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Pharmacology > Positive Inotropes And Vasopressors > Flashcards

Positive Inotropes And Vasopressors Flashcards

1
Q

Beta 1 receptors do what?

A
  • increase HR and contractility

- release renin (increase sodium and water rentention)

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2
Q

Peripheral resistance myocardial fiber contraction at the start of systole

A

After load

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3
Q

Mechanism for Milrinone:

A
  1. Decrease breakdown of cAMP
  2. PKA phosphorylates Ca++ channels
  3. Increase Ca++
  4. Increase in force of cardiac muscle contraction
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4
Q

How does a moderate dose of dopamine increase CO?

A
  1. Act on Beta1 receptors
  2. Increase cAMP
  3. Increase intracellular Ca++
  4. Increase force of cardiac contraction
  5. Increase contractility and HR
  6. Increase CO
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5
Q

What lowers after load?

A

Arterial vasodilation

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6
Q

Filled volume of ventricle prior to contraction

A

EDV

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7
Q

Frank-Starling mechanism is the relationship between what?

A

Preload and cardiac performance

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8
Q

amount of blood that returns to the heart

A

Preload

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9
Q

Alpha 2 receptors do what?

A

NE binds to alpha 2 receptors on pre-synaptic neuron

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10
Q

What is contractility reasonably reflected by?

A

Ejection fraction (EF)

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11
Q

What does low dose (<3mcg/kg/min) of dopamine do?

A
  • vasodilation (increase renal blood flow)

- increase natriuresis (elimination of Na+ in body=decrease water in body)

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12
Q

How does a high dose of dopamine increase BP?

A
  1. Acts on Alpha1 receptors
  2. Increase vascular intracellular Ca++
  3. Vasoconstriction
  4. Increase SVR
  5. Increase BP
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13
Q

Equation for EF

A

Amount of blood pumped out of the ventricle / total amount of blood in ventricle

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14
Q

What do phosphodiesterases do?

A

Breaks down cAMP

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15
Q

Where do you see diastolic dysfunction?

A

Heart failure with preserved EF

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16
Q

How can EF be assessed non invasively?

A

Echocardiography

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17
Q

Where is systolic dysfunction seen?

A

Heart failure with reduced EF

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18
Q

What is CO?

A

Volume blood / minute (HRXSV)

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19
Q

Alpha 1 receptors do what?

A
  • contract walls of blood vessels
  • mydriasis (pupil dilation)
  • urinary retention
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20
Q

3 positive inotropes?

A

Dobutamine
Dopamine
Milrinone

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21
Q

Dobutamine reflects with Beta 1:

A
  • increase HR and contractility

- increase O2 and energy demands

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22
Q

Effects of phenylephrine:

A

Increase SVR (minimal effect on HR or contractility)

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23
Q

NE attachment?

A

Potent Alpha1 receptor agonist

Modest Beta stimulation (B1>B2)

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24
Q

Impaired ventricular filling

A

Diastolic dysfunction

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25
Q

Voluntary movement of our skeletal muscles

A

Somatic nervous system

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26
Q

NE effect with Alpha 1 mechanism:

A
  1. Vasoconstriction
  2. Increase SVR
  3. Increase BP
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27
Q

NE effect with Beta:

A
  • moderate increase CO

- HR remains unchanged

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28
Q

What receptors do Phenylephrine attach to?

A

ONLY Alpha1 agonist

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29
Q

What receptors do dobutamine go for?

A

Beta agonists

-highly selective for Beta1 and some Beta2

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30
Q

What receptors do Epi effect?

A

Balanced Beta1, Beta2, and Alpha1 adrenergic agonist

31
Q

What does moderate dose (4-10mcg/kg/min) of dopamine do?

A

Increase CO

32
Q

What are inotropes?

A

Beta agonists (increase contractility)

33
Q

What is milrinone?

A

Phosphodiesterase inhibitor

34
Q

Therapeutic uses for Phenylephrine (2):

A
  • vasodilatory hypotension (with decrease SVR)

- vagal-mediated and medication-induced hypotension

35
Q

What is Digoxin used for?

A

Decrease HR

36
Q

Therapeutic uses of dopamine (4):

A
  • severe hypotension
  • acute heart failure
  • shock (vasodilator, cardiogenic)
  • sever bradycardia
37
Q

What are vasopressors?

