Pressors

Question 0

Beta-2 stimulation

Answer 0

Vasodilation

Question 1

Beta-1 stimulation

Answer 1

Increased myocardial contractility

Increased chronicity

Question 2

Alpha-1 stimulation

Answer 2

Vascular smooth muscle contraction

Increased systemic vascular resistance

Question 3

D1 and D2 stimulation

Answer 3

Renal and mesenteric vasodilation

Question 4

Low dose dopamine

Answer 4

0.5-3 mcg/kg/min
Vasodilation in and increased blood flow to coronary, renal, mesenteric, and cerebral beds
Diuresis

Question 5

Intermediate dose dopamine

Answer 5

3-10 mcg/kg/min
Increased cardiac contractility and chronotropy
Mild increase in SVR

Question 6

High dose dopamine

Answer 6

10-20 mcg/kg/min

Primarily alpha-1 stimulation - increases SVR

Question 7

Dobutamine dosing

Answer 7

2.5-20 mcg/kg/min

Question 8

Dobutamine action

Answer 8

Increased myocardial contractility and weak chronotropy
Net mild vasodilation at low doses
Progressively more vasoconstriction with higher doses (>15)

Question 9

Side effects of dobutamine

Answer 9

Significantly increases myocardial oxygen demand

Malignant ventricular arrhythmias

Question 10

Norepinephrine dosing

Answer 10

0.05-1.0 mcg/kg/min

Question 11

Norepinephrine action

Answer 11

Primarily alpha-1 stimulation
Significant vasoconstriction (increased systolic AND diastolic pressure)
Mild chronotropy
Net even cardiac output

Question 12

Epinephrine dosing

Answer 12

0. 01-1.2 mcg/kg/min

1: 10,000 dilution

Question 13

Epinephrine action

Answer 13

Low dose - beta stimulation

High dose - alpha stimulation

Question 14

Isoproterenol dosing

Answer 14

2-20 mcg/min

Question 15

Isoproterenol action

Answer 15

Pure beta-agonist
Increased inotropy and chronotropy
Decreased SVR
Net even cardiac output

Question 16

Phenylephrine dosing

Answer 16

1-5 mcg/kg/min

Question 17

Phenylephrine action

Answer 17

Pure alpha-agonist

Increased SVR and BP with virtually no effect on HR

Question 18

Milrinone dosing

Answer 18

0.125-0.75 mcg/kg/min

Question 19

Milrinone action

Answer 19

Phosphodiesterase inhibitor
Increased cardiac contractility
Vasodilation
Improves diastolic relaxation

Question 20

Vasopressin dosing

Answer 20

0.02-0.04 U/min

Question 21

Vasopressin action

Answer 21

Increases SVR
Less coronary and cerebral vasoconstriction than catecholamines
Increases vascular sensitivity to norepi (augments the effect)
Even works in acidotic blood

Question 22

Risk of using pressors in AMI

Answer 22

Increased myocardial oxygen consumption (furthering ischemic damage) and ventricular arrhythmias

Question 23

First line pressor in AMI

Answer 23

For SBP 70-100:
No signs of shock - dobutamine
Signs of shock - dopamine

For SBP <70:
Norepinephrine

Question 24

Pressor used for shock in AMI resistant to norepi

Answer 24

Vasopressin (potentiates norepi)

Question 25

First line pressors for ADCHF

Answer 25

Dobutamine, dopamine, milrinone

Question 26

Purpose of pressors in ADCHF

Answer 26

Support blood pressure and perfusion until appropriate dieresis can be achieved

Question 27

Mxn of epi in cardiopulmonary arrest

Answer 27

Vasopressor: Increase diastolic pressure to support coronary perfusion pressure Inotrope: Restore cardiac contractility