Vasopressor and Inotropic Therapy

Question 1

Vasopressors

Answer 1

Drugs that cause vasoconstriction

Question 2

Inotropes

Answer 2

Change the strength of contraction

Question 3

Chronotropes

Answer 3

Change the rate of contraction

Question 4

Indications for therapy

Answer 4

Decrease in SBP of >30 mmHg from baseline with clinical signs/symptomatology
Decrease in MAP >60 from baseline
Poor organ perfusion secondary to changes in BP or CO (brain, heart, kidney, etc)
Decreased myocardial contraction

Question 5

Location of alpha-1/alpha 2 adrenergic receptors

Answer 5

Vascular wall

Heart

Question 6

Effect of alpha-1/alpha 2 adrenergic receptors

Answer 6

Vascular wall-vasoconstriction

Heart- Increased duration of contraction without increased chronotropy

Question 7

Location of beta adrenergic receptors

Answer 7

Beta-1: heart

Beta-2: blood vessels, lungs

Question 8

Effects of beta adrenergic receptors

Answer 8

Heart: increased inotropy and chronotropy

Blood vessels and lungs: vasodilation

Question 9

Location of dopamine receptors

Answer 9

Renal
Splanchnic
Coronary
Cerebral

Question 10

Effects of dopamine receptors

Answer 10

Vasodilation

Question 11

Generic name of Neosynephrine

Answer 11

Phenylephrine

Question 12

Generic name of Levophed

Answer 12

Norepinephrine

Question 13

Generic name of Adrenalin

Answer 13

Epinephrine

Question 14

Generic name of Inotropin

Answer 14

Dopamine

Question 15

Receptors phenylephrine affects

Answer 15

Alpha-1 (very strong effect)

Question 16

Predominant clinical effects of phenylephrine

Answer 16

Increased SVR

Increased CO

Question 17

Receptors norepinephrine affects

Answer 17

Alpha-1 (very
strong effect)
Beta-1 (moderate effect)

Question 18

Predominant clinical effects of norepinephrine

Answer 18

Increased SVR

Increased CO

Question 19

Receptors epinephrine affects

Answer 19

Alpha-1 (very strong effect)
Beta-1 (very strong effect)
Beta-2 (moderate effect)

Question 20

Predominant clinical effects of epinephrine

Answer 20

Increased CO
Decreased SVR (low dose)
Increased SVR (high dose)

Question 21

Receptors 0.5 to 2 mcg/kg/min of dopamine affect

Answer 21

Beta-1 (weak effect)

Dopaminergic (moderate effect)

Question 22

Predominant clinical effects of 0.5 to 2 mcg/kg/min of dopamine

Answer 22

CO

Question 23

Receptors 5-10 mcg/kg/min of dopamine affect

Answer 23

Alpha-1 (weak effect)
Beta-1 (moderate effect)
Dopaminergic (moderate effect)

Question 24

Predominant clinical effects of 5-10 mcg/kg/min of dopamine

Answer 24

Increased CO

Increased SVR

Question 25

Receptors 10-20 mcg/kg/min of dopamine affect

Answer 25

Alpha-1 (moderate effect) Beta-1 (moderate effect) Dopaminergic (moderate effect)

Question 26

Predominant clinical effects of 10-20 mcg/kg/min of dopamine

Answer 26

Increased SVR

Question 27

Receptors dobutamine affects

Answer 27

Not much alpha-1 effect Beta-1 (very strong effect) Beta-2 (moderate effect)

Question 28

Predominant clinical effects of dobutamine

Answer 28

Increased CO Decreased SVR Dobutamine is solely in vasculature Good inotrope and chronotrope

Question 29

Receptors isoproterenol affects

Answer 29

Beta-1 (very strong effect) | Beta-2 (very strong effect)

Question 30

Predominant clinical effects of isoproterenol

Answer 30

Increased CO | Decreased SVR

Question 31

What is the indication for norepinephrine (Levophed)?

Answer 31

Most potent vasoconstrictor Half life is minutes, so keep on it! Used in septic shock with decreased EF or decreased CO along with decreased SVR Neg inotrope

Question 32

Adverse effects of norepinephrine

Answer 32

``` Toxicity: Peripheral ischemia Tachycardia Dysrhythmias: Ectopy Tachyrhythmias Extravasation Phentolamine- alpha blocker to help minimize this- inject topically ```

Question 33

Use of phenylephrine (Neosynephrine)

Answer 33

1/2 life is minutes | Optimal in spinal shock ideal in medication or procedure-induced hypotension

Question 34

Use of dobutamine

Answer 34

1/2 life is mins Used with decreased EF or decreased CO Septic shock with decreased CO/EF, myocardial stun post surgery, or MI Trauma

Question 35

Adverse effects of phenylephrine

Answer 35

Toxicity: Renal vascular necrosis Peripheral ischemia Dysrhythmias- ectopy

Question 36

Adverse effects of dobutamine

Answer 36

Toxicity- hypotension | Dysrhythmias- ectopy, tachyrhythmias

Question 37

Use of dopamine

Answer 37

Borderline BP and HR 1/2 life is mins Used in septic shock with decreased EF or decreased CO along with decreased SVR

Question 38

Adverse effects of dopamine

Answer 38

``` Toxicity: Peripheral ischemia Tachycardia Dysrhythmias: Ectopy Tachyrhythmias ```

Question 39

Uses for epinephrine

Answer 39

Used in fulminant cardiac arrest, anaphylaxis, septic shock, v-fib, v-tach without a pulse, asystole, EMD

Question 40

Adverse effects of epinephrine

Answer 40

``` Toxicity: Peripheral ischemia Tachycardia Dysrhythmias: Ectopy Tachyrhthmias ```

Question 41

Doses of epinephrine

Answer 41

``` For anaphylaxis: 1:1000 = 1 mg/mL injectable 0.3 mg SC or IM For cardiac arrest 1:10,000= 1 mg/10 mL ```

Question 42

Uses for isoproterenol

Answer 42

Tx for bradycardia in pts with heart transplant

Question 43

Side effects of isoproterenol

Answer 43

Tachycardia | Hypotension

Question 44

MOA of vasopressin

Answer 44

Increases intracellular calcium, maintaining vascular tone in vascular smooth muscle

Question 45

Uses for vasopressin

Answer 45

Used in fulminant cardiac arrest, sepsis, septic shock

Question 46

Under what condition should any of these agents be used?

Answer 46

Pressor therapy should ONLY be utilized when fluid status is optimized