DOCSLIB.ORG

Cardiac and Peripheral Vascular Responses to Adrenoceptor Stimulation and Blockade After Cardiac Transplantation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cardiac and Peripheral Vascular Responses to Adrenoceptor Stimulation and Blockade After Cardiac Transplantation View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector JACC Vol. 14. No. 5 1229 November I, 1989: 1229-38 Cardiac and Peripheral Vascular Responses to Adrenoceptor Stimulation and Blockade After Cardiac Transplantation KENNETH M. BOROW, MD, FACC, ALEX NEUMANN, BS, FREDERICK W. ARENSMAN, MD, FACC, MAGDI H. YACOUB, MB, BS, FACC” Chicago, Illinois and Harejield, Middlesex, England A denervated heart coupled to a periphery previously inotropic and chronotropic effects of dobutamine were exposed to high catecholamine levels provides a unique ablated by propranolol. Dobutamine plus propranolol (un- model to study adrenoceptor physiology. Six orthotopic opposed alpha, effect) did not change mean systemic pres- transplant patients (1.3 2 0.8 years postoperative) were age sure in transplant patients while markedly raising mean matched with six atropine-treated normal subjects. Simul- systemic pressures in normal subjects (36 f 18 mm Hg; p < taneous two-dimensionally targeted left ventricular echo- 0.001). In addition, during initial challenge with methox- cardiograms and calibrated carotid pulse tracings were amine, the transplant patients required 60% more alpha, recorded. Left ventricular contractility was assessed with agonist than did the normal subjects (p < 0.001) to obtain use of heart rate- and load-independent end-systolic in- a pressor effect. dexes. Studies were performed at baseline and during In summary, transplant patients who were previously in dobutamine infusion with and without beta-adrenergic severe heart failure have normal left ventricular inotropic blockade with use of propranolol; effects were assessed response to beta, activation and blockade, exaggerated during afterload changes generated by the alpha, agonist chronotropic response to dobutamine and reduced sensitiv- methoxamine. ity to stimulation with alpha,-adrenoceptor agonists. These There were no differences in baseline contractility or findings are consistent with a differential response of reserve between transplant patients and normal subjects. adrenoceptors to long-term stimulation after cardiac trans- The heart rate response to dobutamine was greater for plantation. transplant patients (p < 0.001). In both groups, the positive (J Am Co11Cardiol1989;14:1229-38) Orthotopic cardiac transplantation represents a unique phys- nists in these patients. To explore this issue, load- iologic model for the assessment of adrenoceptor function in independent sensitive indexes of left ventricular contractility humans. In such cases, a denervated “healthy” heart is in conjunction with systemic blood pressure measurements attached to a peripheral vascular bed that has previously and vascular resistance calculations (5-10) were used to been exposed to low cardiac output and markedly elevated establish the myocardial and peripheral effects of adrenocep- plasma catecholamine concentrations (l-5). With transplan- tor stimulation and blockade in transplant patients and tation, normal levels of cardiac output are usually restored. normal subjects. However, little is known about the effects of improved blood Specijically, three agents were used as pharmacologic flow on peripheral vascular responses to adrenoceptor ago- probes: 1) dobutamine, a catecholamine with beta,, beta, and alpha, agonist effects; 2) methoxamine, a catecholamine with only alpha,-agonist actions; and 3) propranolol, a nonspecific beta-adrenoceptor antagonist. From the Cardiology Division, Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois and the *Division of Cardiovas- cular Surgery, Harefield Hospital, Harefield, Middlesex, England. This study was supported in part by a Grant-in-Aid from the American Heart Association Methods of Metropolitan Chicago, Chicago, and by the Louis Block Fund of the University of Chicago, Chicago, Illinois. Study patients. The study group was composed of six Manuscript received December 12, 1988; revised manuscript received men who underwent orthotopic cardiac transplantation at March 22, 1989,accepted May IO, 1989. Harefield Hospital, Harefield, Middlesex, England. Before Address for reurints: Kenneth M. Borow, MD, Director, Cardiac Nonin- vasive Physiology Laboratory, The University of Chicago Medical Center. transplantation, all patients had long-standing congestive 5841South Maryland Avenue, Box 44, Chicago, Illinois 60637. heart failure and were in New York Heart Association 01989 by the American College of Cardiology 073%1097/89/$3.50 1230 BOROW ET AL. JACC Vol. 14, No. 5 ADRENOCEPTORS AFTER CARDIAC TRANSPLANTATION November 1, 1989: 122%38 functional class IV. No one was treated with alpha,- pg/kg per min infusion of dobutamine. This catecholamine adrenergic receptor blocking agents either before or after was chosen because it has beta,-, beta,- and alpha,-agonist operation and all had taken no anti-hypertensive therapy for effects (12-15). After 7 min of infusion, new baseline record- 21 month. At the time of operation, the subjects ranged in ings were performed. The methoxamine challenge was then age from 41 to 53 years (mean ? SD 49 ? 