Endogenous & Synthetic Catecholamines Flashcards by William Klemczuk

Epinephrine: Class

Endogenous Catecholamine
Adrenergic Agonist

How well did you know this?

Not at all

Perfectly

Epinephrine: Use

Cardiac Arrest
Hypotension
Allergic Reaction
mixed with Local Anesthetics

How well did you know this?

Not at all

Perfectly

Epinephrine: Mechanism of Action

Agonist of Beta 1, Beta 2, Alpha 1 and Alpha 2 receptors

-> Increases cAMP -> Increasing Calcium

Increases BP, CO, Bronchial relaxation, stabilizes mast cells

How well did you know this?

Not at all

Perfectly

Epinephrine: Dose

Cardiac Arrest: 1 mg

Anaphylaxis: 100-500 mcg

Infusion: 2-20 mcg/min

LA Mix: 1 : 200,000 (5mcg/mL)

How well did you know this?

Not at all

Perfectly

Epinephrine: Pharmacokinetics

Absorption: IV, IM, Inhalation

Onset: 1 minute
Duration of Action: 5 minutes

Metabolism: MAO, COMT

Elimination: Renal

How well did you know this?

Not at all

Perfectly

Epinephrine: Contraindications

AVOID in peripheral nerve blocks

Caution in:
CAD
Hyperthyroidism
Pheochromocytoma

How well did you know this?

Not at all

Perfectly

Epinephrine: Considerations

Tachycardia
Arrythmias
Angina
HTN
Decrease perfusion to splanchnic organs/uterus
gangrene in digits

How well did you know this?

Not at all

Perfectly

Norepinephrine: Class

Endogenous Catecholamine
Adrenergic agonist

How well did you know this?

Not at all

Perfectly

Norepinephrine: Use

Treatment of Hypotension

How well did you know this?

Not at all

Perfectly

Norepinephrine: Mechanism of Action

Agonist of Alpha 1, Alpha 2, and weakly Beta 1 receptors

-> Increases cAMP -> Increases Calcium

Results in increased BP

How well did you know this?

Not at all

Perfectly

Norepinephrine: Dose

1-20 mcg/min

How well did you know this?

Not at all

Perfectly

Norepinephrine: Pharmacokinetics

Absorption: IV

Onset: 1 minute
Duration of Action: 2 minutes

Metabolism: MAO, COMT

Elimination: Renally

How well did you know this?

Not at all

Perfectly

Norepinephrine: Contraindications

Avoid in Peripheral nerve blocks
Caution with:
Hyperthyroidism
Pheochromocytoma

How well did you know this?

Not at all

Perfectly

Norepinephrine: Considerations

May cause Bradycardia (Baroreceptor reflex)
HTN
Profound decrease in perfusion to splanchnic organs and uterus
Prefer Central access d/t extravasation

How well did you know this?

Not at all

Perfectly

Ephedrine: Class

Synthetic Catecholamine

How well did you know this?

Not at all

Perfectly

Ephedrine: Use

Treatment of Hypotension WITH bradycardia
With GA/Spinal blockade to treat hypotension/bradycardia

How well did you know this?

Not at all

Perfectly

Ephedrine: Mechanism of Action

Stimulates both Alpha and Beta Receptors directly

Indirectly causes release of endogenous catecholamines

Both Central and peripheral actions

How well did you know this?

Not at all

Perfectly

Ephedrine: Dose

5 mg Bolus

How well did you know this?

Not at all

Perfectly

Ephedrine: Pharmacokinetics

Absorption: IV, IM

Onset: 1 minute
Duration of Action: 10-60 minutes

Metabolism: into Norephedrine

Elimination: Renal

How well did you know this?

Not at all

Perfectly

Ephedrine: Contraindications

Patient taking MAOIs, TCAs, COCAINE

How well did you know this?

Not at all

Perfectly

Ephedrine: Considerations

Long 1/2 life
Subsequent doses need to be increased
Caution with:
CAD
Tachycardia
HTN

How well did you know this?

Not at all

Perfectly

Phenylephrine: Class

Alpha 1 adrenergic agonist

How well did you know this?

Not at all

Perfectly

Phenylephrine: Use

Treatment of Hypotension

How well did you know this?

Not at all

Perfectly

Phenylephrine: Mechanism of Action

Agonist of Alpha1 receptor

-> cAMP -> Calcium levels

Results in constriction of smooth muscle around vasculature = Increased BP

How well did you know this?

