Norepinephrine Medication Quiz

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Questions and Answers

What is the classification of norepinephrine?

Cholinergic agonist

Adrenergic agonist (correct)

Dopaminergic agonist

Anticholinergic antagonist

What is the primary action of norepinephrine as a vasopressor?

Direct stimulation of beta-adrenergic receptors

Inhibition of adrenergic receptors

Direct stimulation of alpha-adrenergic receptors (correct)

Direct stimulation of muscarinic receptors

In what conditions is norepinephrine indicated for use?

Atrial fibrillation with rapid ventricular response

Hypotension with MAP less than 65 (correct)

Hypertension with MAP greater than 100

Bradycardia with heart rate less than 50 bpm

What is the effect of norepinephrine on blood flow to vital organs?

Decreased blood flow Signup and view all the answers

Which receptor does norepinephrine primarily target to produce a positive inotropic response of the heart?

Beta1 receptors Signup and view all the answers

What is the primary effect of norepinephrine on blood vessels?

Constricting both capacitance and resistance blood vessels Signup and view all the answers

In which type of shock is norepinephrine indicated for use?

Cardiogenic shock Signup and view all the answers

What is the main indication for the use of norepinephrine?

Hypotension with mean arterial pressure (MAP) less than 65 Signup and view all the answers

In addition to hypotension, in which of the following conditions is norepinephrine indicated for use?

Beta & Calcium Channel Blocker OD Signup and view all the answers

What is the primary action of norepinephrine in the treatment of shock after appropriate fluid resuscitation?

Increase systolic and diastolic blood pressure Signup and view all the answers

Which of the following factors will affect cardiac output according to the Stroke Volume x Pulse Rate = Cardiac Output equation?

Heart rate Signup and view all the answers

In the context of shock syndromes, which type of shock is characterized by a failing heart?

Cardiogenic Shock Signup and view all the answers

What is the primary action of norepinephrine as a vasopressor in the treatment of shock?

Constricts blood vessels Signup and view all the answers

Which condition is associated with retinal hemorrhage?

Eclampsia Signup and view all the answers

What is the effect of Norepinephrine on the container component of perfusion?

Constricts blood vessels Signup and view all the answers

What factor directly affects the pressure of blood against the aorta (afterload)?

Systemic vascular resistance Signup and view all the answers

What is the most common cause of thyroid storm?

Stress Signup and view all the answers

Which symptom is not associated with hyperthyroidism?

Hypothermia Signup and view all the answers

What is the recommended approach for treating hypertensive encephalopathy?

Lower the BP by no more than 1/3 in a controlled manner over 30-60 mins Signup and view all the answers

What is the defining characteristic of pre-eclampsia?

Hypertension greater than 140/90 on two occasions 4 hours apart Signup and view all the answers

What is the treatment for Eclampsia?

Magnesium Sulfate Signup and view all the answers

What is the clinical presentation of HELLP syndrome?

Hemolysis, elevated liver enzymes, low platelet counts Signup and view all the answers

What are the clinical presentations of obstructive shock?

Hypotension, tachycardia, respiratory distress, cyanosis, JVD, and tracheal deviation Signup and view all the answers

What is the characteristic clinical presentation of neurogenic shock?

Hypotension, bradycardia, warm, dry skin, and flaccid paralysis below the injury site Signup and view all the answers

What characterizes distributive shock from sepsis?

Inflammatory response to infection leading to hypotension, hypoperfusion, and lactic acidosis Signup and view all the answers

What are the signs and symptoms of anaphylaxis?

Urticaria, angioedema, respiratory collapse, tachycardia, vasodilation, and hypotension Signup and view all the answers

What is the treatment for obstructive shock?

High flow oxygen, ventilation, intubation if necessary, and addressing the underlying cause Signup and view all the answers

What is the primary treatment for anaphylaxis?

Epinephrine, bronchodilators, antihistamines, corticosteroids, and fluid boluses Signup and view all the answers

Which of the following is a crucial consideration in managing patients with hypovolemic shock?

