vasopressors and intropes

Question 1

NE mechanism

Answer 1

alpha1 agonist -> vasoconstriction

Question 2

NE used for ?

Answer 2

1. septic shock
2. cardiogenic shock
3. PE

Question 3

NE recommendation?

Answer 3

1st choice vasopressor for many instances

Question 4

NE potential adverse effects

Answer 4

1. MI
2. tissue hypoxia
3. local tissue necrosis
4. hyperglycemia
5. decreased urine output
6. tachyarrhythmia

Question 5

NE may reduce _____ events compared to ______ in patients with shock

Answer 5

1. arrhythmic

2. dopamine

Question 6

alpha1 agonists are?

Answer 6

pressor agents

Question 7

alpha1 agonists prototype

Answer 7

phenylephrine

Question 8

Epinephrine acts on which receptor at low doses? high doses?

Answer 8

1. low doses - stimulate beta-2 receptors

2. high doses - stimulate beta-1 and alpha-1 receptors

Question 9

when if epinephrine added to NE?

Answer 9

if additional agent needed to maintain BP in septic shock

Question 10

dopamine effects on blood vessels

Answer 10

1. vasodilates renal artery to increase blood flow to kidney
2. vasodilates coronary artery
3. vasodilates vascular beds

Question 11

dopamine mainly acts on which receptor?

Answer 11

D1

Question 12

dopamine clinical use

Answer 12

1. shock: cardiogenic shock, unstable CHF
2. an alternative to NE but only suggested in highly selected patients of septic shock with low risk of tachyarrhythmias and absolute or relative bradycardia
3. sometimes used to manage acute crisis in decompensated heart failure

Question 13

what does high doses of dopamine cause?

Answer 13

vasoconstriction and decreased tissue perfusion

Question 14

inotropic agents

Answer 14

1. dobutamine
2. dopamine
3. milrinone

Question 15

dobutamine acts on which receptor?

Answer 15

beta1-selective agonist

Question 16

dobutamine clinical use

Answer 16

short-term treatment of cardiogenic shock, MI, decompensated heart failure

Question 17

dobutamine adverse effects

Answer 17

1. may increase size of infarct
2. potential arrhythmias
3. increase work/O2 req

Question 18

milrinone MOA

Answer 18

inhibit cAMP phosphodiesterase -> raises cAMP levels in vascular and cardiac mm

Question 19

milrinone use

Answer 19

limited to temporary, symptomatic treatment of acute decompensated heart failure

Question 20

milrinone adverse effects

Answer 20

1. dysrhythmias
2. hypotension
3. thrombocytopenia
4. headache

Question 21

vasopressin clinical use

Answer 21

pressor agent - adjunct to NE, Epi, DA, or dobutamine in treatment of shock, can be used during cardiogenic shock