ANS Pharmacology & Pathophysiology 2

Question 1

Which is NOT an endogenous sympathomimetic?
a. ephedrine
b. dopamine
c. norepinephrine
d. epinephrine

Answer 1

a. ephedrine

Question 2

Endogenous catecholamines include

Answer 2

epinephrine, norepinephrine, and dopamine

Question 3

Synthetic catecholamines include

Answer 3

dobutamine
isoproterenol

Question 4

Endogenous and synthetic catecholamines may produce

Answer 4

hypertension
arrhythmias
myocardial ischemia

Question 5

The effects of endogenous and synthetic agonists are dependent on their

Answer 5

specificity for alpha and beta adrenoreceptors and dopaminergic subtypes

Question 6

What is the classification of ephedinre?

Answer 6

synthetic noncatecholamine
sympathomimetic

Question 7

Administration of beta 2 adrenoreceptors agonists in aerosolized form minimizes

Answer 7

side effects such as anxiety, tremor, and restlessness

Question 8

Isoproterenol and dobutamine have _________ activity

Answer 8

beta 1 and some beta 2

Question 9

Epinephrine and norepinephrine undergo metabolism by

Answer 9

catechol-O-methyl transferase and monoamine oxidase to yield vanillymandelic acid

Question 10

_________ is assayed as part of the diagnostic work-up of pheochromocytoma

Answer 10

VMA or vanillymandelic acid

Question 11

Adrenergic agonists mimic ___________ effects via

Answer 11

SNS; direct receptor activation or by encouraging endogenous catecholamine release

Question 12

What is the receptor and dosing of epinephrine?

Answer 12

B1>B2, alpha 1
0.01-0.2 mcg/kg/min.

Question 13

What is the receptor and dosing of norepinephrine?

Answer 13

alpha 1, beta 1>beta 2
0.01-0.2 mcg/kg/min.

Question 14

What is the receptor and dosing of dopamine?

Answer 14

beta 1>beta 2, alpha 1
2-20 mcg/kg/min.

Question 15

What is the receptor and dosing of isoproterenol?

Answer 15

B1>B2
0.015-0.15 mcg/kg/min.

Question 16

What is the receptor and dosing of dobutamine?

Answer 16

B1>B2>A1
2-20 mcg/kg/min

Question 17

What is the receptor and dosing of ephedrine?

Answer 17

a, beta indirect
bolus 5-25 mg IV
up to 50 mg IM

Question 18

What are the systemic effects of catecholamines?

Answer 18

decreased digestive system activity
dilation of bronchioles
increased heart rate
liver converts glycogen to glucose
high blood pressure

Question 19

Epinephrine has more potency at beta receptors than

Answer 19

norepinephrine

Question 20

The net effect of epi depends on the balance of the receptor types in the individual tissues and organs. Organs with a higher incidence of B2 receptors such as skeletal muscle will see

Answer 20

vasodilation

Question 21

With epinephrine, organs with a higher incidence of alpha 2 receptors such as the mesentery and kidneys will experience

Answer 21

vasoconstriction

Question 22

The net effect of epinephrine depends on the

Answer 22

dose

Question 23

Low doses of epinephrine favor

Answer 23

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

Question 24

High doses of epinephrine favor

Answer 24

alpha effects (increased SVR and decreased CO)

Question 25

Significant metabolic changes related to epinephrine administration include

Answer 25

increase in blood glucose hypokalemia occurs due to a transcellular potassium shift

Question 26

Norepinephrine has mostly_________ effects and minimal _______ effects

Answer 26

alpha 1 and beta 1; beta 2

Question 27

Describe the differences in receptor affinity with high doses of norepinephrine versus low.

Answer 27

low doses favor B1 stimulation high doses favor beta 1 and alpha effects

Question 28

The systemic vasoconstriction effect of norepinephrine is _________ epinephrine

Answer 28

greater

Question 29

Describe how the does of dopamine stimulates different receptors.

