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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. Which vasoactive drug combination is most commonly used to treat the combination of low cardiac output AND high pulmonary vascular resistance after cardiac surgery?

    Answer: Milrinone + inhaled nitric oxide

    Milrinone reduces PVR and improves RV contractility, while inhaled NO selectively dilates the pulmonary vasculature, making them complementary for right heart failure with elevated PVR.

  2. The 'calcium sensitizer' class of inotropes is advantageous over traditional catecholamines in heart failure primarily because they:

    Answer: Do not increase myocardial oxygen consumption proportionally to contractile improvement

    Calcium sensitizers like levosimendan enhance contractility without raising intracellular calcium, thereby minimizing the increase in myocardial oxygen demand seen with catecholamines.

  3. A perfusionist is managing a patient with right ventricular failure post-CPB. Which combination of hemodynamic goals is MOST appropriate?

    Answer: Optimize preload, reduce PVR, increase RV contractility

    RV failure management targets adequate (not excessive) preload, reduction of PVR to decrease RV afterload, and augmentation of RV contractility with inotropes.

  4. At low doses (0.5–3 mcg/kg/min), dopamine's predominant effect on renal vasculature is mediated by:

    Answer: Dopamine D1 receptors causing renal vasodilation

    Low-dose dopamine activates D1 receptors in renal and mesenteric vasculature, causing vasodilation; however, evidence does not support improved clinical outcomes ('renal dose dopamine' is not evidence-based).

  5. Which adverse effect is most associated with prolonged high-dose vasopressin infusion in a cardiac surgical patient?

    Answer: Mesenteric and digital ischemia due to intense vasoconstriction

    Vasopressin's potent V1-mediated vasoconstriction can lead to gut and extremity ischemia, particularly at doses exceeding 0.04 units/min.

  6. Esmolol differs from other beta-blockers used perioperatively primarily because of its:

    Answer: Ultrashort duration due to ester hydrolysis by red blood cell esterases

    Esmolol is hydrolyzed by red blood cell esterases with a half-life of approximately 9 minutes, making it ideal for short-term, titratable beta-1 blockade.

  7. When transitioning a patient from CPB with persistent low cardiac output, milrinone is chosen over dobutamine. The PRIMARY advantage in this scenario is:

    Answer: Milrinone also reduces SVR and PVR (afterload reduction) in addition to inotropy

    Milrinone's phosphodiesterase III inhibition increases cAMP in both myocardium and vascular smooth muscle, providing simultaneous inotropy and vasodilation (inodilation) to reduce both SVR and PVR.