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Vasopressors Flashcards

1
Q

Phenylephrine agonizes what SNS receptor

A

Pure alpha 1

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2
Q

Is phenylephrine a catecholamine

A

No, it is a synthetic noncatecholamine

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3
Q

Phenylephrine produces profound

A

arterial vasoconstriction

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4
Q

What effect does phenylephrine have on SVR

A

Increased

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5
Q

What effect does phyenylephrine have on BP

A

Increased

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6
Q

What effect does phyenylephrine have on contractility

A

No direct effect

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7
Q

What effect does phyenylephrine have on HR

A

Reflexive decrease from elevation of SVR

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8
Q

What effect does phyenylephrine have on CO

A

Decreased

  • from baroreceptor reflexive decrease of HR
  • increased afterload
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9
Q

What effect does phyenylephrine have on PAP

A

Increased

-alpha 1 receptors dominant in pulmonary vasculature

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10
Q

What effect does phyenylephrine have on CNS

A

Minimal effects

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11
Q

Phenylephrine is metabolized rapidly by

A

MAO

-DOA= 5 minutes

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12
Q

Pheylephrine is indicated for

A

Hypotension
Hypovolemia (until fluid restored)
SVT
Acute cyanosis

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13
Q

Epinephrine is considered a direct

A

mixed agonist

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14
Q

Epi directly agonizes

A

a1, a2, b1, b2 receptors

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15
Q

Does epinephrine cause the release of endogenous NorEpi

A

No

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16
Q

Is tachyphylaxis not with Epi administration

A

No

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17
Q

What catecholamine is the most potent alpha-adrenergic receptor activator

A

Epi

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18
Q

B1 receptors stimulated by epi cause an increase in

A

Systolic BP
HR
Inotropy
CO

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19
Q

Epi cause a ——– in diastolic pressure

A

decrease

  • due to stimulation of B2 receptors of skeletal muscle vessels
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20
Q

Epi cause a —–in pulse pressure

A

increase

*systolic increase>diastolic with minimal change in MAP

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21
Q

Epi ——- the rate of ventricular relaxation

A

increases

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22
Q

How is epi metabolized

A

MAO

COMT

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23
Q

What two respiratory effects does epi have

A

bronchodilation (B2)

Inhibits antigen-induced release of inflammatory mediators from mast cells (B2)

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24
Q

Epi related positive inotropy, tachycardia, and increased myocardial oxygen demand will have what effect on myocardial cells

A

May induce or worsen myocardial ischemia

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25
If Epi can cause what effect on tissues
necrosis d/t extravasation
26
Epi stimulation on the pancreas exerts what effect, how?`
Glucagon release from alpha cells via stimulation of alpha 2 receptor>>>>increased plasma glucose Subsequently, increased glucagon leads to inhibition of glucose
27
Is Epi lipid soluble
No *No CNS effects
28
Epi can be used to treat hyperkalemia by what mechanism
activaton of sodium-potassium pump in skeletal muscles
29
What are the indications for epi
Cardiac arrest anaphylaxis/ bronchospasm cardiogenic shock Reduced CO after coronary bypass
30
How is coronary perfusion pressure increased by Epi
increases rate of ventricular relaxation and enhances LV filling which improves diastolic function
31
Don't give > how many mcgs of epi
10 mcg
32
What are the routes that epi can be administered
ETT SQ IV *Don't give PO bc rapidly metabolized by GI mucosa and liver
33
Norepi directly agonizes what receptors
a1 a2 b1
34
What effect does Norepi have on SVR
Profound increase *decreases venous return to the heart
35
Norepi causes a decrease venous return to the heart b/c of SVR increases which does what to the HR
Decreases
36
Norepi does what to the PAP
increases
37
How is Norepi metabolized
MAO | COMT
38
Norepi can what effect on end-organ perfusion and cardiac cells
reduced perfusion and myocardial ischemia
39
What effect can Norepi have on skin in unsafe doses
skin necrosis
40
What is the treatment for Norepi induced extravasation
Phentolamine *alpha antagonist
41
Norepi is indicated for
Peripheral vascular collapse | Refractory SVR decreases
42
Ephedrine's primary effect is
indirect release of Norepinephrine from mobile pool 1 *adequate stores required to be effective otherwise tachyphlaxis will develop
43
Epedrine's hemodynamic profile resembles what other catecholamine
Epinephrine * Increased CO, contractility, HR, SVR (slightly), BP ( systolic and diastolic) * however, with epi, the diastolic bp decreases d/t b2 vasodilation
44
Can ephedrine stimulate the CNS
Yes, cross the BBB
45
Ephedrine should be avoided in
patient's taking MAO inhibitors
46
Vasopressin can produce direct peripheral vasoconstriction via
activation of smooth muscle V1 receptors
47
Does vasopressin act on adrenergic receptors
No
48
What are the indications for Vasopressin
DI hemorrhage from esophageal varices, sepsis, and catecholamine-resistant shock refractory cardiac arrest
49
What is the distinction between vasopressin and epinephrine with regards to cardiac arrests
Vasopressin may increase coronary perfusion pressure without tachycardia as seen with epi
50
Adverse effects of vasopressing include
bronchoconstriction uterine contractions visceral hypoperfusion thrombocytopenia
51
Dobutamine is a synthetic beta agonist catecholamine distributed as
a racemic mixture * - isomer = potent alpha 1 agonist * + isomer = potent 1 antagonist Therefore, dobutamine is considered a Beta agonist
52
Dobutamine primarily agonizes
beta 1 receptors
53
Dobutamine agonizes ---- to a limited extent
B2
54
Dobutamine antagonizes -----at high doses
A1
55
Dobutamine causes what effects on SVR
decreased
56
Dobutamine causes what effects on BP
slight increase
57
Dobutamine causes what effects on HR
Dobutamine causes what effects
58
Dobutamine causes what effects on contractility
increased
59
Dobutamine causes what effects on CO
increased
60
Dobutamine causes what effects on LVEDP
decreased
61
Dobutamine causes what effects PAP
decreased via B2
62
How is dobutamine metabolized
COMT
63
What is the plasma half-life of dobutamine
2 minutes
64
Isoproterenol is a
direct acting b1, b2 catecholamine, agonist
65
Isoproterenol has what effect on SVR
Marked decrease via B2 stimulation of skeletal muscle, renal, and splanchnic vasculature
66
Isoproterenol has what effect on CO
Increased
67
Isoproterenol has what effecto on BP
variable *Systolic increase only

Pharmacology (27 decks)

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