5). The donor repeated during the constant dobutamine infusion. hearts were between 18 and 39 years of age (mean 25 + 7). After the methoxamine infusion was discontinued and The interval from transplant surgery to study was 1.3 ? 0.8 peak systolic pressure had fallen to within 5% of the initial years (range 0.6 to 2.8). During this period, the patients had dobutamine value, the final part of the study was begun. an average of 1.2 ? 1.0 episodes of transplant rejection. No With the dobutamine still infusing, the nonspecific beta- patient had evidence of rejection by endomyocardial biopsy adrenergic blocking agent propranolol was given. The dose performed within 7 days of study nor did any patient have of the propranolol was titrated to return heart rate to the evidence for accelerated atherosclerosis on coronary arteri- pre-dobutamine control value. The total dose of propranolol ography. Immunosuppressive therapy included azathioprine given the transplant patients and normal subjects was not in six cases, 10 to 15 mg/day of prednisone in five cases and significantly different (0.07 +- 0.01 versus 0.09 ? 0.02 mg/kg, cyclosporine in two cases. Portions of the transplant pa- tients’ data on left ventricular contractile reserve have been respectively). The methoxamine infusion was then repeated. reported previously (11). All transplant patients and normal subjects completed this Comparisons of contractility data were performed with portion of the experimental design. data acquired from six normal subjects matched for donor In addition, two ancillary protocols were performed: heart age. Comparisons of peripheral vascular hemodynam- 1) At the end of the study, the transplant patients were its were made using these six normal subjects as well as six challenged with an isoproterenol infusion (26 + 4 ng/kg additional normal subjects matched to the cardiac transplant per min for 5 min) to test for adequacy of beta-adreno- recipients’ ages. The protocol used to study the cardiac ceptor blockade. This dose of isoproterenol was compar- transplant patients met the criteria for human investigation able with the highest dose used by Yusuf et al. (16) in previously established at Harefield Hospital. The protocol their study of adequacy of beta-blockade induced by pro- used for the normal control subjects was approved by the pranolol in patients with an orthotopic cardiac transplant. Committee on Human Protection from Research Risks of The increase in heart rate induced by isoproterenol in our The University of Chicago Medical Center. In all cases, patients was only 4 ? 4 beatslmin, thereby demonstrating a informed consent was obtained. high level of effective beta-blockade. 2) One week after Experimentaldesign. The transplant patients and normal completion of the first study, the same normal subjects subjects were studied with use of similar protocols. Simul- underwent a second study. At this time, the identical dose taneous recordings of two-dimensionally targeted M-mode of propranolol was given before rather than after the initia- echocardiograms of the left ventricle, phonocardiogram, tion of the dobutamine infusion. No methoxamine was electrocardiogram (ECG), indirect carotid pulse tracings and administered. Performance of the second study allowed a blood pressure measurements were performed under base- crossover analysis of the effects of dobutamine plus pro- line conditions. Normal subjects were premeditated with pranolol. In addition, it eliminated the possibility that resid- atropine (0.010 to 0.015 mg/kg body weight). This resulted in ual alpha,-receptor activity secondary to methoxamine pharmacologic depression of vagal tone and allowed baseline would confound the blood pressure response in the normal data to be acquired at heart rates comparable with those subjects. noted in the denervated transplanted hearts. In summary, this protocol allowed assessment of left To assess baseline contractility and the response of the ventricular baseline contractility and contractile reserve as systemic arterial circulation to a hypertensive challenge, recordings were made during infusion of the alpha,-receptor well as the effects of alpha,-, beta,- and beta,-adrenergic agonist methoxamine. This drug has no direct cardiac effect receptor stimulation with and without beta-receptor block- in the doses used in the current study (12). Recordings were ade.
