6024 mod 10 cardiotonics.pdf

Module 10 Study Guide Cardiotonics ● What happens when you stimulate alpha 1? ○ Vasoconstriction ● What happens when you stimulate Alpha 2? ○ Sympathetic outflow reduction/pain relief ● What happens when you stimulate Beta 1? ○ Increase in HR, contractility, and CO ● What happens when you stimulate...

Module 10 Study Guide Cardiotonics ● What happens when you stimulate alpha 1? ○ Vasoconstriction ● What happens when you stimulate Alpha 2? ○ Sympathetic outflow reduction/pain relief ● What happens when you stimulate Beta 1? ○ Increase in HR, contractility, and CO ● What happens when you stimulate Beta 2? ○ Relaxation bronchioles ● What happens when you stimulate Dopamine receptors? ○ Dilation kidneys (low dose) vasoconstriction/increased contractility (high doses) ● What is a sympathomimetic? ○ Drugs that mimic the sympathetic nervous system “fight or flight” ● What is a catecholamine? ○ Drug that cannot be given orally ○ Has a short duration ○ Cannot cross the BBB ○ Examples: epi, NE, isoproterenol, dopamine, dobutamine ● What is a non-catecholamine sympathomimetic? ○ Can be given orally ○ Longer duration ○ Can cross BBB ○ Examples: midodrine. Phenylephrine, ephedrine. Turbutaline (asthma & preterm labor) Phenylephrine—Neo ● MOA ○ Selective alpha 1 agonist (vasoconstrictor) ● SE ○ HTN, dysrhythmia, bradycardia, GI upset ● Indications ○ Nasal congestion, last choice for hypotension due to shock ● Contraindications ○ Hypertrophic cardiomyopathy ● Monitoring ○ BP; HR ● Facts/Population Considerations ○ If used for nasal congestion only use < 3 days to avoid rebound congestion Midodrine ● MOA ○ Stimulates alpha 1 in peripheral arterioles & veins→ vasoconstriction→ increase SVR ● SE ○ Supine HTN, bradycardia ● Indications ○ Orthostatic hypotension ● Contraindication ○ HF, PAD, CAD ● Monitoring ○ BP ● Facts/Population Considerations ○ Dont dose Q8hr, instead dose during awake hours Ephedrine ● MOA ○ Causes NE release & activates alpha 1, 2 and beta 1, 2 ● SE ○ HTN, tachy, dysrhythmia ○ Agitation, restlessness ○ Bronchodilation ● Indications ○ Given in OR to prevent anesthesia induced hypotension ○ Asthma ○ Herbal weight loss supplements ● Contraindications ○ Severe agitation, HTN, known arrhythmias ● Monitoring ○ HR, BP ● Facts/Population Considerations ○ Significant risk for HTN urgency, CVA, MI if herbal supp. ○ Use cautiously with caffeine Dopamine ● MOA ○ Potent B1 agonist→ increase contractility/HR ○ Acts directly on Beta1 and indirectly on NE receptors ● SE ○ Increased O2 demand, MI ○ Tachy; ventricular dysrhythmias ● Indications ○ Short term rescue for severe acute HF ○ Cardiac arrest ● Contraindications ○ Ventricular dysrhythmias ○ Angina ○ CAD ● Monitoring ○ Tele, BP, mental status ● Facts/Population Considerations Dobutamine ● MOA ○ Selective Beta 1 agonist with some central alpha 2 agonist of blood vessels to cause vasodilation ● SE ○ Tachycardia→ increased risk for vent. Dysrhythmias ● Indications ○ HFrEF acute decompensation; LV systolic dysfunction; RV dysfunction (if pt can’t tolerate milrinone) ● Monitoring ○ Increases O2 demand & consumption ○ BP→ pt should really have PA catheter ○ Mild hypotension effect ○ HR ● Facts/Population Considerations ○ Available as home infusion for pts with end stage HF Isoproterenol ● MOA ○ Beta 1 & 2 ● SE ○ Tachy, hypotension ○ HA, flushing ● Indications ○ AV blocks refractory to dopamine in setting of RCA infarct that impacts the SA node ○ Cardiogenic shock ● Contraindications ○ Dysrhythmias, pulmonary edema ● Monitoring ○ ICU ● Facts/Population Considerations Norepinephrine ● MOA ○ Alpha 1 (constrict) alpha 2 (release NE) beta 2 (increase CO/HR) ● SE ○ Tachy, HTN ● Indications ○ Cardiogenic shock ● Contraindications ○ HTN ● Monitoring ○ High doses→ mesenteric ischemia ● Facts/Population Considerations ○ “Levophed leave ‘em dead” Epinephrine ● MOA ○ Alpha 1; minimal alpha 2; B1&2 ● SE ○ HTN, unstable MI, dysrhythmias ○ Tremors, hyperglycemia worsening lactic acidosis ● Indications ○ Not 1st line in cardiogenic shock ○ First line in anaphylactic shock and cardiac arrest ○ Superficial bleeding/hematomas ○ Local anesthetic ● Contraindications ○ Hypovolemia ○ MAOIs & TCAs ○ With inhaled anesthetics ○ With BBs, CCBs, and vasodilators ● Monitoring ○ HR, BP