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Pharmacology of Anesthesia > Vasoactive Pharmacology > Flashcards

Vasoactive Pharmacology Flashcards

0
Q

Volatile anesthetics also depress ______ reflex control of arterial pressure to varying degrees.

A
  • Baroreceptor reflex

* Isoflurane has the least effect

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1
Q

In a normal heart, volatile anesthetics produce dose related: ?

A
  1. Depression in myocardial contractility
  2. Left ventricular diastolic function decreases
  3. Decrease left ventricular afterload
  4. Left ventricular -arterial coupling
  5. Depression of the SA node (Direct negative chronotrope)
    * Desflurane exception - tachycardia with rapid increase in dose
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2
Q

Nitrous oxide causes direct negative inotropic effects, but also produces…?

A
  • modest increases in pulmonary and systemic arterial pressure via a sympathomimetic effect
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3
Q

All drugs used in anesthesia cause hypotension except…?

A
  • Ketamine and Etomidate
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4
Q

What is our goal during anesthesia?

A
  • Goal is to maintain organ and tissue perfusion and avoid hypertensive crisis.
  • Brain, Heart, Lungs, and Kidneys are the organs we are most concerned about.
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5
Q

What is autoregulation?

A
  • the intrinsic ability of a circulation to maintain a constant blood flow despite changes in perfusion pressure
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6
Q

In anesthesia, where do we try to maintain patients hemodynamically?

A
  • within 20% of baseline
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7
Q

What are the intrinsic factors of blood pressure control?

A
  1. Frank-Starling Mechanism (Stroke Volume)

2. SA and AV node (HR and A-V synchronization)

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8
Q

What are the nervous system factors for blood pressure control?

A
  1. Sympathetic

2. Parasympathetic

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9
Q

What are the reflexes of blood pressure control?

A
  1. Baroreceptor Chemoreceptor

2. Atrial receptor (Bainbridge)

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10
Q

What are the humoral factors that affect blood pressure control?

A
  • Renin-Angiotensin-Aldosterone System
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11
Q

What is vasopressin (ADH)?

A
  • Potent vasoconstrictor
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12
Q

Where is vasopressin produced?

A
  • Posterior pituitary gland, the heart, and adrenal gland
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13
Q

What is the infusion rate of vasopressin (ADH)?

A
  • 0.01 to 0.04
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14
Q

When is vasopressin used?

A
  • Considered in refractory hypotension (shock, hemorrhage) and patient who are on ACE inhibitors
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15
Q

When alpha 2 receptors are activated on presynaptic neurons, what happens?

A
  • They inhibit neurotransmitter release from presynaptic neurons
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16
Q

Where are alpha 1 receptors found and what is their effect?

A
  • Location: Vascular smooth muscle (peripheral, renal and coronary circulation)
  • Effect: Vasoconstriction (increase SVR)
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17
Q

Where are Beta 1 receptors found and what is their effect when stimulated?

A
  • Location: Heart

- Effect: Increased heart rate and increased contractility (increasing cardiac output)

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18
Q

Where are Beta 2 receptors located and what is their effect?

A
  • Location: Vascular smooth muscle (peripheral and renal circulation)
  • Effect: Vasodilation (reducing systemic vascular resistance)
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19
Q

Where are Beta 3 receptors found and what are their effects?

A
  • Location: Gall Bladder and adipose tissue

- Effect: May play a role in lypolysis and brown fat thermogenesis

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20
Q

What receptors does Phenylephrine work on?

A
  • Mainly Alpha 1
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21
Q

What receptors does Epinephrine work on?

A
  • Alpha 1, Alpha 2, Beta 1, Beta 2
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22
Q

What receptors does Ephedrine work on?

A
  • Alpha 1, Beta 1, mild Beta 2
23
Q

What receptors does Norepinephrine work on?

A
  • Alpha 1, Alpha 2, Beta 1
24
Q

What receptors does Dopamine work on?

A
  • Mainly DA 1 and DA 2

- Alpha 1, Alpha 2, Beta 1, mild Beta 2,

25
Q

Phenylephrine

A
  • Non-catecholamine with predominately Alpha 1 agonist activity
  • Primarily a vasoconstrictor used to increase blood pressure due to vasodilator effects of anesthesia agents.
  • Reflex bradycardia
26
Q

Phenylephrine: What is the dose for small intravenous boluses?

