Vasopressors Flashcards
(20 cards)
What are the tissues that contain a significant number of B1 or B2 receptors?
Beta 1: heart, kidney fat cells
- Heart: increases HR (chronotropic), increases contractility (inotropic)
- kidney: smooth muscle contraction + releases renin
- fat cells: upregulates lipolysis
Beta 2: lungs (airways), uterine, vascular smooth muscle
- causes relaxation
What are the tissues that contain significant numbers of alpha 1 and alpha 2 receptors?
alpha 1: vascular smooth muscle
alpha 2: adrenergic + cholinergic nerve terminals
- decreases smooth muscle contraction + sympathetic tone
What are the effects of a pure alpha agonist?
Increases SVR via vasoconstriction
e.g.
Phenlyphrine - only affects SVR
Midodrine - oral A1 agonist
What are the effects of a pure beta agonist?
beta 1 - simulates HR and contraction strength
beta 2 - smooth muscle relaxation
- think SABA/LABA
Isoproterenol - selective B1 + B2 agonist
- indicated for severe symptomatic bradycardia + Torsades
Describe norepinephrine. What is its MOA, indications, and AEs?
endogenous catecholamine
MOA: mixed alpha and beta activity
- increases MAP primarily due to alpha activity
- BIG increase in SVR, mild increase in CO
indications: FIRST LINE FOR SEPTIC SHOCK
AEs
- bradycardia
- Tachycardia
- HTN
- peripheral ischemia
Describe vasopressin. What is its MOA and indications?
endogenous hormone
MOA: works on vasopressin receptors V1 and V2
- longer onset/duration than catecholamine vasopressors
indications:
- second line for septic shock
- various other shock syndromes
Describe phenylephrine. What are its effects, and what are its AEs?
Synthetic catecholamine
MOA: selective alpha agonist
- ONLY impacts SVR due to NO beta activity
AEs
- reflex bradycardia
- possibly decreases renal and splanchnic perfusion
Describe epinephrine. What is its MOA, indication, and AEs?
endogenous catecholamine
MOA: dose-dependent effects
< 0.05 mcg/kg: mostly beta effects
> 0.05 mcg/kg: mostly alpha effects
indications:
- septic shock when NE unavailable/refractory
- cardiogenic shock: used for inotropic effects in pts with cardiogenic shock/symptomatic bradycardia
Describe dopamine. What is its MOA?
endogenous catecholamine
MOA: dose-dependent effects
- significant overlap
< 5 mcg: dopamine receptors = renal + mesenteric vasodilation
5-10 mcg: beta receptors = increased contractility + HR
10-20 mcg: alpha receptors = vasoconstriction
What are the catecholamine vasopressors and what are their AEs?
NE, Epi, dopamine, phenylephrine
tachyarrhythmias (if they have beta activity)
mesenteric ischemia
myocardial ischemia
peripheral ischemia
extravasation injury
Describe dobutamine. What kind of med it is? What is its MOA and AEs?
catecholamine INOTROPE
MOA: racemic mix of 2 isomers
- D: beta 1 and beta 2 agonist = decreases SVR
- L: Beta 1 and alpha 1
AEs:
tachyarrhythmias
hypotension
Describe vasopressin. What is its MOA, indications?
endogenous hormone
MOA: works on vasopressin receptors V1 and V2
- antidiuretic and vasoconstrictive properties
longer onset + duration than catecholamine vasopressors
indications:
- second line for septic shock
- utilized in various other shock syndromes
Describe angiotensin II. What is its MOA, indications, and AEs?
endogenous hormone with vasoconstrictive properties
MOA: binds to G-coupled ATII receptors on vascular smooth muscle
- causes smooth muscle contraction + vasoconstriction
AEs: thrombotic events
Describe milrinone. What is its MOA, indications, and AEs?
MOA: phosphoesterase inhibitor = increases cAMP
- increased inotropic effects
- increases cAMP in vascular smooth muscle = increases vasodilation + can lead to hypotension
indications: cardiogenic shock when nothing else works
AEs
- hypotension
- arrhythmias
Describe Midodrine. What are its MOA and indications and AEs?
MOA: ORAL alpha 1 agonist
indications:
- wean vasopressors
- orthostatic hypotension
- chronic vasodilatory physiology: cirrhosis, CKD
AE: reflex bradycardia
Describe pseudoephedrine. What is its MOA, indications, and AEs
MOA: ORAL alpha and beta agonist
indications:
- nasal congestion
- hyper lactation
- off label use for NEUROGENIC SHOCK
AEs
- tachyarrythmias
- hypertension
Describe droxidopa. What is its MOA, indications, and AEs?
MOA: ORAL alpha > beta agonist
- metabolized into NE once absorbed
indications: neurogenic orthostasis
AE:
- headache
- hypertension
- tachyarrythmias
expensive
Describe Isoprotenerol. What is its MOA, indications, and AEs?
MOA: selective Beta 1 and beta 2 agonist
indications:
- severe, symptomatic bradycardia
- Torsades
AE:
- tachyarrhythmias
- hypotension
What are the IV vasopressors?
norepinephrine
vasopressin
epinephrine
dopamine
phenylephrine
angiotensin II
What are the IV inotropes?
dobutamine
milrinone
