CVICU EXAM Questions and Verified Answers/Accurate Solutions| New Update Already
Graded A+
Milrinone phosphodiesterase (PDE3) inhibitor
positive inotrope - enhances CO by directly inhibiting phosphodiesterase from metabolizing
cAMP which increases Ca into cells -> forceful contraction.
vasodilator properties (lowers afterload & preload- decrease SVR & PVR, PAOP lv preload) by
decreasing intracellular Ca in vascular smooth muscle
ideal for pts with RV failure. decreases coronary vascular resistance (good for myocardial o2
consumption.
ACLS 1. CPR
2. shock VF/pVT (Epi only and no shock for 3. Asystole & PEA)
4. CPR 2 min, IV/IO access
5. shock
6. epi 1mg q 3-5 min
7. CPR 2 min
8. Amio 300mg then 150mg, or Lido 1mg/kg then 0.5mg/kg
9. Treat reversible causes (H/T)
H&Ts Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hypo/Hyper-Kalemia
Hypothermia
Hypoglycemia
Tension Pneumothorax
,Tamponade, Cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
Vasopressin ADH
V1 receptors on vascular smooth muscle
V2 receptors on renal collecting ducts(Distal convoluted tubule of the loop of henle)
Increases water permeability (cAMP-dependent mechanism), which leads to decreased urine
formation. This increases blood volume, cardiac output and arterial pressure.
Contracts vascular smooth muscle -> causes vasoconstriction of capillaries & small arterioles ->
increase MAP
May improve LV function, which increases CO and coronary blood flow
Increases secretion of corticotropin in the anterior pituitary gland that stimulates the adrenal
cortex. The adrenal cortex produces cortisol which regulates BP.
Norepinephrine Vasopressor (and inotrope) / Adrenergic Agonist
a1 b1 (small b2) - causing vasoconstriction, increased inotropic effects, and cardiac stimulation.
For profound hypotension when volume repletion is inadequate. Can be administered with fluid
resus if the pt's BP and CO are significantly impaired.
, Epinephrine Adrenergic Agonist / Vasopressor
a1 b1 b2
Positive Chronotrope to increase HR in bradycardia. Good in cardiac arrest as it enhances
automaticity
For refractory hypotension
Improves cardiac function and enhances SV
Precedex (dexmedetomidine) a2 agonist
Alpha 2 receptors are responsible for inhibiting presynaptic norepinephrine production (they
SHUT OFF norepi production when agonized. norepi plays a role in pain signal propagation in
the CNS)
Analgesic, Sedative, Anxiolytic
pre-synapse block pain
post-synapse decrease BP & HR
Dexmedetomidine + bupivacaine research study
50 pts - double blind RCT (bupivacaine + NS vs. dex)
Graded A+
Milrinone phosphodiesterase (PDE3) inhibitor
positive inotrope - enhances CO by directly inhibiting phosphodiesterase from metabolizing
cAMP which increases Ca into cells -> forceful contraction.
vasodilator properties (lowers afterload & preload- decrease SVR & PVR, PAOP lv preload) by
decreasing intracellular Ca in vascular smooth muscle
ideal for pts with RV failure. decreases coronary vascular resistance (good for myocardial o2
consumption.
ACLS 1. CPR
2. shock VF/pVT (Epi only and no shock for 3. Asystole & PEA)
4. CPR 2 min, IV/IO access
5. shock
6. epi 1mg q 3-5 min
7. CPR 2 min
8. Amio 300mg then 150mg, or Lido 1mg/kg then 0.5mg/kg
9. Treat reversible causes (H/T)
H&Ts Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hypo/Hyper-Kalemia
Hypothermia
Hypoglycemia
Tension Pneumothorax
,Tamponade, Cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
Vasopressin ADH
V1 receptors on vascular smooth muscle
V2 receptors on renal collecting ducts(Distal convoluted tubule of the loop of henle)
Increases water permeability (cAMP-dependent mechanism), which leads to decreased urine
formation. This increases blood volume, cardiac output and arterial pressure.
Contracts vascular smooth muscle -> causes vasoconstriction of capillaries & small arterioles ->
increase MAP
May improve LV function, which increases CO and coronary blood flow
Increases secretion of corticotropin in the anterior pituitary gland that stimulates the adrenal
cortex. The adrenal cortex produces cortisol which regulates BP.
Norepinephrine Vasopressor (and inotrope) / Adrenergic Agonist
a1 b1 (small b2) - causing vasoconstriction, increased inotropic effects, and cardiac stimulation.
For profound hypotension when volume repletion is inadequate. Can be administered with fluid
resus if the pt's BP and CO are significantly impaired.
, Epinephrine Adrenergic Agonist / Vasopressor
a1 b1 b2
Positive Chronotrope to increase HR in bradycardia. Good in cardiac arrest as it enhances
automaticity
For refractory hypotension
Improves cardiac function and enhances SV
Precedex (dexmedetomidine) a2 agonist
Alpha 2 receptors are responsible for inhibiting presynaptic norepinephrine production (they
SHUT OFF norepi production when agonized. norepi plays a role in pain signal propagation in
the CNS)
Analgesic, Sedative, Anxiolytic
pre-synapse block pain
post-synapse decrease BP & HR
Dexmedetomidine + bupivacaine research study
50 pts - double blind RCT (bupivacaine + NS vs. dex)
