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Cardio Renal II Final > Pharmacology - Shock > Flashcards

Pharmacology - Shock Flashcards

1
Q

a clinical syndrome characterized by a perfusion of tissues is known as

A

shock

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2
Q

shock is usually associated with

A

hypotension
failure of organ systems

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3
Q

is shock a life threatening impairment

A

yes

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4
Q

what is life threatening about shock

A

lack of o2 and nutrients to the organs of the body

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5
Q

how can shock be managed?

A

fluids
determining root cause
blood pressure and HR

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6
Q

BP =

A

CO x SVR

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7
Q

CO is dependent on ___ in shock management

A

inotropesS

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8
Q

SVR is dependent on ____ in shock management

A

vasopressors

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9
Q

pharmacotherapy of shock includes

A

catecholamines
vasopressin
phosphodiesterase inhibitors - milrinone

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10
Q

what are the types of adrenoreceptors

A

alpha 1 and 2

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11
Q

where are alpha 1 receptors located

A

post synaptic effect cells - especiall y smooth muscles

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12
Q

what is the result of ligand binding to alpha 1 receptors

A

Gq - formation of IP3 and DAG
increased intracellular calcium

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13
Q

where are alpha 2 receptors located

A

pre synaptic adrenergic nerve terminals, platelets, lipocytes, smooth muscle

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14
Q

what is the result of ligand binding to alpha 2 receptors

A

GI
Inhibition of adenylyl cyclase, decrease cAMP

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15
Q

what are the beta adrenoceptors

A

beta 1, 2, 3,

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16
Q

what is the result of ligand binding of beta 1 adrenoceptors

A

stimulation of adenylyl cyclase, increased cAMP

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17
Q

where are beta 1 receptors located

A

in the post synaptic effect cells especially heart, lipocytes, brain, presynaptic adrenefic and cholinergic nerve terminals, juxtaglomerular apparatus of renal tubules and ciliary body epithelium

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18
Q

where are beta 2 receptors located

A

post synaptic effector cells, smooth muscle - bronchi and cardiac muscle

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19
Q

what is the result of ligand binding to beta 2 adrenoceptors

A

stimulation of adenylyl cyclase and increased cAMP which activates cardiac Gi under some conditions

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20
Q

where are beta 3 adrenoceptors located

A

post synaptic effector cells especially lipocytes, heart

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21
Q

what is the result of ligand binding of beta 3 adrenoceptors

A

stimulation of adenylyl cyclase and increased cAMP

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22
Q

what are the types of dopamine receptors

A

d1, d5, d2, d3, d4

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23
Q

which dopamine receptors are located in the brain, effector tissues, and especially smooth muscle of the renal vascular bed