Administering 20 ml/kg fluid bolus 2-3 times prior to vasopressors Signup and view all the answers

What is the recommended treatment for hypovolemic and hemorrhagic shock?

Addressing the underlying cause of fluid loss, such as antiemetics and treatments for osmotic losses Signup and view all the answers

What is a potential consequence of abrupt discontinuation of clonidine medication or excess catecholamines?

Hypertensive crisis Signup and view all the answers

What is a crucial consideration in transfusion therapy for patients receiving blood?

Monitoring calcium levels due to citrate-induced hypercalcemia Signup and view all the answers

What is the primary goal of initial management in non-bleeding hypovolemic shock?

Maintaining oxygenation and ventilation Signup and view all the answers

What is the recommended approach for calculating maintenance fluid from dehydration in pediatrics?

Using the 4-2-1 method based on the child's weight Signup and view all the answers

Which of the following is a characteristic of hypovolemic shock in pediatric patients?

They have less blood volume than adults Signup and view all the answers

What is the effect of relative hypovolemia?

It can lead to distributive shock due to fully dilated vascular system Signup and view all the answers

What are the compensatory mechanisms for inadequate tissue perfusion in shock?

Vasoconstriction, release of hormones, and increased cardiac output Signup and view all the answers

What are the symptoms of late (decompensated) shock?

Weakness, altered mental status, tachycardia, and cardiac arrest Signup and view all the answers

What is a crucial consideration in determining hypotensive blood pressure for pediatrics?

Age Signup and view all the answers

What characterizes cardiogenic shock?

Decreased cardiac output and vital organ perfusion Signup and view all the answers

Which of the following is the correct blood volume for males?

70 ml/kg Signup and view all the answers

What is the primary cause of cardiogenic shock?

Reduced cardiac output Signup and view all the answers

What is the characteristic symptom of hypotensive shock?

Weak peripheral pulses Signup and view all the answers

What is the consequence of impaired tissue perfusion in shock?

Vasoconstriction Signup and view all the answers

What is the classification of shock that can lead to multi-organ dysfunction syndrome?

Decompensated shock Signup and view all the answers

What is the defining characteristic of late shock?

Bradycardia Signup and view all the answers

Study Notes

Fluid Management and Shock Treatment in Emergency Medicine

Hypovolemic and hemorrhagic shock result from absolute hypovolemia, causing decreased intravascular volume, venous return, ventricular filling pressure, stroke volume, and cardiac output, leading to inadequate tissue perfusion.
Causes of hypovolemic and hemorrhagic shock include trauma, non-traumatic blood loss, gastrointestinal, genitourinary, and vascular causes, dehydration, vomiting, diarrhea, diuresis, sweating, third space losses, pancreatitis, peritonitis, and bowel obstruction.
Signs and symptoms of hypovolemic and hemorrhagic shock include agitation/anxiousness, nausea/vomiting, decreased urine output, tachycardia, tachypnea, weak pulses, cool and diaphoretic skin, altered mental status, and hypotension.
Initial management of non-bleeding hypovolemic shock involves maintaining oxygenation, ventilation, and administering IV fluid to maintain a mean arterial pressure (MAP) of 65, typically with a 20 ml/kg fluid bolus 2-3 times prior to vasopressors.
Vasopressors, such as norepinephrine, are recommended for hypovolemic and hemorrhagic shock treatment, along with addressing the underlying cause of fluid loss, such as antiemetics and treatments for osmotic losses like DKA/HNKS.
The 4-2-1 method is used for calculating maintenance fluid from dehydration in pediatrics, with specific fluid volumes based on the child's weight.
In hypovolemic shock with bleeding, identifying the source of bleeding, controlling bleeding, and administering tranexamic acid (TXA) when indicated are crucial, along with keeping the patient warm and promptly initiating fluid therapy with lactated Ringer's or 0.9% normal saline.
Massive transfusion protocols typically involve a 1:1:1 ratio of packed red blood cells (PRBC), platelets, and fresh frozen plasma, and the administration of blood must be accompanied by monitoring calcium levels due to citrate-induced hypocalcemia.
Transfusion therapy considerations include using type O RH- blood as a universal donor and the administration of 1 unit of PRBCs raising hemoglobin by approximately 1 gram/dL or 10 gram/L.
Transfusion reactions, which may include fever, back pain, bloody urine, chills, flushing, fainting, or dizziness, require immediate management, including stopping the transfusion, flushing the line with normal saline, and contacting medical direction for further care.
Excess catecholamines can lead to a hypertensive crisis, caused by abrupt discontinuation of clonidine medication, pheochromocytoma, sympathomimetic drug toxicity, or MAOI and tyramine interactions.
Treatment for catecholamine excess involves managing airway, oxygenation, and ventilation, avoiding

