pressors Flashcards
PHENYLEPHRINE (NEOSYNEPHRINE):
IVP dose
50-100 mcg
100 mcg/mL
PHENYLEPHRINE (NEOSYNEPHRINE):
gtt dose
10-200 mcg/min
40 mcg/mL concentration (10 mg/250 mL)
PHENYLEPHRINE (NEOSYNEPHRINE):
onset?
duration?
onset: <1 min
DOA: <5 mins
PHENYLEPHRINE (NEOSYNEPHRINE):
MOA?
- direct sympathomimetic
- alpha-1 adrenergic agonist = constricts both arterial and venous blood vessels = increases afterload by increasing SVR
what is a reflex seen with phenylephrine (neo)?
reflex bradycardia (baroreceptor mediated)
phenylephrine (neo) is useful in what cardiac valve dz? why?
aortic stenosis (b/c increases CoronaryPP)
CAUTION with phenylephrine (neo) should be taken in:
cardiogenic shock or HF it is not useful in HF over Levophed
EPINEPHRINE:
IVP dose
5-10 mcg
EPINEPHRINE:
strong stick vs low-dose stick
strong stick: 100 mcg/mL
low-dose stick: 10 mcg/mL
EPINEPHRINE:
what is the conc for a strong stick of epinephrine?
1 mg in 9 mL = 100 mcg/mL
EPINEPHRINE:
what is the conc for a low dose stick of epinephrine?
1 mL of strong stick (100mcg) in 9 mL = 10 mcg/mL
EPINEPHRINE:
gtt dose
0.01-0.02 mcg/kg/min
(note: this is mcg/kg/min in the pump)
16 mcg/mL concentration (4 mg/250 mL)
EPINEPHRINE:
onset?
peak?
duration?
onset: <1 min
peak: 1-2 mins
DOA: 5-10 mins
EPINEPHRINE:
MOA?
- potent alpha and beta stimulation = incr SV and incr HR!
At a low dose epi, what is more stimulated?
beta = increased HR, CO, contraction, PP
with decreased SVR
at high dose epi, what receptor is more stimulated?
alpha = increased SVR with decreased CO
EPINEPHRINE DOSING:
for beta
0.01 - 0.03 mcg/kg/min
EPINEPHRINE DOSING:
for alpha and beta
0.03 - 0.15 mcg/kg/min
EPINEPHRINE DOSING:
for alpha
0.15 - 0.30 mcg/kg/min
side effects of epinephrine?
- hypokalemia
- increased blood glucose - d/t inc liver glycogenolysis, inc glucagon and dec release of insulin
- accelerates coagulation
Epi may produce myocardial ischemia due to what effect?
positive inotropy and tachycardia = incr o2 demand and decr o2 supply
what is the anaphylaxis dose of epinephrine?
4 mcg = bronchodilator and mast cell stabilizer
ACLS epi dose
1 mg q 3-5 mins
NOREPI (LEVOPHED):
IVP dose
2-4 mcg
4 mcg/mL concentration (5 mL of levo bag with 15 mL NS to quarter the conc from 16 mcg/mL to 4 mcg/mL)
NOREPI (LEVOPHED):
gtt dose
2.5 - 40 mcg/min
- note: this is mcg/min in the pump!
16 mcg/mL concentration (4 mg/250 mL)
NOREPI (LEVOPHED):
onset?
peak?
duration?
onset: <1 min
peak: 1-2 min
DOA: 5-10 min
NOREPI (LEVOPHED):
MOA?
increased SVR - redistributes blood flow to brain and heart b/c all other vascular beds are constricted
NOREPI (LEVOPHED):
low dose levo agonizes which receptor? what effects are seen?
beta-1 = increases HR, CO, ctx, and conduction
NOREPI (LEVOPHED):
high dose levo agonizes which receptor? what effects are seen?
beta-1 and alpha-1 = systematic vasoconstriction (except coronaries)
- and decreased HR (but minimal change d/t counteractions of B1)
MOA of ephedrine (Akovaz)
alpha1, beta1, beta2 agonist = increases HR and BP
dose of ephedrine (Akovaz)
5 mg
what is a consideration when giving repeated doses of ephedrine?
tachyphylaxis can occur!
what push pressor lasts longer, ephedrine or epi?
ephedrine - lasts 10x longer than epi … and BP response is less