Load more

Recommended publications
  • Guidelines for NON - CRITICAL CARE Staff Common Vasoactive Drugs These Drugs Are Used to Maintain Cardiovascular Stability
    Guidelines for NON - CRITICAL CARE staff Common vasoactive drugs These drugs are used to maintain cardiovascular stability. The full guide to administration can be found on BSUH infonet > intensive care unit > clinical guidelines > inotropes These drugs MUST be given via a central venous catheter. Be given via a ‘dedicated’ line (several vasoactives can run together in one lumen of a CVC) with a 2, 3 or 4 lumen connector. given via an ICU specific syringe driver – these allow you to change the rate without pausing the infusion. All ICU pumps have ICU or HDU spray-painted on them. Be ‘double pumped’ ie: when changing syringe, the old and new infusions run concurrently to prevent loss of infusion during change UNLESS ‘RAPID CHANGE- OVER’ TECHNIQUE IS USED, DUE TO LACK OF AVAILABLE PUMPS These drugs MUST NOT be paused, stopped or disconnected suddenly – they have a short half-life and pausing/stopping/disconnection may cause rapid CVS deterioration or arrest UNLESS ‘RAPID CHANGE-OVER’ TECHNIQUE IS USED, DUE TO LACK OF AVAILABLE PUMPS be given as a bolus, or bolused via the pump – this could cause rapid CVS instability run with ANY drug other than a vasoactive drug COMMON VASOACTIVES NORADRENALINE – vasopressor: causes vasoconstriction and used to improve BP USES: sepsis, septic shock, severe hypotension not resolved with fluid ADRENALINE – inotrope: increases contractility, raises BP and HR USES: sepsis, septic shock, severe bradycardia DOBUTAMINE – intrope and vasodilator: increases contractility and reduces cardiac work USES:
    [Show full text]
  • Wednesday, July 10, 2019 4:00Pm
    Wednesday, July 10, 2019 4:00pm Oklahoma Health Care Authority 4345 N. Lincoln Blvd. Oklahoma City, OK 73105 The University of Oklahoma Health Sciences Center COLLEGE OF PHARMACY PHARMACY MANAGEMENT CONSULTANTS MEMORANDUM TO: Drug Utilization Review (DUR) Board Members FROM: Melissa Abbott, Pharm.D. SUBJECT: Packet Contents for DUR Board Meeting – July 10, 2019 DATE: July 3, 2019 NOTE: The DUR Board will meet at 4:00pm. The meeting will be held at 4345 N. Lincoln Blvd. Enclosed are the following items related to the July meeting. Material is arranged in order of the agenda. Call to Order Public Comment Forum Action Item – Approval of DUR Board Meeting Minutes – Appendix A Update on Medication Coverage Authorization Unit/SoonerPsych Program Update – Appendix B Action Item – Vote to Prior Authorize Jornay PM™ [Methylphenidate Extended-Release (ER) Capsule], Evekeo ODT™ [Amphetamine Orally Disintegrating Tablet (ODT)], Adhansia XR™ (Methylphenidate ER Capsule), and Sunosi™ (Solriamfetol Tablet) – Appendix C Action Item – Vote to Prior Authorize Balversa™ (Erdafitinib) – Appendix D Action Item – Vote to Prior Authorize Annovera™ (Segesterone Acetate/Ethinyl Estradiol Vaginal System), Bijuva™ (Estradiol/Progesterone Capsule), Cequa™ (Cyclosporine 0.09% Ophthalmic Solution), Corlanor® (Ivabradine Oral Solution), Crotan™ (Crotamiton 10% Lotion), Gloperba® (Colchicine Oral Solution), Glycate® (Glycopyrrolate Tablet), Khapzory™ (Levoleucovorin Injection), Qmiiz™ ODT [Meloxicam Orally Disintegrating Tablet (ODT)], Seconal Sodium™ (Secobarbital
    [Show full text]
  • FACT SHEET for HEALTHCARE PROVIDERS Coronavirus Emergency Use of the Coviage System During the COVID-19 Pandemic Disease 2019 September 24, 2020 (COVID-19)
    FACT SHEET FOR HEALTHCARE PROVIDERS Coronavirus Emergency Use of the COViage System During the COVID-19 Pandemic Disease 2019 September 24, 2020 (COVID-19) This Fact Sheet informs you of the significant known and What do I need to know about COVID-19 treatment? potential risks and benefits of the emergency use of the Current information on COVID-19 infection, including COViage System (or “COViage”) for use by healthcare case definitions and information about clinical signs and providers (HCP) in the hospital setting for adult patients symptoms and/or epidemiological criteria, is available on (18 years of age or older who are admitted to the the CDC website listed at the end of this fact sheet. hospital) with confirmed COVID-19 (based on a positive . PCR test result) for the computation of proprietary patient status indices referred to as Respiratory What is the COViage System? Decompensation Status and Hemodynamic Instability The COViage System is a non-interventional software Status as an adjunct to patient monitoring during the program that uses vital signs and patient demographic COVID-19 outbreak. The COViage indices provide HCP data from EMR systems. It uses models derived from with predictive screening information as a diagnostic aid machine learning on patient data from EMRs to calculate to assist with the early identification of COVID-19 the likelihood of the occurrence of certain clinically patients who are likely to be diagnosed with significant events, specifically, hemodynamic instability hemodynamic instability or respiratory decompensation, or respiratory decompensation. It then notifies HCP of which are common complications associated with patients who, according to the algorithm, are expected to COVID-19.
