sympathomimetic "drugs to read"

Question 1

dobutamine at higher does exerts its affects on which receptor

Answer 1

alpha

Question 2

isoproterenol acts on which receptors

Answer 2

beta 1 beta 2

Question 3

which medication is the most potent of all sympathomimetics

Answer 3

isoproterenol

Question 4

what is the dose is isoproterenol IV infusion

Answer 4

1-5mcg/min

Question 5

what are the effects seen with isoproterenol

Answer 5

increases hr, myocardial contractility, cardiac automaticity

and

vasodilation in skeletal muscles decreases SVR

Question 6

myocardial oxygen requirements of isoproterenol

Answer 6

increased by tachycardia and contractility.

Question 7

adverse effects of isoproterenol

Answer 7

vasodilation

decrease BP

tachyarrhythmias

MI (decrease BP, increase HR)

Question 8

isoproterenol- uses

Answer 8

bradycardia

pul HTN

bronchodilator

Question 9

which medication is derived from isoproterenol consisting of 50:50 racemic mixture

Answer 9

dobutamine

Question 10

dobutamine (-) enantiomer receptors

Answer 10

potent alpha 1 agonist

weak beta 1 beta 2 agonist

Question 11

dobutamine (+) enantiomers receptors

Answer 11

antagonist at alpha 1

potent b1 b2 agonist

Question 12

at higher doses where does dobutamine exert its effects

Answer 12

on alpha receptors

Question 13

dobutamine how does it increase cardiac output

Answer 13

positive inotropic agent

increases cAMP increasing calcium from SR

Question 14

adverse effects of dobutamine

Answer 14

tachyarrhythmias

ST, ventricular arrhythmias

Question 15

dobutamine prolonged continuous infusion concerns

Answer 15

eosinophilic myocarditis and peripheral eosinophilia

Question 16

dobutamine clinical uses

Answer 16

CHF

weaning from bypass

PUL HTN

stress test

Question 17

dobutamine half life

Answer 17

2 minutes

Question 18

dobutamine infusion dose

Answer 18

2-10mcg/kg/min

Question 19

dobutamine metabolism

Answer 19

biotransformation in the liver inactive glucoronide conjugates and 3-0 methyldobutamine- most of which is excreted in the liver

Question 20

does tachyphylaxis occur with dobutamine

Answer 20

may occur as it acts on B-adrenergic receptors.

Question 21

dopamine receptors

Answer 21

d1, d2, a and b

Question 22

DOPAMINE EFFECTS

d1=
d2=
a1=
b1=

Answer 22

d1- vasodilation
d2- vasodilation
a1 vasoconstriction
b1- increases co

Question 23

which receptors is associated with the reward receptor with dopamine

Answer 23

d2

Question 24

dopamine at dose 0.5-3mg/kg/min

what is this dose used for

Answer 24

d1 & d2= vasodilation, decreased arterial BP,

diuresis and natriuresis

Question 25

dopamine at 3-10mcg/kg/min

Answer 25

beta 1 and alpha receptors norepinephrine release increased cardiac output increasing chronotropy and contractility

Question 26

dopamine > 10mcg/kg/min

Answer 26

acts similar to pure alpha agonist.

Question 27

dobutamine renal blood flow effects

Answer 27

increases renal blood flow due to increase in cardiac output.

Question 28

dobutamine effects less than 5mcg/kg/min

Answer 28

beta adrenergic agonist effects. increasing myocardial contractility and peripheral vasodilation.

Question 29

how much variability does dopamine have

Answer 29

10-75 fold variability in plasma dopamine concentrations .

Question 30

dopamine half life

Answer 30

1-2 minutes

Question 31

how do we treat extravasion of dopamine

Answer 31

local infiltration of phentolamine

Question 32

does dopamine cause CNS effects

Answer 32

no it does not cross the blood brain barrier

Question 33

protein binding of dopamine

Answer 33

partially protein bound

Question 34

is the "renal dose of dopamine" really protecting the kidneys?

Answer 34

diuretic effect-but not protective in the setting of low cardiac output. it does not improve creatinine clearance.

Question 35

is dopamine recommended in right heart failure

Answer 35

no

Question 36

what is concerning about a patient with glaucoma receiving dopamine infusion?

