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Therapeutics II > ANS sympatholytics > Flashcards

ANS sympatholytics Flashcards

1
Q

Sympathetic NTs

A

-norepinephrine
-epinephrine
-adrenergic

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2
Q

veins and arteries only controlled by

A

SNS

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3
Q

Cardiac muscle receptors

A

-B1

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4
Q

Vasc smooth muscle receptors

A

-a1

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5
Q

CNS receptors

A

-a1 and a2

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6
Q

BP=

A

CO x TPR

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7
Q

CO=

A

SV x HR

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8
Q

SV determined by

A

-cardiac contractility
-venous return to heart (preload)
-resistance to left ventricle to eject blood into aorta (afterload)

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9
Q

selectivity of adrenergic receptor agonists

A

-

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10
Q

Baroreceptor reflex when BP decreases

A

-activates sympathetic fibers that feed back and innervate heart (B1)
-inc HR - reflex tachycardia
-a1 constricts bloodvessels
-inhibits vagus PSNS!
=inc blood pressure

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11
Q

Baroreceptor reflex when BP increases

A

-inhibits sympathetic
-activates vagus (PSNS)
-dec HR - reflex bradycardia
-no direct effect on blood vessels
=dec BP

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12
Q

Phenylephrine

A

-act a1
-inc systolic pressure
-vasoconstriction
-DEC HR
-activate baroreceptor to decrease HR

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13
Q

Epinephrine

A

-B and a receptors
-inc pressure and HR
-a1 vasoconstriction
-B2 vasodilation
-B1 positive inotropic and chronotropic effects
-ACTIVATE baroreceptor reflex that mitigates direct effects

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14
Q

Isoproterenol

A

-B receptors
-dec diastolic pressure, inc pulse pressure HR
-vasodilation
-positive I and C effects
-activate baroreceptors

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15
Q

if patient stands up really fast what is the baroreceptor response

A

-activated to inc CO, and vascular resistance to raise BP

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16
Q

Classes of anti-HTNs

A

-diuretics
-sympatholytics
-vasodilators
-renin-angiotensin antagonists

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17
Q

B-blocker action

A

-dec HR, contractility, renin secretion

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18
Q

a and b blockers

A

–dec HR, contractility, renin secretion
-smooth muscle relaxation

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19
Q

central a2 agonist action

A

-dec sympathetic tone

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20
Q

peripheral a1 antagonists

A

-vasc smooth muscle relaxation

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21
Q

a1 ANTAgonist drugs

A

-prazosin
-terazosin
-doxazosin

-double ring and piperazine ring

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22
Q

a1 Antagonist

A

-excreted in bile
-vasodilators
-relax smooth muscle and enlarge prostate
-NO reflex tachycardia

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23
Q

Prazosin vs phentolamine

A

-dec TPR via a1
-activate baroreceptor
-inc NE release

-phentolamine blocks a2 tho so no negative feedback = cardiac overstimulation = reflex tachycardia

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24
Q

Prazosin and terazosin action

A

-a1 ANTAgonist arterioles and venules
-dec TPR
-less tachycardia than nonselective a
-renin release )consider diuretic)

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25
Q

Prazosin and Terazosin use

A

-BPH
-HTN (not first line)
-Reynaud;s disease (mrs pairitz)

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26
Q

a1 antagonist problems

A

-minor
-first dose: orthostatic hypotension and syncope

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27
Q

Direct acting a2 agonists

A

-reduce BP by reducing output from brain
-inhibit NE

=DEC HR, contractility, renin release, vasoconstriction

28
Q

direct acting a2 agonist drugs

A

-clonidine
-guanabenz
-guanfacine
-methyldopa

29
Q

clonidine

A

-a2
-activation of presynaptic a2 receptor in CNS to dec SNS
-dichlorophenyl ring = lipophilic
-HTN, neuropathic pain/opiate withdrawal
-ADHD

30
Q

Clonidine problems

A

-HYPOtension
-sedation
-dry mouth
-withdrawal after long time use (HTN, tachycardia, angina, MI)

31
Q

Guanabenz and Guanfacine

A

-a2 agonists
-open ring imidazolines
-ring w chlorine
-nonionized at phy pH
-HTN
-guanfacine for ADHD

32
Q

Methyldopa

A

-a2 agonist
-prodrug
-dec SNS outtflow
-displaces NE
-esterases
-oral, parenteral (dopate)
-HTN in pregnancy

33
Q

B-blockers use

A

-angina (reduce O2 demand bc dec HR and contractility)
-arrhythmia (slow AV conduction)
-Post MI (reasons above
-HTN (dec CO and renin)
-HF (dec overstimulation and catecholamine toxicity)

34
Q

non-selective B-Blockers

A

-Propranolol and nadolol (HTN, angina, arr, HD, prophylaxis migraines)
-Timolol (glaucoma, dec aq humor)
-minor probs, rebound HTN taper dose

