ANS Flashcards
Benzos are ______ agonists.
GABA A
Which benzo acts more as an anticonvulsant than anything?
Clonazepam
Long acting benzos like diazepam and chlordiazepoxide are converted to a long–lasting active metabolite _____________
Nordiazepam
Similar drug to benzos used as a hypnotic?
Ambien (Zolpidem)
Experimental benzo with an ester linkage that allows for rapid metabolism to inactive metabolites, administered as a continuous infusion, and has a short duration for induction?
Remimazolam
How many benzo antagonists are there?
1
Flumazenil is a ____ antagonist
Competitive
Flumazenil doses? Max ose?
0.2mg
1mg
DOA for flumazenil?
45–90 minutes
Which alpha 2 receptor is associated with N2O, HTN, and Placenta angiogenesis?
Alpha 2B
____ is more alpha 2 selective than clonidine and has 2:1 specificity of 1600:1
Dex
Alpha 2 activation _________ calcium channels and __________ potassium channels.
Inhibits
Activates
Alpha 2 causes exocytosis of __________
Protein
The inhibitory effects of the alpha 2 receptor is due to ____________ of the cell.
Hyperpolarization
Dex works in the Pontine Noradrenergic Nucleus, AKA the :
Locus Coeruleus
What class of alpha 2 blocker are clonidine, dex, and mivazerol?
Imidazolines
What class of alpha 2 blocker are methyldopa and guanabenz?
Phenylethylates
What class of drugs are oxaloazepines?
Alpha 2 agonists
Dex loading dose
1mcg/kg
Dex binds to these 2 proteins
Albumin
Alpha 1 Acid
How is dex sedation different than other GABA agonists?
Resembles sleep
True or false: Dex is a good choice for neuro monitoring, awake craniotomy, deep brain stimulator with remi?
TRUE
What effect does dex have on temp?
Hypothermia
Main side effects of dex (2)
Hypotension and Bradycardia
Transient ______ has been seen with loading doses of dex
Hypertension
Transient hypertension has been seen when using ____ to treat dex related bradycardia
Hypertension
True or False: Dex as an antianginal effect
TRUE
What is the asher phenomenon?
Oculocardiac reflex
Bainbridge decreases and increases which 2 hormones?
Decrease ADH
Increase ANP
The vasomotor becomes ischemic when MAP is less than _______
50mmHg
The chemoreceptors in the medulla detect _______
Increased PaCO2
The peripheral chemoreceptors in the carotid arteries and aortic arch detect _________
Decreased PaO2
Secretion of _____ can increase 5–10 fold under severe stress (surgery, trauma, infection
Cortisol
IV hydrocortisone should be considered if persons underwent: \_\_\_\_mg Prednisone \_\_\_\_mg Methylprednisolone \_\_\_\_mg Hydrocortisone \_\_\_\_mg Dexamethasone
For ____ weeks within the last _____.
20
16
80
3
3
Last year
Stress dose steroids for superficial surgery?
None
Stress dose steroids for minor surgery?
25mg Hydrocortisone before induction
Hydrocortisone dose for moderate surgery (TAH, resection, total joint)?
50–75mg
Taper for 1–2 days
Hydrocortisone dose for major surgery (cardiac, thoracic, liver)?
100–150mg
Taper over 1–2 days
What do neuroectodermal cells become?
Adrenal Medulla
Paraganglia _____ cells cluster outside of the adrenal medulla on either side of the aorta.
Chromaffin
The largest paraganglia of chromaffin cells which is the major source of catecholamines during 1st year of life?
Organ of Zuckerkandl
True or false: Preganglionic cholinergic fibers bypass the paravertebral ganglia on their way to the adrenal medulla
TRUE
Phenylethanolamine–N–methyltransferase activity is _____ by glucocorticoids causing ______ conversion of Epi to NE?
Increased
Increased
What does COMT convert epi to?
Metanephrine
What does COMT convert NE to?
Normetanephrine
What converts metanephrine and normetanephrine to VMA?
Monoamine Oxidation
Dopamine is metabolized by MAO and COMT into _________
Homovanillic Acid (HVA)
PCC primarily secretes this catecholamine
NE
True or false: SNS neural stimulation stimulates hormone release
False (they’re denervated)
What is the rule of ten for PCC?
10% are bilateral
10% are extra–adrenal
10% are malignant
Extra–adrenal metastatic PCCs metastasize through venous and lymphatic channels to the ____
Liver
Fractionated Epi, NE, Dopamine, Metanephrine, normetanephrine, or VMA in the urine diagnose _____?
PCC
Von Hippel–Lindau, MEN 2A/2B, Neurofibromatosis, familial paraganglioma syndrome are linked to _____
PCC
MEN Type 2A/2B PCC are unique in that 50% of them are ______ dominant.
Epi
Most common age for PCC
30–50 (men and women equal
PCC triad?
Diaphoresis
Tachycardia
HA
Spontaneous or triggered by abdominal palpation, exercise, change in posture, lifting, defecation, increased abdominal P, (micturition if PCC is in bladder) suddent increase in HTN related to PCC?
Catecholamine–Mediated Paroxysm (PCC spell)
Due to PCC NE predominance, PCC spells are mostly ______ agonism.
Alpha
Most common symptom of PCC spell
HTN
What two things decrease mortality rate in pre–op PCC treatment?
Antihypertensives
Volume resuscitation
Noneselective alpha blocker?
Phenoxybenzamine
2 selective a–1 antagonists?
