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Autonomic Nervous System > ANS Pharmacology > Flashcards

ANS Pharmacology Flashcards

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1
Q

Identify the class to which the drugs belong: epinephrine, norepinephrine, dopamine

A

Adrenergic agonists

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2
Q

Identify the class to which the drugs belong: isoproterenol, dobutamine

A

Synthetic catecholamine

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3
Q

Identify the class to which the drugs belong: ephedrine, phenylephrine

A

Synthetic noncatecholamine

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4
Q

Identify the class to which the drugs belong: albuterol, salmeterol

A

Selective beta-adrenergic agonists

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5
Q

Identify the class to which the drugs belong: clonidine, dexmedtomidine

A

Selective alpha 2 agonists

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6
Q

Identify the class to which the drugs belong: propanolol, esmolol

A

Beta 1 and 2 antagonists

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7
Q

Identify the class to which the drugs belong: labetalol, carvedilol

A

Mixed function alpha and beta antagonists

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8
Q

Identify the class to which the drugs belong: nicotine, bethanechol, physostigmine

A

Cholinergic agonists

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9
Q

Identify the class to which the drugs belong: atropine, scopolamine, glycopyrrolate

A

Antimuscarinics

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10
Q

Identify the class to which the drugs belong: verapamil, diltiazem

A

Calcium channel blockers

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11
Q

Identify the class to which the drugs belong: milrinone, slidenafil

A

Phosphodiesterase inhibitors

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12
Q

Identify the class to which the drugs belong: vasopressin

A

Arginine vasopressin

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13
Q

Identify the class to which the drugs belong: nitroprusside, nitroglycerin, hydralazine

A

Direct vasodilators/ nitrodilators

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14
Q

Identify the class to which the drugs belong: lisinopril, captopril, enalopril

A

ACE inhibitors

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15
Q

Identify the class to which the drugs belong: valsartan, olmesartan, losartan

A

ARBs

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16
Q

Identify the class to which the drugs belong: volatile agent, propofol, local anesthetics

A

Anesthetic agents

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17
Q

Three alpha-selective drugs

A

Phenylephrine (alpha 1)
Clonidine (alpha 2)
Dexmedetomidine (alpha 2)

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18
Q

Phenylephrine metabolism

A

MAO

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19
Q

Phenylephrine dosing

A

0.15-0.75 mcg/kg/min

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20
Q

Clonidine metabolism

A

50% liver
50% renal unchanged

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21
Q

Clonidine PO dosing

A

0.1-0.6 mg/day

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22
Q

Clonidine primary uses

A

HTN

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23
Q

Clonidine adverse effects

A

Rebound HTN with abrupt cessation
May cause sedation

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24
Q

Dexmedetomidine metabolism

A

CYP liver

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25
Q

Dexmedetomidine dosing

A

1 mcg/kg over 10 min (bolus)
0.2-0.8 mcg/kg/hr

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26
Q

Dexmedetomidine uses

A

Sedation
Analgesia without respiratory depression

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27
Q

Why are beta blockers contraindicated for phenylephrine overdose?

A

May induce pulmonary edema and irreversible cardiac collapse

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28
Q

Location of postsynaptic alpha 2 receptors

A

Smooth muscles
Several organs

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29
Q

Location of nonsynaptic alpha 2 receptors

A

Platelets

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30
Q

Alpha-2 stimulation in: medulla

A

Decrease SNS tone

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31
Q

Alpha-2 stimulation in: vagus nerve

A

Increase PNS tone

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32
Q

Alpha-2 stimulation in: locus coeruleus

A

Sedation, hypnosis

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33
Q

Alpha-2 stimulation in: dorsal horn of spinal cord

A

Analgesia

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34
Q

Alpha-2 stimulation in: vasculature

A

Vasoconstriction

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35
Q

Alpha-2 stimulation in: renal tubules

A

Inhibits ADH

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36
Q

Alpha-2 stimulation in: pancreas

A

Decrease insulin release

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37
Q

Alpha-2 stimulation in: platelets

A

Increase platelet aggregation

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38
Q

Alpha-2 stimulation in: salivary glands

A

Dry mouth

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39
Q

Alpha-2 stimulation in: GI tract

A

Decrease gut motility

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40
Q

Clonidine or Dexmedetomidine: 1600: 1 affinity for Alpha 2: Alpha 1

A

Dexmedetomidine

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41
Q

Clonidine or Dexmedetomidine: Partial alpha-2 agonist

A

Clonidine

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42
Q

Clonidine or Dexmedetomidine: Mild reduction in volatile and IV anesthetic requirement

