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PT3: L3.1
Vasoactive Agents
| Question | Answer |
|---|---|
| Alpha-1 agonism causes? | Peripheral vasoconstriction |
| Alpha-2 agonims causes? | Decreased sympathetic release of NE |
| Beta-1 agonism causes? | -Increased contractility -Increased HR -Enhanced AV node conduction |
| Beta-2 agonism causes? | -Vasodilation -Bronchodilation -GI and uterine relaxation -Modulates fat metabolism, glycogenolysis, and drives K+ intracellularly |
| DA-1 agonism causes? | -Renal, coronary, and mesenteric vasodilation -Natriuresis |
| DA-2 agonism causes? | -Inhibits NE release -Inhibits prolactin release -Induces vomiting -Suppresses peristalsis |
| Vasopressin-1 agonism causes? | Systemic vasoconstriction |
| Vasopressin-2 agonism causes? | Mediates water retention |
| Which drugs increase cardiac output? What are their mechanisms of action? | -Pure Alpha agonist: Phenylephrine -Mixed Alpha/Beta agonist: Dopamine, NE, Epi -V1a receptor agonist: Vasopressin, Terlipressin |
| Which drugs decrease systemic vascular resistance? What is their mechanism of action? | -Hydralazine -ACEi -Nitroprusside (arterial and venous dilator) -Nitroglycerin (venous dilator) -Nesiritide -Nicardipine/clevidipine |
| When would adding vasopressin be appropriate and what starting dose would you use? What are the proposed mechanisms by which it improves blood pressure in septic patients? | -During DI or Variceal hemorrhage or Shock -Dose range: 0.01-0.03 units per minute -Help improve organ perfusion, depleted during shock progression. Increases water resorption and augments catecholamines ability to increase SVR. |
| What are potential reasons for patients being refractory to vasopressor therapy? | -Wrong pharmacotherapy -Hypovolemia -Acidosis -Adrenal Insufficiency |
| Which agent can be used to treat vasopressor extravasation and how would you dose and administer it? | -Phentolamine (alpha1 blocker) within 12 hours of event. -5mg diluted in 10mL of NS, intradermally around site of extravasation. |
| What are the necessary monitoring parameters during continuous infusions of nitroprusside? (see precautionary statements slides, hint: “3 rules of 3”) | -Risk for cyanide tox: >2mcg/mL -Risk for thiocynate tox: Infusion rate >3 mcg/kg/min, prolonged infusion > 3 days, renal failure, SCr > 3mg/dl. |
| What adverse events can happen when infusion rates exceed 20 mcg/kg/min during continuous infusions of dopamine or dobutamine? | Arrythmias |
| Which vasopressors would be reasonable first choices in septic shock? | NE? |
Created by:
Nami01
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