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Anesthesia Pharmacology > Sympathomimetics > Flashcards

Sympathomimetics Flashcards

1
Q

Phenylephrine (Neosynephrine)
MOA
&
Receptors

A

Direct agonist to α1 adrenergic receptors - GCPRs

Primarily only effects venous & arterial vasoconstriction

Indirectly evokes release of NE from postganglionic sympathetic nerve endings

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2
Q

Phenylephrine (Neosynephrine)
Indications
&
CV Effects

A

Hypotension;
Useful in CAD & aortic stenosis

Intense vasoconstriction (venous/arterial) may cause reflex bradycardia

α1 - ↑↑↑
β1 - N/A
β2 - N/A
CO - ↓
HR - ↓
SVR - ↑↑↑

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3
Q

Phenylephrine (Neosynephrine)
Dosing

A

IV: 50-100 mcg
Q 1 min

Infusion:
40-200 mcg/min
Typical: 100 mcg/min

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4
Q

Phenylephrine (Neosynephrine)
Onset
Duration
1/2 Time

A

Onset
Rapid
Duration
1 min
1/2 Time
2.5 hrs

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5
Q

Phenylephrine (Neosynephrine)
Side Effects
&
Considerations

A

Transient HTN; Reflex bradycardia

No significant prolongation of LAs
Used to counteract SNS depression of
inhaled VA & injected Anesthetics

Preferred sympathomimetic for pregnancy hypotension associated w/ SAB;
no effect on uterine blood flow

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6
Q

Ephedrine (Akovaz & Corphedra)
MOA
&
Receptors

A

Indirect: Evokes release of NE from postganglionic sympathetic nerve endings Released NE agonizes α1 adrenergic receptors
- GCPRs

Arteriole vasoconstriction & agonizes
β1 receptors which ↑ cAMP production,
↑ intracellular Ca++; enables intense actin/myosin cross bridging
↑ inotropy

α1 effects > β effects;

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7
Q

Ephedrine (Akovaz & Corphedra)
Indications
&
Effects

A

Hypotension;
Bradycardia;
Bronchoconstriction

BP response less intense than EPI/Neo
however, duration is 10X longer than EPI

Ephedrine DOC if NOT β blocked

α1 - ↑↑
β1 - ↑
β2 - ↑
CO - ↑↑
HR - ↑↑
SVR - ↑

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8
Q

Ephedrine (Akovaz & Corphedra)
Dosing

A

IV: 5-10 mg;
Tachyphylaxis after 2-3 doses
IM: 50 mg

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9
Q

Ephedrine (Akovaz & Corphedra)
Onset
Duration
1/2 Time

A

Onset
Rapid
Duration
60 min
1/2 Time
5 hrs

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10
Q

Ephedrine (Akovaz & Corphedra)
Side Effects
&
Considerations

A

↑HR; transient HTN; does not cause hyperglycemia
Concurrent MAOI use can prolong effects

Agonizes respiratory
β2 adrenergic receptors causes bronchiole smooth muscle dilation/relaxation

No significant prolongation of LAs
Used to counteract SNS depression of inhaled VA & injected anesthetics

No longer preferred sympathomimetic for pregnancy hypotension associated w/ SAB;
can cause fetal acidosis; no effect on uterine blood flow

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11
Q

Vasopressin (ADH & Arginine Vasopressin)
MOA
&
Receptors

A

AVP binds to V1 receptors on vascular smooth muscle to cause vasoconstriction thru the IP3 signal transduction pathway & Rho-kinase pathway resulting in ↑ arterial pressure

Activates V2 receptors in renal collecting tubule to ↑ H2O reabsorption

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12
Q

Vasopressin (ADH & Arginine Vasopressin)
Indications
&
Effects

A

Hypotension; Hypovolemia

Especially effective in ACE-I
induced hypotension

α1 - N/A
β1 - N/A
β2 - N/A
V1 - ↑↑
CO - ↑↑
HR - ↓
SVR - ↑↑

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13
Q

Vasopressin (ADH & Arginine Vasopressin)
Dosing

A

IV: 1-2 units

Infusion:
0.01-0.04 units/min

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14
Q

Vasopressin (ADH & Arginine Vasopressin)
Onset
Duration
1/2 Time

A

Onset
Rapid; peaks in 15 min
Duration
20 min
1/2 Time
10-20 min

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15
Q

Vasopressin (ADH & Arginine Vasopressin)
Side Effects
&
Considerations

A

Possible coronary artery vasoconstriction w/ high doses; Stimulates GI smooth muscles; abd pain & N/V; ↓ PLT count & AB formation

