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Fall 2020 - Pharmacology 2 > Positive Inotropes - Quiz 3 > Flashcards

Positive Inotropes - Quiz 3 Flashcards

1
Q

What are the CV Effects of Septic Shock?

A

↑Cardiac Index

↓SVR

↓PCWP

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2
Q

What are the CV Effects of Hypovolemic Shock?

A

↓Cardiac Index

↑SVR

↓PCWP

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3
Q

What are the CV Effects of Cardiogenic Shock?

A

↓Cardiac Index

↑SVR

↑PCWP

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4
Q

What happens to Intracellular cAMP w/ CHF?

A

Decreased cAMP

Beta Receptor Downregulation & Impaired Coupling

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5
Q

What does CHF respond to?

A

Preload & Afterload Reduction

&

Improved Contraction

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6
Q

What happens w/ Low Cardiac Output Syndrome after coming off Cardio-Pulmonary Bypass?

A

Inadequate O2 Delivery

Hemodilution

Hypocalcemia

Hypomagnesemia

Kaliuresis

Tissue Thermal Gradients

Variable SVR

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7
Q

What risk factors contribute to Low Cardiac Output Syndrome (LCOS)?

A

DM

> 65 y.o.

Female

Decreased LVEF

Prolonged Cardio-Pulmonary Bypass > 6hrs

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8
Q

What might Hypotension in the setting of LCOS NOT respond to?

A

Vasodilators Alone

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9
Q

What is the Goal when treating LCOS?

A

↑O2 Delivery (SvO2) > 70%

&

↑O2 Consumption

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10
Q

What causes Low Cardiac Output Syndrome?

A

Stunned Heart in response to Ischemia & Reperfusion

&

Beta Receptor Downregulation

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11
Q

What classes of Positive Inotropes are cAMP Dependent?

A

Beta Agonist

Dopaminergic Agonists

PDE Inhibitors

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12
Q

What classes of Positive Inotropes are cAMP Independent?

A

Cardiac Glycosides

&

Calcium

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13
Q

What is Levosimendan used for and how does it work?

A

LCOS Treatment & Prophylaxis - Calcium Sensitizer to existing calcium in the body

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14
Q

What do Pure Beta-1 Agonists (Inodilators), like Dobutamine & Isoproterenol do?

A

↑HR

↑AV Condution

↓SVR & PVR (Beta-2)

Variable O2 Consumption Effects

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15
Q

What do Mixed Alpha/Beta Agonists like NE, Epi, & Dopamine do?

A

↑SVR

↑HR

↑Myocardial O2 Consumption

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16
Q

What are complications from using Postive Inotropes?

A

Prolonged High Doses = Reduced Perfusion

Tachyarrhythmias

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17
Q

What are the problems w/ using Digoxin?

A

Narrow Therapeutic Index

Renal Failure

Bradycardia

Drug Interations

Caution w/ Hypokalemia

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18
Q

Which med has the most risk of causing Arrhythmias from most to least?

A

Isoproterneol > Epi > Dopamine > Dobutamine

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19
Q

What do cAMP Dependent Inotropes do?

A

↑Calcium Influx

↑Calcium Sensitivity

↑Contraction

↑Relaxation

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20
Q

What do low doses (1-2 mcg/min) of Epinephrine do?

A

Beta 2 Stimulation - > Vasodilate to ↓SVR, but MAP stays the same

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21
Q

What do Intermediate doses (4 mcg/min) of Epinephrine do?

A

Beta-1 Stimulation - Inotrope

↑HR

↑Contractility

↑Cardiac Output

↑Automaticity

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22
Q

What do High Doses (> 10 mcg/min) of Epinephrine do?

A

Alpha 1 Stimlulation

Potent Vasoconstriction –> Reflex Bradycardia

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23
Q

Which receptors does Norepi act on?

A

ALPHA 1 > Beta 1

Minimal Beta 2

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24
Q

How does Norepi affect Cardiac Output at Low Doses?

A

↑Cardiac output

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25
Q

Why do High Doses of Norepi decrease Cardiac Output?

A

↑Afterload

&

Reflex Bradycardia

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26
Q

Which receptors does Isoproteronal act on?

A

Beta 1 & Beta 2

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27
Q

What does Isoproterenol do?

A

↑CO, HR, Contractility, and Automaticity

↓SVR & DBP

Bronchodilation

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28
Q

When should Isoproterenol be avoided?

A

In Cardiogenic Shock & Ischemic Heart Disease

29
Q

When is Isoproterenol used?

A

S/P Heart Transplant

Complete Heart Block

Bronchospasms

Pulm. HTN

RV Failure

30
Q

What are the Off-Label uses for Isoproterenol?

A

Torsades

Ventricular Arrhythmias

Short QT Syndrome

31
Q

What class of drug is Dobutamine?

A

Synthetic Catecholamine that acts primarily on BETA 1 Receptors w/

Very Little Beta 2 & Alpha 1 effects

32
Q

What does Dobutamine do?

A

Dose Dependent ↑CO & ↑HR

↓Fillling Pressures

Dilate Coronary Vessels

NO Dopamine Receptor effects

33
Q

What dose of Dobutamine would cause Tachycardia & Dysrrhythmias?

