09/25

Question 1

What is another name for special sympathomimetics?

Answer 1

indirect sympathomimetics

i.e. cocaine

Question 2

what is tyramine?

Answer 2

a precursor to tyrosine (an amino acid)
high in fermented food
releases catecholamines and metabolized by MAO

don’t eat fermented food if you are on MAOIs- will increase BP

Question 3

How do you pick a sympathomimetic?

Answer 3

by choosing which receptor activation you want, Alpha, Beta, or both

Question 4

What is the target when maintaining blood pressure?

Answer 4

Maintain blood flow to the heart, kidneys, and brain

Question 5

if you have a hypotensive emergency that has nothing to do with the heart, which type of drug do you want to take?

Answer 5

direct acting alpha agonists

i.e. norepinephrine or phenylephrine

Question 6

If you have a patient in cardiogenic shock, what body system do you want to target?

Answer 6

the heart.
This is a heart problem not a PVR problem

Question 7

What is a good drug choice for non-MI related hypotension?

Answer 7

volume replacement
vasoconstrictors or vasodilators

Question 8

alpha receptor agonists can be used in surgery to help achieve:

Answer 8

hemostasis
reduction in diffusion of local anesthetics

it constricts the blood vessels

Question 9

What receptor do you want to target in bronchial asthma?

Answer 9

Beta 2 agonists

Question 10

In complete heart block and cardiac arrest, what is the target?

Answer 10

vasodilation of coronary arteries

Question 11

Epi targets both

Answer 11

alpha and beta receptors

Question 12

Where alpha 1 agonists increase bp, alpha 2 agonist

Answer 12

decrease BP in the CNS
increase BP in the PNS

overall effect of decreasing blood pressure

Question 13

Clonidine is an alpha 2 agonists and has some use in sedation and:

Answer 13

hemodynamic instability during anesthesia

Question 14

phentolamine is a competitive antagonist for which receptors?

Answer 14

alpha 1 and alpha 2

this means they have a reduction in PVR=reduced BP
and some cardiac stimulation, increased HR d/t compensatory mechanisms from decreased BP and Increase in NE release from the CNS

Question 15

What is phentolamine used for?

Answer 15

lower blood pressure
pheochromocytoma
Erectile dysfunction

Question 16

what is priaprism?

Answer 16

an erection that does not go away

Question 17

What happens when you give an alpha agonist
beta agonist
mixed agonist

Answer 17

phenylephrine: increased BP
Epinephrine: increased BP Increased HR
Isoproterenol: decreased BP increased HR

Question 18

What happens when you give an alpha antagonist all by itself?

Answer 18

Phentolamine: Nothing really, constituent level of activity

Question 19

What happens when you give a beta agonist before an alpha antagonist?

Answer 19

Epinephrine before Phentolamine: Decreases the effects of Epinephrine= overall you have slightly higher BP and HR but not as high as it would be if you only gave Epi

Question 20

What would happen if you gave a beta agonist after an alpha antagonist?

Answer 20

Epinephrine after phentolamine: never really see the increased effects of Epi. Epi can outcompete if you give enough

Question 21

What is used to treat BPH?

Answer 21

-Osin drugs

Question 22

If it is a non-selective drug for alpha 1 or alpha 2 blocker then it will

Answer 22

increase HR

Question 23

alpha 2 receptors are heteroreceptors on the

Answer 23

norepinephrine neuron

Question 24

If it is selective for alpha 1 then there will be

Answer 24

little to no effect on HR

Question 25

beta blockers are prescribed for

Answer 25

nervousness and high BP

Question 26

What is the prototype beta blocker?

Answer 26

propranolol

Question 27

Beta blocker are competitive or noncompetitive agonist or antagonist?

Answer 27

competitive antagonist

Question 28

What are the biggest differences in beta blockers?

Answer 28

half life

Question 29

when you think of beta you think of

Answer 29

heart

Question 30

Other than the heart, beta blockers effect the

Answer 30

respiratory tract Increase airway resistance - B1 is safer Eye- decreases IOP by decreases production of aqueous humor Metabolism- Inhibits lipolysis and glycogenolysis

Question 31

What does glucogenolysis mean?

Answer 31

the breakdown of glycogen to release glucose into the blood stream

Question 32

propranolol vs. metoprolol

Answer 32

propranolol- prototype full agonist, works on Beta1 and beta 2 so have some airway effects metoprolol- mainly B1 so safer in COPD and Diabetics

Question 33

what is a mixed beta blocker?

Answer 33

Labetalol- 2 centers of asymmetry= 4 separate isomers 1 is an alpha blocker, 1 is a beta blocker, 2 are inactive decreases HR and inotrope and bp

Question 34

if the drug doesn't specify the racemic mixture then

Answer 34

it is the racemic mixture, not the pure form

Question 35

Esmolol is important for intraoperative

Answer 35

tachycardia achieved quickly and terminated quickly

Question 36

why aren't Beta blockers interchangeable?

Answer 36

because they work on different receptors

Question 37

blood pressure a measure of how much blood is

Answer 37

pressing against the walls of the vessels

Question 38

By giving beta blockers, you block the renin production. How?

Answer 38

By blocking Beta receptors in the kidney that produce renin

Question 39

How fast is esmolol?

Answer 39

Very short acting

Question 40

Vasodilators effect both

Answer 40

arterial and venous system

Question 41

What is the main difference between vasodilators and alpha blockers?

Answer 41

They don't work on alpha receptors

Question 42

How do vasodilators work?

Answer 42

they release Nitric oxide, a gas that vasodilates blood vessels by activated guanylyl cyclase thereby increasing cyclic GMP

Question 43

Where does the nitric oxide come from that gets released by vasodilators?

Answer 43

from the drug itself (nitroprusside) or the drug stimulates the endothelial cells that line the blood vessels to release their own nitric oxide (hydralazine)

Question 44

How do Calcium channel blockers work?

Answer 44

They block the P-type calcium channels. If Calcium never gets into the cell then no contraction of smooth muscle around the vessels

Question 45

Dopamine at very low levels do what?

Answer 45

lower blood pressure

Question 46

Dopamine at high levels do what?

Answer 46

activate alpha and beta receptors raising BP

Question 47

Polypharmacy can be useful in what situation?

Answer 47

when only using vasodilators. They vasodilate but the body is really good at kicking in compensatory mechanisms and fighting the drugs. Giving a beta blocker as well to decrease the HR and force of contraction will give a much better response

Question 48

What drug gives the side effect that looks like lupus?

Answer 48

slow acetylators taking Hydralazine