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Vasopressors Flashcards

1
Q

Phenylephrine agonizes what SNS receptor

A

Pure alpha 1

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2
Q

Is phenylephrine a catecholamine

A

No, it is a synthetic noncatecholamine

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3
Q

Phenylephrine produces profound

A

arterial vasoconstriction

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4
Q

What effect does phenylephrine have on SVR

A

Increased

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5
Q

What effect does phyenylephrine have on BP

A

Increased

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6
Q

What effect does phyenylephrine have on contractility

A

No direct effect

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7
Q

What effect does phyenylephrine have on HR

A

Reflexive decrease from elevation of SVR

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8
Q

What effect does phyenylephrine have on CO

A

Decreased

  • from baroreceptor reflexive decrease of HR
  • increased afterload
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9
Q

What effect does phyenylephrine have on PAP

A

Increased

-alpha 1 receptors dominant in pulmonary vasculature

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10
Q

What effect does phyenylephrine have on CNS

A

Minimal effects

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11
Q

Phenylephrine is metabolized rapidly by

A

MAO

-DOA= 5 minutes

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12
Q

Pheylephrine is indicated for

A

Hypotension
Hypovolemia (until fluid restored)
SVT
Acute cyanosis

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13
Q

Epinephrine is considered a direct

A

mixed agonist

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14
Q

Epi directly agonizes

A

a1, a2, b1, b2 receptors

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15
Q

Does epinephrine cause the release of endogenous NorEpi

A

No

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16
Q

Is tachyphylaxis not with Epi administration

A

No

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17
Q

What catecholamine is the most potent alpha-adrenergic receptor activator

A

Epi

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18
Q

B1 receptors stimulated by epi cause an increase in

A

Systolic BP
HR
Inotropy
CO

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19
Q

Epi cause a ——– in diastolic pressure

A

decrease

  • due to stimulation of B2 receptors of skeletal muscle vessels
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20
Q

Epi cause a —–in pulse pressure

A

increase

*systolic increase>diastolic with minimal change in MAP

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21
Q

Epi ——- the rate of ventricular relaxation

A

increases

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22
Q

How is epi metabolized

A

MAO

COMT

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23
Q

What two respiratory effects does epi have

A

bronchodilation (B2)

Inhibits antigen-induced release of inflammatory mediators from mast cells (B2)

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24
Q

Epi related positive inotropy, tachycardia, and increased myocardial oxygen demand will have what effect on myocardial cells

A

May induce or worsen myocardial ischemia

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25
Q

If Epi can cause what effect on tissues

A

necrosis d/t extravasation

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26
Q

Epi stimulation on the pancreas exerts what effect, how?`

A

Glucagon release from alpha cells via stimulation of alpha 2 receptor»»increased plasma glucose

Subsequently, increased glucagon leads to inhibition of glucose

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27
Q

Is Epi lipid soluble

A

No

*No CNS effects

28
Q

Epi can be used to treat hyperkalemia by what mechanism

A

activaton of sodium-potassium pump in skeletal muscles

29
Q

What are the indications for epi

A

Cardiac arrest
anaphylaxis/ bronchospasm
cardiogenic shock
Reduced CO after coronary bypass

30
Q

How is coronary perfusion pressure increased by Epi

A

increases rate of ventricular relaxation and enhances LV filling which improves diastolic function

31
Q

Don’t give > how many mcgs of epi

32
Q

What are the routes that epi can be administered

A

ETT
SQ
IV

*Don’t give PO bc rapidly metabolized by GI mucosa and liver

33
Q

Norepi directly agonizes what receptors

34
Q

What effect does Norepi have on SVR

A

Profound increase

*decreases venous return to the heart

35
Q

Norepi causes a decrease venous return to the heart b/c of SVR increases which does what to the HR

36
Q

Norepi does what to the PAP

37
Q

How is Norepi metabolized

38
Q

Norepi can what effect on end-organ perfusion and cardiac cells

A

reduced perfusion and myocardial ischemia

39
Q

What effect can Norepi have on skin in unsafe doses

A

skin necrosis

40
Q

What is the treatment for Norepi induced extravasation

A

Phentolamine

*alpha antagonist

41
Q

Norepi is indicated for

A

Peripheral vascular collapse

Refractory SVR decreases

42
Q

Ephedrine’s primary effect is

A

indirect release of Norepinephrine from mobile pool 1

*adequate stores required to be effective
otherwise tachyphlaxis will develop

43
Q

Epedrine’s hemodynamic profile resembles what other catecholamine

A

Epinephrine

  • Increased CO, contractility, HR, SVR (slightly), BP ( systolic and diastolic)
  • however, with epi, the diastolic bp decreases d/t b2 vasodilation
44
Q

Can ephedrine stimulate the CNS

A

Yes, cross the BBB

45
Q

Ephedrine should be avoided in

A

patient’s taking MAO inhibitors

46
Q

Vasopressin can produce direct peripheral vasoconstriction via

A

activation of smooth muscle V1 receptors

47
Q

Does vasopressin act on adrenergic receptors

48
Q

What are the indications for Vasopressin

A

DI
hemorrhage from esophageal varices, sepsis, and catecholamine-resistant shock

refractory cardiac arrest

49
Q

What is the distinction between vasopressin and epinephrine with regards to cardiac arrests

A

Vasopressin may increase coronary perfusion pressure without tachycardia as seen with epi

50
Q

Adverse effects of vasopressing include

A

bronchoconstriction

uterine contractions

visceral hypoperfusion

thrombocytopenia

51
Q

Dobutamine is a synthetic beta agonist catecholamine distributed as

A

a racemic mixture

    • isomer = potent alpha 1 agonist
    • isomer = potent 1 antagonist
      Therefore, dobutamine is considered a Beta agonist
52
Q

Dobutamine primarily agonizes

A

beta 1 receptors

53
Q

Dobutamine agonizes —- to a limited extent

54
Q

Dobutamine antagonizes —–at high doses

55
Q

Dobutamine causes what effects on SVR

56
Q

Dobutamine causes what effects on BP

A

slight increase

57
Q

Dobutamine causes what effects on HR

A

Dobutamine causes what effects

58
Q

Dobutamine causes what effects on contractility

59
Q

Dobutamine causes what effects on CO

60
Q

Dobutamine causes what effects on LVEDP

61
Q

Dobutamine causes what effects PAP

A

decreased via B2

62
Q

How is dobutamine metabolized

63
Q

What is the plasma half-life of dobutamine

64
Q

Isoproterenol is a

A

direct acting b1, b2 catecholamine, agonist

65
Q

Isoproterenol has what effect on SVR

A

Marked decrease via B2 stimulation of skeletal muscle, renal, and splanchnic vasculature

66
Q

Isoproterenol has what effect on CO

67
Q

Isoproterenol has what effecto on BP

A

variable

*Systolic increase only

Pharmacology (27 decks)

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