Week 1 Cardiac Pharm 2 of 4

Question 1

What is the endogenous central and peripheral neurotransmitter that is derived from dopa in the chain of catecholamine synthesis?

Answer 1

Dopamine

Question 2

Dopamine Doses

Answer 2

–Dopamine receptors: 2 mcg/kg/min

–Beta: 2-5 mcg/kg/min

–Alpha: 10 mcg/kg/min and above

Question 3

What has indirect sympathomimetic effect eliciting the release of norepinephrine via Beta 1 stimulation?

Answer 3

Dopamine

Question 4

Often chosen for patients in shock?

Answer 4

Dopamine (but more often norepi)

Question 5

■May have poor response in cases of gram-negative sepsis b/c of a down regulation in which the sensitivity of beta receptors is diminished

Answer 5

Dopamine

Question 6

■Used in the past periop for “renal dose” dopaminergic effects to increase UOP however has been abandoned by some d/t long-term morbidity and mortality are not improved. This drug also inhibits aldosterone resulting in an increase in sodium excretion and UOP

Answer 6

Dopamine

Question 7

■Dopamine has been implicated in limb ischemia in what patients?

Answer 7

■Dopamine has been implicated in limb ischemia in:

–Pediatric patients

–Vascular diseases such as:

■Diabetes

■Atherosclerosis

■Raynaud’s

–Presence of an artline in the affected limb also increases incidence of limb ischemia with concurrent dopamine administration

Question 8

What is Isoproterenol?

Answer 8

■Synthetic catecholamine

■Potent non-selective agonist of Beta 1 and Beta 2 receptors

■Has no agonistic activity at alpha or dopamine receptors

Question 9

What is Isoproterenol’s clincal use?

Answer 9

■Can be seen used in:

–Brady with heart block

–Torsades de points

–VT

–After heart transplant for chronotropic support (Beta 2 receptor stimulation)

Question 10

Profound Beta 1 stimulation results in both positive _______ and _______ effects in Isoproterenol.

Answer 10

■Profound Beta 1 stimulation results in both positive inotropic an chronotropic effects

Question 11

What happens to the cardiac output in Isoproterenol?

Answer 11

■Increase in CO is seen due to combination B1 and B2 inducing vasodilation and resultant drop in SVR

Question 12

■In IIsoproterenol, the positive inotropic and chronotropic effect results in a dramatic increase in ______________________.

Answer 12

■The positive inotropic and chronotropic effect results in a dramatic increase in myocardial oxygen consumption

■This is in addition to a probable already existing compromise due to the Beta 2 induced peripheral vasodilation causing a decrease in DBP and ultimately a decrease in coronary artery perfusion

Question 13

■Isoproterenol is a also a potent ______ _____ and ____ _____.

Answer 13

■Isoproterenol is a also a potent bronchial dilator and pulmonary vasodilator

Question 14

What detrimental effects does Isoproterenol have on the heart?

Answer 14

■Detrimental effects on the heart limiting its use:

–Excessive tachy

–Myocardial ischemia

–Arrhythmia production

Question 15

What is Dobutamine?

Answer 15

■Synthetic sympathomimetic amine

■Modified isoproterenol but is used widespread

■Primarily Beta 1 agonist with some Beta 2 effects

■Strong inotropic response with minimal chronotropy

■Produces slight drop in SVR b/c of peripheral vasodilation

■Increase in CO compensates for decrease in SVR and the BP is increased (or at low doses relatively unchanged)

Question 16

■With the use of Dobutamine, pulmonary artery pressure______ and an _______ in LV stroke work index is observed

Answer 16

With the use of Dobutamine, pulmonary artery pressure decreases and an increase in LV stroke work index is observed

Question 17

What 3 reason is Dobutamine an option in cardiogenic and septic shock and in select patient with mild heart failure?

Answer 17

■Is an option in Cardiogenic and Septic shock and in select patient with mild heart failure because:

–Positive inotropic effects

–Lack of chronotropy

–Maintenance of normal BP

Question 18

What drug is ised for heart stimulation for cardiac stress test?

Answer 18

Dobutamine?

Question 19

■Recent evidence indicates significant adverse effects when this drug is used in cardiac surgery and clinicians have stopped using it for inotropic support.

Answer 19

Dobutamine

Question 20

Most commonly used purely alpha agonist?

■Has strong alpha stimulating effect with virtually no beta stimulation

■Sharp rise in BP is produced as a result of a significant increase in peripheral resistance secondary to alpha 1 stimulation

Answer 20

Phenylephrine

Question 21

What drug can cause Reflex bradycardia can be elicited secondary to baroreceptor stimulation?

Answer 21

Phenylephrine

Question 22

Must be vigilant in dosing. Can cause large changes in increasing BP and decreasing HR.

Answer 22

Phenylephrine

Question 23

Onset is immediate with 5-20 minute duration.

Answer 23

Phenylephrine

Question 24

■Topical doses should not exceed 0.5 mg (4 drops of 0.25% in adults) and 20 mcg/kg in children in order to prevent severe hypertension

Answer 24

Phenylephrine

Question 25

What class of drug is Milrinone?

Answer 25

Phosphodiesterase Inhibitors

Question 26

■Produces a positive inotropic action and vasodilation without producing tachycardia

Answer 26

Milrinone

Question 27

Which drug

–Substantially improves LV function in association with acceleration of calcium uptake by the sarcoplasmic reticulum

–This acceleration appears to result from an inhibition of membrane-bound PDE3 in the sarcoplasm, which induces a local elevation of cAMP.

–This allows a build-up of cAMP and a subsequent increase in the uptake of intracellular calcium

Answer 27

Milrinone

Question 28

What drug ■Improves weaning of high risk patients from cardiopulmonary bypass?

Answer 28

Milrinone

Question 29

What is the clinical result of milrinone?

Answer 29

■Clinical result is a decrease in both preload and afterload

■These effect along with absence of an increase in HR probably contributes to an absence of myocardial oxygen consumption

Question 30

Which drug ■Acts to enhance diastolic function, increases cardiac output and decreases pulmonary wedge pressure?

Answer 30

Milrinone

Question 31

Side effects of Milrinone?

Answer 31

Arrythmias

Question 32

MIlrinone elimination?

Answer 32

Kidneys

Question 33

Loading Dose of Milrinone?

Answer 33

■Loading Dose:

–50 mcg/kg slowly over 10 minutes

Question 34

Infusion rate that is started after initial loading dose of Milrinone?

Answer 34

■Loading Dose:

–50 mcg/kg slowly over 10 minutes

■Followed by infusion:

–0.5 mcg/kg as needed

Question 35

Ephedrine is a ______ ______ _____.

Answer 35

mixed function agonist

Question 36

What drug

■Synthetic non-catecholamine sympathomimetic

■Stimulates both alpha and beta receptors directly

■Indirectly causes release of endogenous catecholamines, leading to a multiple mechanisms of action

■Acts centrally and peripherally

■Effects similar to epi but to a lesser degree and not accompanied with dramatic increase in serum glucose

Answer 36

Ephedrine?

Question 37

What drug

■Duration is longer than epi due to lack of basic catechol structure so it’s resistant to metabolism by monoamine oxidase

■Produces dose related increase in BP, CO, HR and SVR

■Usually first sympathomimetic chose for alleviation of hypotension due to cardiac depressant effects of anesthetic agents or vasodilation resulting from spinal anesthesia

Answer 37

Ephedrine