Cardiac uppers

Question 1

What generic PK’s and PDs can we say about phosphodiasterase inhibitors?

Answer 1

A: 100
B: Vd around 0.5 L and PB around 70%
M: heapatic
E: renal

PD:
Inotropes for low CO states
Inodilators
Increase all heart but not O2 consumption, can precipitate arrhythmias
Reduce SVR

Headache

Question 2

What generic things can we say for calcium channel sensitisers like Levosemendan?

Answer 2

Same as for phosphodiasterase, but higher pb

Use for acute decompensated HF

CI in severe hepatic/renal, ventricular outflow obstruction and history of TDP

Question 3

What do the different adrenergic receptors do?

Answer 3

A1: vasoconstriction and closed bladder sphincters
A2: inhibits NA, insulin and ACh release

B1: increased HR, contractility, lipolysis and renin
B2: vasodilation, bronchodilation, increased glucagon and glyconeogenesis. Relaxes uterine smooth muscle. Hypokalaemia

Question 4

What are the alpha 1 agonists?

And some quick points about each

Answer 4

Phenylepherine (nasal decongestant, hepatic by MAO, unknown E)
Metaraminol (little bit of beta, 1-2 min lasts 20-60, increased RR and Tv, decreased uterine blood flow but increased contractions)

Can all cause reflex Brady

Question 5

What is the metabolism of adrenaline?

Answer 5

Hepatic mao to inactive

Question 6

How is NA metabolised?

Answer 6

MAO and COMT in liver

Question 7

What do both adrenaline and norad do to organ blood flow?

Answer 7

Reduced sphlanchnic and renal

Question 8

What can we say about the volumes of distribution of all the inotropes?

Answer 8

All small, around 0.5

Question 9

Tell us about ephedrine?

Answer 9

Alpha and beta agonist with indirect and direct action used for hypotension, nasal de congestion and nocturnal enuresis

Physical:
Tablets, basal drops and CCS IV

PK:
A: we’ll absorbed by all
D: under 0.5
M: minimal hepatic
E: 65% renally unchanged

PD:
MAO: above

Caution with MAO’s
Tachyphylaxis

Question 10

Tell me about dopamine?

Answer 10

Inotrope and diuretic working on D1 and D2

Physical:
- CCS
- cupboard
1-20 mcg/kg/min

COMT metabolism to inactive then renal

Low doses = reduced renal resistance therefore increased flow

Higher doses = alpha and beta

N&V from CTZ

Question 11

What receptors does dopexamine do?

Any special things to remember?

Answer 11

B2, D1 and 2

Renal and poo excretion