A

Clonidine

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43
Q

Clonidine or Dexmedetomidine: 50% protein binding

A

Clonidine

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44
Q

Clonidine or Dexmedetomidine: 94% protein binding

A

Dexmedetomidine

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45
Q

Clonidine or Dexmedetomidine: 2 hour elimination half life

A

Dexmedetomidine

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46
Q

Clonidine or Dexmedetomidine: no respiratory depression

A

Both

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47
Q

Clonidine or Dexmedetomidine: 8 hour elimination half life

A

Clonidine

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48
Q

Clonidine or Dexmedetomidine: near total hepatic transformation to inactive metabolites

A

Dexmedetomidine

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49
Q

Clonidine or Dexmedetomidine: distribution half life >10 minutes

A

Clonidine

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50
Q

Clonidine or Dexmedetomidine: ~50% excreted unchanged, inactive metabolites

A

Clonidine

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51
Q

Clonidine or Dexmedetomidine: distribution half life 5-6 minutes

A

Dexmedetomidine

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52
Q

Epinephrine: effect on renal blood flow

A

Decreases

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53
Q

Epinephrine: effect on MAP

A

Moderately increases

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54
Q

Epinephrine: Airway resistance

A

Decreases

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55
Q

Epinephrine: metabolism

A

Reuptake
MAO and COMT

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56
Q

Epinephrine: receptor

A

B1> B2, A1

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57
Q

Epinephrine: infusion dose

A

0.01-0.2 mcg/kg/min

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58
Q

Epinephrine: primary uses

A

Shock
Anaphylaxis
ACLS

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59
Q

Norepinephrine: renal blood flow

A

Significantly decreases

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60
Q

Norepinephrine: MAP

A

Significantly increases

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61
Q

Norepinephrine: airway resistance

A

No change

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62
Q

Norepinephrine: metabolism

A

Reuptake
MAO and COMT

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63
Q

Norepinephrine: receptor agonism

A

A1, B1 > B2

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64
Q

Norepinephrine: infusion dosing

A

0.01-0.2 mcg/kg/min

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65
Q

Norepinephrine: primary uses

A

Shock
Vasoplegia

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66
Q

Dopamine: renal blood flow

A

Significantly increases

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67
Q

Dopamine: MAP

A

Moderately increases

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68
Q

Dopamine: airway resistance

A

No effect

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69
Q

Dopamine: metabolism

A

Reuptake
MAO and COMT

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70
Q

Dopamine: adrenergic receptor agonism

A

B1> B2, A1

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71
Q

Dopamine: infusion dosing

A

2-20 mcg/kg/min

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72
Q

Dopamine: primary uses

A

Shock

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73
Q

Isoproterenol: renal blood flow

A

Moderately decreases

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74
Q

Isoproterenol: MAP

A

Moderately increases

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75
Q

Isoproterenol: airway resistance

A

Significantly decreases

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76
Q

Isoproterenol: metabolism

A

COMT

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77
Q

Isoproterenol: adrenergic receptor agonism

A

B1>B2

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78
Q

Isoproterenol: infusion dosing

A

0.015-0.15 mcg/kg/min

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79
Q

Isoproterenol: primary uses

A

Drug pacing

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80
Q

Dobutamine: renal blood flow

A

Increases

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81
Q

Dobutamine: MAP

A

Moderately increases

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82
Q

Dobutamine: airway resistance

A

No effect

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83
Q

Dobutamine: metabolism

A

COMT

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84
Q

Dobutamine: adrenergic receptor agonism

A

B1 > B2 > A1

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85
Q

Dobutamine: infusion dosing

A

2-20 mcg/kg/min

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86
Q

Dobutamine: primary use

A

Cardiogenic shock
Stress testing

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87
Q

Ephedrine: renal blood flow

A

Decreases

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88
Q

Ephedrine: MAP

A

Increases

89
Q

Ephedrine: airway resistance

A

Decreases

90
Q

Ephedrine: metabolism

A

Liver
Most renal- unchanged

91
Q

Ephedrine: adrenergic receptor agonism

A

A, B, indirect

92
Q

Ephedrine: bolus dosing

A

5-25 mg IV
Up to 50 mg IV

93
Q

Ephedrine: primary uses

A

Hypotension

94
Q

Low dose epinephrine effects vs high dose effects

A

Low doses favor beta stimulation (increased HR, CO, inotropy, and pulse pressure, and a decrease in SVR)

