ICU meds Flashcards
(37 cards)
Calcium chloride: hemodynamic effects. 3
- Transient improvement in systolic function
- Increases the SVR and the MAP
- Little effect on HR
Calcium chloride: indications
- Termination of Cardiopulmonary Bypass
- Myocardial function support
- Hyperkalemia
Epinephrine: Hemodynamic Effects
3
- Increases cardiac output by ↑ HR and contractility
- Also has strong B2 properties that produces bronchodilatation
- Higher doses also cause vasoconstriction
Epinephrine: Indications 5
- Low Cardiac Output
- Stimulates sinus node: useful if pacing
- Bronchospasm/Croup
- Anaphylaxis (protamine reaction)
- ACLS (VT/VF, PEA, etc)
Epinephrine: Adverse reactions? 2
Beware of possible 1. hyperglycemia & 2. acidosis with epinephrine
Vasoconstricting Ionotropes? 2
Epi (higher doses)
Levo
Norepinephrine (Levophed): Hemodynamic effects? 2.5
Very powerful catecholamine
1. Alpha: Increases SVR and BP (MAP)
1.5. Beta 1: Increases both contractility and HR
2. Increasing of myocardial oxygen demand (bad)
Levophed: Indications 2
Low cardiac output with low SVR
Levo: concern at higher doses?
Higher doses may cause significant acidosis
Vasodilating Inotropes: 3
Dopamine
Milrinone
Isoproterenol
Dobutamine: hemodynamic effects 4
- Selective beta-1 agonist that increases heart rate and increases contractility (↑HR, ↑CI)
- Mild arterial vasodilatation (↓ SVR)
- Can worsen hypotension - Pulmonary Vasodilatation (↓ PCW)
- Increases myocardial oxygen demand, inducing or worsening ischemia (bad)
Dobutamine indications 2
- Low Cardiac Output & elevated SVR
- Right heart failure
Why is dobutamine good for Right HF? 2
- Improves RV function & ↓ pulmonary artery afterload
Milrinone: Hemodynamic effects 5
- Inhibits phosphodiesterase (PDE) III
- ↑ myocardial contraction & heart rate (↑HR, ↑CI)
- ↓ systemic vascular resistance (↓SVR)
- ↓ pulmonary vascular resistance (↓PVR)
- Reduces myocardial oxygen demand (good)
Milrinone indications 4
- Low Cardiac Output (2nd line agent)
- Right Heart Failure with elevated PVR
- Significant diastolic dysfunction
- Biventricular dysfunction
Why may you need to add a vasoconstrictor with milrinone?
to maintain SVR, MAP and preload.
Why would milrinone be beneficial in coronary spasm?
PDE inhibitors also vasodilate arterial conduits
Vasoconstricting Medications 3
Vasopressin
Phenylephrine
Methylene Blue
What is Vasopressin?
Where is it produced?
Where is it stored?
What does it cause?
What is its main effect?
- hormone
- Produced in the hypothalamus and
- stored in the posterior pituitary gland
- Causes peripheral vasoconstriction
- Main effect is to conserve the body’s water by increasing resorption in the kidney
Vassopressin: hemodynamic effects? 2
↑ systemic vascular resistance (↑SVR)
↑ mean arterial pressure (↑MAP)
Vaso: indications 3
- Significant hypotension with low SVR
- ACLS: cardiac arrest
- Diabetes Insipidus
Phenylephrine (Neo-Synephrine): Hemodynamic effects 4
- No direct cardiac effects
- Pure alpha agonist
- ↑ systemic vascular resistance (↑SVR)
- ↑ mean arterial pressure (↑MAP)
Neo: indications 2
- Hypotension with low SVR and normal CO
- Can be utilized when the patient is warming and vasodilating with a normal cardiac output
What does activation of alpha receptors do?
- constriction of blood vessels, 2. contraction of uterine, eye, bladder, and prostate muscles, 3. relaxation of intestinal muscles, and
- dilation of the pupils.
