CRNA Interview Pharmacology Exam 2024-2025
Norepinephrine (Levophed) - ANSWER Naturally occurring alpha/beta-1 stimulating
catecholamine
- Primary agent used in distributive shock because it's ability to recruit venous volume and
augment preload, while increasing arterial tone, and increasing cardiac output.
- Alpha-stimulation causes peripheral, renal, splanchnic and pulmonary vasoconstriction.
-Beta-1 stimulation increases myocardial contractility, with less tachycardia produced than
with adrenaline.
-The beta-1 adrenergic effect are prominent in the lower dose range, while alpha-adrenergic
effects predominate at higher doses .
- Dose: 0.03-2mcg/kg/min
- CI: hypovolemia
**First line agent in septic shock
Phenylephrine (Neosynephrine) - ANSWER - Alpha-1 receptor agonist with little effect on beta
receptors of the heart; systemic vasoconstrictor
- Causes a rise in systolic and diastolic pressures, a slight decrease in cardiac output, and a
considerable increase in peripheral resistance
- Used rarely as adjunctive therapy for patients in septic shock. Used more often in
vasodilatory shock states such as neurogenic shock/ shock from epidural/spinal blocks.
Ephedrine - ANSWER - Vasopressor that activates Alpha 1 and 2, more strongly than Beta 1 and
2
- Indirect acting sympathomimetic most effective when treating postural hypotension and
asthma
- Longer acting and less potent that epinephrine
- Dose 5-10 mg IVP.
, Vasopressin (ADH) - ANSWER Potent increase in SVR through 2 different MOA.
1) Acts on renal collecting ducts via V2 receptors (via cAMP-dependent mechanism) to increase
water permeability, which leads to decreased urine formation. This increases blood volume,
cardiac output and arterial pressure.
2) Binds to V1 receptors on vascular smooth muscle to cause vasoconstriction (higher doses)
- Dose: 0.3-2 mu/kg/min
-Normal levels of the medication are below it's vasoactive range, however in profound
hypovolemic shock, AVP rises do contribute to increase in SVR.
-Utilized as adjuvant therapy in septic shock (in addition to levo)
Isoproterenol - ANSWER Isopril (rate 2-20 mcg/min)
-Isoprenaline is an synthetic catecholamine, a sympathomimetic.
-It has effects on beta receptors in the sympathetic nervous system (with minimal Alpha
effects).
- Used to treat shock, cardiac arrest and anaphylaxis (asthma)
Dexmedetomidine (Precedex) - ANSWER - Selective alpha 2 adrenergic agonist (suppresses
release of norepinephrine by negative feedback). The combination of these effects is
anesthesia with analgesia and anxiolysis.
- Provides light to moderate sedation w/o risk of respiratory depression. Can provide
semi-arousable sedation.
- Loading dose is 1 mg/kg while gtt is .2-1.5 mcg/kg/hr
-This agent is often used in patients that would not tolerate a precipitous drop in their
sympathetic tone.
-Alcohol withdrawal is helped with because of excitatory effect of alcohol withdrawal on
adrenergic system
-Side effects; bradycardia, hypotension
Norepinephrine (Levophed) - ANSWER Naturally occurring alpha/beta-1 stimulating
catecholamine
- Primary agent used in distributive shock because it's ability to recruit venous volume and
augment preload, while increasing arterial tone, and increasing cardiac output.
- Alpha-stimulation causes peripheral, renal, splanchnic and pulmonary vasoconstriction.
-Beta-1 stimulation increases myocardial contractility, with less tachycardia produced than
with adrenaline.
-The beta-1 adrenergic effect are prominent in the lower dose range, while alpha-adrenergic
effects predominate at higher doses .
- Dose: 0.03-2mcg/kg/min
- CI: hypovolemia
**First line agent in septic shock
Phenylephrine (Neosynephrine) - ANSWER - Alpha-1 receptor agonist with little effect on beta
receptors of the heart; systemic vasoconstrictor
- Causes a rise in systolic and diastolic pressures, a slight decrease in cardiac output, and a
considerable increase in peripheral resistance
- Used rarely as adjunctive therapy for patients in septic shock. Used more often in
vasodilatory shock states such as neurogenic shock/ shock from epidural/spinal blocks.
Ephedrine - ANSWER - Vasopressor that activates Alpha 1 and 2, more strongly than Beta 1 and
2
- Indirect acting sympathomimetic most effective when treating postural hypotension and
asthma
- Longer acting and less potent that epinephrine
- Dose 5-10 mg IVP.
, Vasopressin (ADH) - ANSWER Potent increase in SVR through 2 different MOA.
1) Acts on renal collecting ducts via V2 receptors (via cAMP-dependent mechanism) to increase
water permeability, which leads to decreased urine formation. This increases blood volume,
cardiac output and arterial pressure.
2) Binds to V1 receptors on vascular smooth muscle to cause vasoconstriction (higher doses)
- Dose: 0.3-2 mu/kg/min
-Normal levels of the medication are below it's vasoactive range, however in profound
hypovolemic shock, AVP rises do contribute to increase in SVR.
-Utilized as adjuvant therapy in septic shock (in addition to levo)
Isoproterenol - ANSWER Isopril (rate 2-20 mcg/min)
-Isoprenaline is an synthetic catecholamine, a sympathomimetic.
-It has effects on beta receptors in the sympathetic nervous system (with minimal Alpha
effects).
- Used to treat shock, cardiac arrest and anaphylaxis (asthma)
Dexmedetomidine (Precedex) - ANSWER - Selective alpha 2 adrenergic agonist (suppresses
release of norepinephrine by negative feedback). The combination of these effects is
anesthesia with analgesia and anxiolysis.
- Provides light to moderate sedation w/o risk of respiratory depression. Can provide
semi-arousable sedation.
- Loading dose is 1 mg/kg while gtt is .2-1.5 mcg/kg/hr
-This agent is often used in patients that would not tolerate a precipitous drop in their
sympathetic tone.
-Alcohol withdrawal is helped with because of excitatory effect of alcohol withdrawal on
adrenergic system
-Side effects; bradycardia, hypotension