High doses favor alpha effect (increased SVR and decreased CO)

95
Q

Epinephrine effects on local anesthestics

A

Prolongs duration

96
Q

Dopamine <3 mcg/kg/min effects

A

D1 stimulation –> vasodilation and increased renal and splanchnic blood flow

97
Q

Dopamine 3-8 mcg/kg/min effects

A

A1 and B1 stimulation (heart and periphery) –> increased contractility and BP

98
Q

Dopamine >10 mcg/kg/min effects

A

Pure A1 agonist –> increased BP

99
Q

Post synaptic D1 receptor stimulation

A

Vasodilation of renal, GI coronary, and cerebral vessels

100
Q

Presynaptic D2 stimulation

A

Inhibit norepinephrine release = vasodilation

101
Q

Location of D2 receptors

A

Pituitary gland
Emetic center
Kidney

102
Q

Isoproterenol potency vs epinephrine

A

2-3x more potent than epinephrine

103
Q

Indirect action of ephedrine

A

Endocytosis of ephedrine into adrenergic presynaptic terminal > NE is displaced from secretory vesicles >NE activates target A1 and B1

104
Q

Beta-2 agonists with black box warning

A

Salmeterol
Formoterol

105
Q

Noncompetitive alpha antagonist that block the alpha- mediated activity of NE and epinephrine

A

Phenoxybenzamine

106
Q

How is the effect of phenoxybenzamine terminated?

A

The synthesis of new receptors; its bond is permanent

107
Q

Phenoxybenzamine indication

A

Preoperative management of pheochromocytoma

108
Q

Common complication of phenoxybenzamine administraton

A

Orthostatic hypotension

109
Q

Best treatment for hypotension in patients who have been taking phenoxybenzamine

A

Vasopressin
Fluids

110
Q

Competitive nonselective alpha receptor antagonist

A

Phentolamine

111
Q

Half-life of phentolamine

A

< 10 minutes
(much shorter than phenoxybenzamine)

112
Q

In what patients should phentolamine be used cautiously?

A

Pts with flow-limited coronary artery disease (d/t rapid vasodilation resulting in reflex tachycardia)

113
Q

Used to treat infiltration of epinephrine or norepinephrine

A

Phentolamine

114
Q

Used to treat refractory hypertension d/t abrupt discontinuation of clonidine

A

Phentolamine

115
Q

Alpha antagonist that has an affinity for 5-HT receptors = stimulates stomach acid secretion and induces mast cell degranulation

A

Phentolamine

116
Q

Highly selective A1 receptor antagonist with 1000:1 A1:A2 affinity

A

Prazosin

117
Q

Side effects of prazosin

A

Orthostatic hypotension

118
Q

Prazosin analogs

A

Terazosin
Doxazosin
Tamsulosin

119
Q

Beta blocker indications

A

Hypertension
Supraventricular tachycardia
Atrial fibrillation
Blunting an acute hemodynamic response
CHF and ischemic heart disease
Reducing myocardial O2 consumption and improving perfusion

120
Q

What is membrane stabilizing activity?

A

Inhibits or abolishes action potential propagation across the cell membrane

121
Q

Nonselective B-adrenergic antagonist prototype

A

Propranolol

122
Q

Class of drugs that competes with B1 and B2 to prevent the action of epinephrine, norepinephrine, dopamine, dobutamine, and isoproterenol

A

Nonselective beta adrenergic antagonists

123
Q

List nonselective beta adrenergic antagonists

A

Carvedilol
Pindolol
Propranolol
Sotalol
Timolol
Nadolol

124
Q

Longest half-life of nonselective beta adrenergic antagonists

A

Nadolol

125
Q

Nonselective beta adrenergic antagonist that has some weak B-agonist effects (ISA) and is associated with less HR slowing and less impact on BP

A

Pindolol

126
Q

Selective beta adrenergic antagonist that has some weak B-agonist effects (ISA) and is associated with less HR slowing and less impact on BP

A

Acebutolol

127
Q

Cardioselective B-adrenergic antagonists (list)