    [Show full text]
  • The Effects of Dobutamine on Cardiac Sympathetic Activity in Patients with Congestive Heart Failure Abdul Al-Hesayen, MD, Eduardo R
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Journal of the American College of Cardiology Vol. 39, No. 8, 2002 © 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)01783-7 The Effects of Dobutamine on Cardiac Sympathetic Activity in Patients With Congestive Heart Failure Abdul Al-Hesayen, MD, Eduardo R. Azevedo, MD, Gary E. Newton, MD, John D. Parker, MD, FACC Toronto, Canada OBJECTIVES The goal of this work was to study the effects of short-term infusion of dobutamine on efferent cardiac sympathetic activity. BACKGROUND Increased efferent cardiac sympathetic activity is associated with poor outcomes in the setting of congestive heart failure (CHF). Dobutamine is commonly used in the therapy of decompensated CHF. Dobutamine, through its effects on excitatory beta-receptors, may increase cardiac sympathetic activity. METHODS Seven patients with normal left ventricular (LV) function and 13 patients with CHF were studied. A radiotracer technique was used to measure cardiac norepinephrine spillover (CANESP) before and during an intravenous infusion of dobutamine titrated to increase the rate of rise in LV peak positive pressure (ϩdP/dt) by 40%. RESULTS Systemic arterial pulse pressure increased significantly in response to dobutamine in the normal LV function group (74 Ϯ 3mmHgto85Ϯ 3 mm Hg, p ϭ 0.005) but remained unchanged in the CHF group. Dobutamine caused a significant decrease in LV end-diastolic pressure in the CHF group (14 Ϯ 2mmHgto11Ϯ 2 mm Hg, p ϭ 0.02), an effect not observed in the normal LV group.
    [Show full text]
  • Wednesday, June 12, 2019 4:00Pm
    Wednesday, June 12, 2019 4:00pm Oklahoma Health Care Authority 4345 N. Lincoln Blvd. Oklahoma City, OK 73105 The University of Oklahoma Health Sciences Center COLLEGE OF PHARMACY PHARMACY MANAGEMENT CONSULTANTS MEMORANDUM TO: Drug Utilization Review (DUR) Board Members FROM: Melissa Abbott, Pharm.D. SUBJECT: Packet Contents for DUR Board Meeting – June 12, 2019 DATE: June 5, 2019 Note: The DUR Board will meet at 4:00pm. The meeting will be held at 4345 N. Lincoln Blvd. Enclosed are the following items related to the June meeting. Material is arranged in order of the agenda. Call to Order Public Comment Forum Action Item – Approval of DUR Board Meeting Minutes – Appendix A Update on Medication Coverage Authorization Unit/Use of Angiotensin Converting Enzyme Inhibitor (ACEI)/ Angiotensin Receptor Blocker (ARB) Therapy in Patients with Diabetes and Hypertension (HTN) Mailing Update – Appendix B Action Item – Vote to Prior Authorize Aldurazyme® (Laronidase) and Naglazyme® (Galsulfase) – Appendix C Action Item – Vote to Prior Authorize Plenvu® [Polyethylene Glycol (PEG)-3350/Sodium Ascorbate/Sodium Sulfate/Ascorbic Acid/Sodium Chloride/Potassium Chloride] – Appendix D Action Item – Vote to Prior Authorize Consensi® (Amlodipine/Celecoxib) and Kapspargo™ Sprinkle [Metoprolol Succinate Extended-Release (ER)] – Appendix E Action Item – Vote to Update the Prior Authorization Criteria For H.P. Acthar® Gel (Repository Corticotropin Injection) – Appendix F Action Item – Vote to Prior Authorize Fulphila® (Pegfilgrastim-jmdb), Nivestym™ (Filgrastim-aafi),
    [Show full text]
  • Authorization Requirements for Medications Under
