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Flashcards in Meds: autonomic Deck (31)
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1

Ephedrine: common uses?

Intra-op hypotension (temporizing tx) without tachycardia

2

Ephedrine: significant properties & effects?

• Sympathomimetic effects
• ↑ HR, ↑ SV, ↑ CO, ↑ peripheral vasoconstriction
• ↑ myocardial demand

3

Ephedrine: mechanism?

• Stimulates release of granules of norepinephrine at sympa- thetic nerve endingsindirect α/β adrenergic stimulation
• May have small amount of direct adrenergic effect
• Tachyphylaxis may occur with repeat doses (catecholamine
depletion)

4

Ephedrine: adverse drug effects?

CNS: Dizziness, tremor
CVS: ↑↑ BP, palpitations, tachyarrhythmias

5

Ephedrine: onset, duration?

<1min
10min

6

Ephedrine: dosing?

Intra-op hypotension (bolus): 5-10mg IV prn to maximum 50mg

7

Phenylephrine: common uses?

✔ Intra-op hypotension (temporizing tx)
✔ Hypotension from spinal/epidural (often used in L&D due to better effects than ephedrine on fetal acid-based status)

8

Phenylephrine: significant properties & effects?

• Pure α drug (i.e. essentially no β-adrenergic activity unless very high doses)
• ↑↑ venous and arterial vasoconstriction = ↑ SVR
• May induce reflex bradycardia (2o to vagal response,
baroreceptor-mediated)
• Variable effect on CO (depends on preload/afterload as it has no chronotropic/inotropic effects)

9

Phenylephrine: mechanism?

• Direct α1-adrenergic receptor agonist

10

Phenylephrine: adverse drug effects?

CVS: Arrhythmia, ↓ CO, ↑↑ BP, R/L ventricular failure, myo- cardial demand ischemia, peripheral ischemia
RESP: Pulmonary edema

11

Phenylephrine: onset, duration?

<1min
10-15min

12

Phenylephrine: dosing?

Intra-op hypotension (bolus): 50-200mcg IV q10-15min prn Intra-op hypotension (infusion): 0.1-1mcg/kg/min IV titrated to BP

13

Epinephrine: common uses?

✔ Cardiac arrest/resuscitation
✔ Anaphylaxis/bronchospasm, status asthmaticus
✔ Unstable/severe bradycardia
✔ Severe hypotension/shock (norepinephrine more com- monly used since less arrhythmogenic)
✔ Adjunct when using local anesthetics (vasoconstriction slows systemic absorption of anesthetic)

14

Epinephrine: significant properties & effects?

• ↑ HR, ↑ SV, ↑ vasoconstriction
• ↑ bronchodilation, ↓ mucosal edema
• ↓ mast cell/basophil inflammatory mediator release

15

Epinephrine: mechanism?

• Direct α1 and non-selective β adrenergic agonist

16

Epinephrine: adverse drug effects?

CNS: Cerebral hemorrhage
CVS: Palpitations, arrhythmias, ↑↑ BP RESP: Pulmonary edema
OTHER: Infusion site necrosis

17

Epinephrine: onset, duration?

<1min
5-10min

18

Epinephrine: dosing?

- Anaphylaxis (bolus): 0.3-0.5mg q5-10min IM or 0.05-1mg IV/IO.
- Cardiac arrest/resus (bolus): 1mg IV/IO q3-5min until ROSC
- Status asthmaticus (bolus): 0.3-0.5mg q20min SQ to maxi- mum 3 doses
- Hypotension/shock (infusion): 0.05-2mcg/kg/min, titrate to desired MAP q10-15min

19

Norepinephrine: common uses?

✔ Hypotension from undifferentiated/refractory shock (1st line especially for septic/distributive shock)
✔ Cardiac arrest/resuscitation

20

Norepinephrine: significant properties & effects?

• At low dose, β1 effect predominant = ↑ HR, positive inotro- pe and chronotrope
• At higher dose, α1 effect predominant = ↑ peripheral vasoconstriction = ↑ SVR
• ↑ myocardial demand

21

Norepinephrine: mechanism?

• Direct α1 and β1 adrenergic receptor agonist

22

Norepinephrine: adverse drug effects?

CVS: ↓ HR (reflex, β1 effects don’t fully compensate), arrhythmia, ↑↑ BP, peripheral ischemia
GI/GU: Urinary retention
OTHER: Infusion site necrosis (from extravasation)

23

Norepinephrine: onset, duration?

1-2min
1-2min

24

Norepinephrine: dosing?

Hypotension, septic shock (infusion): 0.01-3mcg/kg/min IV Cardiac arrest/resus (infusion): initial 8-12mcg/min IV, main- tenance 2-4mcg/min IV

25

Norepinephrine: alternate name?

Levophed

26

Vasopressin: common uses?

✔ Hypotension from septic/distributive shock (2nd line added to norepinephrine for refractory shock)
✔ Cardiac arrest (refractory pulseless VTach/VFib, PEA/ asystole)
✔ GI variceal hemorrhage

27

Vasopressin: significant properties & effects?

• Positive inotrope
• Vasoconstriction = ↑ SVR, ↑ MAP
• ↑ water retention

28

Vasopressin: mechanism?

• Synthetic arginine vasopressin receptor agonist
• V1 receptor contracts vascular smooth muscle
• V2 receptor increases water resorption in renal tubules

29

Vasopressin: adverse drug effects?

CVS: ↓ CO, arrhythmias, coronary artery vasoconstriction RESP: Pulmonary edema, bronchoconstriction
OTHER: Water intoxication syndrome (HypoNa+), infusion site necrosis (from extravasation)

30

Vasopressin: onset, duration?

15min
duration: w/in 20min of infusion discontinuation