A

Metoprolol
Atenolol
Acebutolol
Esmolol
Bisoprolol

128
Q

Relationship between dose of medication and beta selectivity

A

Inverse correlation: as dose increases, selectivity decreases

129
Q

Beta blocker that is metabolized in the bloodstream

A

Esmolol

130
Q

Beta blocker that is metabolized in the kidneys

A

Atenolol

131
Q

Site of metabolism for most beta blockers

A

Liver

132
Q

Metoprolol indications

A

Angina
Heart failure
MI
A fib
HTN

133
Q

Beta blocker that is metabolized in the kidneys

A

Atenolol

134
Q

Metoprolol IV dosing

A

2.5- 5mg increments to a maximum of 15mg

135
Q

First line drug for rapid and perioperative control of HR and BP

A

Esmolol

136
Q

Esmolol duration of action

A

<15 minutes

137
Q

Bolus dose of esmolol

A

10-80 mg

138
Q

Infusion dose of esmolol

A

50-300 mcg/kg/min

139
Q

Name the drug

A

Propanolol

140
Q

Name the drug

A

Esmolol

141
Q

Atenolol indications

A

HTN
Chronic angina
Follow-up post MI

142
Q

Name the drug

A

Labetalol

143
Q

Labetalol primary indication

A

Acute HTN

144
Q

Beta blocker with antioxidant and anti-inflammatory properties

A

Carvedilol

145
Q

Carvedilol indications

A

Heart failure
Left ventricular dysfunction
HTN
Acute MI

146
Q

Carvedilol dosing

A

12.5- 50mg PO in two doses

147
Q

Carvedilol adverse effects

A

Orthostatic hypotension

148
Q

Name the drug

A

Ephedrine

149
Q

Name the drug

A

Phenylephrine

150
Q

Used to identify reactive airway disease in pts who do not have clinically significant asthma

A

Methacholine

151
Q

Receptor that methacholine activates

A

M3

152
Q

Antimuscarinic that does not cross the BBB

A

Glycopyrrolate

153
Q

Antimuscarinics’ effect on HR in descending order

A

Atropine > Glycopyrrolate > Scopolamine

154
Q

Antimuscarinics’ effect as antisialagogue in descending order

A

Scopolamine > glyco > atropine

155
Q

Antimuscarinics’ effect as sedative in descending order

A

Scopolamine > atropine > glyco (no effect)

156
Q

Antimuscarinics’ mydriasis effect in descending order

A

Scopolamine > atropine > glyco (no effect)

157
Q

Antimuscarinics’ effect on motion sickness in descending order

A

Scopolamine > atropine > glyco (no effect)

158
Q

Effect of low dose atropine (<0.1 mg)

A

Worsening bradycardia d/t blocking M1 receptors on preganglionic parasympathetic fibers

159
Q

Scopolamine and atropine toxicity symptoms

A

Increased HR
Dry mouth
Anhidrosis
Thirst

Palpitations
Mydriasis
Cycloplegia
Restlessness
Confusion

Hot, flushed skin
Fever
Hallucinations
Coma
Death

160
Q

Treatment for scopolamine or atropine toxicity

A

Physostigmine 1-2mg IV (may need to be repeated)

161
Q

Type of Ca++ channels that CCB block?

A

Long (L) type Ca++ channels

162
Q

Three classes of CCB

A
  1. Dihydropyridines
  2. Benzothiazipines
  3. Phenylalkylamines
163
Q

Dihydropyridines (list)

A

Nifedipine
Nimodipine
Nicardipine
Clevidipine

164
Q

Benzothiazipines

A

Diltiazem

165
Q

Phenylalkylamines

A

Verapamil

166
Q

Best CCBs for HR control

A

Verapamil
Diltiazem

167
Q

Rank CCB from highest to lowest impact on contractility reduction

A

Verapamil > nifedipine > diltiazem > nicardipine

168
Q

Best CCB for treatment of HTN from elevated SVR

A

Nifedipine
Nicardipine

169
Q

CCB used as a coronary antispasmodic

A

Nicardipine

170
Q

The only CCB proven to reduce morbidity and mortality from cerebral vasospasm

A

Nimodipine

171
Q

CCB have a greater impact on arterial or venous smooth muscle?