Doxazosin
Prazosin
What is the mnemonic for knowing the selective beta 1 antagonist
MABE AB
What CCB is used for preop PCC treatment
Nicardipine
What drug is used for PCC patient unamenable to surgery and inhibits the biosynthesis of catecholamines
Alpha=Methyltyrosine
Phenoxybenzamine DOA/length of time you should stop it before surgery?
24–48 hours
It typically takes _____ days until normotension, volume restoration, and dcreased symptoms from phenoxybenzamine
10–14
Normotension is evident after stopping phenoxybezamine when there is a 5% decrease in ______
Hematocrit
Induction and surgical manipulation of tumors cause HTN in PCC. What cause hypotension
Ligation of tumor’s venous drainage
What volatile agent to avoid during PCC surgery
Des
2 NMBs to avoid in PCC
Panc, atracurium
Peri–op nonselective IV alpha blocker for PCC
Phentolamine
3 drugs that treat PCC tachydysrhythmias
Esmolol
Labetalol
Lido
Oral labetolol beta:alpha ratio
3:1
____________glycemia is common before PCC removal and vice versa
Hypo common before
Most common postop adverse event in PCC
Sustained HTN
Sympathomimetic amines contain a substituted ____ ring and a _______ side chain
Benzene
Ethylamine
Beta 2 stimulation __________ insulin secretion
Inhibits
What receptors does dopamine hit at less than 2 mcg/kg?
Dopaminergic
What receptors does dopamine hit at doses greater than 10mcg/kg?
Alpha
Dopamine’s indirect sympathomimetic effect is by stimulating NE via ____ stimulation.
Beta 1
Dopamine inhibits ______, leading to increased sodium excretion.
Aldosterone
What metabolizes dopamine
MAO
True or false: Isoproterenol causes vasodilation through B2 agonism
TRUE
Dobutamine _______ ventricular stroke work index.
Increases
Nagelhout recommends against using this inotrope during cardiac surgery?
Dobutamine
Phenylephrine has what effect on the pupil?
Mydriasis
What produces and releases vasopressin? What type of neurons release it?
Hypothalamus
Magnocellular
Where is vasopressin stored?
Posterior Pituitary
Vasopressin release is stimulated by _____ osmolality and hypovolemia.
Increased
GI ischemia, cardiac arrest, decreased CO, digit/skin necrosis are side effects of this hormone?
Vasopressin
Name 2 vasopressin agonists?
Teripressin
Desmopressin
What type of agonist would be helpful for bleeding reduction, DI, and enuresis (bedwetting)?
Vasopressin
What does phosphodiesterase breakdown?
cAMP
cGMP
In smooth muscle, cAMP causes efflux of ______, leading to vasodilation (decreased preload and after load).
Calcium
True or False: Phosphodiesterase cause increased O2 consumption by myocardium
FALSE
What type of drugs are viagra and revadio?
PDE–5 Inhibitors
What type of drug is milrinon?
PDE–3 Inhibitor
What drug is commonly referred to as an inodilator
Milrinone
Milrinone prevents breakdown of cAMP, which in the heart improves LV function by ______ calcium uptake by the SR.
Accelerates/Increases
True or false: PDEIs have no effect on adrenergic receptors
TRUE
Milrinone loading dose?
50mcg/kg over 10 minutes
What organ eliminates milrinone, meaning you need to use with caution if organ dysfunction
Kidney
True or false: Ephedrine is mostly metabolized by MAO
False, it resists it
True or false: Ephedrine should be used with caution when there is questionable coronary perfusion
TRUE
What adrenergic agonists have a tocolytic effect, meaning you can relax the uterus with increased cAMP and decreased intracellular Ca?
Beta–2 Agonists
True or false: All Beta 2 agonists are completely selective
False (none are)
B2 agonists have a long DOA due to resistance to ______
COMT
Beta 2 agonists result in tachyphylaxis due to ______regulation of beta receptors and hyperactivity of the airway
Down
Why did the long acting Beta–2 agonists salmeterol and formoterol receive a black box warning?
Increased risk of asthma–related death
Clonidine decreases BP at which two A–2 receptors?
Presynaptic
Central
Which alpha 2 stimulation causes inhibition of catecholamine release and subsequent vasodilation?
Presynaptic
The main antihypertensive mechanism of clonidine is though CENTRAL A2 receptors decreasing ______ outflow.
Sympathetic
Which agonist causes rebound hypertension when dc’d?
Clonidine
Giving epi after phenoxybenzamene cause cause worsened hypotension and tachycardia due to what receptor being unopposed?
Beta–2
2 primary side effects of phenoxybenzamine
Orthostatic Hotn
Nasal Congestion
Which alpha antagonist is a halo alkyl amine?
Phenoxybenzamine
Which alpha antagonist is an imidazole?
Phentolamine
Prazosin, doxazosin, and terazosin are selective for what receptor? What are they used to treat besides HTN?
Alpha 1
BPH
Why does prazosin have no effect on NE levels, leading to less NE induced tachycardia?
Leaves Alpha–2 receptors alone, which leaves inhibitory effect in place
What type of drug are tamsuoosin, alfuzosin, and silodosin?
Alpha 1 antagonists
Alpha 1 antagonists receive obstruct urinary symptoms due to relaxation of these 2 things
Prostate
Bladder neck
What type of drugs are finasteride and dutasteride? What are they used with?
5–Alpha Reductase Inhibitors
Alpha antagonists
