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Anesthesia Drug Test Quick Facts > sympathomymetics > Flashcards

sympathomymetics Flashcards

1
Q

trade name of albuterol

A

proventil

ventolin

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2
Q

MOA of albuterol

A

beta 2 agonist

: Relaxes bronchial smooth muscle by action on beta 2 receptors in the lungs

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3
Q

use of albuterol

A

Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease;

prevention of exercise-induced bronchospasm.

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4
Q

dose of albuterol

A

Nebulization solution: 2.5 mg 3-4 times daily as needed;

Quick relief: 1.25-5 mg every 4 to 8 hours as needed (Hold puffer over end of ETT tube making the best seal you can and give 6 puffs)

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5
Q

onset of albuterol

A

10 minutes

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6
Q

peak effect of albuterol

A

: 0.5-2 hours

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7
Q

duration of albuterol

A

Nebulization/oral inhalation: 3-4 hours;

Oral: 4-6 hours

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8
Q

Metabolism: albuterol

A

Hepatic to an inactive sulfate

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9
Q

Half-life elimination: albuterol

A

Inhalation: 3.8 hours; Oral: 3.7-5 hours

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10
Q

Excretion: albuterol

A

Urine (30% as unchanged drug)

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11
Q

Contraindications: albuterol

A

Hypersensitivity to albuterol or any component of the formulation

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12
Q

Adverse Reactions: albuterol CV

A

Angina pectoris, atrial fibrillation, cardiac arrhythmia, chest discomfort, chest pain, extrasystoles, flushing, hypertension, hypotension, palpitations, supraventricular tachycardia, tachycardia,

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13
Q

Adverse Reactions: albuterol Central nervous system

A

stimulation, dizziness, drowsiness, headache, insomnia, irritability, migraine, nervousness, nightmares, restlessness, seizure, vertigo,

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14
Q

Adverse Reactions: albuterol Derm, GI/ GU

A

Diaphoresis, skin rash, urticarial, Hyperglycemia, hypokalemia, lactic acidosis, Diarrhea, dysgeusia, dyspepsia, gastroenteritis, nausea, vomiting, xerostomia, Difficulty in micturition, Lymphadenopathy, Anaphylaxis, angioedema, hypersensitivity reaction, Pain at injection site, Muscle cramps, musculoskeletal pain, tremor, weakness, Otitis media,

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15
Q

adverse reactions: albuterol pulmonary

A

Bronchospasm, cough, epistaxis, exacerbation of asthma, laryngitis, oropharyngeal edema, oropharyngeal irritation, pharyngitis, rhinitis, upper respiratory tract inflammation, viral upper respiratory tract infection

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16
Q

trade name dobutamine

A

dobutrex

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17
Q

how is dobutatmine supplied?

A

1000mg/250mL

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18
Q

MOA dobutamine

A

Stimulates beta1-adrenergic receptors, causing increased contractility and heart rate, with little effect on beta2- or alpha-receptors.

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19
Q

use of dobutamine

A

short-term management of patients with cardiac decompensation. Positive inotropic agent for use in myocardial dysfunction related to sepsis; stress echocardiography.

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20
Q

Dose: Dobutamine Infusion Initial Dose

A

Cardiac decompensation: I.V. infusion:
0.5-1 mcg/kg/minute

may also initiate at higher doses (eg, 2.5 mcg/kg/minute) depending on severity of decompensation with titration to desired response (Leier, 1977).

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21
Q

Dose: Dobutamine InfusionMaintenance dose:

A

2-20 mcg/kg/minute.

Note: In patients with heart failure, lower doses are preferred to minimize adverse effects

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22
Q

max dose of dobutamine

A

Maximum dose: 40 mcg/kg/minute

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23
Q

Onset of action: dobutamine

Half-life elimination:

A

I.V.: 1-10 minutes

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24
Q

Peak effect: dobutamine

A

10-20 minutes

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25
Q

Metabolism: dobutamine

A

In tissues and hepatically to inactive metabolites

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26
Q

half-life elimination dobutamine

A

2 minutes

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27
Q

Excretion: Dobutamine

A

Urine (as metabolites)

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28
Q

Adverse Reactions: CV

A

Increased heart rate, increased blood pressure, increased ventricular ectopic activity, hypotension, premature ventricular beats (5%, dose related), anginal pain (1% to 3%), nonspecific chest pain (1% to 3%), palpitation (1% to 3%),

