10a - Vasopressors Flashcards
(39 cards)
Vasopressors
What are they and what are they primarily used for?
- Drugs that cause constriction of arterial walls
- Used to increase MAP due to vascular issues (ex: increased vascular permeability or vasodilation)
What are the 5 drugs to focus on?
- Epinephrine
- Norepinephrine
- Phenylephrine
- Dopamine
- Alpha1 Vasopressors
Reminder Question
What do a1, a2, b1, and b2 receptors do?
- a1: Vasoconstriction
- a2: Vasodilation
- b1: HR Increases
- b2: Bronchodilation
Look at the back and remember the wheel
Drug: Adrenalin (Epinephrine)
What are the effects from this drug?
- Vasoconstriction (a1)
- Increased HR (b1)
- Slight vasodilation (B2) but overlooked b/c effects so small.
In the end, MAP increases (Increase SVR + Increase HR + Increase SV)
Adrenalin (Epinephrine)
What are ideal situations for it?
- Wanting one drug to work on heart + vasculature
- Decreased vascular tone isnt the only issue
- Want drug to work on pulmonary + cardiovascular system
Adrenalin (Epinephrine)
When is this drug not ideal?
When you only want to increase vascular tone
Adrenalin (Epinephrine)
How often is this given when performing CPR?
every 3-5 minutes
Levophed (Norepinephrine)
What are its effects?
- A1 specific (more vs epinephrine)
- Better to use if you want to vasoconstrict
Levophed (Norepinephrine)
What is it used to treat?
- Septic shock
- Given as IV fusion, but ideally should be given via central line.
Levophed (Norepinephrine)
In addition to giving levophed, what do you need to give with it?
Fluid, so it can get into the pipes.
Levophed (Norepinephrine)
What do you think could happen if Levophed was given to someone who has low intravascular
volume and is already peripherally shut down?
- Vessels would squeeze so much that we cut off perfusion to any periphreal areas.
- Important to replace volume in order for it to work.
Phenylephrine
What does it do?
- Pure a1 activation –> Increased MAP
- If not enough fluid, pipes squeeze so tignt that organs receive little blood.
Dopamine
What does it do?
Recall: Depends on the dose
- 1-10 mcg/kg/min = B1 effects
- 10mcg/kg/min or more = A1 + B1 effects
Added onto norepinephrine or epinephrine if needed
Dopamine
Why is it used less?
- Less effective vs levophed in treating distributive shock (sepsis)
- Has more cardiac side effects at doses needed for vasoconstricting effects
- Increases myocardial O2 demand at higher doses b/c of tachycardia.
Pitressin (Vasopressin)
What is it and why is it secreted?
- A naturally occuring anti-diuretic hormone
- Secreted to increase H2O absorption + Improve MAP
Pitressin (Vasopressin)
When is it recommended to be used?
When delivering Levophed during septic shock, as an add on.
Low Intravascular Volume
What happens if there is no fluid?
- There is NO PRESSURE in the pipes
- Ex: Excessive bleeding (hypovolemic shock)
For Low Intravascular Volume, what is the problem with distributive shock?
The pipes. They are vasodilated + permeable.
- This means that pipes are Bigger + Leaking
Sepsis
What is it?
- Body’s toxic response to infection
- Leading cause of death in US hospitals
Sepsis
What are the 6 symptoms?
- Shivering, fever, or cold
- Extreme pain or discomfort
- Clammy ow sweaty skin
- Confusion or disorientation
- Shortness of Breath
- High HR
Types of Medical Fluids
What are the 3 main categories?
- Crystalloids
- Colloids
- Blood and Blood Products
#1: Crystalloids
What are they?
- Fluids given to maintain + Replace intravascular volume
#1: Crystalloids
What are the 3 types of crystalloids?
- 0.9% Normal Saline
- Ringer’s Lactate (RL)
- PlasmaLyte