A

Alpha 1 agonists (increase SVR, vasoconstriction)

38
Q

Impaired ventricular emptying, loss of contractile strength

A

Systolic dysfunction

39
Q

What is SV determined by? (3)

A
  • preload
  • after load
  • strength of contraction
40
Q

Percentage of end-diastolic volume ejected with each contraction

A

EF

41
Q

Does NE or dopamine have a greater dysrhythmia effect?

A

Dopamine

42
Q

What is the mechanism for Dobutamine (beta1)?

A
  1. Attaches to beta1
  2. Adenylate cyclase convert ATP to cAMP
  3. PKA phosphorylates Ca++ channels
  4. Increase Ca++ = increase force of cardiac muscle contraction
43
Q

Therapeutic uses for Epi (4):

A
  • cardiopulmonary resuscitation for cardiac arrest
  • shock (cardiogenic, vasodilator)
  • bronchospasm/anaphylaxis
  • symptomatic bradycardia
44
Q

Adverse effects of phenylephrine (4):

A
  • reflex bradycardia
  • ischemia of digits and various organ systems
  • tissue necrosis with extravasation
  • severe HTN
45
Q

What are the vasopressors?

A

NE
Epi
Phenylephrine

46
Q

What does a high dose (>10mcg/kg/min) of dopamine do?

A

Increase BP

47
Q

Toxicity of Digoxin:

A
  • GI upset, altered color perception, malaise

- bradycardia, AV block, ventricular tachycardia

48
Q

What is “inodilator”?

A

Milrinone that causes increase in cardiac contraction and smooth muscle vasodilation

49
Q

When is milrinone not used when considering SBP?

A

<90mmhg

50
Q

Adverse effect of NE (2):

A
  • dysrhythmias

- ischemia of digits and various organ systems

51
Q

If there’s increased preload, what happens to SV?

A

Increase

52
Q

Residual volume of blood remaining in the ventricle after ejection

A

ESV

53
Q

What is the mechanism for Dobutamine (beta2)?

A
  1. Attach to Beta 2

2. Causes vasodilation and lowers PVR

54
Q

Adverse effect of dopamine (4):

A
  • tachycardia
  • atrial and ventricular dysrhythmias
  • nausea and vomiting
  • ischemia of digits and various organ systems
55
Q

When should milrinone NOT be used?

A

Chronic heart failure

Cause increase morbidity and mortality

56
Q

What are the side effects for dobutamine?

A

Tachycardia
Palpitations
Arrhythmias

57
Q

In LV dysfunction: as SVR goes down, what does SV do?

A

Goes up

58
Q

What does increase in cAMP in smooth muscle cause?

A

Relaxation, vasodilation

59
Q

What is SV?

A

Volume blood / beat

60
Q

What is the treatment for milrinone used for?

A

Acute heart failure

61
Q

Involuntary movement of the smooth muscles and glands of our organs
Sympathetic and parasympathetic

A

Autonomic nervous system

62
Q

Beta 2 receptors do what? (6)

A
  • dilate smooth muscle cells
  • bronchodilation
  • decrease motility
  • secretion of aqueous humor
  • more glucose
  • release of glucagon
63
Q

Effects of Epi:

A

Increase contractility
Increase HR
Increase SVR

64
Q

Increase BP by contracting blood vessels

A

Vasopressors

65
Q

Increase strength of heart muscle contraction

A

Positive inotropes

66
Q

Dobutamine effects of beta 2:

A
  • stimulate heart (acute heart failure or cardiogenic shock)

- not appropriate for chronic heart failure (tolerance)

67
Q

Adverse effects of Epi (4):

A
  • dysrhythmias
  • ischemia of digits and various organ systems
  • high and prolonged doses can cause direct cardiac toxicity
  • severe HTN (cerebral hemorrhage)
68
Q

What is ventricular SV?

A

Ventricular end-diastolic volume - end-systolic volume

69
Q

What neurons are responsible for sympathetic nervous system?

A

Postganglionic neurons (adrenergic neurons)

70
Q

Side effects for milrinone:

A
  • arrhythmia

- hypotension (due to vasodilation)

71
Q

Indication for Digoxin:

A
  • atrial flutter (control ventricular rate)

- HR with reduced EF

72
Q

What does Digoxin do?

A

Inhibit ATPase

  • increase Na+
  • Increase Ca++
73
Q

Therapeutic uses for NE (2):

A
  • hypotension

- shock-like state accompanied by peripheral vasodilation

Pharmacology (14 decks)

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