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Barash > 2 - Cardiovascular Pharmacology > Flashcards

2 - Cardiovascular Pharmacology Flashcards

1
Q

Most potent arterial vasopressin available.

A

Vasopressin

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2
Q

This class of drugs MIMIC, ENHANCE, or BLOCK the actions of acetylcholine in autonomic ganglia and skeletal muscle at nicotine’s receptors or in parasympathetic postganglionic neurons.

A

Cholinergic drugs

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3
Q

Two important binding sites of acetylcholine. (2)

A

Ester

Amine

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4
Q

Cholinergic agonists two types.

A
  1. Choline esters

2. Alkaloids

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5
Q

Give the 5 choline esters

Give the 3 choline alkaloids

A

Choline esters

  1. Choline
  2. Ach
  3. Carbamylcholine
  4. Methacholine
  5. Bethanecol

Choline alkaloids

  1. Pilocarpine
  2. Muscarine
  3. Arecoline
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6
Q

This drug is almost used exclusively as a provocative agent for identyfying the presence of reactive airway disease. This drug causes bronchoconstricton, increases airway secretions, and reduces peak expiratory flow rate.

A

Methacholine

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7
Q

Is a choline ester that is relatively selective for the M3 receptors in the urinary and GIT. Used for the treatment of non-obstructing urinary retention.

A

Bethanecol

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8
Q

Is a choline ESTER used topically to produce miosis in wide angle glaucoma.

A

Carbamylcholine

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9
Q

Is an alkaloid cholinergic agonist used as a topical miotic agent to reduce IOP. This drug is also used orally to increase salivary and lacrimal gland production in patients with xerostomia.

A

Pilocarpine

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10
Q

These drugs are used to treat myasthenia gravis, glaucoma and less commonly urinary or intestinal atony. They inhibit the enzyme acetylcholinesterase.

A

Cholinsterase inhibitors

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11
Q

2 classes of cholinesterase inhibitors (2)

A
  1. Carbamoyl esters

2. Quarternary ammonium alcohols

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12
Q

Examples of carbamoyl esters (cholinesterase antagonists) (3)

A
  1. Neostigmine
  2. Pyridostigmine
  3. Physostigmine
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13
Q

Example of quartenary ammonium compound (cholinesterase inhibitor)

A

Edrophonium

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14
Q

Cholinesterase inhibitor, a tertiary amine that readily crosses the BBB and inhibits the acetylcholinesterase in the central nervous system.

A

Physostigmine

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15
Q

Is the ONLY clinically used organophosphate cholinesterase inhibitor, which is applied TOPICALLY for the treatment of glaucoma.

A

Ecothiophate

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16
Q

What are the 3 common muscarinic antagonists?

A
  1. Atropine (belladonna alkaloids)
  2. Scopolamine (belladonna alkaloids)
  3. Glycopyrrolate
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17
Q

Muscarinic antagonists that penetrate the BBB (2)

A
  1. Atropine

2. Scopolamine

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18
Q

Muscarinic antagonist particularly useful as an IM premedication before midazolam.

A

Scopolamine

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19
Q

What dose of atropine that is devoid of central nervous system effect?

A

<2 mg

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20
Q

Dose of atropine that can decrease HR through blockade of M1 receptors

A

Less than 0.1 mg

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21
Q

What comprises the signs and symptoms of atropine toxicity (5)

A 
Dry as a bone
Red as a beet
Blind as a bat
Hot as a hare
Mad as a hatter
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22
Q

Treatment of choice for anticholinergic syndrome

A

Physostigmine 1 or 2 mg

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23
Q

Atropine toxicity

A

0.5 - 1.0 mg: Inc HR, xerostomia (dry mouth), thirst, lack of sweat, mild pupillary dilation

2-5 mg: tachycardia, palpitations, mydriasis, cycloplegia, inability to urinate or defecate

10 or greater: fever, hallucinations, coma, death

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24
Q

Most common adrenoreceptor in the skeletal muscles?

A

B2

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25
Q

Methylation of norepinephrine by what enzyme converts the NE to epinpehrine in the adrenal medullary chromaffin cells.