Understanding Hypovolemic Shock and Cardiogenic Shock

Hypovolemic shock occurs due to loss of blood volume from exogenous (hemorrhage) or endogenous (fluid loss contained inside the body) causes, leading to low blood pressure and inadequate tissue perfusion.
Adult females have 65ml/kg and males have 70ml/kg of blood volume, and significant changes in vital signs occur with blood loss of 1L or more.
Compensation for blood loss is related to the speed of blood loss, and infants and children have less blood volume than adults.
Relative hypovolemia can lead to distributive shock, such as neurological, anaphylactic, or sepsis shock, due to fully dilated vascular system causing low blood pressure.
Shock occurs with inadequate tissue perfusion, leading to compensatory mechanisms including vasoconstriction, release of hormones, and increased cardiac output.
Impaired cellular metabolism results from inadequate tissue perfusion, causing lactic acid production, metabolic acidosis, and changes in electrolytes.
Shock can be compensated (early) or decompensated (late), with symptoms including weakness, altered mental status, tachycardia, and cardiac arrest.
Late shock can lead to multi-organ dysfunction syndrome and relative bradycardia, especially in patients taking specific medications or with internal bleeding.
Hypotensive blood pressure for pediatrics is determined by age, and any decrease in systolic blood pressure of 10mmHg from the baseline should prompt assessment for shock.
Hypotensive patients with bradycardia may be experiencing cardiogenic shock, characterized by decreased cardiac output and vital organ perfusion.
Clinical presentation of cardiogenic shock includes reduced cerebral and renal perfusion, pulmonary or pedal edema, and hypotension, and treatment involves oxygenation, ventilation, and possible vasopressors.
In a trauma scenario, chest trauma can lead to cardiogenic shock, presenting with shortness of breath, cyanosis, and distended neck veins, requiring assessment and appropriate treatment.

Understanding Shock in Cardiac Patients

Hypovolemic shock occurs when blood volume loss leads to low blood pressure, affecting tissue perfusion.
Females have 65ml/kg blood, males have 70 ml/kg blood, and children have 80-80 ml/kg blood volume.
Inadequate tissue perfusion leads to compensation mechanisms such as vasoconstriction and release of hormones.
Impaired cellular metabolism due to inadequate tissue perfusion results in anaerobic metabolism and metabolic acidosis.
Shock can be classified as compensated (early), decompensated (late), and relative bradycardia can occur.
Late shock can lead to multi-organ dysfunction syndrome, including renal, respiratory, and liver failure.
Hypotensive shock is characterized by weak peripheral pulses, altered mental status, and decreased urinary output.
Cardiogenic shock is caused by reduced cardiac output and can lead to decreased LOC, peripheral vasoconstriction, and pulmonary edema.
Treatment for cardiogenic shock includes oxygenation, ventilation, IV fluid therapy, and vasopressors.
Hypotension in pediatric patients is defined using age-specific blood pressure percentiles.
A hypotensive patient with pale, cool skin and diaphoresis may be experiencing cardiogenic shock.
In cases of chest trauma, such as from an MVC, symptoms like SOB, cyanosis, and distended neck veins should prompt immediate assessment for cardiogenic shock.

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Description

Test your knowledge of paramedic medication with this quiz focusing on the generic and trade names, classification, and actions of norepinephrine, a vasopressor used in emergency medical scenarios.