A

Arterial

172
Q

Verapamil effect on cardiac conductivity

A

Reduces SA node discharge and decreases AV node conduction, prolonging PR interval

173
Q

Verapamil dose

A

2.5-10 mg over 2 minutes

174
Q

Diltiazem dose

A

0.25mg/ kg over 2 minutes

175
Q

Clevidipine half life

A

~2 minutes

176
Q

CCB that is useful in treating acute HTN, even in setting of pheo and intracerebral hemorrhage

A

Clevidipine

177
Q

Clevidipine dose

A

1-2 mg/hr

178
Q

Most lipophilic CCB

A

Nimodipine

179
Q

CCB that fosters cerebral vasodilation

A

Nimodipine

180
Q

CCB with baroreceptor-mediated increases in HR

A

Nifedipine

181
Q

CCB that may worsen mortality in those with MI

A

Nifedipine

182
Q

CCB often prescribed for pt with Raynaud’s

A

Nifedipine

183
Q

Nifedipine dose

A

0.5 mg/hr

184
Q

CCB that dilates coronary arteries with little effect on inotropy

A

Nicardipine

185
Q

Nicardipine dose

A

5 mg/hr

186
Q

Direct vasodilators (list)

A

Nitroglycerin
Nitroprusside
Hydralazine

187
Q

Nitroglycerine primary action

A

Venodilator with reduced preload

188
Q

Nitroprusside primary action

A

Reduces afterload and preload

189
Q

Hydralazine primary action

A

Arterial smooth muscle dilator

190
Q

Nitroglycerin dosing

A

5-100 mcg/min

191
Q

Nitroglycerin onset

A

2-5 min

192
Q

Nitroglycerin duration

A

5-10 min

193
Q

Nitroglycerin site of artery dilation (possibly)

A

Coronary arteries

194
Q

Nitroprusside dosing

A

0.3- 10 mcg/ kg/ min

195
Q

Nitroprusside onset

A

Seconds

196
Q

Nitroprusside duration

A

<5 minutes

197
Q

Nitroprusside adverse effect

A

Potential for cyanide toxicity

198
Q

Hydralazine dosing

A

2.5- 20 mg

199
Q

Hydralazine onset

A

2- 20 min

200
Q

Hydralazine duration

A

Up to 12 hours

201
Q

NTG mechanism of action

A

Liberates nitric oxide = dilation

202
Q

Why is nitroprusside not used in MI

A

It will induce coronary steal, taking blood flow away from ischemic tissue

203
Q

PDE 5 inhibitors (list)

A

Slidenafil
Tadalafil
Vardenafil

204
Q

PDE 5 inhibitors mechanism of action

A

Increase levels of cGMP by inhibiting its breakdown –> increase cGMP targets lungs and penis

205
Q

PDE 5 inhibitors’ effects

A

Pulmonary vasodilation
Decrease PAP

206
Q

PDE 4 inhibitors (list)

A

Roflumilast
Apremilast
Ibudilast

207
Q

PDE 4 inhibitors MOA

A

Increase levels of cAMP targeting the airways, skin, and immune system

208
Q

PDE 4 inhibitors uses

A

Airway smooth muscles relaxation
Inflammatory disorders of the skin, bowel, and joints

209
Q

PDE 3 inhibitors (list)

A

Milrinone
Cilostazol

210
Q

PDE 3 inhibitors MOA

A

Increase levels of cAMP and cGMP

211
Q

PDE 3 inhibitors uses

A

Cardiovascular disease
Intermittent claudication
Prevent platelet aggregation for thrombosis prophylaxis
CPBP weaning

212
Q

Milrinone dosing

A

25-50 mcg/kg over 10 min

0.375 -0.75 mcg/kg/min infusion

213
Q

Nonspecific PDE inhibitors (list)

A

Theophylline
Methylxanthine

214
Q

Vasopressin effect on healthy, conscious person

A

Little effect on BP d/t reflex mediation

215
Q

Vasopressin effect on pt with SNS or renin-angiotensin- aldosterone axis dysfunction

A

Activates V1 to restore BP

216
Q

Vasopressin indications

A

Distributive shock, pulmonary HTN, anaphylaxis, ACLS

217
Q

Vasopressin dose

A

1-2 unit bolus
0.01- 0.1 unit/ minute infusion

218
Q

Side effects of ACEi

A

Dry cough
Hyperkalemia
Fatigue
Renal dysfunction
Angioedema

219
Q

Treatment for ACEi hypotension

A

Vasopressin may be necessary d/t refractory hypotension

Autonomic Nervous System (13 decks)

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