Adrenergic drugs for CV dysfunction Flashcards
1
Q
agonists
A
Epi NE Iso Dobutamine Dopamine Fendoldopam Clonidien Methyldopa
2
Q
Epi
A
alpha and beta
3
Q
NE
A
alpha and Beta 1, 3
4
Q
Iso
A
Beta
5
Q
Dobutamine
A
beta 1
6
Q
Dopamine
A
D1>beta1>alpha1
7
Q
fendolopam
A
D1
8
Q
Clonidine
A
alpha2
9
Q
methyldopa
A
alpha 2
10
Q
alpha antagonists
A
prazosin- alpha 1
phentolamine- alpha 1 and 2
11
Q
nonselective beta antagonists
A
propanolol nadolol timolol pindolol carteolol sotalol esmolol (short acting)
12
Q
cadioselective beta blockers
A
atenolol
acebutolol
metoprolol
13
Q
third generation beta blockers
A
labetalol
carvedilol
betaxolol
carteolol
14
Q
Epi B1 effects on heart
A
primary effects positive inotropy and chronotropy increased work of heart and increased O2 demand shortens AP and refractor period decreases grade of AV block
15
Q
supraventricular arrhythmias
A
apt to occur w/combo of Wpi and cholinergic stimulation
treat w/beta blocker
16
Q
Epi B2 effects on heart
A
B2 may play important role in remodeling of heart tissue that occurs in CHF
17
Q
Epi alpha 1 effects on heart
A
prolings refractory period and strengthens myocardial contractions
18
Q
low dose epi on vasculature
A
primarily beta 2 vasodilation
19
Q
high does epi on vasculature
A
primarily alpha 1 vasoconstriction
20
Q
epi and cutaneous blood flow
A
markedly decreased
decreased flow to hand and feet
21
Q
epi and renal flow
A
induce alpha mediated vasoconstriction reducing renal blood flow -> increases RAAS
22
Q
epi and coronary blood flow
A
increased, but may not increase enough to meet increased demand brought on by Epi
23
Q
cardiac arrest uses of Epi
A
- during CPR for persistent or recurrent VT/VF after 1-2 cycles of defibrillation and CPR
- during CPR for PEA
- following CPR and TCP for asystole
- to treat bradycardia w/serious signs and symptoms (combine w/atropine and dopamine)
24
Q
other uses of Epi
A
hypersensitivity rxns (anaphylaxis) prolongation of action of local anestetic (vasoconstriction) topical hemostatic agent on bleeding surfaces nebulizer -> pediatric asthma
25
NE
full agonist at all receptors, but has low affinity for B2
26
CV effects of NE
- systolic, diastolic, and pulse pressure increased
- CO unchanged or decreased
- TPR increased
- compensatory vagal reflex slows heat
- SV increased
27
uses of NE
- vasoconstrictor to raise or support BP under certain IC condtions
- in shock level of circulating catecholamines already usually high and NE may further decrease perfusion to tissues, especially kidney
28
dopmaine
agaonist at all DRs
at high concentrations will activate beta 1 at heart and at even higher concentrations will activate alpha 1 -> generalized vasoconstriction
D1Rs mediate vasodilation in renal and mesenteric vascular bedsq
29
CV effects of low concentrations DA
D1
vasodilation, increased GFR, RBF, and Na excretion
useful in low CO states such as shock or CHF
30
CV effects of moderate does of DA
-positive ionotropic effect via B1Rs
-causes release of NE from nerve terminals
-increases CO which can be used in treatment of cardiogenic shock
-increased systolic BP and pulse pressure, no effect or slight increase of diastolic BP
TPR unchanged
31
high concentrations of DA
activates vascular A1 -> more generalized vasoconstricton
| counterproductive and undesirable in shock
32
fendolapam
D1
IV infusion pump for severe HTN
dilates coronaries, afferent and efferent arterioles in kindey and mesenteric aa
33
+ isomer dobutamine
potent alpha 1 antagonist
| 10x more potent beta agonist than - isomer
34
- isomer dobutamine
potent alpha 1 agonist
| weaker beta agonist than + isomer
35
racemic dobutamine
beta 1 like
36
dobutamine on CV
relatively greater inotropic then chronotropic effects when compared to iso
due to unchanged TPR
37
therapeutic uses of dobutamine
short term treatment of caRdiac decompenstation after cardiac surgery or CHF or AMI
infusion w/echocardiogram useful in noninvasice assessmetn of coronary artery disease
38
iso
potent non selective beta agonist
lowers TPR, primarily in skeletal m via beta 2
diastolic pressure falls