35
Q

propranolol effects

A

-dec CO and HR
-inc VLDL, dec HDL
-inhibit lipolysis
-inhibit response to hypoglycemia
-inc bronchial airway resistancw

36
Q

Nonselective B-bloxkers w Intrinsic sympathomimetic activity

A

-pindolol (angina, migraine)
-carteolol (glaucoma)

-less likely to cause bradycardia and lipid probs
-HTN

37
Q

selective B1 blockers

A

-metoprolol
-bisoprolol
-atenolol
-esmolol (very short acting, tachycardia, afib)
-nebivolol (NO production)

-less bronchoconstriction
-admin oral and parenteral
-use HTN, anigina, arr, HF

38
Q

B-blocker side effects

A

-bradycardia
-AV block
-sedation
-mask hypoglycemia sx
-withdrawal syndrome

39
Q

B-blocker contraindications

A

-asthma
-copd
-congestic HF type IV

40
Q

mixed a1 B1 and B2 antagonists

A

-labetolol (HTN emergency, pheochromocytoma)
-carvedilol (HF)

-dec TPR via a (prevent tachycardia)
-b-blocking prevents tachycardia)
-a1 vasodilation mitigates bradycardia from B-blocking

41
Q

Mixed adrenergic antagonist probs

A

-similar to B-blockers
-taper dose

42
Q

Fenoldopam

A

-dopamine receptor agonist
-does not activate a1 or B receptors
-severe HTN
-dont use in glaucoma
-good for renal impairment

43
Q

if B-blocker can produce vasodilation it is

44
Q

renin

A

-aspartic acid protease that converts to angiotensin I

45
Q

ACE

A

-converts angiotensin I to II
-inactivate bradykinin that promotes vasodilation

46
Q

renin inhibitor drug

A

-direct inhibitor of renin and dec formation of angiotensisn I from angioteninogen
-expensive HTN tx

47
Q

B1 blockers inhibit

A

-renin release

48
Q

ACE inhibitors (-pril) classes

A
  1. sulfhydryl-containing
    -dicarboxyl-containing
    -phosphorus containing
49
Q

Dicarboxyl-containing ACEi

A

-lisinopril
-enalapril (prodrug)
-quinapril (prodrug)

ring chain

50
Q

Sulfhydryl ACEi

A

-captopril
-not prodrug
-short acting

51
Q

phsophorus containing ACEi

A

-fosinopril (monopril)
-prodrug

52
Q

ACE inhibitor action

A

-inhibit ACE
-reduce vasoconstriction
-reduce myocardial mitogenic activity = dec hypertrophy
-reduce Na and water retention
-reduce TPR

53
Q

ACEi use

A

-first line monotherapy for HTN, HF
-works better in whites
-good for pt w HF and CKD
-better for pt w diabetes than thiazides
-better for pt w ischemic HD than vasodilators

54
Q

ACEi probs

A

-cough
-angioedema (lips and tongue, worse in black pt)
-hyperkalemia (dec production of aldosterone_
-NOT in preg
-dont use if GFR<30%
-NSAIDs may reduce effectiveness (dec bradykinin)

55
Q

bradykinin

A

-produces vasodilation
-mediated by prostaglandins

56
Q

ARBs SAR

A

-acidic group
-simidazole
-carboxylic acid group

57
Q

ARB drugs

A

-Sartans
-block angiotensin II w higher affinity for AT1 than AT2

58
Q

ARB action

A

-competitive inhibition of AT1
-reduce vasoconstriction
-dec TPR
-dec afterload
-dec preload
-dec SNS
-dec remodling

59
Q

ARB use

A

-usually pt that cant tolerate ACE
-better in diabetes than TZDs
-better in ischemic HD
-better in pt w CKD

60
Q

ARB side effects

A

-HYPOtension
-hyperkalemia
-angioedema
-fetal pathologies
-reduced GFR
-no cough tho (dont breakdown bradykinin)
-less effecgtive in black pt

61
Q

Aldosterone ANTAgonist (MRA)

A

-spirinolactone and eplerenone
-block reabsorption of sodium and dec bBP

62
Q

MRA use

A

-heart failure
-reduce mortality
0not monotherapy for HTN but used to reduce hypokalemia

63
Q

Thiazides

A

-block NaCl transporter on DCT
-diuretic effect dec BP
-long term effect on contractility
-first line HTN
-better for black pt
-not drug of choice for diabetes, hyperlipidemia, gout

64
Q

thiazide probs

A

-hypokalemia
-alkalosis
-hyperuricemia
-hypercalcemia
-hyperglycemia
-hyperlipidemia

65
Q

other diuretics

A

-loop not recommended first line, potent but short acting
-K+ spaing not recommended first line bc week and hyperkalemia risk

66
Q

HTN in pregnancy

A

-methyldopa
-labetalol, metoprolol
-avoid ACE/ARBs/renin inhibitors, and MRAs

Therapeutics II (55 decks)

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