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Anesthesia Pharmacology > Synethetic Catecholamines > Flashcards

Synethetic Catecholamines Flashcards

1
Q

Dobutamine Class

A

Synthetic catecholamine, selective beta 1 adrenergic agonist

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2
Q

Dobutamine MOA

A

Synthetic analog of isoproterenol

Acts on B1, G proteins to increase cAMP, influx of Ca causing increased contractility & CO

Some B2 (vasodilation, decrease SVR) & A1 (minimum)

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3
Q

Dobutamine Uses (3)

A

Cardiogenic and septic shock
Treat mild CHF
Cardiac stress tests

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4
Q

Dobutamine Dose

A

Infusion: 2 to 20 mcg/kg/min

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5
Q

Dobutamine Onset and DOA

A

Onset: 1 minute
DOA: 10 minutes

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6
Q

Dobutamine Metabolism

A

MAO, COMT

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7
Q

Dobutamine Excretion

A

Renally excreted

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8
Q

Dobutamine Admin Considerations

A

Caution in patients with tachycardia, CAD, hypertrophic cardiomyopathy

Decrease SVR, platelet inhibition

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9
Q

Phenylephrine Class

A

Selective Alpha 1 adrenergic agonist

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10
Q

Phenylephrine MOA

A

Agonizes A1 receptors, triggering a G protein response to ⬆️ cAMP -> ⬆️ Ca, resulting in ⬆️ BP

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11
Q

Phenylephrine Uses (2)

A

Vasodilatory shock

Hypotension (with a normal heart rate) s/p spinal anesthesia

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12
Q

Phenylephrine Dosing

A

Small boluses of 40-80 mcg

Infusion: 20 – 50 mcg/min

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13
Q

Phenylephrine Onset and DOA

A

Onset: 1 minutes
DOA: 15 minutes

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14
Q

Phenylephrine Metabolism

A

MAO

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15
Q

Phenylephrine Excretion

A

Renally excreted

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16
Q

Phenylephrine Admin Considerations

A

Reflex bradycardia mediated by the vagus nerve can reduce cardiac output

Caution in patients with bradycardia, hyperthyroidism, pheochromocytoma

Phenylephrinemust be diluted from a 1% solution (10 mg/1-mL ampule), usually to a 100 mcg/mL solution and titrated to effect

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17
Q

Vasopressin Class

A

Exogenous antidiuretic peptide & vasopressor

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18
Q

Vasopressin MOA

A

Agonizes vasopressin receptors.

V1: constriction of vascular smooth muscle

V2: in DCT & collecting ducts of kidneys = increased water reabsorption

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19
Q

Vasopressin Uses (3)

A

Septic shock

Post–cardiopulmonary bypass shock state

ACE Inhibitor related hypotension

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20
Q

Vasopressin Dosing

A

Bolus: 1 – 20 units
Infusion: 0.01-0.04 units/min

21
Q

Vasopressin Onset and DOA

A

Onset: 1 minutes
DOA: 10 minutes

22
Q

Vasopressin Metabolism

A

Tissue peptidase

23
Q

Vasopressin Excretion

A

Renally excreted

24
Q

Vasopressin Admin Considerations (4)

A

Gastrointestinal ischemia

Decreased cardiac output

Skin or digital necrosis

Cardiac arrest (especially at doses greater than 0.04 units/min)

25
Q

Milrinone Class

A

Phosphodiesterase 3 Inhibitor

26
Q

Milrinone MOA (4)

A

Inhibits PDE III which degrades cAMP

cAMP buildup in cardiac smooth muscle causes increased contractility & HR

cAMP buildup in vascular smooth muscle causes decreased PVR & SVR

Overall increase in CO

27
Q

Milrinone Uses (4)

A

Cardiogenic shock

Right heart failure

Dilates pulmonary artery

Inotropy in the setting of beta blockade

28
Q

Milrinone Dosing

A

Loading dose: 50 mcg/kg over 10 minutes

Infusion: 0.375–0.75 mcg/kg/min

29
Q

Milrinone Onset

A

Onset: 5 – 15 minutes

30
Q

Milrinone Elimination

A

Renally excreted (80% unchanged)

31
Q

Milrinone Metabolism

A

Minor Hepatic Metabolism (20%)

Rest not metabolized

32
Q

Milrinone Admin Considerations

A

Caution in patients with hypotension, renal failure

Side effects include arrythmias

33
Q

Ephedrine Class

A

Synthetic noncatecholamine, indirect and direct acting

34
Q

Ephedrine MOA

A

It stimulates both α- and β-receptors directly, and it indirectly causes release of endogenous catecholamines, leading to multiple mechanisms of action. It has both central and peripheral actions.

35
Q

Ephedrine Uses (3)

A

Treat hypotension with bradycardia

Used w/ GA or SNS blockade to treat hypotension caused by bradycardia after spinal

Like epinephrine, but weaker action and lasts 10x longer

36
Q

Ephedrine Doses

A

Small Bolus: 5 - 10 mg

37
Q

Ephedrine Onset and DOA

A

Onset: 1 minutes
DOA: 10 – 60 minutes

38
Q

Ephedrine Metabolism

A

Resistant to MAO since lacks catecholamine

39
Q

Ephedrine Excretion

A

Renally excreted (40% unchanged)

40
Q

Ephedrine Admin Considerations (4)

A

Risk for those with CAD, tachycardia, hypertension

Patients taking MAOIs, TCAs & cocaine

Caution in trauma because subsequent doses are increased to offset the development of tachyphylaxis, which is probably due to depletion of norepinephrine stores.

Ephedrineis available in 1-mL ampules containing 25 or 50 mg of the agent

41
Q

Albuterol Class

A

Selective B2 agonist

42
Q

Albuterol MOA

A

Acts directly on Beta 2 receptors coupled to G protein

Activates adenylyl cyclase which increases cAMP and decreases Ca++

Increases K+ conductance causing smooth muscle relaxation & bronchodilation

43
Q

Albuterol Uses

A

Bronchodilation

44
Q

Albuterol Dosing

A

90 mcg per puff

45
Q

Albuterol Onset and Duration

A

Onset: 5 minutes
DOA: 4 hours

46
Q

Albuterol Metabolism

47
Q

Albuterol Excretion

A

Renally excreted (30 % unchanged)

48
Q

Albuterol Admin Considerations (3)

A

Tremors
Tachycardia
Hypokalemia

Anesthesia Pharmacology (23 decks)

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