A

Phenylehtanolamine N-methyltransferase

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26
Q

Catecholamines and their receptors

A

Epinephrine: activates a1, b1, b2

: causes vasoconstriction EXCEPT in the blood vessels supplying the SKELETAL MUSCLES
: dose dependent (0.02 ug/kg/minj stimulates B2
: higher doses (>0.1 ug/kg/min) activates a1

Norepinephrine: a1,a2, b1

Dopamine: a1, b1, DA1, DA2

Dobutamine: b1,b2,a1

: potent stimulato of b receptors with little a receptor at inf rates less than 5 ug/kg/min
: dobutamine (-) isomer stimulates a1 rceptor above t ug/kg/min

Isoproterenol: selective B agonist derived from dopamine

: reduces coronary perfusion and decease diastolic filling time

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27
Q

Drug of choice for AHA advanced cardiac life support for malignant ventricular arrhythmias, pulseless electrical activity and asystole.

A

Epinephrine 1 mg

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28
Q

Why is intramuscular route more preferred over inhalation in pediatric patients with severe croup?

A

Because rebound edema may occur as a result of relatively short half life.

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29
Q

Most often used for the treatment of refractory hypotension resulting from prnounced vasodilation.

A

Norepinephrine

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30
Q

Norepinephrine in combination with nitirc oxide scavenge this drug, useful for vasoplegic syndrome.

A

Methylene blue

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31
Q

What is the drug used to partially counteract the actions of NE on renal blood flow and may preserve renal perfusion and renal output but most likely prevent AKI.

A

Fenoldopam

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32
Q

Where should NE ideally be administered?

A

Central venous catheter to avoid tissue necrosis from extravasation.

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33
Q

Is a biochemical precursor of NE. Lower doses < 3 ug/kg/min to dilate renal, mesenteric and splenic arterial blood flow.

Moderate doses (3-8 ug/kg/min) activate which receptors?(2)

High doses (10 ug/kg/min) activate which receptor?

A

Dopamine

a1 and b1

a1

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34
Q

A b2 receptor agonist that is administered subcutaneously and intramuscularly.

A

Terbutaline

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35
Q

Is an intravenous selective DA1 receptor agonist that does not exert activity at a or b receptors

A

Fenoldoopam

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36
Q

This drug exerts both direct and indirect effects. Endocytosis of this drug into a1 and b1 presynaptic postganglionic nerve terminal displaces NE from the synaptic vesicles. The displaced NE is is the released to activate the corresponding postsynaptic receptors to cause vasoconstriction and increased contractility. May cross the placenta and cause fetal acidosis.

A

Ephedrine

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37
Q

Why is there tachyphylaxis with ephedrine?

A

Because presynaptic norepinephrine stores are quickly depleted.

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38
Q

a1 adrenoreceptor antagonist drugs

A
  1. Prazosin
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39
Q

a adrenoreceptor anTagonists (3)

A
  1. Prazosin (a1 receptor antagonist)
  2. Phenoxybenzamine (non selective)
  3. Phentolamine
40
Q

Is an orally administered non-selective a receptor anTagonist that binds IRREVERSIBLY to a receptors. Synthesis of NEW receptors is required to reverse the drug’s effect.

A

Phenoxybenzamine

41
Q

Drug used to normalize arterial pressure in patients with pheochromocytoma.

A

Phenoxybenzamine

42
Q

Most common side effect of phenoxybenzamine is?

A

Orthostatic hypotension

43
Q

Treatment of hypotension with phenoxybenzamine?

A

Vasopressin

44
Q

Potent intravenous reversible non-selective a adrenoreceptor antagonist

A

Phentolamine

Causes reflex tachycardia

45
Q

This a receptor antagonist may also cause arrhythmias. It also has an antihistamine and cholinergic activity.

A

Phentolamine

46
Q

What condition is contraindicated with phentolamine?

A

Flow-limiting coronary artery stenoses

47
Q

Is effective in treating refractory hyprtension in patients associated with clonidine withdrawal or tyramine exposure.

