Vasopressors

Dosing

100

What vasopressor generally uses fixed dosing instead of titrations?

Vasopressin

200

What is the default initial dose of norepinephrine here at SNGH?

A. 0.5 mcg/min

B. 5 mcg/min

C. 5 mg/min

D. 0.5 mg/min

B. 5 mcg/min

300

Our standard concentration of norepinephrine is 4mg/250mL, what is the concentration of our highly concentrated bag?

A. 8mg/250mL

B. 12mg/250mL

C. 16mg/250mL

D. 20mg/250mL

C. 16mg/250mL

400

What is the dose of vasopressin that is used in the majority of units at SNGH?

A. 0.02 units/min

B. 0.03 units/min

C. 0.04 units/min

D. 0.05 units/min

B. 0.03 units/min

500

Dopamine exerts its effects on different receptors depending on the dose. What are the receptors and the doses at which they are activated?

DAILY DOUBLE

D1 and D2 - 1-5 mcg/kg/min

B - 5-10 mcg/kg/min

a - >10 mcg/kg/min

Adverse Effects

100

Alpha-1 agonism of phenylephrine leads to a(n)_____ in cardiac output.

Decrease

200

What electrolyte abnormality can be attributed to vasopressin?

A. Hypernatremia

B. Hyponatremia

C. Hypocalcemia

D. Hypercalcemia 

B. Hyponatremia 

300

Dusky extremities are a sign of what adverse effect of vasopressors?

(HINT: VIALI)

Vasopressor-Induced Acute Limb Ischemia

400

Which of these vasopressors is not associated with splanchnic hypoperfusion? 

A. Low Dose Dopamine

B. Phenylephrine

C. Vasopressin

D. Epinephrine

A. Low Dose Dopamine

500

Which vasopressor can increase lactate levels even if perfusion is adequate?

A. Epinephrine

B. Phenylephrine

C. Angiotensin II

D. Dopamine

A. Epinephrine

Receptors

100

Which vasopressor acts on angiotensin receptors?

A. Norepinephrine

B. Vasopressin

C. Dopamine

D. Angiotensin II

D. Angiotensin II

200

What is the only vasopressor to act on dopamine receptors?

Dopamine 

300

This vasopressor exerts its effect exclusively through alpha-adrenergic agonism 

A. Vasopressin

B. Norepinephrine

C. Phenylephrine

D. Epinephrine

C. Phenylephrine

400

Which of these receptors is vasopressin NOT an agonist of?

A. V1a

B. V1b

C. V1c

D. V2

C. V1c

500

On which receptors does epinephrine act?

A. Angiotensin

B. alpha-1 and beta-1

C. beta-1, beta-2, and alpha-1

D. alpha-1, alpha-2, beta-1, and D1

C. beta-1, beta-2, and alpha-1

Clinical Scenarios

100

A patient presents with septic shock, what vasopressor would be preferred?

Norepinephrine

200

You're rounding on a patient in the GICU who is experiencing refractory shock on a high dose of norepinephrine. What vasopressor would you recommend adding?

A. Angiotensin II

B. Terlipressin

C. Isoproterenol

D. Vasopressin

D. Vasopressin

300

A patient requiring vasopressors has developed relative bradycardia. You remember your ACLS bradycardia training and recommend what vasopressor?

Dopamine 

400

A patient has improved perfusion on their vasopressor but has developed a tachyarrhythmia and their lactate is increasing. What vasopressor are they likely taking?

Epinephrine

500

A nurse comes running up to your team on rounds and tells you that they ran norepinephrine through a PIV which has now extravasated causing tissue ischemia. The resident panics and stares at you, what medication do you recommend the doctors order?

DAILY DOUBLE

Phentolamine 5-10mg injected along the area of extravasation 

Miscellaneous

100

What is the MAP goal for patients with septic shock receiving norepinephrine? 

A. 55

B. 65

C. 75

D. 85

B. 65

200

If high dose vasopressors are run peripherally, this adverse event may occur and cause tissue damage.

Extravasation 

300

What type of line is preferred for vasopressor administration?

Central line

400

Vasopressors are compatible to y-site with each other.

TRUE or FALSE

TRUE

500

What year was norepinephrine first approved? 

1950