    Authorization Requirements for Medications Under the Medical Benefit HCPC/MOD Marketplace BRAND NAME LONG DESCRIPTION SHORT DESCRIPTION Limits Rabies Immune Globulin 90375 No Auth. Required HyperRab Rabies Immune Globulin (Human) (Human) Up to 5 90378 Auth Required Synagis Palivizumab Synagis treatments Imovax Rabies vaccine, for intramuscular Rabies vaccine, for 90675 No Auth. Required Rabavert use (Code price is per 1 mL) intramuscular use Maximum 2 units Pfizer-Biontech Covid-19 Must be billed 91300 No Auth. Required Pfizer COVID-19 Vaccine SARSCOV2 VAC 30MCG/0.3ML IM Vaccine with 0001A or 0002A Maximum 2 units Must be billed 91301 No Auth. Required Moderna COVID-19 Vaccine SARSCOV2 VAC 100MCG/0.5ML IM Moderna Covid-19 Vaccine with 0011A or 0012A Postpartum Maternal Newborn Postpartum Maternal 4 Units Within 180 99501 No Auth. Required Assessment Service Newborn Assessment Service days 4 Units Within 180 99502 No Auth. Required Newborn Assessment Newborn Assessment days Home Nursing Visit for Medication Home Nursing Visit for 99506 Auth Required Administration Medication Administration 17Alpha- 17Alpha-hydroxyprogesterone hydroxyprogesterone 99600 No Auth. Required Caproate (17P) Administration Caproate (17P) Nursing Service Administration Nursing Service Home infusion/specialty drug Home infusion/specialty drug Up to 2 hours per 99601 No Auth. Required administration, per visit (up to 2 administration, per visit (up day hours) to 2 hours) Home infusion/specialty drug Home infusion/specialty drug administration, per visit (up administration, per visit (up to 2 to 2 hours); each additional hours); each additional hour (List hour (List separately in Up to 2 hours per 99602 No Auth. Required separately in addition to code addition to code 99601 for day 99601 for primary procedure) (Use primary procedure) (Use 99602 in conjunction with 99601) 99602 in conjunction with 99601) Maximum 1 Pfizer-Biontech Covid-19 Pfizer COVID-19 Vaccine administration 0001A No Auth.
    [Show full text]
  • Postoperative Vasopressor Usage: a Prospective International Observational Study
    SQUEEZE Postoperative vasopressor usage: a prospective international observational study CRF1 PATIENT IDENTIFICATION NUMBER: _____________ PRE-OPERATIVE DATE OF SURGERY: ___________________________ Month and year of birth Sex [m/f] Height [cm] Weight [kg] Clinical Frailty Scale (Rockwood): point 0 to 9. (Will be explained in final CRF) Previous medical history: Coronary Artery Disease: Y/N Cerebrovascular Disease: Y/N Peripheral vascular disease: Y/N Atrial fibrillation: Y/N Heart failure: Y/N Hypertension: Y treated and controlled, Y treated but not controlled, No Diabetes: Takes insulin/managed without insulin/None Chronic liver disease: Y/N Chronic respiratory disease: COPD/other/None Chronic immunosuppression: HIV/other/none Chronic Kidney Disease: No/Yes/Yes and receives renal replacement therapy Long-term steroid use: Y/N Recent/current treatment for cancer (including chemotherapy, radiotherapy, surgery) Regular medications ACE inhibitor: Y and took today/ Y omitted today/N Alpha blocker: Y and took today/ Y omitted today/N Angiotensin Receptor Blocker: Y and took today/ Y omitted today/N Beta blocker: Y and took today/ Y omitted today/N Calcium channel blocker: Y and took today/ Y omitted today Diuretic: Y and took today/ Y omitted today/N Regular NSAIDs: Y/N Regular PPI: Y/N Haemodynamics Measurement in the past 6 months, at least 12h prior to the operating room, at rest: Systolic, Diastolic Heart rate The reading immediately prior to induction of anaesthesia: Systolic, Diastolic Heart rate Laboratory results, most recent (if known
