Review Exam ANS Pharmacology

Question 1

Rank Drugs from Highest to Lowest affinity for Alph-1 R:

Dopamine, Isoproterenol, Dobutamine, Norepinephrine, phenylephrine, Epinephrine, Ephedrine

Answer 1

1. Norepinephrine
2. Phenylephrine
3. Epinephrine
4. Dopamine
5. Ephedrine
6. Dobutamine
7. Isoproterenol

N P E D E D I

Question 2

Hemodynamic effects of HIGH DOSE NE include?

Answer 2

Decreased Cardiac Output

Question 3

What type of catecholamine is NE?

Answer 3

Natural occurring catecholamine

Question 4

What receptors does NE have an affinity for?

Answer 4

Dose-dependent A1, A2, B1

Question 5

Receptor affinity for LOW dose NE?

Answer 5

B1

Question 6

Low dose NE Effects?

Answer 6

B1- Increased Contractility, CO, BP

Question 7

Receptor affinity for HIGH dose NE?

Answer 7

A1

Question 8

High dose NE effects?

Answer 8

Increase SVR
Decreased HR (BBR) 

*masks B1 effects

Question 9

NE is an ideal drug for?

Answer 9

LOW SVR states

-Sepsis or Post CPB HoTN d/t LOW after load

Question 10

Avoid NE in which settings?

Answer 10

Cardiogenic Shock

-Increases MVO2 & SVR

Question 11

What risk can peripheral administration of NE cause?

Answer 11

Extravasation of NE can cause tissue necrosis

should be administered via CL

Question 12

How do you Tx NE extravasation at peripheral site?

Answer 12

PhenTolAmine – 2.5 - 10 mg in 10mL diluent
-vasodilates affected region

OR

Stellate Ganglion Block on affected side
-counteracts vasoconstriction by increasing BF

Question 13

Key Drug interactions for NE

Answer 13

MAO inhibitors (MAOi)
Tricyclic antidepressants (TCA)

MAOi – decreased NE clearance –> excessive SNS stimulation

TCA- reduced NE reuptake –> Excessive SNS stimulation

Question 14

Infusion rate: Low Dose Epi

Answer 14

0.01 - 0.03 mcg/kg/min

Question 15

Infusion rate: Intermediate Dose Epi

Answer 15

0.03 - 0.15 mcg/kg/min

Question 16

Infusion rate: High Dose Epi

Answer 16

> 0.15 mcg/kg/min

Question 17

Effects of Low Dose Epi

Answer 17

Dominating receptor: Non-selective Beta

• B1 –> increase HR + contractility
• B2–> vasodilation skeletal muscles

net effect:
increased CO, decreased SVR, slight decrease BP, wide PP

Question 18

Effects of Intermediate Dose Epi

Answer 18

Mixed beta & alpha effects

Question 19

Effects of High Dose Epi

Answer 19

Dominating receptor: Alpha

Increased SVR

Question 20

Common side effects of High Dose Epi

Answer 20

SVT

*limits usefulness of high dose epi

Question 21

Rank affinity of dopamine vs. Beta vs. Alpha at adrenergic receptors?

Answer 21

DA > Beta > Alpha

Question 22

Infusion rate: Low Dose Dopamine

Answer 22

Renal: 1 -2 mcg/kg/min

Question 23

Infusion rate: Intermediate Dose Dopamine

Answer 23

Cardiac: 2-10 mcg/kg/min

Question 24

Infusion rate: High Dose Dopamine

Answer 24

Vasopressor: 10-20 mcg/kg/min

Question 25

Effects of LOW Dose Dopamine

Answer 25

DA1 (post) Vasc, DA2 (pre) Renal DA1- vasodilation in renal DA2-inhibits NE release from presynaptic NT Net effect: Increased RBF, UOP

Question 26

Effects of Intermediate Dose Dopamine

Answer 26

Beta receptor dominate - Increased: HR, contractility, CO - same: BP

Question 27

Which dopamine dose (low, intermediate, high) for CHF?

Answer 27

Intermediate

Question 28

Effects of High Dose Dopamine

Answer 28

Alpha receptor dominates Alpha > beta & DA Resembles High dose NE

Question 29

Isoproterenol and CPP

Answer 29

decreases CPP Isoproterenol- decreases SVR - SVR decrease can drop DBP--> impair CPP

Question 30

CPP calculation?

Answer 30

CPP = AoDB - LVEDP (APEX) AoDB- Aortic Diastolic BP CPP = DBP - LVEDP (Edwards) Range: 60-80 mmHg

Question 31

Isoproterenol and Sepsis

Answer 31

AVOID in Sepsis Isoproterenol causes: - severe dysrhythmias - tachycardia - Vasodilates nonessential vascular beds (muscle/skin)

Question 32

Clinical uses for Isoproterenol?

Answer 32

- Chemical PM - Heart transplant - Bronchoconstriction - Cor Pulmonale

Question 33

2 organic key components in Catecholamines

Answer 33

1. Catechol Nucleus (benzene ring w/ hydroxyl group 3,4 | 2. Amine side chain

Question 34

Organic size rank of Catecholamines (largest to smallest)

Answer 34

Dobutamine > Isoproterenol > Epi > NE > Dopa

Question 35

How many Benzene rings does Dobutamine have?

Answer 35

Dobutamine is the ONLY one that has TWO benzene rings