systolic maintained or rise
MAP typically falls
CO increased
may cause palpitations, sinus tachycardia, arrhythmias
39
uses of iso
stimulate heart rate in patients w/bradycardia or heart block, usually just before placement of pacemaker or in patients w/torsades de pointes
40
clondidine
prototypic alpha2 agonist
initially used as vasoconstricting nasodecongestant
bind in CV control centers of CNS suppressing sympathetics
41
methyldopa
false neurotransmitter
agonist on brain alpha 2 receptors
preferred treatment for HTN in pregnancy
42
effect of clonidine
changes in BP and HR
-IV infusion -> acute rise in BP due to activation of postsynpatic alpha 2 in peripheral smooth m vasculature
affinity of these Rs is strong, but clonidine is only a partial agonist
-transient vasoconstriction followed by more prolonged hypotensie response due do decreased sympathetics
-HTN follows parenteral administration generally not seen PO,
43
uses of clonadine
```
treatment of HTN
off label for
-diarrhea due to autonomic neuropathy in DI
-preoperative sedation
-patch for postmenopausal hot flashes
-differential diagnosis of pheocrhomocytoma
-ADHS
-tourettes
-restless leg syndrome
```
44
non-selective alpha blockers
phenoxybenzamine (irreversible)
| phentolamine
45
alpha 1 selective blockers
```
prazosin
doxazosin
terazosin
tamsulosin (BPH)
ALFUZOSIN (BPH)
third line for treatment of essential HTN
```
46
labetolol and carvediol
block beta and alpha
47
carteolol
block alpha and beta, except agonist at beta 2
48
nebivolol and carteolol
activate NO production
49
carvediol
antioxidant activity
50
tilisolol
K channel opening
51
beta blocker CV effects
slow sinus rate, decrease spontaneous rate of ectopic pacemakers, slow conduction in atria and AV node, increase functional refractory period of AV node
52
beta blockers and HTN
blocks renin release which is usually mediated by beta 1
| long term use of beta blockers will lead to fall in TPR, not understood
53
CV adverse effects of beta blockers
- may induce CHF in susceptible patients
- bradycardia normal, however can be threatening in partial or complete AV conduction defects
- abrupt discontinuation
- decreased exercise treatment
54
uses of beta blockers
```
HTN
angina
acute coronary syndromes
CHF
supraventricular and ventricular arrythmias
```
55
CHF
certain beta blockers are highly effective treatments for all grades of heart failure
carvediol, metoprolol, xamterol
usually takes weeks-months to see benefit (except carvediol)
56
MI
beta blockers in early phases, but must be continued long term
57
hypertrophic obstructive cardiomyopathy
beta blockers, specifically propranolol
| relieves angina, palpitations, and syncope
58
actue dissecting aortic aneurysm
reductionin force of contraction and rate
| chronic treatment w/propranolol in marfans as prevention
59
hyperthyroidism
beta blockers useful
60
nadolol
long-acting antagonsit w/equal affinity for beta 1 and 2
relatively long half life
used for HTN and angina, magraine porphylaxis, parkinsonian tremors, and variceal bleeding in portal HTN
61
metoprolol
cardioselective
extended release available
essential HTN, angina, tachycardia, heart failure, vasovagal syncope, hyperthyroidism, and for migraine prophylaxis
62
atenolol
cadioselective
hydrophilic -> penetrates CNS to a limited extent
half life longer then metoprolol
HTN, coronary heart disease, arrhythmias, angian, post MI, graves disease
63
atenolol combos
with diuretic in elderly w/isolated systolic HTN
64
esmolol
```
cardioselective
rapid onset, short acting
IV
surgery to prevent or treat tachycardia
supraventricular tachycardia
striking hypotensive effects
```
65
labetalol mixture properties
selective blockade of alpha, beta 1, beta 2
partial agonist of beta 2
inhibits neuronal uptake of NE
blocks beta 5-10x more then alpha
66
labetaolol effects
fall in BP
HR maintained or slightly reduces
CO maintained
can be used in pregnancy induced HTN crisis
67
carvediolol
blocks beta 1,2 and alpha 1, but also has antioxidant and anti-inflammatory effects
HTN, CHF, left ventricular dysfunction post MI