    [Show full text]
  • Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: a Systematic Review and Meta-Analysis
    Journal of Clinical Medicine Review Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis 1, 2, 1 3 Mina Karami y , Veemal V. Hemradj y, Dagmar M. Ouweneel , Corstiaan A. den Uil , Jacqueline Limpens 4, Luuk C. Otterspoor 5, Alexander P. Vlaar 6 , Wim K. Lagrand 6 and José P. S. Henriques 1,* 1 Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; [email protected] (M.K.); [email protected] (D.M.O.) 2 Department of Cardiology, Isala, 8025 AB Zwolle, The Netherlands; [email protected] 3 Departments of Cardiology and Intensive Care Medicine, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands; [email protected] 4 Medical Library, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; [email protected] 5 Heart Center Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; [email protected] 6 Department of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; [email protected] (A.P.V.); [email protected] (W.K.L.) * Correspondence: [email protected] These two authors contributed equally. y Received: 5 May 2020; Accepted: 25 June 2020; Published: 30 June 2020 Abstract: Vasopressors and inotropes are routinely used in acute myocardial infarction (AMI) related cardiogenic shock (CS) to improve hemodynamics. We aimed to investigate the effect of routinely used vasopressor and inotropes on mortality in AMI related CS. A systematic search of MEDLINE, EMBASE and CENTRAL was performed up to 20 February 2019.
    [Show full text]
  • DOBUTAMINE - Dobutamine Hydrochloride Injection, Solution Physicians Total Care, Inc
    DOBUTAMINE - dobutamine hydrochloride injection, solution Physicians Total Care, Inc. ---------- Rx only DESCRIPTION Dobutamine Injection, USP is 1,2-benzenediol, 4-[2-[[3-(4-hydro-xyphenyl)-1- methylpropyl]amino]ethyl]-hydrochloride, (±). It is a synthetic catecholamine. The clinical formulation is supplied in a sterile form for intravenous use only. Each mL contains: Dobutamine hydrochloride, equivalent to 12.5 mg (41.5 µmol) dobutamine; 0.24 mg sodium metabisulfite (added during manufacture), and water for injection. pH adjusted between 2.5 to 5.5 with hydrochloric acid and/or sodium hydroxide. Dobutamine is oxygen sensitive. CLINICAL PHARMACOLOGY Dobutamine is a direct-acting inotropic agent whose primary activity results from stimulation of the β receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects. It does not cause the release of endogenous norepinephrine, as does dopamine. In animal studies, dobutamine produces less increase in heart rate and less decrease in peripheral vascular resistance for a given inotropic effect than does isoproterenol. In patients with depressed cardiac function, both dobutamine and isoproterenol increase the cardiac output to a similar degree. In the case of dobutamine, this increase is usually not accompanied by marked increases in heart rate (although tachycardia is occasionally observed), and the cardiac stroke volume is usually increased. In contrast, isoproterenol increases the cardiac index primarily by increasing the heart rate while stroke volume changes little or declines. Facilitation of atrioventricular conduction has been observed in human electrophysiologic studies and in patients with atrial fibrillation. Systemic vascular resistance is usually decreased with administration of dobutamine. Occasionally, minimum vasoconstriction has been observed.