A

Phentolamine

48
Q

This a anTagonist undergoes hepatic metabolism

A

Phentolamine

49
Q

a2 adrenoreceptor aGonist (2)

A
  1. Clonidine

2. Dexmedetomidine

50
Q

Unlike other antihypertnsive medications, this drug does not affect the baroreceptor-mediated relfex control of heart rate. This may also cause HYPERGLYCEMIA because the a2 adrenoreceptor agonist inhibits insulin release.

51
Q

The sedative and anxiolytic effect of clonidine are attributed to the activation of a2 adrenoreceptors in which part of the brain?

A

Locus coerleus

52
Q

It is important to remember that transdermal clonidine requires how many hours after initial application to achieve therapeutic concentrations?

53
Q

This a agonist exerts neuroptotective effects against cerebral ischemia. Related to a direct cytoprotective effect.

A

Dexmedetomidine

54
Q

This antagonist has also been shown to inhibit platelet aggregation.

55
Q

Is the prototypical B-BLOCKER against which all other medications of this class is compared.

A

Propranolol

56
Q

3 generations of B blockers and their corresponding drugs

  1. (1)
  2. (3)
  3. (4)
A 
1st generation (non-selective): propranolol
2nd generation (b1 blocker): metoprolol, atenolol, esmolol
3rd generation: labetalol (a1 blocker), carvedilol (anti-oxidant and anti-inflammatory), bucindolol (intrinsic sympathomimetic effects, partial b1 agonist), nebivolol (produces nitric oxide)
57
Q

The estimated reduction in mortality associated with use of B blockers in myocardial infarction is approximately how many %?

58
Q

Examples of topical beta blockers (2) used for glaucoma

A
  1. Timolol

2. Betaxolol

59
Q

A selective B1 blocker with metabolism via hydrolysis by red blood cell esterases resulting in elimination half life of 9 minutes.

60
Q

Unlike other vasodilators, this drug produces vasodilation without triggering the baroreceptor reflex tachycardia.

61
Q

Third generation b blocker that also inhibits a1 like labetalol. This drug not only suppresses production of ROS but is also a scavenger of free radicals. This drug has been efficacious in patients with heart failure.

A

Carvedilol

62
Q

These drug class are structurally related enzymes that hydrolyze the cAMP and cGMP. Inhibition of cardiac PDE III alerts intracellular Ca regulation to enhance myocardial contractility without affecting catecholamine release. Inhibition of cAMP stimulates greater calcium uptake enhancing the rate and extent of relaxation.

A

Phophodiesterase inhibitors

63
Q

These drugs block platelet aggregation, supress neointimal hyperplasia and attenuate proinflammatory effects. In addition, these drugs dilate native epicardial coronary arteries and arterial bypass conduits.

A

PDE inhibitors.

64
Q

PDE III inhibitor drugs (2)

A
  1. Milrinone

2. Inamrinone (1st used, causes profound thrombocytopenia)

65
Q

The only currently available class of positive inotropic drugs for oral treatment for mild to moderate heart failure.

A

Cardiac glycoside

66
Q

Digitalis glycoside are naturally occuring substances found in plant species called?

67
Q

Most commonly prescribed digitalis glycosides? (2)

A
  1. Digoxin

2. Digitoxin

68
Q

Are nitrovasodilators that release NO through enzymatic sulfhydryl group reduction.

A

Nitroglycerin

69
Q

What does nitroglycerin dilate? Arteries or venules?

A

Venules

But at higher doses nitroglycerin dilates arterioles.

70
Q

Is an ultra-short acting direct NO donor. It is a potent VENOUS and ARTERIAL vasodilator that rapidly reduces venous and arterial pressure by decreasing LV preload and afterload. It is also a first line drug for hypertensive emergency. Also useful for cardiogenic shock.

A

Sodium nitroprusside

71
Q

This drug causes coronary steal. This effect occurs because it causes greater vasodilation in vessels that perfuse normal myocardium. This causes a more pronounced reflex tachycardia.

A

Sodium nitroprusside

72
Q

Metabolism of this drug produces cyanide

A

Sodium nitroprusside

73
Q

Is a direct vasodilator that reduces intracellular calcium concentration. This pronounced tachycardia might produce acute MI in patients with critical coronary stenoses. This drug is commonly used for management of sustained hypertension in the absence of tachycardia.

