Week 1 Cardiac Pharmacology and Autonomic 1 of 4

Question 1

Sympathomimetic Amines

• Name Naturally occurring catecholamines:
• Name synthetic agents:

Answer 1

-Naturally occuring:
Epinephrine, norepinephrine, and dopamine

• synthetic agents:
  Phenylphrine and dobutamine

Question 2

Epinephrine Strongly stimulates

Answer 2

• both B1 and B2 receptors

Question 3

Epinephrine Treats:

Answer 3

Treatment:

• Anaphylaxis
• Cardiopulmonary resuscitation
• Treatment of shock with poor tissue O2 delivery and hypotension are combined (this is b/c of its alpha and beta effects)

Question 4

____ May be useful as a sympathomimetic agent in patients unresponsive to indirect-acting agents and in those in whom simultaneous Beta 1 (cardiac stimulation) and Beta 2 receptor stimulation (vasodilation).

Answer 4

Epinephrine

Question 5

Dominance of alpha or beta effects is dose related in what sympathomimetic?

Answer 5

epi

Question 6

Epi Beta 1 produces + or - :

• inotropic
• Chronotropic
• dromotropic

Answer 6

+ inotropic
+ chronotropic
+ dromotropic

Question 7

inotropic

Answer 7

(force of contraction)

Question 8

chronotropic

Answer 8

(heart rate)

Question 9

dromotropic

Answer 9

(conduction velocity)

Question 10

As HR, LV Stroke work, SV, and CO increase, what also increases?

Answer 10

Myocardial O2 consumption

Question 11

Because of increased automaticity of all foci (including those that are ectopic) there is a possibility of:

Answer 11

arrhythmia

Question 12

to ensure that an imbalance of myocardial oxygen supply and demand does not occur requires:

Answer 12

vigilance

Question 13

Epi Beta 2 stimulation:

Answer 13

• Bronchodilation
• Vasodilation
• Stabilization of mast cells (resulting in decreasing histamine release)
• Concurrent alpha stimulation promotes a decrease in bronchial secretion. Net effects are a decrease in airway resistance with an improvement in oxygenation

Question 14

-Stabilization of mast cells results in

Answer 14

decreasing histamine release

Question 15

-Concurrent alpha stimulation promotes a decrease in bronchial secretion. Net effects are

Answer 15

a decrease in airway resistance with an improvement in oxygenation

Question 16

Epinephrine - Low Doses 10 mcg/min:

The peripheral vasculature promotes the redistribution of blood flow to skeletal muscle, thus producing

Answer 16

a decrease in SVR

Question 17

As epinephrine doses increase, alpha effects

Answer 17

predominates

-resulting in vasoconstriction and increased SVR

Question 18

increasing epi doses do what do SBP, DBP and Pulse Pressure

Answer 18

• SBP increases
• DBP remains relatively unchanged
• Pulse Pressure increasesq

Question 19

(in regards to Epi) If coronary arteries are not obstructed, autoregulation

Answer 19

increases O2 delivery to meet the increase in demand

Question 20

(in regards to Epi) If coronary arteries are obstructed

Answer 20

O2 delivery may be insufficient to meet demand resulting in myocardial ischemia

Question 21

(Epi) increases in alpha effect also causes what in relation to abdominal organ blood flow and renal blood flow?

Answer 21

• Splanchnic vasoconstriction

- Renal vasoconstriction: Renal vascular resistance and ultimately renal blood flow are decreased

Question 22

Beta stimulation (with epi) leads to activation of: (think kidneys)

Answer 22

the renin-angiotensin system

Question 23

Beta Stimulation (with epi) increases what metabolic effects?

Answer 23

1. lipolysis
2. glycogenolysis
3. gluconeogensesis
4. ketone production
5. lactate release by skeletal muscle

Question 24

alpha or beta stimulation effect:

Splanchnic vasoconstriction

Answer 24

alpha

Question 25

alpha or beta stimulation effect: renin-angiotensin system

Answer 25

beta

Question 26

alpha or beta stimulation effect: lipolysis

Answer 26

beta

Question 27

alpha or beta stimulation effect: gluconeogensesis

Answer 27

beta

Question 28

alpha or beta stimulation effect: renal vasoconstriction

Answer 28

alpha

Question 29

alpha or beta stimulation effect: keytone production

Answer 29

beta

Question 30

alpha or beta stimulation effect: lactate release

Answer 30

beta

Question 31

With epi, what receptor is stimulated to cause a decrease in insulin?

