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Flashcards in Autonomic Physio And Pharm Deck (54):
0

Beta 1 Heart Effect

Increase rate/force of contraction

1

Alpha 1 blood vessel effect, major site

Arteries- vasoconstrict

2

Beta 2 blood vessel effect, major site

Skeletal muscle, vasodilation

3

Alpha 2 major blood vessel effect, site

Veins, vasoconstrict

4

Beta 2 bronchial tree effect

Bronchodilate

5

Alpha 1 eye effect

Mydriasis

6

Beta 1 kidney effect

Renin secretion

7

Alpha 2 pancreas effect

Decrease insulin release

8

Beta 1 major targets

Heart, eye, kidney

9

Beta 2 major targets

Skeletal muscle vasculature, bronchial tree

10

Alpha 1 major targets

Arteries, gI, eye, sweat/salivary

11

Alpha 2 major targets

Veins, gI tract pancreas

12

Dopamine effects

1. + MAP, HR, SVR, dysthymia
2. +++ CO, renal blood flow

13

Prep and IV dose of dopamine

Prep- 200mg/250ml (800 ug/mL)

Dose- 2-20 ug/kg/min

14

Norepinephrine effects

1. + cardiac dysthymia
2. +++ MAP, SVR
3. - HR, CO
4. --- renal blood flow

15

Norepinephrine prep and IV dose

Prep- 4mg/250ml (16ug/ml)

Dose - 0.01-0.1 ug/kg/min

16

Epinephrine effects

1. + MAP
2. ++ HR, CO, SVR
3. +++ cardiac dysthymia
4. -- renal blood flow

17

Epinephrine prep and IV dosage

Prep- 1mg/250ml (4ug/ml)

Dose- .03-0.15 ug/kg/min

18

Isoproterenol effects

IsoP effects 1-B

1. +++ HR, CO
2. - MAP, renal blood flow
3.-- SVR

19

Isoproternol preparation and IV dosage

Prep- 1mg/250ml (4ug/ml)

Dose - 0.03-0.15 ug/kg/min

Same as epi

20

Dobutamine effects

1. + MAP, HR
2. ++ renal blood flow
3. +++ CO
4. - SVR, dysthymia

21

Dobutamine preparation and IV dosage

250mg/ml (800ug/ml)

Dose 2-20ug/kg/ml

Same as dopamine

22

Norepinephrine half life, typical infusion rate

2.5 min

3ug/min, titrate to effect (recall: typical dosage is 0.01-0.1 ug/kg/min)

23

Pitfall of norepinephrine infusions

decreased organ blood flow (Pulm, renal, med enteric) and limb ischemia

24

Epi dose in cardiovascular collapse, a systole, v fib, anaphylaxis

1 mg IV

25

Epi titration curve effects

1-2 ug/min - B2 (decrease airway resistance and vasculature)

2-10ug/min - increase hr, co, and AV conduction

>10ug/min - sognificant vasoconstrict (alpha 1) . Can cause reflex brady

26

Dopamine infusion curve

0.5-2ug/kg/min - mostlyD1 effects (splanch) decrease BP

2-10ug/kg/min- B1 receptors ( increase CO)

>10ug/kg/min - alpha1 (constrict vasc)

27

Ephedrine Effect

Which situation is it best used in

Increase arterial BP
+ ionotropy

Moderate hypotension accompanied by bradycardia (due to B1 stim effects)

28

Typical dose of Ephedrine

2.5-25mg IV

29

Phenylephrine site of effect

alpha 1 agonist, peripheral vasoconstriction in setting of adequate CO--> i.e. neuroaxial anesthesia

30

Typical patient phenylephrine used in

Afterload maintenance in patients with AS and coronary perfusion issues in setting of normal/decreased SVR

31

Half life of phenylephrine

5-10 min, rapid onset

32

Dosing of phenylephrine

Bolus- 40-100ug IV (> 1mg dose = slow SVT via reflex brady)

Infusion- 10-20ug/min

33

Major effect of alpha-2 agonist

sympatholytic

reduce peripheral NE release by stimulation of presynatptic inhib alpha2 receptor

34

Antihypertensive used to treat clonidine withdrawl htn

Labetelol

35

Dexmedetomidine receptor, half life

alpha 2 agonist

half life 2.3 hrs, clinical effect is short though due to distribution half life 5 min

36

Dexmedetomidine dosing

Infusion- 0.3-0.7ug/kg/hr +/- LD 1ug/kg over 10 min

37

Major effect of Dexmedetomidine

Increases sedation, analgesia, and amnesia

Decrease HR, CO, and circulating catecholamine

minimal if any respiratory depression (good for awake fiberoptic intub)

MAC sparing sedative/analgesic effects

38

Major side effects of alpha-1 antagonist

orthostatic hypotension, fluid retention

39

Phenoxybenzamine site of action, and effect

alpha-1 antagonist (some alpha2 effects as well)

decrease PVR, increases CO

40

Most common use for phenoxybenzamine

pre-treatment of pheochromocytoma (chemical sympathectomy preop) = less lability of BP during surgical resection

41

Antidote for phenoxybenzamine OD

norepinephrine (acts on remaining free alpha-1 receptors)

42

Major B-blockers used in anesthesia

labetelol, propranolol, metoprolol, and esmolol

43

Metoprolol dosing

2.5-5mg IV q2-5 min, up to total dose of 15mg IV

Titrate based on HR and BP

44

Labetelol dosing

5-10mg IV q5 min

Infusion- 2mg/min (max)

45

Why may labetelol be useful in post-cardiac surgery pts?

Vasodilation (decrease BP) w/out reflex tachycardia (works on alpha 1 as well as Beta 1)

46

What makes esmolol unique?

hydrolyzed by esterases, short half life of 9-10min

makes useful in anesthesia, critically ill patients,

47

Esmolol timing, dosing

peak 5-10min, diminished 20-30min

Dose- 0.5mg/kg IV bolus

48

Side effects of anticholinergic drugs (muscarinic antagonists)

tachycardia, sedation, dry mouth

49

Which anticholinergic can cross the BBB?

atropine

50

When would you use glycopyrrolate?

to blunt the muscarinic effects (bradycardia, etc) that occur when anticholinesterases (pyridostigmine, neostigmine, etc) are given to reverse neuromuscular blockade

51

Antidote for CNS effects (mentation disorders) from atropine/scopolamine

physostigmine (anticholinesterase that crosses BBB)

52

What are cholinesterase inhibitors (anticholinesterases) used for?

reverse NMJ blockade and treat MG

53

Major side effect of cholinesterase inhibs?

bradycardia