A

Hydralazine

74
Q

Myocardial and sm cell membranes contain two types of voltage-dependent Ca channels. (2)

A
  1. T (transient)

2. L (long)

75
Q

This CA type channel is the predominant target of Ca channel blockers.

76
Q

The Ca channel blockers may be divided into 4 chemical groups (4)

A
  1. Dihidropyridines (used clinically)
  2. Benzothiazepines (used clinically)
  3. Phenylalkylamines (used clinically)
  4. Diarylaminopropylamine ethers
77
Q

ALL Ca channel blockers produce greater relaxation of this blood vessel compared with other blood vessels.

78
Q

This drug is a direct epicardial coronary vasodilator. Its more specific indication is variant angina, a disease process in which reductions in coronary blood flow occur as a result of regional coronary vasoconstrictor independent of coronary artery stenoses. It is also used to provide arterial vasodilation in patients with Raynauds phenomenon.

A

Nifedipine

79
Q

Similar to nifedipine but longer half life. Preferentially dilates arteriolar vessels. It does not depress myocardial contractility or affect SA node firing. Causes tachycardia but less effect. Used for SUSTAINED perioperative hypertension not acute.

A

Nicardipine

80
Q

Ultra-short acting dihydropyridine with a plasma half-life of 2 mins after IV administration. Causes dose related arterial vasodilation while sparing VENOUS vasomotor tone, not affecting LV preload. Does not cause rebound hypertension and tachyphylaxis.

A

Clevidipine

81
Q

What metabolizes clevidpine?

A

Plasma and tissue esterases.

82
Q

This dihydropyridine is more lipophilic and easily crosses the BBB. Exerts more cerebral vasodilation. ONLY drug approved for cerebral vasospasm after SAH. Its only action is to reduce cerebral arteriolar resistance and enhance blood flow NOT affect incidence of recurrent hemorrhage.

A

Nimodipine

83
Q

Is the ONLY benzothiazepine in current clinical use. In contrast to dihydropyridine, it exerts potent negative chronotropic and dromotropic effects. This drug may prevent subsequent MI. Prolongs AV conduction.

84
Q

This phenylalkylamine produces less arterial vasodilation but exerts more effects on automaticity, conduction and myocardial contractility than dihydropyridines. Has the potential to markedly worsen pre-existing LV systolic dysfunction because of its depressant effects. May be effective in patients with MI and angina who tolerate B1 antagonists. Also a useful alternative for adenosine for treatment of SVT.

85
Q

Contraindication of verapamil?

A

Re-entrant SVT.

86
Q

Use of verapamil with this drug may cause complete heart block or profound myocardial depression.

A

B1 antagonist

87
Q

1st ACE inhibitor but less used due to great advserse effects.

88
Q

ONLY available IV ACE inhibitor.

89
Q

ONLY orally available ACE inhibitor that does not require multiple dosing.

A

Lisinopril

90
Q

This drug decreases LV afterload and decrease arterial pressure. Cardiac output remains unchanged. Sympathetic NS remains unchanged. As a result, patients do not develop orthostatic hypotension unless relative hypovolemia is present. This drug halt or delay the progression of heart failure and improve the quality of life. Exerts renoprotective effects in patients with DM.

A

ACE inhibitors

91
Q

Most common side effect of ACE inhibitors due to blockade of bradykinin degradation.

A

Dry cough

May also cause hyperkalemia in patients with CKD treated with K-sparing diuretics.

Also blocks the hypokalemic side effects of thiazide and loop diuretics.

92
Q

A rare but life threatening adverse effect of ACE inhibitor. It usually occurs with initial dose and may require endotracheal intubation.

A

Angioedema

93
Q

Profound hypotension may occur with general anesthetics in patients treated with chronic ACEi. What is the best treatment for this.

A

V1 agonist (terlipressin)

94
Q

This drug is commonly used in patients with HF and AMI who are unable to tolerate the effects of ACEi. This drug also reduces the risk of stroke in patients with hypertension.

95
Q

2 common side effects of ARBs?

A

Fetal toxicity

Hyperkalemia (in patients treated with K sparing diuretics.

Barash (16 decks)

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