Maintenance of hemodynamics;
may ↓ effectiveness of sedation d/t ↑ metabolic activity & CO

Significant prolongation of LAs activity;
Used to counteract SNS depression of
inhaled VA & injected anesthetics

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16
Q

Epinephrine (Adrenaline)
MOA
&
Receptors

A

Endogenous “prototype” catecholamine:
Direct agonists to α1 β1 β2
adrenergic receptors -
GCPRs

β effects > α1 effects

↑ cAMP production, ↑ intracellular Ca++; enables intense actin/myosin cross-bridging ↑ inotropy

17
Q

Epinephrine (Adrenaline)
Indications
&
Effects

A

Hypotension;
Cardiogenic shock;
ACLS;
Anaphylaxis

α1 - ↑
β1 - ↑↑
β2 - ↑↑
CO - ↑↑↑
HR - ↑↑↑
SVR - ↑/↓

18
Q

Epinephrine (Adrenaline)
Dosing

A

IV: 2-8 mcg

Anaphylaxis: 10-20 mcg

Infusion:
1-2 mcg/min - β2
4 mcg/min - β1
10 -20 mcg/min - α1

19
Q

Epinephrine (Adrenaline)
Onset
Duration
1/2 Time

A

Onset
Rapid
Duration
1-5 min
1/2 Time
<5 min

20
Q

Epinephrine (Adrenaline)
Side Effects
&
Considerations

A

↑HR; transient HTN;
hyperglycemia;
metabolic acidosis

Agonizes respiratory β2 adrenergic receptors causes bronchiole smooth muscle dilation/relaxation

Maintenance of hemodynamics;
may ↓ effectiveness of sedation d/t ↑ metabolic activity & CO
Significant prolongation of LAs activity;
Used to counteract SNS depression of
inhaled VA & injected anesthetics

21
Q

Norepinephrine (Levophed)
MOA
&
Receptors

A

Endogenous catecholamine: Direct agonists to α1, β1 adrenergic receptors -GCPRs

↑ cAMP production, ↑ intracellular Ca++; enables intense actin/myosin cross-bridging ↑ inotropy

22
Q

Norepinephrine (Levophed)
Indications
&
Effects

A

Hypotension;
Cardiogenic shock;
1st line treatment for sepsis

α1 - ↑↑↑
β1 - ↑
β2 - N/A
CO - ↑↑↑
HR - ↑↑↑
SVR - ↑/↓

23
Q

Norepinephrine (Levophed)
Dosing

A

Infusion:
4-16 mcg/min

NO IVP

24
Q

Norepinephrine (Levophed)
Onset
Duration
1/2 Time

A

Onset
Rapid
Duration
1-2 min
1/2 Time
<5 min

25
Q

Norepinephrine (Levophed)
Side Effects
&
Considerations

A

↑HR; transient HTN

Maintenance of hemodynamics;
may ↓ effectiveness of sedation d/t ↑ metabolic activity & CO
Significant prolongation of LAs activity;
Used to counteract SNS depression of
inhaled VA & injected anesthetics

26
Q

Dopamine (Intropin, Dopastat, Revimine)
MOA
&
Receptors

A

D1/D2
↑ renal & splanchnic vascular blood flow

Direct agonist to β1

Direct agonist to α1 adrenergic receptors (GCPRs)

↑ cAMP production, ↑ intracellular Ca++; enables intense actin/myosin cross-bridging ↑ inotropy

27
Q

Dopamine (Intropin, Dopastat, Revimine)
Indications
&
Effects

A

Hypotension;
Bradycardia

α1 - ↑↑
β1 - ↑
β2 - N/A
D1/D2 - ↑↑
CO - ↑
HR - ↑
SVR - ↑↑

28
Q

Dopamine (Intropin, Dopastat, Revimine)
Dosing

A

Infusion:
0.5-3 mg/kg/min - D1/D2
3-10 mg/kg/min - β1
> 10 mg/kg/min - α1

NO IVP

29
Q

Dopamine (Intropin, Dopastat, Revimine)
Onset
Duration
1/2 Time

A

Onset
5 min
Duration
<10 min
1/2 Time
1-2 min

30
Q

Dopamine (Intropin, Dopastat, Revimine)
Side Effects
&
Considerations

A

Tachyarrhythmias; transient HTN

Maintenance of hemodynamics;
may ↓ effectiveness of sedation d/t ↑ metabolic activity & CO
Significant prolongation of LAs activity;
Used to counteract SNS depression of
inhaled VA & injected anesthetics

Anesthesia Pharmacology (16 decks)

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