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270 S1 > 6.1 Adrenergic > Flashcards

6.1 Adrenergic Flashcards

1
Q

What are the adrenoreceptors?

A

Alpha
Beta
Dopamine

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2
Q

Where are Alpha 1 receptors found?

A

Mostly found in vascular beds, and bladder base, urethral sphincter, and prostate

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3
Q

What is the affect of an Alpha 1 agonist?

A

Arterial and venous vasoconstriction = BP up

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4
Q

What is the mechanism go Alpa 1 agonists? In normal pts? In pts with impaired ANS?

A

In normal pts–> baroreflex function kick in–> vagal tone increase–> slow heart rate–> counteract elevation of BP

Impaired autonomic function pts  extremely hypersensitive to stimuli because loss of “baroreflex buffering”
= pt very sensitive to medication because baroreceptors can’t detect the elevation of BP and can’t respond to compensate
IMPLICATION- eg Parkinsons has some autonomic dysfunction, use A1 agonists with these pts, may see an exaggerated response

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5
Q

What are the effects of Alpha 2 agonists?

A

When stimulated, causes vasoconstriction increase blood pressure PERIPHERALLY
When stimulated, epi/norepi outflow slowed = sympatholytic effects  lower BP CENTRALLY

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6
Q

What is the effect of Alpha 2 agonists on the CNS?

A

Pure agonist: impair sympathetic tone (sympatholytic) –> lower BP
Ex- Clonidine, anti HTN- a central-acting A2 agonist, when given to a pt with intact ANS, have a slowdown of autonomic outflow, and BP decreases

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7
Q

What happens to a pt with ANS failure and Alpha 2 agonists?

A

Central agonist can INCREASE BP
med stimulates A2 receptor in brain, doesn’t reduce the outflow or does not affect the outflow, so stimulation of peripheral A2 stimulation masks stimulation of A2 central

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8
Q

Where are Beta-1 receptors found?

A

HEART

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9
Q

What are the cardiac effects of Beta-1 agonists?

A

Heart rate (positive chronotropy)
Contractility (positive inotropy)
Conduction between AV node (positive dromotropy)
=increase cardiac output

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10
Q

Where are Beta-2 receptors found?

A

peripheral vasculature, bronchial smooth muscle

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11
Q

Where are Beta-3 receptors found?

A

Adipose tissue- increase lipolysis

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12
Q

What do Beta-2 agonists do?

A

Bronchodilation

Peripheral vasodilation

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13
Q

Where are dopamine receptors?

A

In cerebral, coronary, splanchnic, and kidneys blood vessels; and presynaptic neurons

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14
Q

What do dopamine agonists do?

A

Vasodilation

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15
Q

What receptors does epi effect?

A

A1, A2

B1, B2

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16
Q

What are the effects of epi?

A

Very potent vasoconstrictor and cardiac stimulant
Positive inotropy and chronotropy
Vascular beds vasoconstriction
Skeletal muscle blood vessels dilation (i.e via beta-2 stimulation)

17
Q

What are the toxicities of epi?

A 
Restlessness
Throbbing HA
Tremor
Palpitation
Cardiac arrhythmias
Cerebral hemorrhage
18
Q

What receptors does NorEpi work on?

A

A1, A2

B1

19
Q

What is the effect of NorEpi?

A

Pressor
Increase peripheral resistance
Increase BP (systolic and diastolic)

20
Q

What is extravasation? What is the risk with NorEpi?

A

Infiltrate into tissues from IV

Closes down capillaries –> shuts down perfusion –> badness (dead tissue)

21
Q

Why is lido mixed with epi?

A

Makes the lido stay in place… epi vasoconstricts which keeps the local anesthetic local

22
Q

What are the contraindications to norepinephrine?

A 
Severe volume depletion
Vascular thrombosis
Profound hypoxia
Use of MAO inhibitor
Hyperthyroidism
23
Q

What are the side effects of norepinephrine?

A 
HA, anxiety
Bradycardia
Dyspnea
Severe HTN
Asthma exacerbation
arrhythmias
24
Q

What are the cardiac effects of epi vs norepinephrine?

A

Epi: + HR, + cardiac output
Norepi: - HR, - or no change to cardiac output

25
Q

What are the BP effects of epi vs norepinephrine?

A

Norepi is the pressor… use

Epi will raise systolic, not as much for diastolic

26
Q

What are the peripheral circulation effects of epi vs norepinephrine?

A

Epi: - peripheral resistance, + cerebral blood flow, +++ muscle blood flow (fight vs flight)
Norepi: ++ peripheral resistance, - or no change to cerebral/muscle flow

27
Q

Epi or norepinephrine for the spleen?

A

Epi

28
Q

What are the metabolic effects of epi vs norepi?

A

Epi: (Think fight or flight) + O2 consumption, + blood glucose, + lactate, + eosinophil response
NE: No change in O2 or blood glucose

29
Q

What is the precursor to epi, NE?

A

Dopamine

30
Q

What is the function of dopamine?

A

Na+ excretion
CNS–> reward center
Regulation of movement in basal ganglia

31
Q

What pathology comes from a defect of domaine in the basal ganglia?

A

Parkinsons

32
Q

What are the indications for dopamine?

A

Cardiogenic shock

Septic shock

33
Q

What are the contraindications to dopamine?

A

Pheochromocytoma- tumor on adrenals that up Epi/NE
Tachyarrhythmias
Occlusive vascular dz

34
Q

What are the side affects of dopamine?

A

Tachycardia/angina/HTN
HA/N/V/Anxiety
Extravasation tissue necrosis

35
Q

What receptors does dopamine target?

A

Low dose: dopamine receptors
Medium doses: B1
Big dose: A1

36
Q

What does dobutamine target?

A

B1

37
Q

What metabolizes catecholamines?

A

MAO

COMPT

270 S1 (19 decks)

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