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Boards Pharm 03: Autonomics > 2. Adrenergics > Flashcards

2. Adrenergics Flashcards

1
Q

Sympathomimetics - Available Drugs

A 
Epinephrine
Norepinephrine
Isoproterenol
Dopamine
Dobutamine
Phenylephrine
Metaproterenol
Albuterol
Salmeterol
Terbutaline
Ritodrine
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2
Q

Epinephrine - MOA

A

Agonist at a1, a2, b1, and b2 adrenergic receptors.

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3
Q

Epinephrine - Clinical Use

A

Anaphylaxis, glaucoma (open angle), asthma, hypotension

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4
Q

Norepinephrine - MOA

A

Agonist at a1, a2, and b1 adrenergic receptors.

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5
Q

Norepinephrine - Clinical Use

A

Hypotension (but decreases renal perfusion)

  • Increase systolic BP due to effects on b1 increase on chronotropy and ionotropy of heart.
  • Increase diastolic BP due to effects on a1 causing vasoconstriction
  • Large BP increase will cause reflex bradycardia
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6
Q

Isoproterenol - MOA

A

Beta selective adrenergic agonist (b1 and b2)

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7
Q

Isoproterenol - Clinical Use

A
  • AV block
  • Bradycardia
  • Transient increase systolic BP due to effects on b1 increase on chronotropy and ionotropy of heart. Overcome by vasodilatory effects and will drop slightly
  • Decrease diastolic BP due to effects on b2 causing vasodilation
  • Large BP decrease will cause reflex tachycardia
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8
Q

Dopamine - MOA

A
  • D1 selective receptor agonist at low doses
  • At medium doses also agonist at b1 and b2 adrenergic receptors
  • At high doses also agonist at a1 and a2 adrenergic receptors
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9
Q

Dopamine - Clinical Use

A
  • At low doses to increase renal perfusion in shock [D1 receptor]
  • At medium doses for heart failure –> ionotropic and chronotropic [b1 and b1 receptors]
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10
Q

Dobutamine - MOA

A

Agonist at a1, a2, and b1 adrenergic receptors.

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11
Q

Dobutamine - Clinical Use

A

Heart failure, cardiac stress testing

- ionotropic and chronotropic

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12
Q

Phenylephrine - MOA

A

Alpha selective adrenergic agonist (a1 and a2)

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13
Q

Phenylephrine - Clinical Use

A
  • Hypotension (vasoconstrictor)
  • Ocular procedures (mydriatic)
  • Rhinitis (decongestant)
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14
Q

Metaproterenol - MOA

A

Beta selective adrenergic agonist (b1 and b2)

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15
Q

Metaproterenol - Clinical Use

A

Acute asthma

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16
Q

Albuterol - MOA

A

Beta selective adrenergic agonist (b1 and b2)

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17
Q

Albuterol - Clinical Use

A

Acute asthma

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18
Q

Salmeterol - MOA

A

Beta selective adrenergic agonist (b1 and b2)

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19
Q

Salmeterol - Clinical Use

A

Long term treatment of asthma

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20
Q

Terbutaline - MOA

A

Beta selective adrenergic agonist (b1 and b2)

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21
Q

Terbutaline - Clinical Use

A

Reduce premature uterine contraction

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22
Q

Ritodrine - MOA

A

b2 selective adrenergic agonist

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23
Q

Ritodrine - Clinical Use

A

Reduce premature uterine contractions

24
Q

Indirect Sympathomimetics - Available Drugs

A

Amphetamine
Ephedrine
Cocaine

25
Q

Amphetamine - MOA

A

Indirect adrenergic agonist –> Causes release of stored catecholamines

26
Q

Amphetamine - Clinical Use

A

Narcolepsy, obesity, ADD

27
Q

Ephedrine - MOA

A

Indirect adrenergic agonist –> Causes release of stored catecholamines

28
Q

Ephedrine - Clinical Use

A

Nasal decongestion, urinary incontinence, hypotension

29
Q

Cocaine - MOA

A

Indirect adrenergic agonist –> Prevents reuptake of catecholamines

30
Q

Cocaine - Clinical Use

A

Causes vasoconstriction and local anesthesia

31
Q

Sympathoplegics - Available Drugs

A

Clonidine

a-Methyldopa

32
Q

Sympathoplegics - MOA

A

Centrally acting a2-agonists –> decrease central adrenergic outflow

(Clonidine, a-Methyldopa)

33
Q

Sympathoplegics - Clinical Use

A

Hypertension, especially with renal disease (does not decrease blood flow to kidney.

