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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
Voluntary movement of our skeletal muscles
Somatic nervous system
26
NE effect with Alpha 1 mechanism:
1. Vasoconstriction 2. Increase SVR 3. Increase BP
27
NE effect with Beta:
- moderate increase CO | - HR remains unchanged
28
What receptors do Phenylephrine attach to?
ONLY Alpha1 agonist
29
What receptors do dobutamine go for?
Beta agonists | -highly selective for Beta1 and some Beta2
30
What receptors do Epi effect?
Balanced Beta1, Beta2, and Alpha1 adrenergic agonist
31
What does moderate dose (4-10mcg/kg/min) of dopamine do?
Increase CO
32
What are inotropes?
Beta agonists (increase contractility)
33
What is milrinone?
Phosphodiesterase inhibitor
34
Therapeutic uses for Phenylephrine (2):
- vasodilatory hypotension (with decrease SVR) | - vagal-mediated and medication-induced hypotension
35
What is Digoxin used for?
Decrease HR
36
Therapeutic uses of dopamine (4):
- severe hypotension - acute heart failure - shock (vasodilator, cardiogenic) - sever bradycardia
37
What are vasopressors?
Alpha 1 agonists (increase SVR, vasoconstriction)
38
Impaired ventricular emptying, loss of contractile strength
Systolic dysfunction
39
What is SV determined by? (3)
- preload - after load - strength of contraction
40
Percentage of end-diastolic volume ejected with each contraction
EF
41
Does NE or dopamine have a greater dysrhythmia effect?
Dopamine
42
What is the mechanism for Dobutamine (beta1)?
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
Therapeutic uses for Epi (4):
- cardiopulmonary resuscitation for cardiac arrest - shock (cardiogenic, vasodilator) - bronchospasm/anaphylaxis - symptomatic bradycardia
44
Adverse effects of phenylephrine (4):
- reflex bradycardia - ischemia of digits and various organ systems - tissue necrosis with extravasation - severe HTN
45
What are the vasopressors?
NE Epi Phenylephrine
46
What does a high dose (>10mcg/kg/min) of dopamine do?
Increase BP
47
Toxicity of Digoxin:
- GI upset, altered color perception, malaise | - bradycardia, AV block, ventricular tachycardia
48
What is “inodilator”?
Milrinone that causes increase in cardiac contraction and smooth muscle vasodilation
49
When is milrinone not used when considering SBP?
<90mmhg
50
Adverse effect of NE (2):
- dysrhythmias | - ischemia of digits and various organ systems
51
If there’s increased preload, what happens to SV?
Increase
52
Residual volume of blood remaining in the ventricle after ejection
ESV
53
What is the mechanism for Dobutamine (beta2)?
1. Attach to Beta 2 | 2. Causes vasodilation and lowers PVR
54
Adverse effect of dopamine (4):
- tachycardia - atrial and ventricular dysrhythmias - nausea and vomiting - ischemia of digits and various organ systems
55
When should milrinone NOT be used?
Chronic heart failure | Cause increase morbidity and mortality
56
What are the side effects for dobutamine?
Tachycardia Palpitations Arrhythmias
57
In LV dysfunction: as SVR goes down, what does SV do?
Goes up
58
What does increase in cAMP in smooth muscle cause?
Relaxation, vasodilation
59
What is SV?
Volume blood / beat
60
What is the treatment for milrinone used for?
Acute heart failure
61
Involuntary movement of the smooth muscles and glands of our organs Sympathetic and parasympathetic
Autonomic nervous system
62
Beta 2 receptors do what? (6)
- dilate smooth muscle cells - bronchodilation - decrease motility - secretion of aqueous humor - more glucose - release of glucagon
63
Effects of Epi:
Increase contractility Increase HR Increase SVR
64
Increase BP by contracting blood vessels
Vasopressors
65
Increase strength of heart muscle contraction
Positive inotropes
66
Dobutamine effects of beta 2:
- stimulate heart (acute heart failure or cardiogenic shock) | - not appropriate for chronic heart failure (tolerance)
67
Adverse effects of Epi (4):
- dysrhythmias - ischemia of digits and various organ systems - high and prolonged doses can cause direct cardiac toxicity - severe HTN (cerebral hemorrhage)
68
What is ventricular SV?
Ventricular end-diastolic volume - end-systolic volume
69
What neurons are responsible for sympathetic nervous system?
Postganglionic neurons (adrenergic neurons)
70
Side effects for milrinone:
- arrhythmia | - hypotension (due to vasodilation)
71
Indication for Digoxin:
- atrial flutter (control ventricular rate) | - HR with reduced EF
72
What does Digoxin do?
Inhibit ATPase - increase Na+ - Increase Ca++
73
Therapeutic uses for NE (2):
- hypotension | - shock-like state accompanied by peripheral vasodilation

Pharmacology (14 decks)

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