Answer 36

dopamine continuous infusion increases ocular pressure- concerns for patients with glaucoma

Question 37

dopamine and respiratory effects

Answer 37

inhibitory NT to the carotid bodies- results in depression of ventilation and decreased 02

Question 38

dopamine endocrine and immunologic effects.

Answer 38

suppress the secretion and function of anterior pituitary hormones aggravating catabolism & cellular immune function induces central hypothyroidism

Question 39

what is the function of selective beta 2 adrenergic agonist

Answer 39

relax bronchiole and uterine smooth muscle.

Question 40

do selective beta 2 stimulate the heart, which drug is the exception

Answer 40

no, isoproterenol

Question 41

beta 2 agonist clinical uses

Answer 41

asthma, prevention of exercise induced asthma, COPD, stop premature uterine contractions

Question 42

how much of a beta 2 is delivered from a MDI vs tracheal intubation

Answer 42

12% MDI | decrease 50-70% with ETT

Question 43

how much more must be delivered for bronchodilation to occur for some intubated

Answer 43

6-10x what is used for an MDI

Question 44

side effects of beta 2 inhalation

Answer 44

``` tremor increased HR hyperglycemia hypokalemia hypomagnesia lactic acidosis ```

Question 45

albuterol - other name and dose

Answer 45

salbutamol 100mcg per puff 1-2 puff every 4-6 hours

Question 46

in relation to intubation, how is albuterol helpful

Answer 46

it blunts airway responses to tracheal intubation in asthmatic patients.

Question 47

metaproterenol- clinical uses

Answer 47

beta 2 agonist to treat asthma

Question 48

terbutaline receptor? admin routes

Answer 48

beta 2 agonist PO, sub q, inhalation

Question 49

terbutaline sub q dose

Answer 49

0.25mg

Question 50

terbutaline mdi dose

Answer 50

200mcg

Question 51

3 examples of cardiac glycosides

Answer 51

digoxin, digitoxin, ouabain

Question 52

digitalis- what are cardiac glycosides made from

Answer 52

naturally occuring- foxglove plant

Question 53

digoxin clinical uses

Answer 53

svt, afib, aflutter, uncommonly used for left ventricular contractility due to the availability of more potent less toxic drugs

Question 54

how does digoxin work

Answer 54

it slows conduction down in the av node

Question 55

what do we co administer with digoxin to limit the possibility of toxicity

Answer 55

propranolol or esmolol combined with digoxin

Question 56

if a patient has been taking digoxin and the doctor wants to do direct current cardio version what is our concern for the patient?

Answer 56

they will have an increased risk of developing cardiac dysrhythmias including vfib

Question 57

digoxin half life | peak after administration

Answer 57

1-2 days | 2 hours

Question 58

in the absence of renal dysfunction, what is the most frequent cause of digitalis toxicity

Answer 58

diuretics that cause potassium depletion.

Question 59

during anesthesia what must we not do to avoid digitalis toxicity

Answer 59

hyperventilate the patient- when we hyperventilate the patient their potassium goes down0.5 per 10 decrease in pac02 leading to lethal arrhythmias.

Question 60

why is cardiopulmonary bypass dangerous with digitalis toxicity

Answer 60

impaired renal function and electrolyte changes such as hypokalmiea, hypomangesia prepose patient to digitalis toxicity

Question 61

early manifestation of digitalis toxicity

Answer 61

anorexia, nausea and vomiting

Question 62

what is the most common ecg finding associated with death from digitalis toxicity

Answer 62

ventricular fibrillation

Question 63

treatment of digitalis toxicity

Answer 63

correct hypokalemia, hypomangesia, hypoxemia administer phenytoin, lidocaine, atropine to treat cardiac dysrhythmias insert TVP if complete heart block present

Question 64

what is the effect of an antacid for digitalis absorption

Answer 64

decreases absorption

Question 65

fentanyl enflurane and isofnlurance do what in relation to digitalis

Answer 65

protect against digitalis enhanced cardiac automaticity

Question 66

what does quinidine do to digoxin

Answer 66

increases the plasma concentration of digoxin

Question 67

what do we consider calcium

Answer 67

potent inotrope

Question 68

normal calcium levels

Answer 68

8.5-10.5mg/dl

Question 69

normal ionized calcium

Answer 69

1-1.26

Question 70

levosimendan moa

Answer 70

increases the sensitivity of the myocardium to calcium

Question 71

levosimendan clinical uses

Answer 71

heart failure and preoperative reduces risk of kidney injury after cardiac surgery