Sympathomimetic- Epinephrine

Question 1

direct acting synthetic non catecholamines

Answer 1

phenylephrine

methoxamine

Question 2

indirect acting synthetic non-catecholamines

Answer 2

ephedrine
mephentermine
amphetamine
metaraminol

Question 3

synthetic catecholamine

Answer 3

isoproterenol

dobutamine

Question 4

what drug is the prototype of all sympathomimetics

Answer 4

epinephrine

Question 5

where is epi synthesized, stored, and release from

Answer 5

the adrenal medulla

Question 6

epinephrine regulates 6 things. name these 6 things

Answer 6

myocardial contractility
heart rate
vascular smooth muscle tone
bronchial smooth muscle tone
glandular secretions
metabolic process (glycogenolysis, lipolysis)

Question 7

is Epi a CNS stimulant

Answer 7

no

Question 8

what make up of epi makes it a poor CNS stimulant

Answer 8

poorly lipid soluble

Question 9

what receptor activation accounts for EPI cardiovascular effects

Answer 9

alpha and beta

Question 10

how does epi affect renal blood flow

Answer 10

substantially decreased- even in the absence of systemic blood pressure changes

Question 11

how much more potent is epi to NE as a real vasoconstrictor

Answer 11

2-10x

Question 12

higher doses of EPI affect which receptor

Answer 12

alpha receptors

Question 13

lower doses of epi affect which receptor

Answer 13

beta receptor

Question 14

high doses of epi- alpha activity create what

Answer 14

vasoconstriction increased afterload

Question 15

epi HR effects

Answer 15

initial tachycardia followed by HR decrease due to baroreceptor reflexes

Question 16

increase CI & SVR from EPI leads to

Answer 16

increase blood pressure

Question 17

EPI stimulates b1 receptors which increases 3 things

Answer 17

HR contractility and co

Question 18

what happens to diastolic BP in the presence of EPI

Answer 18

mild decrease reflects vasodilation in skeletal muscle vasculature due to stimulation of beta 2 receptors

Question 19

increases in HR associated with EPI accelerates which phase

Answer 19

phase 4

Question 20

which epi stimulates phase 4 what are you at risk for

Answer 20

cardiac dysrhythmias

Question 21

is tachyphylaxis seen with epi

Answer 21

no

Question 22

what effects does EPI have through the heart

Answer 22

increases conduction velocity, decreases refractory period in AV node, bundle of HIS, purkinje fibers and ventricular muscle

Question 23

EPI causes what effect to myocardial oxygen consumption

Answer 23

increased with enhanced LV preload, increase contractility increased after load and tachycardia

Question 24

epi and diastolic function?

Answer 24

improved diastolic function by increasing the rate of myocardial relaxation

Question 25

EPI effects of coronary blood flow NE effects of coronary blood flow Phenylephrine effects of coronary blood flow

Answer 25

epi increases-do not alter systemic bp NE- no affect on coronary blood flow phenylephrine- increases coronary blood flow

Question 26

how to you block the hemodynamic effects of EPI

Answer 26

administration of alpha or beta adrenergic receptor antagonist

Question 27

name the 5 things supra therapeutic doses of EPI can lead to

Answer 27

``` pulmonary edema acute heart failure arrhythmias hypertension myocardial ischemia ```

Question 28

what is the EPI effect of beta 2 activation

Answer 28

smooth muscles of the bronchi relaxaing

Question 29

when epi stimulates beat 2 in relation to asthma - what release is decreased?

Answer 29

vasoactive mediators.

Question 30

if the patient is beta blocked and given EPI what effects are seen in the lungs

Answer 30

bronchoconstriction - from stimulation of bronchial alpha receptors.

Question 31

of all catecholamines EPI has the most significant effect on _____

Answer 31

metabolism

Question 32

epi beta receptor effect on metabolsim

Answer 32

increase liver glcogenolysis and adipose tissue lipolysis

Question 33

Epi and alpha 1 receptor affects on metabolism

Answer 33

inhibits release of insulin

Question 34

EPI infusion usually increases the concentration of what 4 things

Answer 34

glucose cholesterol phospholipids low density lipoproteins

Question 35

why do patients experience perioperative hyperglycemia

Answer 35

endogenous epi release results in inhibition of insulin secretion and glycogenolysis and inhibits peripheral glucose uptake

Question 36

Epi induced hypokalemia may contribute to what?

Answer 36

cardiac dysrhythmias

Question 37

EPI is also responsible for the release of what electrolyte from the liver

Answer 37

potassium- tending to offset the decrease in extracellular concentration of potassium produced by entrance into the skeletal muscle

Question 38

explain the two different reasons for increase concentration of lactate as seen with EPI administration

Answer 38

1. may reflect epi induced glycogenolysis in skeletal muscles 2. transient increase due to inhibition of pyruvate dehydrogenase and has no relationship with cellular hypoxia and tissue perfusion nor is it associated with metabolic acidosis

Question 39

what is the reason for low potassium levels associated with EPI

Answer 39

beta 2 adrenergic agonist activate the sodium potassium pump

Question 40

during induction what does the endogenous release of EPI do to your electrolytes

Answer 40

decrease potassium level

Question 41

what can we give preop to prevent hypokalemia

Answer 41

propranolol may prevent hypokalemia

Question 42

what is the concern with cardioselective beta 1 antagonist atenololol

Answer 42

may cause hypokalemia

Question 43

what two things do you see with the eye when administering EPI which receptor is responsible for this

Answer 43

mydriasis and exophthalmos alpha receptors contraction of radial muscle of the iris producing mydriasis contraction of the orbital muscles produces and appearance of exopthalmos

Question 44

what three medication produce gi relaxation of the smooth muscles

Answer 44

EPI, NE, isoproterenol

Question 45

Epi activates beta adrenergic receptor to do what with the bladder

Answer 45

relaxes the detrusor muscle of the bladder

Question 46

EPI activation of alpha receptors contracts the trigone and sphincter muscles. meaning what exactly

Answer 46

stretch muscles signaling the brain the need to empty

Question 47

what coagulation effects are seen with EPI

Answer 47

platelet aggregation and increase factor V activity- hypercoaguable state in intro and post op reflect stress associated release of EPI

Question 48

what labs on the CBC are changed with EPI

Answer 48

increases leukocyte count | eosinopenia

Question 49

EPI effects of the Liver

Answer 49

hepatosplanchnic vasoconstriction

Question 50

renal effects with EPI

Answer 50

impaired renal blood flow as co is diverted to dilated skeletal muscles.

Question 51

stimulates renal beta receptors resulting in what

Answer 51

increase secretion of renin

Question 52

EPI receptors

Answer 52

a1 a2 b1 b2

Question 53

EPI general uses (from chart)

Answer 53

Anaphylaxis, glaucoma (open angle) asthma, hypotension with LA

Question 54

EPI administration forms

Answer 54

Sub q, Iv or IM

Question 55

absorption of EPI sub q

Answer 55

slow