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29
Q

Adverse Reactions Dobutamine- other

A

Fever (1% to 3%), headache (1% to 3%), paresthesia, Slight decrease in serum potassium, Nausea (1% to 3%), Thrombocytopenia (isolated cases), Phlebitis, local inflammatory changes and pain from infiltration, cutaneous necrosis (isolated cases), Mild leg cramps, Dyspnea (1% to 3%)

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30
Q

Contraindications: Dobutamine

A

Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate), or any component of the formulation; idiopathic hypertrophic sub aortic stenosis (IHSS)

31
Q

usual adult con

A

250 mg in 500 mL (concentration: 500 mcg/mL),

500 mg in 250 mL (concentration: 2000 mcg/mL),

1000 mg in 250 mL (concentration: 4000 mcg/mL) of D5W or NS

32
Q

trade name of Dopamine

A

Dopamine

33
Q

how is dopamine supplied

A

(400mg/250mL)

34
Q

MOA of dopamine
low
medium
high dose

A

Stimulates both adrenergic and dopaminergic receptors,

lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation,

medium doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation

large doses stimulate alpha-adrenergic receptors.

35
Q

low dose of dopamine and its effect

A

Low-dose: 1-5 mcg/kg/minute, increased renal blood flow and urine output

36
Q

medium dose of dopamine and its effect

A

Intermediate-dose: 5-15 mcg/kg/minute, increased renal blood flow, heart rate, cardiac contractility, and cardiac output

37
Q

high dose of dopamine and its effect

A

High-dose: >15 mcg/kg/minute, alpha-adrenergic effects begin to predominate, vasoconstriction, increased blood pressure

38
Q

dopamine dose in heart failure

A

Inotropic support in advanced heart failure: I.V. infusion: 5-15 mcg/kg/minute; lower doses are preferred

39
Q

onset dopamine

A

Onset of action: Adults: Within 5 minutes

40
Q

duration of action dopamine

A

Duration: Adults:

41
Q

metabolism of dopamine

A

Metabolism: Renal, hepatic, plasma; 75% to inactive metabolites by monoamine oxidase and 25% to norepinephrine

42
Q

half life of dopamine

A

Half-life elimination: ~2 minutes

43
Q

excretion of dopamine

A

Excretion: Urine (as metabolites)

44
Q

AE Dopamine

A

Adverse Reactions: Angina pectoris, atrial fibrillation, bradycardia, ectopic beats, hypertension, hypotension, palpitations, tachycardia, vasoconstriction, ventricular arrhythmia, ventricular conduction, widened QRS complex on ECG,

Anxiety, headache, Gangrene (high dose), piloerection, Increased serum glucose (usually not above normal limits), Nausea, vomiting, Azotemia, Increased intraocular pressure, mydriasis, Polyuria, Dyspnea, Tissue necrosis

45
Q

contraindications dopamine

A

Contraindications: Hypersensitivity to sulfites (commercial preparation contains sodium bisulfite); pheochromocytoma; ventricular fibrillation

46
Q

trade name epinephrine

A

Adrenalin

47
Q

MOA of epinephrine

A

Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature; small doses can cause vasodilation via beta2-vascular receptors; large doses may produce constriction of skeletal and vascular smooth muscle.

48
Q

use: Epinephrine

A

Treatment of type I allergic reactions including anaphylactic reactions.

Treatment of bronchospasm associated with bronchial asthma.

Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) unresponsive to initial defibrillatory shocks; pulseless electrical activity; asystole; hypotension/shock unresponsive to volume resuscitation;

symptomatic bradycardia unresponsive to atropine or pacing; inotropic support; acute severe asthma with respiratory failure unresponsive to inhaled beta-agonist; croup.

49
Q

dose of epinephrine systole:

A

I.V., I.O.: 1 mg every 3 to 5 minutes until return of spontaneous circulation;

if this approach fails, higher doses of epinephrine (up to 0.2 mg/kg) have been used for treatment of specific problems (eg, beta-blocker or calcium channel blocker overdose)

50
Q

endotracheal epinephrine dose
how to prepare
special precautions

A

2 to 2.5 mg every 3 to 5 minutes until I.V./I.O access established or return of spontaneous circulation;

dilute in 5 to 10 mL NS or sterile water. Note: Absorption may be greater with sterile water. May cause false-negative reading with exhaled CO2 detectors; use second method to confirm tube placement if CO2 is not detected

51
Q

epinephrine dose with bradycardia

A

Bradycardia (symptomatic; unresponsive to atropine or pacing): I.V. infusion: 2 to 10 mcg/minute or

0.1 to 0.5 mcg/kg/minute (7 to 35 mcg/minute in a 70 kg patient); titrate to desired effect

52
Q

IV dosing epinephrine w/ bronchoconstriction

A

I.V.: 0.1 mg (1:10,000 [0.1 mg/mL] solution) over 5 minutes; may infuse at 1 to 4 mcg/minute to prevent the need to repeat injections frequently or may initiate with an infusion at 5 to 15 mcg/minute (with crystalloid administration).

