Adrenergic lecture Flashcards

1
Q

SNS

A

Organ systems, blood pressure
Hormone vs. neurotransmitter
Adrenal medulla

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2
Q

NT Termination
Acetylcholine
(2)

A

ACh-esterase
150ms

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3
Q

NT Termination
Norepinephrine
(3)

A

Reuptake
Monoamine oxidase
Catechol-O-
Methyltransferase

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4
Q

sympathetic agonists
Direct
(3)

A

Route
Affinity
Expression of receptor subtypes

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5
Q

sympathetic agonists
Indirect
(2)

A

Catecholamine displacement
Amphetamines

Decreased NE clearance
Reuptake inhibition

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6
Q

adrenergic receptors
(4)

A

α1 α2
β1 β2
Dopamine
Sympathomimetic vs sympatholytic

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7
Q

adrenergic receptors
Can be downregulated / desensitized
(3)

A

Congestive Heart Failure (CHF)
Acidosis
Hypoxia

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8
Q

α1
(6)

A

Peripheral vascular beds
Excitatory

Vasoconstriction
Blood pressure increased
Mydriasis
Urinary sphincter constriction

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9
Q

α2
(6)

A

Inhibitory

In the vasculature
Inhibition of NE and ACh
Decreased sympathetic tone
Decreased BP
Sedation

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10
Q

β1
(3)

A

Excitatory

Cardiac excitation
Increased rate, contractility,
conduction

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11
Q

β2
(5)

A

Inhibitory

Bronchodilation
Smooth muscle relaxation
Skeletal muscle vasodilation
Decreased vascular resistance

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12
Q

DA
Resistance vessel vasodilation
(4)

A

Renal
Splanchnic
Coronary
Cerebral

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13
Q

Primary catecholamines

A

Dopamine (DA) and
norepinephrine (NE)

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14
Q

DA –
NE –
Epinephrine –

A

Brain and kidney
Sympathetic nerve endings
Adrenal medulla

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15
Q

norepinephrine

A

a1, b1, b2
Endogenous
Primary neurotransmitter at sympathetic nerve endings
Maintenance of sympathetic tone
BP
No cardiac output changes
Minimal chronotropic changes
Increased coronary blood flow
Caution with prolonged infusions

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16
Q

epi
@ higher doses
@ lower doses
@ lower doses

A

α1
β1
β2

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17
Q

epi

A

Endogenous
Only released by adrenal medulla
Stress preparation
coronary blood flow
Caution prolonged infusions

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18
Q

DA
α1
β1
β2

A

Endogenous
NE precursor
Dose-specific effects
Low dose (0.5 – 3 mcg/kg/min)
Intermediate (3 – 10 mcg/kg/min)
High (10 – 20 mcg/kg/min)

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19
Q

dobutamine
β1
β2
α1

A

Synthetic
Augments myocardial contractility
Dose-dependent increase in stroke volume (SV) and cardiac output (CO)
Alpha agonist AND antagonist
Beta-mediated vasodilation (low dose)
High dose increases myocardial O2 consumption

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20
Q

phenylephrine
α1

A

Synthetic
All alpha, no beta
Not a catechol derivative, not
metabolized by COMT
Can lead to baroreceptor-mediated
decrease in HR
Push dose pressor

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21
Q

milrinone
β1“like effect”
β2“like effect”

A

Phosphodiesterase-3 inhibitor
Inhibits breakdown of cAMP
Positive inotropy
Potent vasodilator
Increased diastolic relaxation
Reduced preload and afterload
Good in the setting of receptor
downregulation

22
Q

vasopressin
α1“like effect”

A

AKA: antidiuretic hormone
Stored in posterior pituitary
Released when plasma osmolality increases or BP drops
V1 and V2 receptor agonist
Neutral to negative impact on CO
Dose dependent SVR and vagal tone increase
Not affected by pH

23
Q

Alpha-2 selective agonists
ex (4)

A

Clonidine
Dexmedetomidine
Guanfacine
Methyldopa

24
Q

Alpha-2 selective agonists
(3)

A

Drop BP by reducing
sympathetic tone
Effective antihypertensive
Class effect = sedation Clonidine

25
Q

indirect acting sympathomimetics
mechanism (2)

A

Displacers
Reuptake inhibition

26
Q

amphetamine like agents
Amphetamine
(3)