Answer 29

low dose dopamine (<3 mcg/kg/min) stimulates D1 receptors moderate doses of dopamine (3-8 mcg/kg/min) stimulate alpha1 and beta 1 adrenergic receptors in the heart and periphery high dose dopamine (>10 mcg/kg/min) acts a a pure alpha 1 agonist

Question 30

Postsynaptic D1 receptors cause

Answer 30

vasodilation of renal, GI, coronary, and cerebral vessels

Question 31

Presynaptic D2 receptors

Answer 31

inhibit norepinephrine release and thus cause vasodilation

Question 32

Dopamine ___________ prevent or reverse AKI or failure

Answer 32

Does NOT

Question 33

Dopamine undergoes what kind of metabolism?

Answer 33

metabolic degradation by catechol-O-methyl transferase and MAO (same as norepi & epi!)

Question 34

The end product of dopamine metabolism is

Answer 34

homovanillic acid

Question 35

Isoproterenol is derived from

Answer 35

dopamine

Question 36

IV infusion dose of isoproterenol is

Answer 36

0.015-0.15 mcg/kg/min.

Question 37

What is the MOA of isoproterenol?

Answer 37

potent sympathomimetic with B1 and B2 activity (2-3x potency of epinephrine)

Question 38

What can isoproterenol precipitate?

Answer 38

supraventricular and ventricular arrhythmias

Question 39

What does dobutamine do?

Answer 39

enhances myocardial contractility and reduces vascular tone

Question 40

What is the IV infusion dose of dobutamine?

Answer 40

2-20 mcg/kg/min.

Question 41

Uses of dobutamine include:

Answer 41

inotropic agent in those with pulmonary hypertension (beta 2 stimulation reduces pulmonary vascular resistance) potent inotrope that may be used in select cases of heart disease, MI, and depressed myocardial states dobutamine stress echo to assess heart function during exertion

Question 42

What is the MOA of dobutamine?

Answer 42

selective b1 agonist with mild B2 effects

Question 43

Adverse effects of dobutamine include

Answer 43

extending cardiac muscle infarction increasing AV conduction which can trigger rapid ventricular rate in those with A-fib

Question 44

What is the drug class of ephedrine?

Answer 44

synthetic, noncatecholamine sympathomimetic

Question 45

What receptors does ephedrine stimulate?

Answer 45

both alpha and beta receptors (indirect agent as well)

Question 46

_______________ is seen with repeat administrations of ephedrine due to ____________

Answer 46

tachyphylaxis; due to depletion of presynaptic norepinephrine

Question 47

Ephedrine has mild stimulating effects because

Answer 47

it crosses the BBB

Question 48

Short-acting beta 2 agonist drugs include

Answer 48

albuterol terbutaline levalbuterol

Question 49

Long-acting B2 agonist drugs include

Answer 49

salmetrol formoterol

Question 50

An FDA "black box" warning is attached to the

Answer 50

longer-acting B2-selective agents (salmeterol & formoterol) d/t risk of asthma-related death -possibly d/t development of airway hyperresponsiveness

Question 51

What effect does beta 2 agonists have on the uterus?

Answer 51

increased cAMP leading to decreased Ca2+ levels--> uterine smooth muscle relaxation and a tocolytic effect

Question 52

With escalated doses of B2 agonists over time, the B2

Answer 52

selectivity wanes, and B2 effects such as tachycardia and arrhythmias may become apparent

Question 53

Chronic B2 agonist therapy can lead to

Answer 53

down-regulation of the target receptors resulting in tachyphylaxis also evidence of airway hyperresponsiveness

Question 54

What potent alpha agonist is the chemical precursor of epinephrine?

Answer 54

norepinephrine

Question 55

Which adrenoreceptor agonist is metabolized by the liver?

Answer 55

ephedrine

Question 56

Which synthetic catecholamine is derived from dopamine?

Answer 56

isoproterenol

Question 57

Which drug has the greatest increase in MAP?

Answer 57

norepinephrine

Question 58

Which drug is the precursor of norepinephrine?

Answer 58

dopamine

Question 59

Which drug results in a large increase of renal blood flow?

Answer 59

dopamine