A

> 10 mcg/kg/min

34
Q

Why should Dobutamine & Dopamine be mixed in D5W instead of NS?

A

NS Inactivates these meds

35
Q

What happens with D1 & D5 Receptor stimulation?

A

Stimulates Adenylate Cyclase & cAMP

Vasodilation

Naturesis

Diuresis

36
Q

What happens w/ D2, D3, & D4 Receptor stimulation?

A

Inhibits Adenylate Clases & cAMP

Inhibit Norepi Release

Vasodilation

↑Renal Blood Flow

37
Q

What does Low Dose (1-3 mcg/kg/min) Dopamine do?

A

Renal Dose - D1 & D2 effects

Inhibits Aldosterone

NOT RENAL PROTECTIVE

38
Q

What does a 3-10 mcg/kg/min dose of Dopamine do?

A

Beta Effect

↑Contractility & CO WITHOUT HR & BP Changes

Indirectly Releases Norepi

39
Q

What does a 10-20 mcg/kg/min dose of Dopamine do?

A

Alpha > Beta Effects

(Alpha starts to take over)

40
Q

Which receptor is effected with Dopamine doses > 20 mcg/kg/min?

A

Alpha

41
Q

How does Dopamine affect Ventilation during Hypoxia?

A

↓Ventilatory Response d/t Carotid Body Inhibition

42
Q

How does Dopamine affect Blood Sugar?

A

Hyperglycemia

43
Q

What are some side effects of Dopamine?

A

N/V

Angina

Headache

Tachyarrhythmias

HTN

44
Q

Which receptor does Fenoldopam act on?

A

Mostly D1

Some Alpha 2

45
Q

What are the effects of Fenoldopam?

A

↓SVR

↑Renal Blood Flow
(NOT Renal Protective)

Reflex Tachy

46
Q

How does Fenoldopam compare with Sodium Nitroprusside?

A

Same Effectiveness for BP Control, but also ↑RBF

47
Q

How does Fenoldopam compare w/ Dopamine?

A

10-100x more potent

48
Q

How should Fenoldopam be adminstered?

A

Slow Titration

No Bolus

49
Q

What are the side effects of Fenoldopam?

A

Headache

Flushing

Restless Legs

N/V

T-Wave Inversion

50
Q

What do PDE3 Inhibitors like Milrinone & Inamrinone do?

A

↓cAMP breakdown = ↑Calcium & ↑Calcium Sensitivity

↑Cardiac Output

Vasodilation

51
Q

How does Inamrinone compare to Dobutamine?

A

More Effective & Less Complications

52
Q

How does Inamrinone compare to Epi?

A

Same Effectiveness, but even more if added to Epi

53
Q

When should Inamrinone be avoided?

A

Thrombocytopenia

Elevated LFTs

Arrhythmias

Aortic Stenosis

54
Q

How does Milrinone compare to Inamrinone?

A

15-20x more potent

Shorter Half-Life

No Thrombocytopenia risk

55
Q

What are the side effects of Milrinone?

A

Hypotension

Syncope

Arrhythmias

V-Tach w/ AFib/Flutter

56
Q

Which receptor does Glucagon work on?

A

Increases cAMP via Glucagon Receptor, NOT Beta

57
Q

What are the CV effects of Glucagon?

A

↑CI

↑HR

↑BP

↓SVR

↓LVEDP

58
Q

What are the side effects of Glucagon?

A

↑Blood Sugar

↑Coronary & Pulmonary Vascular Resistance

59
Q

How do Anticholinergic Meds affect Glucagon?

A

Enhances the GI Side Effects (N/V)

60
Q

How does Glucagon affect clotting times?

A

Vitamin K Antagonist –> Increases INR

61
Q

What is Digoxin?

A

A Cardiac Glycoside w/ the effects of

Positive Inotrope

&

Negative Dromotrope & Chronotrope

62
Q

How does Dixogin work?

A

Inhibits Na/K-ATPase Pump & causes Calcium to remain in the Myocyte

63
Q

When is Digoxin used?

A

Heart Failure

&

A-Fib

64
Q

What is the Therapeutic Range of Digoxin?

A

0.8 - 2 ng/mL

65
Q

What conditions increases the risks of Digoxin Toxicity?

A

Hypokalemia

Hypomagnesemia

Hypoxemia

Hypothyroid

Hypercalcemia

66
Q

How does Digoxin Toxicity present?

A

Anorexia

N/V

Paroxysmal Atrial Tach w/ Block

Mobitz II Block

V-Fib

67
Q

What is the Antidote for Digoxin Toxicity?

A

Digibind - Antibody Fragments that bind to drug and decrease Digoxin levels via Kidneys

68
Q

What is the Strategy for treating Low Cardiac Output?

A
  1. Optimize Preload - Venous Dilators, Fluids
  2. Optimize Afterload - Arterial Dilators, then Inodilator
  3. Add Inotrope
  4. IABP or LVAD

Fall 2020 - Pharmacology 2 (9 decks)

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