A

Rapid CNS uptake
Stimulant
Effects mediated by NE and
DA

27
Q

Methylphenidate (Ritalin)
(4)

A

Amphetamine variant
Similar effect and abuse
potential
Use: ADD-spectrum
Caution - UDS

28
Q

Modafinil (Provigil)
(5)

A

Psychostimulant
Totally different from
amphetamine
NE, DA reuptake inhibition
NE, DA, 5-HT3, glutamate
increase; GABA decrease
Use: narcolepsy

29
Q

Straterra
(3)

A

Selective NE reuptake
inhibition
No CV effects
Clonidine-like effect
Use: ADD

30
Q

Cocaine
(5)

A

Local anesthetic, peripheral
sympathomimetic
Reuptake inhibition,
especially dopamine
Excited delirium
Avoid concurrent beta-
blockade
Use: epistaxis

31
Q

Beta-2 agonism

A

Key to management of acute asthma
Common “allergy” in dentistry7.9%
Triggered by allergens, stress, food, drugs
Angioedema = similar but different

32
Q

acute management
ex (3)

A

Albuterol
Levalbuterol
Terbutaline

33
Q

acute management
(2)

A

Short term control
Short acting beta agonists
(SABA)

34
Q

Long term management
ex (2)

A

Formoterol
Salmeterol

35
Q

Long term management
(4)

A

Longer term control
Long acting beta agonists (LABA)
Blocks receptors 12-18h
NOT FOR ACUTE ATTACKS

36
Q

NOT FOR ACUTE ATTACKS
Have to be used with steroids
Advair =
Symbicort =
Dulera –

A

salmeterol + fluticasone
formoterol + budesonide
formoterol + mometasone

37
Q

dental management of asthma patients
(3)

A

Minimize likelihood of
exacerbation
Talk to your patient to learn
their management strategies
Instruct pt. to bring albuterol
inhaler to all appointments
Decrease stressors

38
Q

dental management of asthma patients
Drug considerations
(4)

A

No ASA or NSAIDS
Avoid histaminic drugs
Avoid antihistamines
Avoid cholinergics

39
Q

dental management of asthma patients
In an emergency
(3)

A

Supplemental O2
Consider epinephrine
0.3 mg IM (or use EpiPen)

40
Q

alpha receptor antagonists
Two types
Reversible
(2)
Irreversible
(2)

A

Concentration dependent
Duration dependent on t1/2

Body has to generate new receptors
Drug effect can persist even after drug is cleared

41
Q

alpha receptor antagonists
Pharmacologic Effects
Cardiovascular
(2)
Other
(2)

A

α1 blockade blocks
vasoconstriction
Orthostatic hypotension

Miosis, nasal stuffiness
Decreased resistance to
urinary flow

42
Q

phentolamine
(3)

A

Blocks α1 and α2
Decreased PVR and
cardiac stimulation
Can lead to CV adverse
reactions

43
Q

PrazosinTerazosinDoxazosin

A

Selective α1
Arterial and venous vascular smooth muscle relaxation and prostate relaxation
50% bioavailabilityFirst pass effect
T1/2

44
Q

T1/2 Prazosin:
Terazosin:
Doxazosin:

A

3h
9h
22h

45
Q

Tamsulosin

A

Competitive α1 blocker
High bioavailability
More specific to prostate
Less orthostatic
hypotension

46
Q

Beta Blockers

A

Antagonize effects of catecholamines and beta agonists
Differ in affinity for β1 and β2
β1 specificity decreases as dose increases
End in -lol (-olol, -ilol, -alol)

47
Q

Receptor affinities
Labetalol, carvedilol
Metoprolol, betaxolol, acebutolol, esmolol, atenolol, nebivolol
Propranolol, carteolol, penbutolol, pindolol, timolol

A

β1= β2 > α1 > α2
β1»> β2
β1= β2

48
Q

Beta-1 specific

A

Betaxolol
Esmolol
Acebutolol
Metoprolol
Atenolol
Nebivolol

49
Q

Esmolol
(5)

A

Beta-1 selective
Short t1/2
Quick onset
Requires central line for
administration
Great for tight BP control

50
Q

Labetalol

A

Beta and alpha blockade
3:1 oral
7:1 IV
Dose dependent duration of
action
up to 20 hours

51
Q

— specific drugs safer for
asthmatic patients
Caution with

A

β1
non-specific β-
blockers and epi