In general, I.V. administration should only be done in patients who are profoundly hypotensive or are in cardiopulmonary arrest refractory to volume resuscitation and several epinephrine injections

53
Q

onset of epinephrine

A

immediate

1 minute inhaled

54
Q

Metabolism of Epinephrine

A

Metabolism: Taken up into the adrenergic neuron and metabolized by monoamine oxidase and catechol-o-methyltransferase; circulating drug hepatically metabolized

55
Q

excretion of epinephrine

A

Excretion: Urine (as inactive metabolites, metanephrine, and sulfate and hydroxy derivatives of mandelic acid, small amounts as unchanged drug)

56
Q

adverse reactions: Epi

A

Adverse Reactions: Angina, cardiac arrhythmia, chest pain, flushing, hypertension, pallor, palpitation, sudden death, tachycardia (parenteral), vasoconstriction, ventricular ectopy, ventricular fibrillation, Anxiety (transient), apprehensiveness, cerebral hemorrhage, dizziness, headache, insomnia, lightheadedness, nervousness, restlessness, Dry throat, loss of appetite, nausea, vomiting, xerostomia, Acute urinary retention in patients with bladder outflow obstruction, Tremor, weakness, Allergic lid reaction, burning, corneal endothelial damage (intraocular use), eye pain, ocular irritation, precipitation of or exacerbation of narrow-angle glaucoma, transient stinging, Dyspnea, pulmonary edema, Diaphoresis

57
Q

Contraindications: Epi

A

Oral inhalation (OTC labeling): Concurrent use or within 2 weeks of MAO inhibitors

58
Q

ephedrine trade name

A

ephedrine

59
Q

Ephedrine MOA

A

Mechanism and use: Releases tissue stores of norepinephrine and thereby produces an alpha- and beta-adrenergic stimulation; longer-acting and less potent than epinephrine.

60
Q

Ephedrine use

A

Treatment of anesthesia-induced hypotension.

61
Q

Dose: ephedrine

A

I.V.: 5 to 25 mg/dose slow I.V. push repeated after 5 to 10 minutes as needed to maintain blood pressure

62
Q

Metabolism: ephedrine

A

Minimally hepatic; metabolites include p-hydroxyephedrine, p-hydroxynorephedrine, norephedrine

63
Q

Half-life elimination: ephedrine

A

2.5 to 3.6 hours

64
Q

Excretion: ephedrine

A

Urine (60% to 77% as unchanged drug) within 24 hours

65
Q

Adverse reactions: ephedrine

A

Adverse Reactions: Arrhythmias, chest pain, elevation or depression of blood pressure, hypertension, palpitation, tachycardia, unusual pallor,

Agitation, anxiety, apprehension, CNS stimulating effects, dizziness, excitation, fear, headache hyperactivity, insomnia, irritability, nervousness, restlessness, tension,

Anorexia, GI upset, nausea, vomiting, xerostomia, Painful urination, Trembling, tremor (more common in the elderly), weakness,

Dyspnea, Diaphoresis increased

66
Q

Contraindications: Ephedrine

A

Hypersensitivity to ephedrine or any component of the formulation; angle-closure glaucoma; concurrent use of other sympathomimetic agents

67
Q

trade name of Isoproterenol

A

Isuprel

68
Q

how is Isoproterenol supplied?

A

0.2 mg/mL

69
Q

what is the MOA of Isoproterenol

A

Mechanism Stimulates beta1- and beta2-receptors resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, vasodilation of peripheral vasculature.

70
Q

Isoproterenol uses

A

Mild or transient episodes of heart block that do not require electric shock or pacemaker therapy;

serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation)

; cardiac arrest until electric shock or pacemaker therapy is available;

bronchospasm during anesthesia; adjunct to fluid and electrolyte replacement therapy and other drugs and procedures in the treatment of hypovolemic or septic shock and low cardiac output states (eg, decompensated heart failure, cardiogenic shock)

71
Q

dose Isoproterenol

A

Dose: Bradyarrhythmias, AV nodal block, or refractory torsade de pointes: Continuous I.V. infusion: Usual range: 2-10 mcg/minute; titrate to patient response

72
Q

onset of Isoproterenol

A

immediate

73
Q

duration Isoproterenol

A

I.V.: 10-15 minutes

Anesthesia Drug Test Quick Facts (19 decks)

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