Answer 31

Beta 2 stimulation

Question 32

Epinephrine induced beta 2 stimulation can cause a transient :

Answer 32

hyperkalemia as potassium follows glucose out of the hepatic cells

Question 33

Epinephrine induced beta 2 stimulation also causes a longer ____. Why?

Answer 33

hypokalemia b/c beta 2 stimulation forces K (extracellular) into the RBC

Question 34

What is a: - Potent vasopressor - Not as potent as epi in stimulating alpha receptors in equal doses - Has little Beta 2 activity at low doses - Has for the most part unopposed alpha stimulation - Chronotropic activity seen with Beta 1 stimulation is generally absent in low doses - This is because of increase in SVR which includes reflex vagal activity

Answer 34

Norepinephrine

Question 35

Norepi's adrenergic stimulation results in a decrease in

Answer 35

vital organ blood flow

Question 36

Coronary artery perfusion (with norepi) may be:

Answer 36

increased -b/c of the increase in DBP

Question 37

Increased renal vascular resistance (with Norepi) may cause:

Answer 37

UOP to fall

Question 38

due to norepi's vasoconstriction properties, preload may

Answer 38

increase

Question 39

Norepi is first line therapy for:

Answer 39

shock (as is dopamine)

Question 40

Norepi is generally used in patient with adequate:

Answer 40

Cardiac Output but low SVR

Question 41

Norepi may exacerbate what issues even though BP is adequate? What is the cause of this?

Answer 41

- Tissue perfusion oxygenation issues | - by intense peripheral vasoconstriction

Question 42

What might we see norepi do to insulin production?

Answer 42

decrease insulin production

Question 43

Metabolic effects of epi and norepi (greater and less)

Answer 43

epi > norepi

Question 44

Endogenous central and peripheral neurotransmitter

Answer 44

Dopamine

Question 45

is derived from dopa in the chain of catecholamine synthesis

Answer 45

Dopamine

Question 46

Dopamine Dose that dependently stimulates Dopamine receptors:

Answer 46

2 mcg/kg/min

Question 47

Dopamine Dose that dependently stimulates Beta receptors:

Answer 47

2-5 mcg/kg/min

Question 48

Dopamine Dose that dependently stimulates Alpha receptors:

Answer 48

10mcg/kg/min and above

Question 49

Dopamine also has indirect sympathomimetic effect eliciting the release of

Answer 49

norepinephrine via Beta-1 stimulation

Question 50

Dopamine has an indirect or direct sympathomimetic effect eliciting the release of norepinephrine?

Answer 50

indirect

Question 51

What receptor does dopamine stimulate to elicit norepi release?

Answer 51

beta-1

Question 52

Dopamine is often first chose for patients in:

Answer 52

shock

Question 53

Dopamine also inhibits what mineralcorticoidsteroid? Resulting in an increase in:

Answer 53

inhibits: aldosterone an increase in: sodium excretion and UOP

Question 54

Dopamine has been implicated in limb ischemia in: (patient population, patients with certain diseases)

Answer 54

- Pediatric patients - vascular diseases: DM, Atherosclerosis, Raynaud's - Art-line in affected limb also increases incidence of limb ischemia w/concurrent dopamine gtt

Question 55

Isoproterenol - MOA information

Answer 55

- synthetic catecholamine | - Potent non-selective agonist of B1 and B2 receptors

Question 56

Has no agonist activity at alpha or dopamine receptors:

Answer 56

isoproterenol (and also dobutamine)

Question 57

Uses of Isoproterenol:

Answer 57

- Brady w/HB - Torsades VT - after Heart transplant for chronotropic support (B2 stimulation) *limited use since dobutamine and milrinone emergence