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Vasoactive Drug Pharmacology Flashcards

7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A patient on high-flow CPB has a MAP of 40 mmHg. The perfusionist adds phenylephrine to the prime. What is the PRIMARY concern with this intervention?

    Answer: Peripheral vasoconstriction may reduce organ perfusion despite adequate MAP

    While phenylephrine raises MAP, excessive vasoconstriction can compromise regional organ perfusion beds even when the overall pressure appears adequate.

  2. Epoprostenol (prostacyclin) is used during CPB for pulmonary hypertension. Its mechanism involves:

    Answer: Stimulating IP receptors to increase cAMP in vascular smooth muscle

    Epoprostenol binds prostacyclin (IP) receptors, activating adenylyl cyclase, increasing cAMP, and causing pulmonary vasodilation and platelet inhibition.

  3. Which vasoactive agent is contraindicated in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing cardiac surgery?

    Answer: Dobutamine

    Dobutamine's positive inotropic and chronotropic effects worsen LVOT obstruction in HOCM by increasing the dynamic gradient; alpha agonists and volume are preferred.

  4. The half-life of dobutamine is approximately:

    Answer: 10–12 minutes

    Dobutamine has a plasma half-life of approximately 10–12 minutes, allowing rapid titration of hemodynamic effect with infusion rate adjustments.

  5. A patient post-cardiac transplant requires vasopressor support. Which agent is preferred because the denervated heart responds best to direct-acting agonists?

    Answer: Epinephrine

    The denervated transplanted heart lacks sympathetic innervation, so indirect-acting agents like ephedrine are ineffective; direct-acting catecholamines like epinephrine are preferred.

  6. Sodium nitroprusside reduces both preload and afterload via which intracellular second messenger?

    Answer: cGMP

    Nitroprusside releases nitric oxide, which activates guanylate cyclase to increase cGMP, causing smooth muscle relaxation in both arterial and venous beds.

  7. During CPB rewarming, a patient develops severe systemic hypertension. Which agent provides rapid, titratable reduction of SVR with minimal effect on heart rate?

    Answer: Sodium nitroprusside

    Sodium nitroprusside is an arterial and venous dilator with a near-immediate onset and ultrashort duration, making it ideal for intraoperative hypertensive crises requiring precise titration.