Inotropes

Question 1

Discuss the hemodynamic profile of the phosphodiesterase III inhibitors amrinone and milrinone.

Answer 1

Increasing cardiac output through increased inotropy and improved lusitropy (myocardial relaxation)

Question 2

What untoward effects can result from use of phosphodiesterase inhibitors?

Answer 2

Vasodilation

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Question 3

Prolonged use of amrinone may result to?

Answer 3

Thrombocytopenia

Question 4

This drug is an extremely potent b1- and b2- agonist that possesses no a-stimulating properties.

Answer 4

Isoproterenol

Question 5

What nitrovasodilator becomes degraded to cyanide and may cause toxicity?

Answer 5

Sodium nitroprusside

Question 6

Site of action

1) Sodium nitroprusside
2) Nitroglycerin

Answer 6

1) Arteries

2) Veins

Question 7

Benefits of nitroglycerin (3)

Answer 7

1) Improved coronary perfusion
2) Decreased O2 demand
3) Antiplatelet

Question 8

What nitrovasodilator is confounded with tachyphylaxis?

Answer 8

Nitroglycerin & nitroprusside

Because of changes in the enzymatic machinery responsible for its transformation into NO

Question 9

What is the therapeutic ceiling dose of nitroprusside?

Answer 9

2 mcg/kg/min

Question 10

This vasodilating agent relaxes smooth muscle, dilating arterioles to a much greater extent than veins and decreasing diastolic more than systolic blood pressure.

Answer 10

Hydralazine
Onset 15 to 20 mins
Reflex tachycardia

Question 11

This drug is a short-acting selective calcium channel blocker (CCB) that acts on the arteriolar beds, providing easier titration and controlled reduction in systemic blood pressure.

Answer 11

Nicardipine

Question 12

This drug is becoming the arterial vasodilator of choice for cardiac surgery patients with hypertension since it has more selective coronary vasodilation than systemic vasodilation.

Answer 12

Nicardipine
Onset: 5 to 15 mins
Duration 4-6 hours

Question 13

This drug is a new third-generation CCB that is considered an ultrashort-acting arteriolar vasodilator

Answer 13

Clevidipine

Question 14

Half-life of clevidipine

Answer 14

2 minutes

Question 15

Is a unique parenteral vasodilator that acts via peripheral dopamine-1 receptors. This has a vasodilatory effect that is selective for renal and splanchnic vasculature and causes mild renal diuresis.

Answer 15

Fenoldopam

Question 16

Arginine vasopressin (AVP) has action at three subtypes of receptors (V1, V2, and V3).

Which receptor stimulates vascular smooth muscle contraction, resulting in the vasopressor response
of AVP?

Answer 16

V1

Question 17

This arginine group of receptors primarily act in the kidney to produce water retention (antidiuretic
hormone).

Answer 17

V2

Question 18

This arginine group of receptors act in the central nervous system, and modulate corticotropin secretion.

Answer 18

V3

Question 19

Congestive heart failure in the presence of preserved left ventricular systolic function (ejection fraction [EF] >35%) and the absence of ischemia and valvular pathology suggests?

Answer 19

Diastolic heart failure

Question 20

Is a pyridazinone-dinitrite and a member of a new class of pharmacologic agents, the “calcium sensitizers.” This drug acts to increase contractility without elevating intramyocardial calcium levels. This is achieved by stabilizing troponin C in an active form, thus providing inotropic support in similar fashion to other agents but with much lower intracellular calcium requirements.

Answer 20

Levosimendan