pressors

Question 1

PHENYLEPHRINE (NEOSYNEPHRINE):

IVP dose

Answer 1

50-100 mcg

100 mcg/mL

Question 2

PHENYLEPHRINE (NEOSYNEPHRINE):

gtt dose

Answer 2

10-200 mcg/min

40 mcg/mL concentration (10 mg/250 mL)

Question 3

PHENYLEPHRINE (NEOSYNEPHRINE):

onset?
duration?

Answer 3

onset: <1 min
DOA: <5 mins

Question 4

PHENYLEPHRINE (NEOSYNEPHRINE):

MOA?

Answer 4

• direct sympathomimetic
• alpha-1 adrenergic agonist = constricts both arterial and venous blood vessels = increases afterload by increasing SVR

Question 5

what is a reflex seen with phenylephrine (neo)?

Answer 5

reflex bradycardia (baroreceptor mediated)

Question 6

phenylephrine (neo) is useful in what cardiac valve dz? why?

Answer 6

aortic stenosis (b/c increases CoronaryPP)

Question 7

CAUTION with phenylephrine (neo) should be taken in:

Answer 7

cardiogenic shock or HF it is not useful in HF over Levophed

Question 8

EPINEPHRINE:

IVP dose

Answer 8

5-10 mcg

Question 9

EPINEPHRINE:

strong stick vs low-dose stick

Answer 9

strong stick: 100 mcg/mL
low-dose stick: 10 mcg/mL

Question 10

EPINEPHRINE:

what is the conc for a strong stick of epinephrine?

Answer 10

1 mg in 9 mL = 100 mcg/mL

Question 11

EPINEPHRINE:

what is the conc for a low dose stick of epinephrine?

Answer 11

1 mL of strong stick (100mcg) in 9 mL = 10 mcg/mL

Question 12

EPINEPHRINE:

gtt dose

Answer 12

0.01-0.02 mcg/kg/min
(note: this is mcg/kg/min in the pump)

16 mcg/mL concentration (4 mg/250 mL)

Question 13

EPINEPHRINE:

onset?
peak?
duration?

Answer 13

onset: <1 min
peak: 1-2 mins
DOA: 5-10 mins

Question 14

EPINEPHRINE:

MOA?

Answer 14

• potent alpha and beta stimulation = incr SV and incr HR!

Question 15

At a low dose epi, what is more stimulated?

Answer 15

beta = increased HR, CO, contraction, PP
with decreased SVR

Question 16

at high dose epi, what receptor is more stimulated?

Answer 16

alpha = increased SVR with decreased CO

Question 17

EPINEPHRINE DOSING:

for beta

Answer 17

0.01 - 0.03 mcg/kg/min

Question 18

EPINEPHRINE DOSING:

for alpha and beta

Answer 18

0.03 - 0.15 mcg/kg/min

Question 19

EPINEPHRINE DOSING:

for alpha

Answer 19

0.15 - 0.30 mcg/kg/min

Question 20

side effects of epinephrine?

Answer 20

• hypokalemia
• increased blood glucose - d/t inc liver glycogenolysis, inc glucagon and dec release of insulin
• accelerates coagulation

Question 21

Epi may produce myocardial ischemia due to what effect?

Answer 21

positive inotropy and tachycardia = incr o2 demand and decr o2 supply

Question 22

what is the anaphylaxis dose of epinephrine?

Answer 22

4 mcg = bronchodilator and mast cell stabilizer

Question 23

ACLS epi dose

Answer 23

1 mg q 3-5 mins

Question 24

NOREPI (LEVOPHED):

IVP dose

Answer 24

2-4 mcg

4 mcg/mL concentration (5 mL of levo bag with 15 mL NS to quarter the conc from 16 mcg/mL to 4 mcg/mL)

Question 25

# NOREPI (LEVOPHED): gtt dose

Answer 25

2.5 - 40 **mcg**/min - *note: this is mcg/min in the pump!* ## Footnote 16 mcg/mL concentration (4 mg/250 mL)

Question 26

# NOREPI (LEVOPHED): onset? peak? duration?

Answer 26

onset: <1 min peak: 1-2 min DOA: 5-10 min

Question 27

# NOREPI (LEVOPHED): MOA?

Answer 27

increased SVR - redistributes blood flow to brain and heart b/c all other vascular beds are constricted

Question 28

# NOREPI (LEVOPHED): low dose levo agonizes which receptor? what effects are seen?

Answer 28

beta-1 = increases HR, CO, ctx, and conduction

Question 29

# NOREPI (LEVOPHED): high dose levo agonizes which receptor? what effects are seen?

Answer 29

beta-1 and alpha-1 = systematic vasoconstriction (except coronaries) - and decreased HR (but minimal change d/t counteractions of B1)

Question 30

MOA of ephedrine (Akovaz)

Answer 30

alpha1, beta1, beta2 agonist = increases HR and BP

Question 31

dose of ephedrine (Akovaz)

Answer 31

5 mg

Question 32

what is a consideration when giving repeated doses of ephedrine?

Answer 32

tachyphylaxis can occur!

Question 33

what push pressor lasts longer, ephedrine or epi?

Answer 33

ephedrine - lasts 10x longer than epi ... and BP response is less