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Pharm II > Kyle Lecture Vasopressors/inotropes > Flashcards

Kyle Lecture Vasopressors/inotropes Flashcards

1
Q

Catecholamine synthesis

A

Tyrosine
TH
Dopa
AADC
Dopamine
DBH
Norepinephrine
PNMT
Epinephrine

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2
Q

How are you going to fix bradycardia if the patient is hypertensive

A

Glycopyrrolate 0.2

Emergency-atropine

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3
Q

Beta agonist MOA (WEEDS)- in cardiac myocyte

A

Binds BAR

Upregulates cAMP

Activating PKA

Causes increased calcium influx and release from SR

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4
Q

Role of calcium in myocardial contractility

A

Direct interaction with cardiac troponin (actin)

Causes binding’movement of myosin head

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5
Q

Beta Agonism (weeds) smooth muscle

A

cAMP and PKA block calcium influx!!

=Vasodilation via B2

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6
Q

Vascular smooth muscle contraction

A

Increased calcium

Calcium binds camodulin

CaM- activates myosin light chain kinase

MLCK phosphorylates the myosin light chain

This creates a cross bridge and creates contraction

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7
Q

What is present in myosin light chain contraction

A

Phosphate

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8
Q

What is myosin light chain without phosphate?

A

Relaxed

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9
Q

Difference between Beta agonism in the heart VS VSM

A

Heart- brings in Ca

VSM- blocks Ca

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10
Q

Role of IP3 in Alpha activation

A

Calcium release from endoplasmic reticulum

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11
Q

DAG

A

Alpha activation of smooth muscle

Activates protein kinase C

Which leads phosphorylation of MLCs=contraction

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12
Q

Adverse effects of Epinephrine

A

Hyperglycemia
Hypokalemia
Lactic acidosis
Myocardial ischemia

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13
Q

Epi Dosing

A

Moderate hypotension-5-10 mcg

Infusion 0.02-0.3 mcg/kg/min

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14
Q

What will you see with low dose Epi

A

Beta 2 vasodilation

See alpha vasoconstriction at higher doses

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15
Q

Impact of norepinephrine on CO and HR

A

NOTHING

CO may decrease

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16
Q

Dopamine Dosing

A

Low dose 0.5-3 mcg/kg/min RENAL

Moderate 3-10 mcg/kg/min Beta 1

High 10-20 mcg/kg/min Alpha 1

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17
Q

List 3 inodilators

A

Dobutamine

Isoproterenol

Milrinone

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18
Q

When will you see Isoproterenol and what are 2 adverse effects

A

Stress echo- PUUUUUre Beta stimulation

Tachycardia/palpitations
Flushing

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19
Q

What impact does milrinone have on adrenergic receptors?

A

Trick question, fuck you its a PDE3 inhibitor that increases cAMP and therefore Ca in the myocardium

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20
Q

Dosing phenylephrine

A

5-200 mcg
0.2-2 mcg/kg/min

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21
Q

Hypotension in setting of spinal in C-section?

A

Phenylepherine

Previous recommendation was ephedrine

22
Q

Considerations and effects for phenylephrine

A

Do you have a heart rate? You really need a heart rate Jack

Severe Reflex bradycardia with pure alpha stimulation

23
Q

What’s your indirect/direct agent?

A

Ephedrine 5-10 mg

24
Q

Dosing Vasopressin

A

Low and slow

0.5-2 units… probs just 0.5 units

Reflex bradycardia

25
Q

Electrolyte abnormalities you will see increased digoxin toxicity

A

Hypokalemia

Hypomagnesemia

Hypercalcemia

26
Q

RAAS

A

Renin release

Conversion of angiotensinogen to angiotensin I in Liver

Conversion Via ACE to angiotensin II which is our vasoactive molecule

27
Q

Angiotensin receptor stimulation

A

Vasoconstriction

Salt retention

Vascular growth

28
Q

Which is the only cardiac med we have people hold before surgery?

A

ACE-I

ARAs

29
Q

What do you give in setting of refractory hypotension in patients on an ace inhibitor?

A

Vasopressin

30
Q

Impact of nitroglycerin on vasculature

A

VENO dilation

Liver decongestant

Do not give in PRELOAD dependent states (right sided MI)

31
Q

What do Beta blockers depress?

A

Central vasomotor center in the brain
Heart
Renin release from the kidney

32
Q

What patient population are we cautious with beta blockers?

A

Asthmatics

B2 inactivation causes bronchoconstriction

33
Q

Which beta blocker causes the release of nitric oxide

A

Nebivolol

34
Q

Which beta blocker has alpha antagonism effects?

A

LAbetolol

35
Q

Selective Beta blockers

A

Metoprolol
Esmolol
Atenolol
Nebivolol

Biosprolol

36
Q

Nonselective beta blockers

A

Labetolol
Carvedilol
Propranolol
Nadolol
Sotalol

37
Q

What do you give with HTN and a high heart rate?

A

Metoprolol

38
Q

What do you give with hypertension and a normal heart rate?

A

Labetolol

39
Q

What do you give with normotensive patient with high heart rate?

A

A beer

Esmolol

40
Q

CCB with most cardiac effects

A

Verapamil

41
Q

Best drug to give to lower SVR in patient with LV systolic dysfunction and an EF<30

A

Amlodipine

42
Q

Metabolism of clevidipine

A

Nonspecific esterases

43
Q

Selective alpha blockers

A

Prazosin
Indoramin
Terazosin
Doxazosin

44
Q

Nonselective alpha blockers

A

Phentolamine

Phenoxybenzamine

45
Q

Difference between phenoxybenzamine and phentolamine

A

Phenoxybenzamine is a non competitive antagonist- long duration of action

46
Q

Only time you will maybe give an alpha blocker

A

Pheocryocytoma?

Hyperplasia of adrenal medulla and exaggerated sympathetic response

47
Q

What to give in low heart rate high BP

A

Hydralazine

48
Q

What’s your only venodilator

A

Nitroglycerin

49
Q

What drug acts on venous an arteriolar

A

Nitroprusside

50
Q

What is the defining factor of hypertensive emergency?

A

End organ damage

51
Q

Overall… according to Kyle… what does alpha 2 agonism do?

A

Vasodilation

Despite some postsynaptic alpha2B mediated vasoconstriction in the periphery

Pharm II (11 decks)

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