(Clonidine, a-Methyldopa)

34
Q

Non-selective alpha Blockers - Available Drugs

A

Phenoxybenzamine (irreversible)

Phentolamine (reversible)

35
Q

Phenoxybenzamine - MOA

A

Irreversible block of alpha adrenergic receptors

36
Q

Phenoxybenzamine - Clinical Use

A

Pheochromocytoma, use before removal of the tumor

37
Q

Phenoxybenzamine - Toxicities

A

Orthostatic hypotension, reflex tachycardia

38
Q

Phentolamine - MOA

A

Reversible block of alpha adrenergic receptors

39
Q

Phentolamine - Clinical Use

A

Give to patients on MAOi’s who eat tyramine containing foods (fava beans, aged cheese)

40
Q

Phentolamine - Toxicities

A

Orthostatic hypotension, reflex tachycardia

41
Q

a1 Selective Blockers - Available Drugs

A

Prazosin, Terazosin, Doxazosin

“-zosin”

42
Q

a1 Selective Blockers - MOA

A

Selective blockade of the a1 adrenergic receptor.

Prazosin, Terazosin, Doxazosin

43
Q

a1 Selective Blockers - Clinical Use

A
  • Hypertension
  • Urinary retention in BPH

(Prazosin, Terazosin, Doxazosin)

44
Q

a1 Selective Blockers - Toxicities

A
  • 1st dose orthostatic hypotension
  • dizziness, headache

(Prazosin, Terazosin, Doxazosin)

45
Q

a2 Selective Blockers - Available Drugs

A

Mirtazapine

46
Q

Mirtazapine - MOA

A

Selective blockade of the a2 adrenergic receptor.

47
Q

Mirtazapine - Clinical Use

A

Depression

48
Q

Mirtazapine - Toxicities

A

Sedation, increased cholesterol, increased appetite

49
Q

Effects of alpha Blockade on Epinephrine vs. Phenylephrine

A

Epinephrine has both alpha and beta effects. When combined with an alpha blocker the beta effects will win and the net result will be a depressor effect below baseline BP.

Phenylephrine has only alpha effects. When combined with an alpha blocker it has little or no effects and the net result will be a reversal of the pressor effect back to baseline BP.

50
Q

b1 Selective Blockers - Available Drugs

A

Acebutelol, Betaxolol, Esmolol, Atenolol, Metoprolol

“A BEAM through the heart”

51
Q

Non-selective beta Blockers - Available Drugs

A

Propranolol, Timolol, Nadolol, Pindolol

“Please Try Not (b)eing Picky”

52
Q

Partial beta Agonists - Available Drugs

A

Pindolol, Acebutolol

“Partial Agonist - Pindolol, Acebutolol –> PAPA”

53
Q

Non-selective alpha and beta Antagonists - Available Drugs

A

Carvedilol, Labetalol

54
Q

Beta Blockers - Clinical Use

A
  • Hypertension - decrease CO, decrease renin secretion (beta blockade on juxtaglomerular cells)
  • Angina - Decrease HR and contractility resulting in decrease O2 consumption
  • MI - Reduce mortality
  • Supraventricular tachycardia (SVT) - Decrease AV conduction velocity (class II antiarrhythmic) [Propranolol and Esmolol]
  • CHF - Slows progression of chronic failure - decrease cardiac dilation
  • Glaucoma - Decrease secretion of aqueous humor [Timolol]
55
Q

Beta Blockers - Toxicities

A
  • Impotence, exacerbation of asthma, bradycardia, AV block, CHF, sedation, sleep alteration.
  • Use with caution in diabetics - can decrease body’s response to hypoglycemia
56
Q

b1 Selective Blockers - Advantage Over Other beta Blockers

A

Cardiac specific - Better to use in patients with comorbid pulmonary disease - Less chance of exacerbation due to b2 effects.

57
Q

Partial beta Agonists - Advantage Over Other beta Blockers

A

Will have less of the negative cardiovascular side effects (ie less bradycardia)

Boards Pharm 03: Autonomics (3 decks)

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