A

D1, D5

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24
Q

D1 and D5 dopamine receptors lead to the _____ with ligand binding

A

stimulation of adenylyl cyclase and increased cAMP

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25
D2 dopamine receptor binding leads to
inhibition of adenylyl cyclase , increased potassium conductance
26
alpha 1 receptor actions are ____ when innervated
contractions
27
alpha 2 adrenergic and cholinergic nerve terminals led to ____ when innervated
inhibition of transmitter release
28
what beta adrenoceptors are found in the juxtaglomerular cells
beta 1
29
what are the actions when beta 1 adrenoceptors are innervated
increases fore and rate of contraction increases renin release
30
which beta receptor promotes smooth muscle relaxation? and where
beta 2 repspiratory, uterine and smooth muscle
31
d1 receptors when innervated
dilate renal blood vessels
32
what is the final product in most sympathetic postganglionic neurons
norepinephrine
33
in the adrenal medulla and certain areas of the brain some NE is converted to
epinephrine
34
in dopaminergic neurons, synthesis terminates wtih
dopamine
35
_____________ inhibits monoamine oxidase and enhaces NE and dopamine neurotransmission
amphetamine
36
termination of noradrenergic transmission results from what processes
simple diffusion away from receptor site reuptake into the nerve terminal by NET or intro peri synaptic glia or other cells
37
phenylephrine has an affinity for
alpha agonists , a1
38
NE and Epinephrine have an affinity for
mixed alpha and beta agonists
39
dobutamine and isoproterenol have an affinity for
beta agonists
40
dobutamine has a greater affinity for
beta 1
41
T or F NE has a greater affinity for a1 than a2
F, =
42
which dopamine agonists has an equal affinity for D1 and D2
dopamine
43
what is known as the primary transmitter
norepinephrine
44
what are the indirectly acting and mixed sympathomimetics that release stored transmitter from noradrenergic nerve endings by a calcium independent process
tyramine, amphetamines, and ephedrine
45
phenylephrine lacks an -oh group which impacts its activity by
decreases sympathomimetic activity
46
ephedrine lacks 2 -oh groups which impacts its activity by
increasing its distribution in the CNS
47
ephedrine, amphetamine and methoxamine have a methyl substitution on alpha carbon leads to
decreased oxidation by MAO
48
is dobutamine beta 1 or beta 2 selective
beta 1
49
terbutaline is beta 2 or beta 1 selective
beta 2
50
substitution on ___ increases beta receptor activity on dobutamine and terbutaline
N
51
the vasopressor of choice for septic and cardiogenic shock is
norepinephrine
52
how does norepinephrine differ from epinephrine
by the absence of a methyl group on the nitrogen atom
53
norepinephrine is indicated for
blood pressure control in certain acute hypotensive states myocardial infarction septicemia blood transfusion drug reactions
54
norepinephrine is used as an adjunct in the treatment of
cardiac arrest profound hypotension
55
norepinephrine is a direct acting
adrenergic agonist
56
what is the mechanism of acting of norepinephrine
constricts arteriolar and venous beds to elevate both systolic and diastolic BP
57
norepinephrine has major alpha 1 and small beta 1 activity and used in
reversing vascular shock with bradycardia
58
what is the onset of norepinephrine
quick onset
59
how is norepinephrine administered
short duration requires continuous IV infusion 1-2 min
60
T or F norepinephrine crosses the placenta and the blood brain barrier
F, crosses the placenta not the blood brain barrier
61
how is NE metabolized?
COMT - normetanephrine which is active MAO - vanilylmandelic acid which is inactive
62
what are the ADR of norepinephrine
leads to tissue hypoxia HA palpitation, bradycardia, hypertension, arrhythmia N,V loca VC and tissue necrosis extravasation ischemia could progress to gangrene avoid local vein, use large vein
63
what are CI of norepinephrine?
arrhythmias pheochromocytoma in hypovolemic shock, dont give with fluid replacement
64
norepinephrine should be taken with caution in patients who are
pregnant lactating peripheral vascular disease
65
DDIs with norepinephrine
MAO-Inhiibitors , tricyclic antidepressants which increase pressor response beta blockers increase pressor response alpha blokers decrease pressor response ergot vasoconstrictors increase pressor response sodium bicarbonate a-b int decreases response atropine increases heart rate diuretics decrease pressor cyclopropane and general anesthetics enhance arrhythmia liability
66
phenylephrine is uses systemically but best know for its
local applications in nose drops, eye drops, and cough preps as a decongestant
67
phenylephrine is mostly a _____ agonist
alpha 1, arteriolar vasoconstrictor
68
when phenylephrine is used systemically it is used to ______ in vascular shock
elevate PR
69
_____ is a second line agent to NE in septic shock
phenylephrine
70
what are the ADR of phenylephrine
CNS HA, weakness, dizziness CV reflex bradycardia, lowered CO, ischemia, HTN, arrhythmias EENT stinging, lacrimation, blurred vision Skin pruritis
71
phenylephrine is CI in pts with
narrow angle glaucoma
72
which patients should take phenylephrine precautiously
severe HTN diabetes - increases glucose hyperthyroidism elderly - coronary pt severe ASHD - compromised o2 delivery cardiac disease - o2 delivery problem infants - use nasal spray extravasation ischemia
73
DIs with phenylepinephrine
increased pressor effects with MAOinhibitors and tricyclic antidepressants
74
phenylephrine has storage instructions. what are they?
they should be stored in a light resistant container do not use if discolored because forms adrenochromes (inactive)
75
what is released endogenously in the emergency reaction from the adrenal medulla?
epinephrine
76
epineprhine is used in the emergency treatment of
allergic reactions including anaphylaxis induction and maintenance of mydriasis during intraocular surgery
77
what are the dosage forms for epinephrine
iv infusion or im in the thigh
78
what is the onset of epinephrine
quick onset - seconds short duration - minutes
