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61 Cards in this Set

  • Front
  • Back
Anesthesiology has been described as the practice of ____ medicine.
autonomic nervous system (ANS)
Preoperatively, what is the most practical bedside test to evaluate the ANS function?
recording SBP and HR response when patient changes from supine to upright posture.
in regard to SBP & HR, ANS dysfunction is suspected when what 2 things occurs?
1.orthostatic hypotension (SBP decrease more than 30mmHg)

2.absence of an increase in HR on assuming the upright posture.
The central ANS includes?
1.hypothalamus (stress responses, SBP control, temperature regulation)

2.medulla and pons (hemodynamic and ventilatory control)
Preganglionic fibers of the SNS arise from ?
thoracolumbar portions of the spinal cord
Preganglionic fibers in the PNS arise from ?
craniosacral portions of the spinal cord
the small amount of norepinephrine that is not subjected to reuptake into the postganglionic nerve endings, is subjected to what?
deamination in the cytoplasm by the enzyme monoamine oxidase
are postganglionic fibers of SNS distributed all over body or limited at effector organs?
distributed all over body

mass reflex
are postganglionic fibers of PNS distributed all over body or limited at effector organs?
limited at effector organs
what are postganglionic fibers of PNS that release ACh called?
what are postsynaptic receptors that respond to ACh 2 classifications?
nicotinic or muscarinc
Action of acetylcholine at responsive receptors is terminated by ?
hydrolysis of this neurotransmitter by the enzyme acetylchoninesterase (true cholinesterase)
Beta 1 effector organs & responses (2)
--increased HR, contractility, conduction velocity

2.Fat cells
Beta 2 effector organs & responses (6)
1.Blood vessels (especially skeletal and coronary arteries)- dilation
2.Bronchioles - dilation
3.Uterus - relaxation
4.Kidneys - renin secreation
5.Liver - Gluconeogenesis
6.Pancreas - insulin secretion
Alpha 1 effector organs & responses (4)
1.Blood vessels - constriction
2.Pancreas - inhibition of insulin secretion
3.Intestine - relaxation
4.bladder - consgtriction of spincter
Alpha 2 effector organs & responses (3)
1.Postganglionic (presynaptic sympathetic nerve endings) - inhibition of NE release

2.CNS (postsynaptic) - increased K+ conductance

3.Platelets - aggregation
Dopamine 1 effector organ & response
Blood vessels - dilation
Dopamine 2 effector organ & response
Postganglionic (presynaptic) sympathetic nerve endings - inhibition of NE release
Muscarinic effector organs & responses (5)
1.Heart - decreased HR, contractility, conduction velocity

2.Bronchioles - constriction
3.Salivary glands - stimulation of secretions
4.Intestines - constriction, relaxation of sphincters, stimulation of secretions
5.Bladder - contraction, relaxation of sphincter
Nicotinic effector organs & responses (2)
1.Neuromuscular Junction - skeletal muscle contraction

2.Autonomic Ganglia - SNS stimulation
________ are compounds with hydroxyl groups on the 3 and 4 positions on the benzene ring of phenylethylamine.
Endogenous catecholamines are ?
dopamine, norepinephrine, and epinephrine
Cathecholamines that do not occur endogenously are ?
isoproternol and dobutamine.
Catecholamines are predominantly effect which system?
the CV system
List from most to least the effect of dopamine on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias
1.CO, renal blood flow
2.SVR, MAP, HR, cardiac dysrhythmias
List from most to least the effect of NE on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias
2.cardiac dys
3.decreased HR, CO, renal BF
List from most to least the effect of epinephrine on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias
1.cardiac dys
4.decreased renal BF
List from most to least the effect of isoproternol on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias
1,HR, CO, cardiac dys
2.decreased MAP, SVR, renal BF
List from most to least the effect of dobutamine on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias
2.Renal BF
4.decreased SVR, cardiac dys
what does dopmaines effects depend on?
which receptors does dopamine stimulate?
Depending on dose, directly stimulates dopamine, beta, and alpha adrenergic receptors.
what makes dopamine unique among this class of drugs?
ability to stimulate dopamine receptors and redistribute blood flow to the kidneys
Renal effects at what dose of dopamine? and what are the renal effects?
< 3mcg/kg/min

aldosterone secretion & increased BF to kidneys resulting in increased UOP
Beta adrenergic stimulation at what dose of dopamine? and what are the effects?
(3-10 mcg/kg/min)

1.myocardial contractility w/o marked changes in HR and SBP
2.evoking the release of endogenous stores of norepinephrine, which predisposes to cardiac dysrhythmias.
when is the secondary release of NE not effective with dopamine administration?
when cardiac catecholamine stores are depleted, as with chronic CHF
Beta and alpha adrenergic agonist effects at what dose of dopmaine?
10-20 mcg/kg/min
Predominate alpha adrenergic effects at what dose of dopamine?
>20 mcg/kg/min
IV infusion of dopamine interferes with what mechanism related to respiratory system? why?
ventilatory response to hypoxemia

it's an inhibitory neurotransmitter at carotid bodies
High dose dopamine can inhibit ?
release of insulin, leading to hyperglycemia.
Most often used in clinical situations characterized by?
1.decreased CO
3.increased LVEDP
Extravazation of dopamine produces? and what's the tx?
intense local vasoconstriction

treated with phentolamine
an endogenous neurotransmitter for alpha and beta adrenergic receptors
clinial indications for NE?
MOA of NE maintenance of BP?
vasoconstriction, increased SVR
which effects are greater with NE, beta 1 or alpha 1? and where?
alpha 1 > beta 1

in the peripheral vasculature
why might CO be decreased despite increased SBP when NE is administered?
1.increased ventricular afterload

2.baroreceptor-mediated reflex bradycardia
are the beta 2 effects of NE significant?
no mininmal
Used for treatment of refractory hypotension as may occur in early period following ligation of vascular supply to a phenochromocytoma.
Epinephrine stimulates which receptors?
alpha-1, beta-1, and beta-2 receptors
where does vasoconstriction occur when epi stimulates alpha 1 receptors?
skin, mucosa, hepatorenal vasculature
where does vasodilation occur when epi stimulates beta 2 receptors? net effect?
skeletal muscles

decreased SVR and a preferential distribution of CO to skeletal muscles
Effect of epi on Beta-1 receptor?
1.increase HR
2.increased contractility
3.increased CO
4.increased automaticity (manifest as cardiac irritability in form of PVC’s)
what effect does epi have on renal blood flow?
greatly decreased
which catecholamine has the most significant effect on metabolism of all the catecholamines?
what in response to surgical stimulation is a likely explanation for the hyperglycemia that is often observed in perioperative period?
Epinephrine release
Subcutaneous epinephrine is also used in combination with local anesthetics. Why?
to decrease systemic absorption and provide local hemostasis
Along with oxygen, what is the most important pharmacologic treatment of cardiac arres?
a synthetic catecholamine with potent stimulant effects on beta-1 and beta-2 receptors. No alpha-1.
Effects of Isoproterenol
1.Myocardial contractility
2.increased CO
3.increased HR
4.increased SBP
5.increased cardiac automaticity
6.decrased SVR
7.decreased diastolic BP
regarding isoproterenol, Excessive tachycardia and simultaneous diastolic hypotension may ?
decrease coronary blood flow at time myocardial oxygen requirements are increased by tachycardia.
Clinical uses of Isoproterenol ?
1.increase HR after heart transplant or complete heart block (chemical packmaker). patients with valvular heart disease to decrease PVR