Autonomic Drugs, Vasopressors, Inotropes, and Perioperative Cardiovascular Pharmacology — WACS Viva & Clinical Scenarios (Pharmacology and Applied Pharmacology)

Exam-style autonomic drugs, vasopressors, inotropes, and perioperative cardiovascular pharmacology viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 26-year-old primigravida develops profound hypotension (blood pressure 70/40 mmHg, heart rate 54 beats per minute) immediately after subarachnoid block for emergency Caesarean delivery. Compare and contrast the pharmacological actions of ephedrine versus phenylephrine in this clinical situation and justify your drug selection.
• SCENARIO 2: A 60-year-old male with severe septic shock secondary to ruptured diverticulum remains hypotensive (MAP 50 mmHg) despite 30 mL/kg crystalloid resuscitation. Outline your choice and pharmacological hierarchy of inotropes and vasopressors, including receptor profiles and starting infusion rates.
• SCENARIO 3: A 52-year-old male with known phaeochromocytoma is scheduled for open adrenalectomy. Detail the preoperative pharmacological preparation using alpha- and beta-adrenergic antagonists, emphasizing the rule of sequence and consequences of premature beta-blockade.
• SCENARIO 4: During a thyroidectomy, the patient develops narrow-complex supraventricular tachycardia with a rate of 180 beats per minute and blood pressure 85/50 mmHg. Provide your pharmacological management algorithm including adenosine, beta-blockers, and anti-arrhythmic agents.