Induction for CV patient

Question 1

Milrinone MOA

Answer 1

phosphodiesterase 3 inhibitor; prevent the breakdown of cAMP

Causes positive inotropic action and vasodilation without producing tachycardia

Question 2

Milrinone dosing

Answer 2

start infusion at 0.375 mcg/min up to .75 mcg/min

Question 3

Dobutamine MOA

Answer 3

synthetic sympathomimetic amine

Primarily a beta 1 agonist with some B2 effects

Increases: inotropy, cardiac output  BP may slightly increase or remain the same

Decreases: SVR due to peripheral vasodilation; pulmonary artery pressure

Question 4

Dobutamine dosing

Answer 4

Dosing: 0.5-20 mcg/kg/min

Question 5

Norepi causes increased _______ d/t increase in ________BP.

Answer 5

-coronary artery perfusion
-diastolic

Question 5

Nitro MOA

Answer 5

direct vasodilator – venous&raquo_space; arterial; caused by an induced increase of vascular nitric oxide

Question 6

Nitro concentration dosing

Answer 6

nitro “lite” vials obtained from pharmacy come 40 mcg/mL in a 10 mL vial  dose in increments of 40 mcg at a time

Question 7

Nitro infusion dosing

Answer 7

is 400 mcg/mL in a 250 mL bottle  infusion rate is typically started at 5 mcg/min in heart room

Question 8

Esmolol MOA and metabolism

Answer 8

beta 1 selective antagonist

Unique metabolism: nonspecific plasma esterases

Question 9

Esmolol uses and onset/side effects

Answer 9

Has an extremely quick (2 min or less) onset and short half-life  useful to transiently treat elevated HR without carrying lasting effects that may cause subsequent low BP

Often used alongside induction agents prevent an increase in HR during laryngoscopy

Question 10

Esmolol concentration

Answer 10

10 mg/mL in a 10 mL vial  administer in increments of 10-30 mg at a time

Question 11

Vasopressin MOA

Answer 11

endogenous hormone produced in the hypothalamus, stored in posterior pituitary gland; release is stimulated by increased osmolality and hypovolemia
Aka ADH

Question 12

Vasopressin dosing

Answer 12

Dosing: comes in vials 20 units/mL  mix one mL with 19 mL NS for a concentration of 1 unit/mL  dose in increments of 1 unit at a time
Infusion dose: 0.04 units/min

Question 13

Epi “heavy”

Answer 13

Epi “heavy” 100 mcg/mL – mix 1 mL vial of epi in 9 mL of NS dilutent

Question 14

Epi “light”

Answer 14

” 10 mcg/ml- mix 1 mL of epi “heavy” mixture into 9 mL of NS dilutent

Question 15

Ephedrine MOA

Answer 15

synthetic noncatecholamine sympathomimetic
Stimulates Alpha and Beta receptors directly
INDIRECTLY causes a release of endogenous catecholamines (baby epi)

Question 16

Ephedrine Dosing

Answer 16

comes in vials of 50 mg/mL  mix 1 mL of ephedrine with 9 mL of NS for a concentration of 5 mg/mL – dose in 5-10 mg increments IV

Can see tachyphylaxis with subsequent dosing due to depletion of catecholamine stores

Question 17

Phenylephrine Infusion dosing

Answer 17

start infusion at 0.02 mcg/kg/min

usually comes 20 mg/250 mL (peripheral strength concentration – a heavier concentration may be used via central line in ICU so always check the bag!)

Question 18

Precedex for CABG

Answer 18

no loading dose used – often just as an adjunct sedation for time on bypass and transport to ICU at a drip rate of 0.4 mcg/kg/hr