    [Show full text]
  • PHARMACEUTICAL APPENDIX to the HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2008) (Rev
    Harmonized Tariff Schedule of the United States (2008) (Rev. 1) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2008) (Rev. 1) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. ABACAVIR 136470-78-5 ACIDUM GADOCOLETICUM 280776-87-6 ABAFUNGIN 129639-79-8 ACIDUM LIDADRONICUM 63132-38-7 ABAMECTIN 65195-55-3 ACIDUM SALCAPROZICUM 183990-46-7 ABANOQUIL 90402-40-7 ACIDUM SALCLOBUZICUM 387825-03-8 ABAPERIDONUM 183849-43-6 ACIFRAN 72420-38-3 ABARELIX 183552-38-7 ACIPIMOX 51037-30-0 ABATACEPTUM 332348-12-6 ACITAZANOLAST 114607-46-4 ABCIXIMAB 143653-53-6 ACITEMATE 101197-99-3 ABECARNIL 111841-85-1 ACITRETIN 55079-83-9 ABETIMUSUM 167362-48-3 ACIVICIN 42228-92-2 ABIRATERONE 154229-19-3 ACLANTATE 39633-62-0 ABITESARTAN 137882-98-5 ACLARUBICIN 57576-44-0 ABLUKAST 96566-25-5 ACLATONIUM NAPADISILATE 55077-30-0 ABRINEURINUM 178535-93-8 ACODAZOLE 79152-85-5 ABUNIDAZOLE 91017-58-2 ACOLBIFENUM 182167-02-8 ACADESINE 2627-69-2 ACONIAZIDE 13410-86-1 ACAMPROSATE
    [Show full text]
  • PHARMACOLOGY Lecture: Adrenergic Drugs
    PHARMACOLOGY Lecture: Adrenergic drugs OBJECTIVES: •Identify the classification of adrenergic agonists •Describe pharmacokinetics and dynamics of adrenergic agonists • Differentiate between the actions of a and b-adrenoceptors agonists • List the clinical uses of adrenergic agonists. • know adverse effects & contraindications of adrenergic agonists • Identify one specific adrenergic agonist for each of the following special uses: Hypotensive states, shock, heart failure, heart decompensation, asthma, premature labour…ect.. Terminology: Chronotropic = increase cardiac output Inotropic = increase cardiac force of contraction Dromotropic = increase conduction velocity Tocolytics (anti-contraction) are medications used to suppress premature labor. Extravasation: leakage of drug from the vessel into tissues surrounding the injection site Adrenaline = epinephrine (E) Noradrenaline (NA) = norepinephrine (NE) . Important. Extra notes. Neurotransmission at adrenergic neurons Adrenergic transmission: Note: Adrenergic neurons 1) Synthesis of norepinephrine release norepinephrine as the 2) Storage of norepinephrine in vesicles primary neurotransmitter. 3) Release of norepinephrine 4) Binding to post synaptic receptors 5) Ending the action of NE by: • Neuronal reuptake into neuron • Monoamine oxidase (MAO) in neuronal mitochondria • Catechol -O-methyl transferase (COMT) in synaptic space Adrenergic receptors Adrenergic receptors Dopaminergic a- b- adrenoceptors adrenoceptors receptors a1 a2 b1 b2 b3 e.g. D1 α1 β2 β1 β3 Post-synaptic excitatory in function (cause inhibitory in function excitatory in In adipose contraction) except in GIT. (cause relaxation) function, present tissue mainly in heart Present mainly in smooth muscles. Contraction of pregnant Relaxation of the uterus (Delay ↑ heart rate: ↑ lipolysis uterus. premature labor) + chronotropic ↑ free effect, Tachycardia fatty acids. Vasoconstriction of skin & Relaxation of skeletal & peripheral blood vessels coronary blood vessels ↑ force of →increased peripheral (vasodilatation) contraction : resistance → hypertension.
    [Show full text]
  • Dobutamine and Isoprenaline After Open Heart Surgery
    British Heart Journal, 1976, 38, 622-626. A comparison of cardiovascular effects of dobutamine and isoprenaline after open heart surgery Friedrich Kersting,l Ferenc Follath, Robert Moulds, John Mucklow, Rory McCloy, Joe Sheares, and Colin Dollery From the Departments of Clinical Pharmacology and Surgery, Royal Postgraduate Medical School, Ducane Road, London In a cross-over study, the cardiovascular effects ofdobutamine were assessed in 11 patients who had undergone operation for replacement of the mitral or aortic valve approximately four hours earlier. In 9 of these the effects of isoprenaline were assessedfor comparison. Dose-resporse curves were obtained usingfour dose levels of dobutamine in the range 1-25-10 Vg/kg per min and of isoprenaline in the range of 0 005-0 04 [tg/kg per min. Both drugs produced similar dose-dependent increases in heart rate and cardiac output and a dose- dependent decrease in peripheral resistance. Mean arterial pressure was only slightly increased by either drug. The positive inotropic effect of dobutamine was confirmed, but the chronotropic effect was not significantly different from that of isoprenaline. This contrasts with the findings of previous studies, and possible reasons for this are discussed. One of the most serious sequels of cardiac surgery is naline were compared in 9 patients, the other 2 cardiovascular failure associated with low cardiac receiving dobutamine alone. Only those patients output (Dietzman et al., 1969). Isoprenaline is of in sinus rhythm and free of other postoperative benefit in this situation (Harrison, Kerber, and complications requiring continuous intensive treat- Alderman, 1970) but its use is often limited by the ment were included in the study.
    [Show full text]