Hemodynamic Drugs

Question 1

What do beta 1 receptors do?

Answer 1

Cardio acceleration
Increase contractile they
Lipgloss

Question 2

What do beta 2 receptors do?

Answer 2

Vasodilation
Bronchodilator
Increased glycolysis
Uterine relaxation

Question 3

What receptors does dobutamine act on?

Answer 3

Beta 1>beta 2

Question 4

What happens to systemic vascular resistance when you use dobutamine?

Answer 4

It decreases due to weak beta 2 activity

Question 5

What happens to cardiac output when you use dobutamine?

Answer 5

Increases

Question 6

What condition is dobutamine used for?

Answer 6

Myocardial depression after septic shock

Question 7

What is the infusion rate of dobutamine?

Answer 7

3-5 micrograms/kg/min

Increase in increments of 3-5 micrograms/kg/min

Question 8

In what heart condition is dobutamine contraindicated?

Answer 8

Hypertrophic cardiomyopathy

Question 9

What receptors does dopamine act on in moderate dose?

Answer 9

Beta 1 and 2

Question 10

What receptors does dopamine act on in high doses?

Answer 10

Alpha and beta 1/2

Question 11

What is the low infusion rates of dopamine?

Answer 11

3 micrograms/kg/min

Question 12

Which organ circulations does dopamine act on at low rates?

Answer 12

Renal and splanchnic

Question 13

What is the effect of low infusion dopamine on renal and splanchnic circulation?

Answer 13

Increased sodium excretion

Increases blood flor to these regions

Question 14

What organs are affected with moderate infusion of dopamine?

Answer 14

Beta 1 in the heart and beta 2 in the periphery causing increase heart rate and contractility with vasodilation

Question 15

What is a moderate infusion rate of dopamine?

Answer 15

3-10 micrograms/kg/min

Question 16

What is a high dopamine infusion rate?

Answer 16

Greater than 10

Question 17

What are the effects of a high dopamine rate?

Answer 17

Alpha - vasoconstriction

Question 18

Why does dopamine have to be administered into a large central vein?

Answer 18

Because extravasation from a peripheral vessel cause extensive tissue necrosis

Question 19

What are the adverse effects of dopamine?

Answer 19

1. Sinus tachycardia and afib (25%) of patients
2. Increased intraocular pressure
3. Splanchnic hypoperfusion
4. Delayed gastric emptying

Question 20

What drug should you inject if you get extravasation of a vasoconstrictor?

Answer 20

Phentolamine - alpha antagonist

Question 21

What organ releases epinephrine?

Answer 21

Adrenal medulla

Question 22

What drug is a more potent beta 1 agonist than dopamine?

Answer 22

Epinephrine

Question 23

What receptors does epinephrine act on?

Answer 23

All of them

Question 24

What is epinephrine used for?

Answer 24

Cardiac arrest

Postop cabg

Question 25

What is the infusion of epinephrine started at?

Answer 25

1-2 micrograms/kg/min

Question 26

What is the usual dose range for epinephrine for augmenting cardiac output or correcting hypotension?

Answer 26

5-15 micrograms/kg/min

Question 27

What are the other effects of epinephrine?

Answer 27

1. Hyperglycemia 2. Increased metabolic rate 3. Splanchnic vasoconstriction 4. Increased lactate (because increases the rate of glycolysis thru beta 2 effects)

Question 28

What is the preferred drug for septic shock and why?

Answer 28

Norepinephrine because it has fewer side effects than dopamine or epinephrine

Question 29

What are norepinephrine infusions usually started at?

Answer 29

8-10 micrograms/min

Question 30

What receptors does norepinephrine work on?

Answer 30

``` Alpha 1 Beta 1 (weak) ```

Question 31

What are the effects of using norepinephrine in a patient with septic shock?

Answer 31

Increased renal and splanchnic blood flow (paradoxical)

Question 32

What phenylephrine cause?

Answer 32

Systemic vasoconstriction with reflex bradycardia

Question 33

What is the principal use of phenylephrine?

Answer 33

Reversal of severe hypotension produced by spinal anesthesia

Question 34

How much phenylephrine do you initially give someone?

Answer 34

0.2 mg

Question 35

What is the max dose of phenylephrine?

Answer 35

0.5 mg

Question 36

What does vasopressin do?

Answer 36

V1 - causes vasoconstriction in the skin, skeletal muscle and splanchnics V2 - increases water resorption in the distal renal tubules V3 - causes ACTH release by anterior pituitary

Question 37

What is vasopressin used in?

Answer 37

In cardiac arrest (40 units) Septic shock that is refractory to norepinephrine or dopamine to raise bp and reduce the catecholamine requirement In cases of hemorrhagic get varices to promote splanchnic constriction

Question 38

What is the half life of vasopressin?

Answer 38

5-20 minutes

Question 39

What is the infusion rat of vasopressin?

Answer 39

0.03 units/he

Question 40

What is terlipressin?

Answer 40

Vasopressin analogue that is V1 receptor selective and has a longer duration of action

Question 41

What is the duration of action of terlipressin?

Answer 41

5 hours

Question 42

What is the danger of terlipressin?

Answer 42

Splanchnic ischemia

Question 43

What does nitroglycerin do?

Answer 43

Binds to the surface of endothelial cells and releases inorganic nitrite which is converted to NO which promotes cGMP and cause muscle relaxation - venodilation at lower infusion rates It also inhibits platelet aggregation

Question 44

Why does nitroglycerin have to be in a glass bottle of PET tubing?

Answer 44

Because it binds to polyvinylchloride plastics

Question 45

What is the initial infusion rate of nitroglycerin?

Answer 45

5-10 micrograms/min

Question 46

What are the adverse effects of nitroglycerin?

Answer 46

Right heart infarction Increased cerebral blood flow --> increased ICP Increased pulmonary blood flow --> physiologic shunt Methemoglobinemia Solvent toxicity

Question 47

What solvents must be used to keep nitroglycerin dissolved?

Answer 47

Ethanol | Propylene glycol

Question 48

How can you prevent nitrate tolerance?

Answer 48

6 hours a day drug free

Question 49

How does nitroprusside work?

Answer 49

It releases NO when it enters the blood

Question 50

What is nitroprusside better at?

Answer 50

Arterial dilation

Question 51

What is nitroprusside used for?

Answer 51

Hypertensive emergency | Decompensated heart failure

Question 52

How is cyanide cleared from the body?

Answer 52

Thiosulfate gives a sulfur group to cyanide and then this thiocyanate is cleared by the kidneys Cyanide binds to the oxidized iron in methemoglobin

Question 53

How much thiosulfate should be given for 50 mg of nitroprusside?

Answer 53

500 mg

Question 54

What is the first sign of cyanide toxicity in nitroprusside infusion?

Answer 54

Increasing nitroprusside requirement

Question 55

What are the signs of thiocyanate toxicity?

Answer 55

Anxiety, confusion, seizure, miosis, tinnitus, hallucinations, hypothyroidism

Question 56

What is the diagnostic level for thiocyanate toxicity?

Answer 56

Above 100

Question 57

What is the treatment for thiocyanate toxicity?

Answer 57

Dialysis

Question 58

What do alpha receptors do?

Answer 58

1. Vasoconstriction 2. Iris dilatation 3. Piloerection

Question 59

What does dopamine do to TSH?

Answer 59

Inhibits its release from the pituitary

Question 60

What does dopamine do to T cell function?

Answer 60

Inhibits their function

Question 61

What is the MOA of methylene blue?

Answer 61

Inhibits nitric oxide synthase and cGMP counteracting refractory hypotension from vasoplegia from endothelial dysfunction