79
which action of epinephrine requires a high dose
pressor amine to treat vascular shock
80
what action of epinephrine requires low doses
positive inotrope and chronotrope for heart to treat cardiogenic shock vasodilation of cerebral coronary and renal dopaminergic receptors
81
epinephrine's response is dose related, which receptor response is high dose
alpha 1 VC
82
epinephrine's response is dose related, which receptor response is low dose
beta 1 cardiac stimulant and beta 2 vasodialator
83
what are the uses of epinephrine
cardiac arrest - cardiogenic shock hemostasis - hemorrhagic shock anaphylaxis - IM epi opthalmic . nasal asthma
84
what are the ADR of epinephrine
CNS - tremors, anxiety, depression, insomnia, hA CONVULSIVE SEIZURES EENT - dry nose, irritation of nose and throat CV - palpitations, tachy, HTN, chest pain, arrhythmias, GI - anorexia, NV Resp - depression high dose Extravasation ischemia
85
Epinephrine is CI in
narrow angle glaucoma
86
______ and _____ are used to retain water, and increase blood volume to treat shock
vasopressin desmopressin
87
how many amino acids make up vasopressin a
9 amino acids
88
what is the moa of vasopressin
retains water from posterior pituitary hormone vasoconstrictor at high doses
89
what is the therapeutic use of vasopressin
septic shock esophageal varices with GI bleeds diabetes insipidus prevents post op abdominal distention
90
what are the ADR of vasopressin
CV - increased BP, brady, arrhythmia, venous thrombosis, VC with high dose, anginal pain CNS fever vertigo pounding head derm - uticaria pallow GI NV adb pain flatulence NM skeletal muscle tremor misc diaphoresis MI
91
what type of receptors are involved in the MOA of vasopressin
GPCRs
92
V1a,b act on which coupled receptors
Gq - peripheral and brain
93
V2 act on which coupled receptors
Gs - peripheral , kidneys
94
what is the mechanism of action of desmopressin
retains water in the body by altering the collecting duct membrane to water VC at high doses, elevates factor 8 and von willebrand factor
95
desmopressin is a vasopressin analogue but with
greater hemostatic activity
96
what is the therapeutic use of desmopressin
increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines hemostatic, antihemophilic to control bleeding in hemophilia, von willebrand disease, thrombocytopenia treat diabetes insipidus
97
what are the ADRs of desmopressin
CV - FACIAL FLUSHING CNS - dizziness and HA GI - abd cramps, N local pain at inj site
98
angiotensin II is made up of __ amino acids
8
99
angiotensin II is available as which dosage form
IV
100
Angiotensin II is used to treat
septic and other distributive vasodilatory shock in adults
101
what are the AE of angiotensin II
thromboembolic events DVT thrombocytopenia tachycardia
102
drugs that increase HR and force such as NE, EPI, ISO are CI in
obstructive cardio myopathy with HF because blood vessels exiting the heart rate are narrowed and increase HR and force will only further damage of th heart and increase HF
103
dopamine and dobutamine are both ___ inotrope
positive
104
dopamine is a positive inotrope with ____ pressor effects
alpha 1
105
dobutamine is a positive inotrope with ____ vasodialator effects
beta 2
106
dopamine is used in
cardiogenic and vascular shock
107
dobutamine is used in
cardiogenic shock with HTN
108
T or F dopamine is synthetic
F, dopamine is natural and dobutamine is synthetic
109
dopamine is considered a ____ EPI with dopamine receptor activity
weak
110
dobutamine is a ___ derivative
ISO
111
dopamine must be administered via
IV
112
what must be used when administering dopamine
an infusion pump to control rate
113
what is the mechanism of action of dopamine
"less potent epi" inotropic action - beta 1, cAMP mediated increase in myocardial Ca++ availability - low dose chronotropic - beta 1 stimulation - low dose vasopressor - alpha 1 vasoconstriction - high dose
114
moderate dose of dopamine effects are active on
alpha 1 and beta 1
115
T or F dopamine crosses the BBB
F does not, widely distributed
116
how is dopamine metabolized
in the liver, kidney, plasma by MAO and COMT
117
how is dopamine excreted
renally
118
dopamine is CI in
tachyarrhythmias pheochromocytoma ventricular fibrillation
119
what is a key side effect of dopamine?
metabolic - hyperglycemia misc extravastion ischemia at injection site CNS HA CV ectopi beats, tachy, anginal pain, palpitations, hypotension, brady, conduction disturbances, HTN, VC, widening QRS complex GI NV resp dyspnea, asthmatic episodes
120
dobutamine is a _____ analogue
isoproterenol
121
what is the mechanism of action of dobutamine
a potent beta 1 agonist positive inotrope and chronotrope increasing CO with a new vasodilator or unloading effect on the heart
122
what are the ADR of dobutamine
CNS - anxiety HA dizziness CV tachy palpitations PVCs HTN angina GI heartburn NV ms Muscle cramps
123
DI for dobutamine is
all antiHTN drugs (decreases bP)
124
name a bipyridine drug
milrinone
125
what is the mechanism of action of milrinone
inhibits phosphodiesterase 3, the enzyme that degrades CAMP elevated cAMP leads to increased calcium availability at cardiac muscle increasing inotropic and chronotropic activity relaxes vascular smooth muscle causing vasodilation which serves to unload the heart decreases blood viscosity
126
what is a caution of the positive inotropic an chronotropic activity of milrinone
positive inotropic effects are beneficial chronotropic increases HR which can be o2 wasting and precipitate anginal pain
127
milrinone is metabolized to
glucuronide
128
a majority of milrinone is metabolizes to
nothing, remains unchanged
129
how is milrinone eliminated
renally
130
what is the dosage form of milrinone
IV continuous infusion
131
____ % of milrinone is protein bound
70
132
what is a DDI of milrinone
forms a precipitate with IV furosemide
133
what are the ADR of milrinone
CV - cardiac arrhythmias, hypotension, Vtach, anginal chest pain CNS HA HEMA thrombocytopenia hypotensive liability
134
what is the duration of therapy of milrinone
5 days

Cardio Renal II Final (8 decks)

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