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Pharm 2 > Antiarrhythmic Agents Part 2 > Flashcards

Antiarrhythmic Agents Part 2 Flashcards

1
Q

Natural Catecholamines

A

Epinephrine
Norepinephrine
Dopamine

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2
Q

Synthetic Catecholamines

A

Isoproterenol

Dobutamine

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3
Q

Synthetic NonCatecholamines

A

Ephedrine

Phenylephrine

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4
Q

Alpha Receptor Affinity

A

norepi>epi>iso

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5
Q

Beta Receptor Affinity

A

Iso>epi>norepi

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6
Q

Alpha 1 Receptor Locations

A

post-synaptic
vasculature, heart, glands, and gut
activation causes vasoconstriction and relaxation at the GI tract

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7
Q

Alpha 2 Receptor Locations

A

Presynaptic: peripheral vascular smooth muscle, coronaries, brain. Activation causes inhibition of norepi release and inhibition of SNS outflow leading to decreased BP, HR and inhibition of CNS activity.
Postsynaptic: coronaries and CNS. Activation causes constriction, sedation and analgesia.

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8
Q

Beta 1 Receptor Locations

A

myocardium, SA node, ventricular conduction system, coronaries, and kidney.
increases inotropy, chronotrophy, myocardial conduction velocity, coronary relaxation and renin release.

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9
Q

Beta 2 Receptor Locations

A

vascular, bronchial, smooth muscle in the skin, myocardium, coronaries, kidneys and GI tract and uterine smooth muscle.
Vasodilation, bronchodilation, uterine relaxation, gluconeogenesis, insulin release, potassium uptake (hypokalemia)

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10
Q

Use of CV agents in Anesthesia

A
  1. improve arterial BP
  2. improve myocardial contractility
  3. improve oxygenation through bronchodilation
  4. anaphylaxis treatment
  5. ACLS protocols
  6. Additive to L.A.
  7. sedation and analgesia (alpha2)
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11
Q

Alpha Adrenergic Receptors

A

GPCR
Ligands: NE, EPI, DOPA
Alpha 1: increases DAG + IP3, increased calcium leading to contraction
Alpha2: decreased camp leads to inhibition of Norepi

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12
Q

Beta Adrenergic Receptors

A

activation of adenyl cyclase, increased camp, increased kinase production and phosphorylation.

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13
Q

Classes of Drugs to treat HTN: Sympathetic Nervous System

A

beta antagonists
alpha 1 antagonists
mixed alpha & beta antagonists
centrally acting alpha 2 agonists

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14
Q

Classes of Drugs to treat HTN: RAAS

A

ACE-I
ARB
Diuretics

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15
Q

Classes of Drugs to treat HTN: Endothelium derived mediator and/or ion channel modulators

A 
direct vasodilators (nitro, hydralazine) 
calcium channel antagonists 
potassium channel opener
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16
Q

When to Treat HTN

A

> 120/80 “lifestyle modifications”
<140/90 18-59 no comorbidities OR >60 with diabetes and/or CKD
<150/90 60 or older with no DM or kidney disease

17
Q

First Line Therapy HTN

A

Thiazide diuretic UNLESS compelling indication such as already showing organ decompensation
I.E. elevated BUN/Cr or cardiac hypertrophy

18
Q

Hypertensive Emergency

A

diastolic >120 with evidence of progressive end organ damage
Goal: decrease DBP to 100-105 within 24 hours (clonidine)

19
Q

Hypertensive Crisis

A

diastolic >120 with evidence of end organ FAILURE
Goal: decrease DBP to 100-105 ASAP
nitroprusside, nitroglycerin, labetalol, fenoldapam

20
Q

Alpha Antagonists

A

bind selectively to alpha receptors and interfere with the ability of catecholamines to cause a response

21
Q

Phenoxybenzamine

A

binds covalently, nonselective (less alpha 2)
less tachycardia with decreased SVR
PO med for preop BP control in pheochromocytoma
PRODRUG (1 hr onset, long acting 24 half time)

22
Q

Phentolamine

A

non selective, competitive alpha antagonist
reflex mediated and alpha2 associated increases in HR and CO
produce vasodilation and decrease in SVR

23
Q

Prazosin

A

selective alpha 1 competitive alpha antagonist
less likely to cause tachycardia
dilates arteries and veins
used preop for pheo patients, essential HTN with thiazides, decreasing afterload in HF, raynaud phenomenon

24
Q

Yohimibine

A

Competitive alpha antagonist
alpha 2 selective
increases release of NE from post-synaptic neuron (vasoconstriction)
used for orthostatic hypotension and impotence

25
Q

Alpha Antagonists for BPH

A

Terazosin & Tamsulosin
long acting selective alpha 1a
prostatic smooth muscle relaxation
orthostatic hypotension is biggest concern

26
Q

Alpha 1 Antagonism

A

decreases PVR and lowers BP

Postural hypotension d/t failure of venous vasoconstriction upon standing

27
Q

Alpha 2 Antagonism

A

increases NE release from nerve terminals results in tachycardia due to stimulation of beta receptors in heart

28
Q

Alpha 2 Antagonists Effects

A

blockade in prostate and bladder (muscle relaxation)
miosis
increased nasal congestion

29
Q

Phentolamine Dosing

A

30-70 mcg/kg intraop HTN emergencies, pheo or autonomic hyperreflexia
2.5mg to 5.0 mg for extravascular admin of sympathomimetic agents

30
Q

Beta Antagonists “Beta Blockers”

A

disallow sympathomimetics from provoking a beta response on the heart

Pharm 2 (4 decks)

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