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39 Cards in this Set
- Front
- Back
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What receptors does Dopamine bind?
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Precursor to NorEpi (+ino and chrono)
<5 mcg/kg/min D1, vasodilation (renal flow) 5-10 mcg/kg/min ß1, (some ß2)- ↑CO >10 mcg/kg/min α1- ↑ vasoconstriction |
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What receptors does Dobutamine bind?
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Primarily ß agonist activity (inotropic)
Generally indicated when CO is inadequate May lead to ↓ in BP |
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Neosynephrine
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Phenylephrine
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What does Phenylephrine bind to?
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α1 agonist- primarily vascular effects- does NOT impair cardiac/renal fx
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What does NE bind to?
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Primary α-agonist (minimal ß agonist)
"Pure Pressor" |
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What does Epinephrine bind to?
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Non specific α & ß agonist
↑ serum lactate conc, impairs blood flow to splanchnic system ↑ CI and significant peripheral vasoconstriction |
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Phenylephrine treatment
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Treat mild/moderate hypotension, also PSVT
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Vasopressin
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ADH analog (Posterior pituitary hormone)
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NE treatment
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MAP and SVR
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Epi
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↑ in SVR predominates, vasodilator in low dose
↑ CO by ↑ inotrope and↑ HR |
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Ephedrine
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↑: in SVR predominates
Mild ↑:CO by ↑:inotrope |
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Phenylepherine
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↑↑ in SVR predominates
CO neutral at low doses s/t ↑:venous return offsets the ↑:SVR effect on CO At high doses,↑ : in SVR predominates with ↓ ;CO |
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Amrinone/milrinone
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↓;SVR
↑:CO by phosphodiesterase inhibition |
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Dobutamine
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↑↓:SVR
↑:CO by ↑:inotrope Minimal stimulation to HR |
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Norepinephrine
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↑↑ in SVR predominates because of alpha effects
↓;CO s/t ↑: in SVR offset by inotrope ↑:HR at higher doses may limit clinical effectiveness |
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α1 agonism
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primary effect on smooth muscle with resultant
constriction |
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ß2 agonism
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causes relaxation of smooth muscle. In smooth muscle beds of small coronary
arteries, arteries of visceral organs, and arteries of skeletal muscle b2 activation results in vasodilation. Additionally, b2 stimulation results in mild chronotropic and inotropic improvement, although these effects are minimal |
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α2 agonism
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vasodilatation by endothelial nitric oxide production
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Arixtra dosing
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<50 kg: 5 mg once daily
50-100 kg: 7.5 mg once daily >100 kg: 10 mg once daily Clcr <30 mL/minute: Contraindicated THROMBOCYTOPENIA |
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fondaparinux
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Arixtra
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Arixtra
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Fondaparinux is a synthetic pentasaccharide that causes an antithrombin III-mediated selective inhibition of factor Xa. Neutralization of factor Xa interrupts the blood coagulation cascade and inhibits thrombin formation and thrombus development.
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Protamine
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Heparin antidote
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Protamine dose
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Dose of Protamine (mg) to Neutralize 100 units of Heparin
Immediate 1-1.5 mg 30-60 min 0.5-0.75 mg >2 h 0.25-0.375 mg Max 50 mg |
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Lovenox prophylaxis dose
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40 mg SQ Q 24 hr
30 mg SQ Q 24 hr (CrCl <30) RENAL ELIMINATION Monitor: Platelets |
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When to get aPTT with UFH?
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Every 6 hours
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What to give for HIT?
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Direct Thrombin Inhibitors (argatroban, lepirudin)
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Lovenox treatment dose
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1 mg/kg SQ Q12 hr
1 mg/kg QSQ Q 24 hr (CrCl <30) |
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Prothrombin t1/2
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60-100 hours
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X t1/2
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24-40 hours
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VII t1/2
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6-8 hours
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Warfarin Metabolism
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S- (strong, 2C9)
R- (3A4) |
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EtOH and Warfarin
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Acute EtOH- inhibit metabolism (↑ INR)
Chronic EtOH- induce metabolism (↓ INR) |
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Smoking and Warfarin
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Smoking induces P450
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Hydralazine
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need to look up
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cilostazole MOA
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need to look up
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Lexiscan
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regadenoson
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Adenosine MOA
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slows conduction at AV node
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Adenosine use
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PSVT and Wolf-Parkinson-White Syndrome
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Atropine MOA
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Antagonizes action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands and CNS. (Muscarinic reversal, no effects on Nicotinic)
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