Pharmacology - Shock Part 2 Flashcards
epinephrine is mainly used for..
it can also be used for what?
anaphylaxis
can also be used to maintain mydriasis (dilated pupil) during ocular surgery
true or false
epinephrine is considered a MIXED receptor adrenergic antagonist
false - mixed receptor adrenergic AGONIST
epinephrine effects on a1, b1, b2
at high or low doses?
low dose - b1 cardiac stimulant and b2 vasodilator
high dose - a1 vasoconstrictor
true or false
at low doses, epinephrine is used to treat vascular shock
FALSE - at high doses
role of epi in cardiogenic shock
at high or low dose?
positive inotrope and chronotrope for the heart
low dose
true or false
epinephrine is a vasodilator at low doses
true
true or false
as an IV infusion, epinephrine has a quick onset (seconds) and a short duration (minutes)
true
when epi is given in the thigh, is this SUBQ or IM
IM
what would an epinephrine nasal spray do
deongest
explain how epinephrine is extremely beneficial in asthma patients
b2 bronchodilation + vasoconstricting decongestant - very good for anaphylatic brochoconstriction
name some ADR of epinephrine
seizures
palpitations
tachycardia
hypertension
chest pain
arrhythmias
epi contraindication
narrow angle glaucoma
true or false
epinephrine is contraindicated in pregnant patients
false - precaution
true or false
diuretics decrease the pressor response
true
true or false
beta blockers decrease the pressor response
false - increase
explain how vasopressin and desmopressin work to treat shock
by retaining water and increasing blood volume
___ is also known as ADH
vasopressin
general structure of vasopressin/desmopressin
9 amino acids - “nonapeptide”
at high does, vasopressin/desmopressin is a _____
vasoconstrictor
true or false
vasopressin is a ADH analog
true
3 uses for vasopressin
-septic shock
-esophageal varices with GI bleed
-diabetes insipidus (they dont make enough ADH)
-prevent post op abdominal distention
ADR of vasopressin
increased BP - and thus reflex bradycardia
**MOA vasopressin
V2 (located in kidneys) receptor agonist. Gs coupled. vasopressin binds receptor. INCREASED AQUAPROTEINS (AQP-2) – CELL TAKES IN MORE WATER!!!!!
V1a and V2b receptors – Gq coupled. regulation of calcium. body tends to retain more calcium with vasopressin present
desmopressin elevates what 2 things?
factor 8 and von willebrand factor
**V2 receptor type
Gs coupled!!!!
4 uses for desmopressin aside from vasodilatory shock
used as a hemostatic (stops bleeding) in:
-hemophilia
-von willebrand disease
-thrombocytopenia
-diabetes insipidus
true or false
desmopressin is broken down in the liver
true
true or false
the more norepinephrine, the less amount of renin released
FALSE - more renin
RAAS system
angiotensinogen -> angiotensin I (through renin). -> angiotensin II -> adrenal gland secretes aldosterone which causes the kidney to reabsorb NACL and water
3 general effects of angiotensin II
-increased peripheral resistance
-altered renal function
-altered cardiovascular structure
route of administration angiotensin II
IV
angiotensin II types of shock can be used in
septic and other distributive, vasodilatory shock
ANY DRUG that increase heart rate and force is CONTRAINDICATED in what? why?
name 3 of these drugs
CI in obstructive cardiomyopathy with heart failure
because the blood vessels that leave the heart are narrowed. thus, increasing the heart rate and force only damages the heart more and increases heart failure
NE, epi, isoproterenol
true or false
dopamine and dobutamine are both positive inotropes
true
as mentioned, both dopamine and dobutamine are positive inotropes
dopamine has ____ effects and is thus used in what type of shock?
dobutamine has ____ effects and is thus used in what ype of shock
dopamine - alpha 1 pressor effects. cardiogenic and vascular shock
dobutamine - beta 2 vasodilation. used in cardiogenic shock with HYPERTENSION
between dopamine and dobutamine, which is natural and which is synthetic
natural - dopamine
dobutamine is synthetic
_____ is considered a “weak epinephrine” with _____ receptor activity
dopamine, dopamine
dobutamine is a ____ derivative with added _______ action
ISO (isoprenaline)
added vasodilation action
***true or false
dobutamine has NO vasopressor activity
TRUE
dopamine route of administration
IV
MOA dopamine
same as epi basically, but weaker
-at low doses, inotropic action on B1, increased calcium. chronotropic by b1 stimulation
high dose - a1 vasoconstrictor (vasopressor)
true or false
dopamine has a slow onset and prolonged duration of action
false - fast onset and short duration - need IV infusion!
3 dopamine contraindication
tachyarrhtyhmias
ventricular fibrillation
pheochromocytoma
true or false
dopamine can cause tachycardia and palpitations
true
mwtabolic effect of dopamine
hyperglycemia
misc ADR of dopamine
what is treatment
extravasation ischemia at the injection site
give phentolamine 5-10mg/5-10 mL of normal saline
true or false
dopamine has same DDI profile has epi
true
dobutamine is a ____ analog
isoproterenol
dobutamine is a potent ______ agonist.
b1
positive inotrope and chronotrope
true or false
dobutamine does not have vasodilatory activity
FALSE - it does. has an unloading effect on the heart (but less than its parent molecule - ISO)
true or false
dobutamine has a DDI concern with all antihypertensives
true - decrease BP too much
true or false
dobutamine decreases cardiac output
FALSE - increases
true or false
dobutamine is a potent beta 1 agonist
true
milrinone MOA
PDE3 inhibitor
increased cAMP levels in the heart. increased calcium – positive inotropy and chronotropy
as mentioned, milrinone has positive inotropic and chronotropic effects
is there anything negative about this?
the chronotropic effect of increasing HR can be oxygen wasting. pt may have anginal pain
positive inotropy is good tho
true or false
milrinone does not relax smooth muscle
FALSE - it does, causing vasodilation
what does milrinone do to blood viscosity
decreases viscosity of the blood by decreasing fibrinogin and increase fibrinolytic activity
milrinone route administration
IV
true or false
milrinone does not need to be dose adjusted based on renal function
FALSE - it does
bc most excreted through urine unchanged
specific milrinone drug interaction
milrinone + furosemide = precipitate formation
milrinone ADR
there is a ______ liability
hypotensive liability
arrhythmias, hypotension, V tach, angina (bc of positive chronotropy
milrinone max duration of therapy
up to 5 days
**true or false
NE causes extravasation ischemia that could pregress to gangrene
true
**true or false
epinephrine does not causes extravasation ischemia
false - it can
