CRNA Interview: Pharmacology Exam Questions And Correct Answers
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CRNA Interview: Pharmacology Exam
Questions And Correct Answers
Norepinephrine (Levophed) - answerNaturally 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 t...
CRNA Interview: Pharmacology Exam
Questions And Correct Answers
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
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 concentrations of the drug are below it's vasoactive range, nevertheless in severe
hypovolemic shock, AVP increases do contribute to increase in SVR.
- Used as adjunctive therapy in septic shock (in addition to levo)
Isoproterenol - answer✔Isopril (rate 2-20 mcg/min)
- Isoprenaline is a synthetic catecholamine, a sympathomimetic.
- It stimulates 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 without 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 for patients who would not tolerate a precipitous drop in their
sympathetic tone.
- Helps with alcohol withdrawal because alcohol withdrawal has excitatory effect on adrenergic
system
- Side effects; bradycardia, hypotension
Propofol - answer✔Propofol is a lypophylic general anesthetic
- GABA receptor agonist, very similar to benzodiazepines, except instead of increasing the
FREQUENCY of Cl- channel opening, it slows its closing time.
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