q

Vasodilating Inotropes: 3

A

Dopamine

Milrinone

Isoproterenol

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11
Q

Dobutamine: hemodynamic effects 4

A
  1. Selective beta-1 agonist that increases heart rate and increases contractility (↑HR, ↑CI)
  2. Mild arterial vasodilatation (↓ SVR)
    - Can worsen hypotension
  3. Pulmonary Vasodilatation (↓ PCW)
  4. Increases myocardial oxygen demand, inducing or worsening ischemia (bad)
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12
Q

Dobutamine indications 2

A
  1. Low Cardiac Output & elevated SVR
  2. Right heart failure
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13
Q

Why is dobutamine good for Right HF? 2

A
  • Improves RV function & ↓ pulmonary artery afterload
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14
Q

Milrinone: Hemodynamic effects 5

A
  1. Inhibits phosphodiesterase (PDE) III
  2. ↑ myocardial contraction & heart rate (↑HR, ↑CI)
  3. ↓ systemic vascular resistance (↓SVR)
  4. ↓ pulmonary vascular resistance (↓PVR)
  5. Reduces myocardial oxygen demand (good)
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15
Q

Milrinone indications 4

A
  1. Low Cardiac Output (2nd line agent)
  2. Right Heart Failure with elevated PVR
  3. Significant diastolic dysfunction
  4. Biventricular dysfunction
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16
Q

Why may you need to add a vasoconstrictor with milrinone?

A

to maintain SVR, MAP and preload.

17
Q

Why would milrinone be beneficial in coronary spasm?

A

PDE inhibitors also vasodilate arterial conduits

18
Q

Vasoconstricting Medications 3

A

Vasopressin

Phenylephrine

Methylene Blue

19
Q

What is Vasopressin?
Where is it produced?
Where is it stored?
What does it cause?
What is its main effect?

A
  1. hormone
  2. Produced in the hypothalamus and
  3. stored in the posterior pituitary gland
  4. Causes peripheral vasoconstriction
  5. Main effect is to conserve the body’s water by increasing resorption in the kidney
20
Q

Vassopressin: hemodynamic effects? 2

A

↑ systemic vascular resistance (↑SVR)
↑ mean arterial pressure (↑MAP)

21
Q

Vaso: indications 3

A
  1. Significant hypotension with low SVR
  2. ACLS: cardiac arrest
  3. Diabetes Insipidus
22
Q

Phenylephrine (Neo-Synephrine): Hemodynamic effects 4

A
  1. No direct cardiac effects
  2. Pure alpha agonist
  3. ↑ systemic vascular resistance (↑SVR)
  4. ↑ mean arterial pressure (↑MAP)
23
Q

Neo: indications 2

A
  1. Hypotension with low SVR and normal CO
  2. Can be utilized when the patient is warming and vasodilating with a normal cardiac output
24
Q

What does activation of alpha receptors do?

A
  1. constriction of blood vessels, 2. contraction of uterine, eye, bladder, and prostate muscles, 3. relaxation of intestinal muscles, and
  2. dilation of the pupils.
25
Q

What do beta 1 receptors do? 2

A

heart = increase CO
kidneys = increase renin release

26
Q

What do beta 2 receptors do? 4

A

smooth muscle relaxation
1. bronchodilation
2. vasodilation
3. decreases peristalsis and digestion
4. decreased urination

27
Q

Methylene Blue: hemodynamic effects?

A

Increases systemic vascular resistance

28
Q

Methylene Blue Indications

A

Vasoplegic Syndrome

29
Q

What is vasoplegic syndrome? 5

A
  1. Hypotension,
  2. low filling pressures (↓MAP), 3. high or normal cardiac index, 4. low peripheral resistance (↓SVR) &
  3. vasopressor requirements
30
Q

Methylene Blue Side effects 2

A

Side Effects
Blue sclera
Green urine

Also used in carbon monoxide poisoning

Beware of serotonin syndrome

31
Q

HOw does Dopamine affect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR - lowers at low doses. higher at higher doses
HR- INCREASES
PCW- lowers at low doses, higher at higher doses
CI: increases
MAP: low at low, high at high
MVO2: increase

32
Q

How does dobutaminie affect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR- lower
HR- INCREASE
PCW- lower
CI- increase
MAP- usual lower, may increase
MVO2- may increase or no affect

33
Q

How does epi affect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR- lower at low, higher at high
HR- INCREASE
PCW- low at low, high at high
CI- increase
MAP- increase
MVO2- increase

34
Q

HOw does milrinone affect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR- DEcrease
HR- increase
PCW- decrease
CI- increase
MAP- decrease
MVO2- high at low, low at high

35
Q

HOw does calcium chloride effect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR- increase
HR- nothing
PCW- increase
CI- increase
MAP- INCrease
MVO2- increase

36
Q

How does norepi effect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR- INCrease
HR- INcrease
PCW- INcrease
CI- increase
MAP- INCREASE
MVO2- increase

37
Q

How does neo effect:
SVR?
HR?
PCW?
CI?
MAP?
MVO2?

A

SVR- INcrease
HR- nothing
PCW- increase
CI- nothing
MAP- INcrease
MVO2- nothing, possibly increase

CT surgery March 2022 (3 decks)

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