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My Pharm II > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

Septic:

A

Increased CI, Decreased PCWP, Decreased SVR

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2
Q

Hypovolemic

A

Dec CI, Dec PCWP, Inc SVR

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3
Q

Cardiogenic

A

Dec CI, Inc PCWP, Inc SVR

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4
Q

cAMP Dependent positive inotropes

A
  • Beta Agonists
  • Dopaminergic Agonists
  • Phosphodiesterase Inhibitors
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5
Q

cAMP independent positive inotropes

A
  • Cardiac Glycosides

- Calcium

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6
Q

Look at slide 11-12

A

.

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7
Q

Drug highest risk of tachyarrhythmias?

A

Isoproterenol

then Epi, Dopa, Dobutamine

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8
Q

Prototypical catecholamine Stimulates

A

Alpha-1, Beta-1, and Beta-2 receptors

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9
Q

Low dose Epi

A

-Stimulate alpha-1 receptors in the skin, mucosa, and hepatorenal system while beta-2 receptors are stimulated in skeletal muscle

  • Beta-2 effects in peripheral vasculature predominate.
  • The net effect is decreased SVR and distribution of blood to skeletal muscle
  • MAP remains essentially the same

-Essentially a vasodilator.

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10
Q

Intermediate dose Epi

A
  • Inotrope
  • Increased H.R. and contractility and increased C.O.
  • Inotropic activity.
  • Increased automaticity
  • May lead to dysrrhythmias (PVCs) in sensitized myocardium
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11
Q

High dose Epi

A
  • Most potent activator of Alpha-1 receptors
  • Potent vasoconstrictor including cutaneous, splanchnic and renal vascular beds
  • Used to maintain myocardial and cerebral perfusion
  • Increases Aortic dBP.
  • Reflex bradycardia can occur
  • Vasoconstrictor.
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12
Q

Norepi: Cardiac output may ______ at low doses, but at higher doses may ________ because of increased afterload and baroreceptor-mediated reflex bradycardia

A

increase

decrease

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13
Q

Catecholamine Complications

A
  • Local tissue ischemia from SQ infiltration of inoconstrictors.
  • Increased myocardial oxygen consumption
  • Enhance lipolysis and gluconeogenesis
  • Alter electrolyte concentrations
  • Activate coagulation
  • Override microvascular control mechanisms
  • Alter distribution of CO
  • Increase myocardial work
  • Increase the risk of cardiac arrhythmias
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14
Q

Isoproterenol

A
  • Beta-1 and Beta-2 Receptor Effects (No Alpha-1 effects)
  • Increases HR , contractility, B.P., and cardiac automaticity
  • Decreases SVR and diastolic BP
  • Net effect is increased C.O. and decreased M.A.P.
  • Bronchodilator
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15
Q

Isoproterenol uses

A
  • Chemical pacemaker after heart transplant or in complete heart block
  • Bronchospasm management during anesthesia
  • Maybe used to attempt to decrease PVR in patients with pulmonary hypertension and RV failure***
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16
Q

Synthetic catecholamine with structural characteristics of Dopamine and Isoproterenol

A

Dobutamine

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17
Q

Dobutamine

A
  • Acts primarily on Beta-1 receptors with small effects on Beta-2 and Alpha-1 receptors.
  • Less increase in conduction compared to isoproterenol.
  • Less likelihood of adverse increase in myocardial O2 requirements.
  • Dilates coronary vasculature.
  • No dopaminergic receptor activation.
  • Increases renal blood flow by increasing C.O.
18
Q

_____________ interacts with itself at alpha receptors agonist and antagonist effects

A

Dobutamine

19
Q

D-1 like receptors

A
  • G coupled > stimulate adenylate cyclase > activate cAMP
  • Smooth muscle of blood vessels: vasodilatation
  • Naturesis, Diuresis
20
Q

D-2 like receptors

A
  • G coupled > inhibits AC > inhibits cAMP
  • Presynaptic: Inhibit NE release and promote vasodilation
  • Attenuate the beneficial effects of DA on renal blood flow
21
Q

Dopamine Dose Dependent Effects

A
  • 0.5-3 mcg/kg/min dopamine effect (DA1 and DA2)
  • 3-10 mcg/kg/min beta effect
  • 10-20 mcg/kg/min beta and alpha effects
  • Over 20 mcg/kg/min alpha effects
22
Q

Dopamine Receptor Effects

A
  • DA1 stimulation produces vasodilatation in the renal, mesentery, coronary, and cerebral arteries
  • Inhibit secretion of aldosterone
  • Increases RBF, GFR, Na+ excretion and urine output
  • BUT NOT RENAL PROTECTIVE
  • Had been used a lot during periods of renal stress (aortic surgery, sepsis, resuscitation, CPB, and NE infusion)
23
Q

Look at slide 40

A

.

24
Q

__________ interferes with the ventilatory response to hypoxemia

A

Dopamine

Inhibitory role of DA at the carotid bodies.

25
Q

inhibits presynaptic reuptake of NE

A

Dopexamine

26
Q

Fenoldopam

A
  • Selective D1 agonist with moderate affinity for presynaptic Alpha-2 receptors reduces NE
  • Decreases SVR and renal vasculature resistance resulting in decreased BP and increased LVEF and RBF
  • Reflex tachycardia can occur with rapid upward titration
  • Dose-related increase in RBF (0.03 to 0.3 mcg/kg/min)
  • As effective as SNP in controlling BP with the added benefit of increased RBF
  • 10-100 times more potent than Dopamine
27
Q

Look at slide 51

A

.

28
Q

Inamrinone Adverse Reactions/Cautions:

A
  • Thrombocytopenia (10%)
  • Elevated LFTs
  • Arrhythmias
  • Do NOT administer to patients with AS
  • May aggravate outlet obstruction in patients with IHSS
29
Q

Acts at a receptor other than beta to increase cAMP

A

Glucagon

30
Q

Digoxin heart effects

A
  • Positive inotrope.
  • Negative dromotrope.
  • Negative chronotrope.
31
Q

Blocks NA/K ATPase pump, which slows Ca removal

A

Digoxin

32
Q

Predisposing causes of digoxin toxicity

A
  • Hypokalemia
  • Hypomagnesemia
  • Hypoxemia
  • Hypercalcemia
  • Hypothyroid
33
Q

digoxin toxicity Presentation

A
  • Early: anorexia, N/V
  • PVCs
  • Paroxysmal atrial tachycardia with block
  • Most common dysrrhythmia.
  • Mobitz type II A-V- block
  • V. fib. (most common cause of death)
34
Q

Digibind

A
  • Fab (antibody fragments) bind to the drug and decrease plasma concentrations of cardiac glycosides.
  • Fab-digitalis complex is eliminated by the kidneys.
  • Do not check levels. Levels are useless for several days (will see 2-3x levels for 48 hours or more)
35
Q

Look at slide 68-69

A

.

36
Q

Initial Drug Selection: Pulmonary &/or systemic HTN:

A

dobutamine, inamrinone or milrinone, isoproterenol

37
Q

Initial Drug Selection: Low SVR

A

NE, DA, epi

38
Q

Initial Drug Selection: Normal PVR and SVR

A

DA, epi

39
Q

Initial Drug Selection: Tachycardia

A

inamrinone or milrinone, calcium, NE, epi

40
Q

Look at slide 78

A

.

My Pharm II (8 decks)

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