Not at all

Perfectly

Phenylephrine: Dose Infusion + Bolus

Small Boluses: 40 - 80 mcg Infusion: 20 - 50 mcg/min

Phenylephrine: Pharmacokinetics

Absorption: IV, Intranasal, Occular Onset: 1 minute Duration of Action: 15 minutes Metabolism: MAO Elimination: Renal

Phenylephrine: Contraindications

Caution in patients with BRADYcardia Hyperthyroidism Pheochromocytoma

Phenylephrine: Considerations

Can cause reflex bradycardia from vagus nerve leading to reduced cardiac output *Best for Hypotension with Normal HR* Can be given to prevent nose bleeds

Dobutamine: Class

Synthetic Catecholamine, selective Beta1 adrenergic agonist

Dobutamine: Use

Chemical Stress Test Increase Cardiac Output (In sepsis, cardiogenic shock)

Dobutamine: Mechanism of Action

Acts on Beta1 to increase cAMP causing Increase in Calcium levels = Increase in Contractility and Cardiac Output

Dobutamine: Dose

2 - 20 mcg/kg/min

Dobutamine: Pharmacokinetics

Absorption: IV Onset: 1 minute Duration of Action: 10 minutes Metabolism: MAO, COMT Elimination: Renal

Dobutamine: Contraindications

Tachycardia CAD Hypertrophic Cardiomyopathy

Dobutamine: Considerations

Increases HR Decreases SVR Inhibits PLTs

Dopamine: Class

Endogenous nonselective adrenergic and dopaminergic agonist

Dopamine: Use

Increase BP and HR

Dopamine: Mechanism of Action

Stimulates Dopamine receptors, Beta and Alpha receptors in a dose dependent manner

Dopamine: Dose

Dopamine receptors: 2 mcg/kg/min Beta receptors: 2 - 5 mcg/kg/min Alpha receptors: >10 mcg/kg/min

Dopamine: Pharmacokinetics

Absorption: IV Onset: 2 minutes Duration of Action: 10 minutes Metabolism: MAO and COMT **25% metabolism into Norepinephrine** Excretion: Renal

Dopamine: Contraindications

Hypernatremia Pt taking MAOI, TCAs Tachycardia/arrythmias

Dopamine: Considerations

Active metabolite: Norepinephrine Increases urine output and Na levels Risk for extravasation

Vasopressin: Class

Exogenous antidiuretic peptide & vasopressor

Vasopressin: Use

Septic Shock ACE inhibitor related hypotension

Vasopressin: Mechanism of Action

Stimulates V1 receptors on vascular smooth muscle, glomerular mesangial cells and vasa recta ADH (activates V2 receptors)

Vasopressin: Dose Infusion +Bolus

Bolus: 1 unit Infusion: 0.01- 0.08 units/min

Vasopressin: Pharmacokinetics

Absorption: IV Onset: 1 minute Duration of Action: 10 minutes Metabolism: Tissue peptidase Elimination: Renal

Vasopressin: Contraindications

Hypersensitivity

Vasopressin: Considerations

Gastrointestinal ischemia Decreased Cardiac Output Skin/Digit necrosis Cardiac Arrest

Milrinone: Class

Phosphodiesterase 3 Inhibitor

Milrinone: Use

Cardiogenic shock Right sided Heart Failure Inotropy in the setting of Beta Blockade

Milrinone: Mechanism of Action

Inhibits PDE (usually breaks down cAMP and cGMP) More cAMP and cGMP in myocardium and smooth muscle Myocardium: More cAMP -> Increase in Calcium levels = Increased Contractility Smooth Muscle: More cGMP causes vasodilation = lowering PVR

Milrinone: Dose

Loading Dose: 50 mcg/kg over 10 minutes Infusion: 0.375- 0.75 mcg/kg/min

Milrinone: Pharmacokinetics

Absorption: IV Onset: 5 minutes Duration of Action: 6 hours Metabolism: Hepatic Elimination: Renal

Milrinone: Contraindications

Hypotension Renal Failure

Milrinone: Considerations

Arrythmias

Albuterol: Class

Selective Beta2 Agonist

Albuterol: Use

Bronchodilation

Albuterol: Mechanism of Action

Acts directly on Beta 2 receptors activates adenylyl cyclase which increases cAMP and decreases Calcium causing smooth muscle relaxation and bronchodilation

Albuterol: Dose

90 mcg / puff

Albuterol: Pharmacokinetics

Absorption: Inhalation Onset: 5 minutes Duration of Action: 4 hours Metabolism: MAO Elimination: Renal

Albuterol: Contraindications

Allergy

Albuterol: Considerations

Tremors Tachycardia Hypokalemia