A
  • 50-100 mcg (0.5-1.0 mcg/kg)
27
Q

What is the infusion rate for phenylephrine?

A
  • 0.25 to 1.0 mcg/kg/min
28
Q

Ephedrine

A
  • Non-catecholamine indirect and direct acting Alpha and Beta agonist
  • Works by increasing the release of NE at the synaptic junction and similar direct Alpha and Beta effects as epinephrine
  • Increase BP, HR, contractility, CO, and bronchodilator
  • Longer duration of action and less potent than epinephrine
  • Direct stimulation of the CNS (may increase MAC)
  • Tachyphylaxis b/c you deplete NE stores
29
Q

Ephedrine: What is the IV bolus dose?

A
  • 2.5 to 10 mg (pediatric 0.1 mg/kg)

* Dilute for IV administration

30
Q

Ephedrine: What is the IM/SQ dose?

A
  • 25-50 mg (Onset may be 10-20 min)
31
Q

Epinephrine

A
  • Endogenous catecholamine synthesized in adrenal medulla
  • Alpha 1 = Alpha 2 ; Beta 1 = Beta 2
  • Peripherally vasoconstricts, inotrope, chronotrope, relaxation of peripheral vessels may lead to decrease in diastolic pressure (overall increases MAP)
  • Increased oxygen demand on the heart
  • Principle treatment in anaphylaxis
32
Q

Epinephrine: What is the dose in a code?

A
  • 1 mg IV
33
Q

Epinephrine: What is the IV anaphylaxis dose?

A
  • 0.3 - 0.5 mg IV
34
Q

Epinephrine: What is the IV gtt dose?

A
  • 0.1 to 1.0 mcg/kg/min

* 1 mg/250 (4mcg/ml)

35
Q

Norepinephrine

A
  • Direct Alpha 1 stimulation with little Beta 2 activity produces intense vasoconstriction
  • Alpha 1 = Alpha 2 ; Beta 1»»Beta 2
  • Increased contractility. Increased afterload and some reflective bradycardia
  • Does not have the advantages of Beta 2 stimulation (renal and GI blood dilation)
  • Extravasation can cause tissue necrosis
36
Q

Norepinephrine: What is the bolus dose?

A
  • 0.1 mcg/kg (short duration)
37
Q

Norepinephrine: What is the infusion dose?

A
  • 2-20 mcg/min, or 0.01 to 3 mcg/kg/min (higher rates in septic shock)
38
Q

Dopamine

A
  • Endogenous non-selective direct and indirect adrenergic and dopaminergic agonist which varies with dosage
39
Q

Dopamine: What is the Beta 1 dose?

A
  • 2-10 mcg/kg/min
40
Q

Dopamine: What is the Alpha effects dose?

A
  • > 10 mcg/kg/min
41
Q

Dopamine: What is the Dopaminergic effects dose?

A
  • 0.5-2 mcg/kg/min
42
Q

Activation of Alpha 1 and Beta 2 increase….?

A
  • Glucose release into the circulation
43
Q

Beta 2 activation also…?

A
  • Promotes the uptake of potassium into cells
44
Q

What are the two Beta selective inotropes?

A
  • Isoproterenol

- Dobutamine

45
Q

Isoproterenol

A
  • Potent Beta 1 agonist, little effect on Alpha

- Positive chronotrope and inotrope

46
Q

Dobutamine

A
  • Initially considered as Beta 1 selective, but more complicated than that
  • Positive inotrope over chronotrope when compared to isuprel
  • Some Alpha 1
47
Q

Esmolol

A
  • Beta 1 blocker
48
Q

Esmolol: What is the intermittent dose?

A
  • Up to 1 mg/kg
49
Q

Hydralazine

A
  • Direct arteriole vasodilation
50
Q

Hydralazine: What is the intermittent dose?

A
  • 10-40mg IV q4
51
Q

Labetalol

A
  • Alpha 1 blocker (primarily)
  • Beta 1 blocker
  • Beta 2 blocker
52
Q

Labetalol: What is the intermittent dose?

A
  • 10-40 mg IV q4
53
Q

Metoprolol

A
  • Beta 1 blocker
54
Q

Metoprolol: What is the intermittent dose?

A
  • 1.25-5 mg IV q6

Pharmacology of Anesthesia (6 decks)

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