Pharmacology - Shock Part 2 Flashcards by amanda kastel

epinephrine is mainly used for..

it can also be used for what?

anaphylaxis

can also be used to maintain mydriasis (dilated pupil) during ocular surgery

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true or false

epinephrine is considered a MIXED receptor adrenergic antagonist

false - mixed receptor adrenergic AGONIST

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epinephrine effects on a1, b1, b2

at high or low doses?

low dose - b1 cardiac stimulant and b2 vasodilator

high dose - a1 vasoconstrictor

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true or false

at low doses, epinephrine is used to treat vascular shock

FALSE - at high doses

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role of epi in cardiogenic shock

at high or low dose?

positive inotrope and chronotrope for the heart

low dose

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true or false

epinephrine is a vasodilator at low doses

true

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true or false

as an IV infusion, epinephrine has a quick onset (seconds) and a short duration (minutes)

true

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when epi is given in the thigh, is this SUBQ or IM

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what would an epinephrine nasal spray do

deongest

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explain how epinephrine is extremely beneficial in asthma patients

b2 bronchodilation + vasoconstricting decongestant - very good for anaphylatic brochoconstriction

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name some ADR of epinephrine

seizures
palpitations
tachycardia
hypertension
chest pain
arrhythmias

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epi contraindication

narrow angle glaucoma

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true or false

epinephrine is contraindicated in pregnant patients

false - precaution

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true or false

diuretics decrease the pressor response

true

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true or false

beta blockers decrease the pressor response

false - increase

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explain how vasopressin and desmopressin work to treat shock

by retaining water and increasing blood volume

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___ is also known as ADH

vasopressin

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general structure of vasopressin/desmopressin

9 amino acids - “nonapeptide”

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at high does, vasopressin/desmopressin is a _____

vasoconstrictor

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true or false

vasopressin is a ADH analog

true

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3 uses for vasopressin

-septic shock
-esophageal varices with GI bleed
-diabetes insipidus (they dont make enough ADH)
-prevent post op abdominal distention

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ADR of vasopressin

increased BP - and thus reflex bradycardia

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**MOA vasopressin

V2 (located in kidneys) receptor agonist. Gs coupled. vasopressin binds receptor. INCREASED AQUAPROTEINS (AQP-2) – CELL TAKES IN MORE WATER!!!!!

V1a and V2b receptors – Gq coupled. regulation of calcium. body tends to retain more calcium with vasopressin present

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desmopressin elevates what 2 things?

factor 8 and von willebrand factor

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**V2 receptor type

Gs coupled!!!!

4 uses for desmopressin aside from vasodilatory shock

used as a hemostatic (stops bleeding) in: -hemophilia -von willebrand disease -thrombocytopenia -diabetes insipidus

true or false desmopressin is broken down in the liver

true

true or false the more norepinephrine, the less amount of renin released

FALSE - more renin

RAAS system

angiotensinogen -> angiotensin I (through renin). -> angiotensin II -> adrenal gland secretes aldosterone which causes the kidney to reabsorb NACL and water

3 general effects of angiotensin II

-increased peripheral resistance -altered renal function -altered cardiovascular structure

route of administration angiotensin II

angiotensin II types of shock can be used in

septic and other distributive, vasodilatory shock

ANY DRUG that increase heart rate and force is CONTRAINDICATED in what? why? name 3 of these drugs

CI in obstructive cardiomyopathy with heart failure because the blood vessels that leave the heart are narrowed. thus, increasing the heart rate and force only damages the heart more and increases heart failure NE, epi, isoproterenol

true or false dopamine and dobutamine are both positive inotropes

true

as mentioned, both dopamine and dobutamine are positive inotropes dopamine has ____ effects and is thus used in what type of shock? dobutamine has ____ effects and is thus used in what ype of shock

dopamine - alpha 1 pressor effects. cardiogenic and vascular shock dobutamine - beta 2 vasodilation. used in cardiogenic shock with HYPERTENSION

between dopamine and dobutamine, which is natural and which is synthetic

natural - dopamine dobutamine is synthetic

_____ is considered a "weak epinephrine" with _____ receptor activity

dopamine, dopamine

dobutamine is a ____ derivative with added _______ action

ISO (isoprenaline) added vasodilation action

***true or false dobutamine has NO vasopressor activity

TRUE

dopamine route of administration

MOA dopamine

same as epi basically, but weaker -at low doses, inotropic action on B1, increased calcium. chronotropic by b1 stimulation high dose - a1 vasoconstrictor (vasopressor)

true or false dopamine has a slow onset and prolonged duration of action

false - fast onset and short duration - need IV infusion!

3 dopamine contraindication

tachyarrhtyhmias ventricular fibrillation pheochromocytoma

true or false dopamine can cause tachycardia and palpitations

true

mwtabolic effect of dopamine

hyperglycemia

misc ADR of dopamine what is treatment

extravasation ischemia at the injection site give phentolamine 5-10mg/5-10 mL of normal saline

true or false dopamine has same DDI profile has epi

true

dobutamine is a ____ analog

isoproterenol

dobutamine is a potent ______ agonist.

b1 positive inotrope and chronotrope

true or false dobutamine does not have vasodilatory activity

FALSE - it does. has an unloading effect on the heart (but less than its parent molecule - ISO)

true or false dobutamine has a DDI concern with all antihypertensives

true - decrease BP too much

true or false dobutamine decreases cardiac output

FALSE - increases

true or false dobutamine is a potent beta 1 agonist

true

milrinone MOA

PDE3 inhibitor increased cAMP levels in the heart. increased calcium -- positive inotropy and chronotropy

as mentioned, milrinone has positive inotropic and chronotropic effects is there anything negative about this?

the chronotropic effect of increasing HR can be oxygen wasting. pt may have anginal pain positive inotropy is good tho

true or false milrinone does not relax smooth muscle

FALSE - it does, causing vasodilation

what does milrinone do to blood viscosity

decreases viscosity of the blood by decreasing fibrinogin and increase fibrinolytic activity

milrinone route administration

true or false milrinone does not need to be dose adjusted based on renal function

FALSE - it does bc most excreted through urine unchanged

specific milrinone drug interaction

milrinone + furosemide = precipitate formation

milrinone ADR there is a ______ liability

hypotensive liability arrhythmias, hypotension, V tach, angina (bc of positive chronotropy

milrinone max duration of therapy

up to 5 days

**true or false NE causes extravasation ischemia that could pregress to gangrene

true

**true or false epinephrine does not causes extravasation ischemia

false - it can

Pharmacology - Shock Part 2 Flashcards

(65 cards)