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Pharm II > Vasopressor and Inotropic Therapy > Flashcards

Vasopressor and Inotropic Therapy Flashcards

1
Q

Vasopressors

A

Drugs that cause vasoconstriction

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2
Q

Inotropes

A

Change the strength of contraction

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3
Q

Chronotropes

A

Change the rate of contraction

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4
Q

Indications for therapy

A

Decrease in SBP of >30 mmHg from baseline with clinical signs/symptomatology
Decrease in MAP >60 from baseline
Poor organ perfusion secondary to changes in BP or CO (brain, heart, kidney, etc)
Decreased myocardial contraction

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5
Q

Location of alpha-1/alpha 2 adrenergic receptors

A

Vascular wall

Heart

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6
Q

Effect of alpha-1/alpha 2 adrenergic receptors

A

Vascular wall-vasoconstriction

Heart- Increased duration of contraction without increased chronotropy

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7
Q

Location of beta adrenergic receptors

A

Beta-1: heart

Beta-2: blood vessels, lungs

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8
Q

Effects of beta adrenergic receptors

A

Heart: increased inotropy and chronotropy

Blood vessels and lungs: vasodilation

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9
Q

Location of dopamine receptors

A

Renal
Splanchnic
Coronary
Cerebral

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10
Q

Effects of dopamine receptors

A

Vasodilation

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11
Q

Generic name of Neosynephrine

A

Phenylephrine

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12
Q

Generic name of Levophed

A

Norepinephrine

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13
Q

Generic name of Adrenalin

A

Epinephrine

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14
Q

Generic name of Inotropin

A

Dopamine

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15
Q

Receptors phenylephrine affects

A

Alpha-1 (very strong effect)

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16
Q

Predominant clinical effects of phenylephrine

A

Increased SVR

Increased CO

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17
Q

Receptors norepinephrine affects

A

Alpha-1 (very
strong effect)
Beta-1 (moderate effect)

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18
Q

Predominant clinical effects of norepinephrine

A

Increased SVR

Increased CO

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19
Q

Receptors epinephrine affects

A

Alpha-1 (very strong effect)
Beta-1 (very strong effect)
Beta-2 (moderate effect)

20
Q

Predominant clinical effects of epinephrine

A 
Increased CO
Decreased SVR (low dose)
Increased SVR (high dose)
21
Q

Receptors 0.5 to 2 mcg/kg/min of dopamine affect

A

Beta-1 (weak effect)

Dopaminergic (moderate effect)

22
Q

Predominant clinical effects of 0.5 to 2 mcg/kg/min of dopamine

A

CO

23
Q

Receptors 5-10 mcg/kg/min of dopamine affect

A

Alpha-1 (weak effect)
Beta-1 (moderate effect)
Dopaminergic (moderate effect)

24
Q

Predominant clinical effects of 5-10 mcg/kg/min of dopamine

A

Increased CO

Increased SVR

25
Q

Receptors 10-20 mcg/kg/min of dopamine affect

A

Alpha-1 (moderate effect)
Beta-1 (moderate effect)
Dopaminergic (moderate effect)

26
Q

Predominant clinical effects of 10-20 mcg/kg/min of dopamine

A

Increased SVR

27
Q

Receptors dobutamine affects

A

Not much alpha-1 effect
Beta-1 (very strong effect)
Beta-2 (moderate effect)

28
Q

Predominant clinical effects of dobutamine

A

Increased CO
Decreased SVR
Dobutamine is solely in vasculature
Good inotrope and chronotrope

29
Q

Receptors isoproterenol affects

A

Beta-1 (very strong effect)

Beta-2 (very strong effect)

30
Q

Predominant clinical effects of isoproterenol

A

Increased CO

Decreased SVR

31
Q

What is the indication for norepinephrine (Levophed)?

A

Most potent vasoconstrictor
Half life is minutes, so keep on it!
Used in septic shock with decreased EF or decreased CO along with decreased SVR
Neg inotrope

32
Q

Adverse effects of norepinephrine

A 
Toxicity:
Peripheral ischemia
Tachycardia
Dysrhythmias:
Ectopy
Tachyrhythmias
Extravasation
Phentolamine- alpha blocker to help minimize this- inject topically
33
Q

Use of phenylephrine (Neosynephrine)

A

1/2 life is minutes

Optimal in spinal shock ideal in medication or procedure-induced hypotension

34
Q

Use of dobutamine

A

1/2 life is mins
Used with decreased EF or decreased CO
Septic shock with decreased CO/EF, myocardial stun post surgery, or MI
Trauma

35
Q

Adverse effects of phenylephrine

A

Toxicity:
Renal vascular necrosis
Peripheral ischemia
Dysrhythmias- ectopy

36
Q

Adverse effects of dobutamine

A

Toxicity- hypotension

Dysrhythmias- ectopy, tachyrhythmias

37
Q

Use of dopamine

A

Borderline BP and HR
1/2 life is mins
Used in septic shock with decreased EF or decreased CO along with decreased SVR

38
Q

Adverse effects of dopamine

A 
Toxicity:
Peripheral ischemia
Tachycardia
Dysrhythmias:
Ectopy
Tachyrhythmias
39
Q

Uses for epinephrine

A

Used in fulminant cardiac arrest, anaphylaxis, septic shock, v-fib, v-tach without a pulse, asystole, EMD

40
Q

Adverse effects of epinephrine

A 
Toxicity:
Peripheral ischemia
Tachycardia
Dysrhythmias:
Ectopy
Tachyrhthmias
41
Q

Doses of epinephrine

A 
For anaphylaxis:
1:1000 = 1 mg/mL injectable
0.3 mg SC or IM
For cardiac arrest
1:10,000= 1 mg/10 mL
42
Q

Uses for isoproterenol

A

Tx for bradycardia in pts with heart transplant

43
Q

Side effects of isoproterenol

A

Tachycardia

Hypotension

44
Q

MOA of vasopressin

A

Increases intracellular calcium, maintaining vascular tone in vascular smooth muscle

45
Q

Uses for vasopressin

A

Used in fulminant cardiac arrest, sepsis, septic shock

46
Q

Under what condition should any of these agents be used?

A

Pressor therapy should ONLY be utilized when fluid status is optimized

Pharm II (8 decks)

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