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Autonomic Pharmacology Flashcards

1
Q

where are the D2 receptors located

A

renal blood vessels

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2
Q

where are the alpha 1 receptors located

A

vascular smooth muscle

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3
Q

action that results when alpha 1 stimulated

A

vasoconstriction, increase Peripheral vascular resistance and increase blood pressure

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4
Q

action that results when alpha 2 is stimulated

A

inhibition of NE release, vasoconstriction, inhibition of insulin release, inhibition of acetylcholine release

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5
Q

where are the beta 1 receptors loated

A

heart, kidney, presympatic adrenergic terminals and adipose tissue

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6
Q

action of beta 1 in relationship to CV system

A

tachycardia, increased lypolysis, increase myocardial contractility, increase renin release

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7
Q

action of beta 2 in relationship to CV system

A

vasodilation, decreased PVR, bronchodialtion, increased glycogenolysis and release of glucagon

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8
Q

where are the beta 2 receptors located

A

vascular smooth muscle, bronchial smooth muscle, liver

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9
Q

what drugs are specifically dentrimental to asthmatics

A

carvidilol, pindolol and propanolol (nonselective antagonists

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10
Q

timolol is a ________-and is used to treat specifically_____

A

nonspecific beta antagonists used to treat glaucoma

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11
Q

drugs selective for beta 1 antagonisms

A

metoprolol, atenolol, acebutalol and nebivolol

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12
Q

why/when are beta 1 selective antagonists preferred

A

in pts with diabetes and asthma

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13
Q

________is highly selective for beta 1 and exhibits additional effects of vasodialation

A

nebivolol

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14
Q

what are the two alpha 2 adrenergic agonists

A

clonidine and guanabenz

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15
Q

what are clonidine and guanabenz used for

A

hypertension

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16
Q

MOA of alpha 2 adrenergic agoniss

A

act by inhibiting sympathetic outflow from CNS and thus decreases heart rate, contractility and vasomotor tone

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17
Q

type of receptors carvedilol acts on

A

mixed alpha and beta antagonist but more potent at beta receptors than alpha1

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18
Q

what is carvedilol used for

A

treatment of chronic heart failure with decreased systolic function

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19
Q

when a patient is in hypotension, shock, acute heart failure or hemistasis you should give them a

A

adrenergic agent

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20
Q

when patient has angina pectoris, cardiac arrhytmias, heart failure (long erm) and hypertension should give

A

antiadrenergic agent

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21
Q

dopamine mainly worse at what receptors

A

alpha and beta 1

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22
Q

dobutamine mainly acts in

A

beta 1

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23
Q

NE mainly acts on

A

alpha and beta 1

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24
Q

epi mainly acts on

A

alpha and beta and very small beta2

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25
isoprotenol mainly acts on
beta 1 and beta 2
26
nonselective beta agonst
isoproternol
27
beta 2 agonists
terbutaline, metaproterenol, albuterol, ritrodrine
28
beta 1 agonsts
dobutamine
29
alpha 1 agonst
phenylephrine, methoxamine
30
alpha 2 agonist
clonidine, methylnorepinpehrine
31
mixed alpha and beta agonists
NE and Epi
32
ionotropic drugs (increase strength of contraction) and act at
cardiac beta 1 receptors
33
two inotropic drugs used to treate acute, severe heart failure
dopamine and dubutamine
34
what are the two main uses for epinphrine
resucitation from cardiac arrest and anaphylactic shock
35
whats a potential problem of epinephrine administration in cardiac arrest patients
total peripheral resistance may fall because of actiation of the beta 2 receptors in skeletal muscle blood cells -->dilation, so fall in diastolic pressure after epi injection
36
adverse affects of epinephrine
tachycardia | hypertensive crisis, hyperglycemia
37
effects of epinephrine (all sympathomimetic agonist drugs) are increased by
cocain and tricyclic antidepressants MAO inhibitors thyroid hormones
38
cocaine inhibits
selective NE transporter that releases NE back into presynaptic terminal
39
alpha methyltyrosine inhibits
tyrosine hydroxylase (rate llimiting step in catecholamine synthesis)
40
reserpine
inhibits vMAT involved in filling or refilling of synpatic vesicles with dipamine or NE respectively
41
stimulates presynaptic autoreceptor resulting in decreased release of NE
clonidine
42
what receptors does NE stimulate
alpha 1, alpha 2 and beta 1
43
NE is used for
cardiac arrest and hypotensive states
44
what are the adverse effects of NE
angina, tachyarrhthmias, and bradycardia
45
NE with MAOI's may cause
hypertension
46
what receptors does isoproterenol act on
stimulates the beta 1 and beta 2 receptors
47
what is the effect of isoproterenol on CV
potent vasodilator, increased CO,
48
what are the clinical indications for isoproterenol
AV block, bradycardia emergency
49
what are the adverse effects of osoproterenol
angina, hyper or hypotension, tachy, ventricular arrhthmia, adams stokes attack
50
what are contraindications for isoproterenol
pts with angina, tachycardia, tachyarrhthmias, ventricular arrhthmias, hyperthroid and diabetes, elederly
51
what is the one drug interaction with isproternol
COMT inhibitors
52
low dose dopaine affects
D1 (renal vasc)
53
mid dose dopamine affects what receptors
beta 1 (cardiac)
54
high dose dopamine affects a
alpha 1
55
______is a D1 agonist used for severe hypotension
fenoldapam
56
adverse effects of dopamine at high doses
tachycardia and tachyarrhthmias
57
what are the contraindications for dopamine
pheochromocytoma, ventribular fibrillation and post MI and high doses with Cardiac failure
58
_____is a synthetic seletive beta agonist that increases cardiac contractility
dobutamine
59
action of dobutamine
increases Cardiac output with little or no effect on HR, does NOT increase peripheral resistance
60
what is dobutamine used for
heart failure
61
what are the adverse effects of dobutamine
tachyarrhythmias, ventricular ectopy and hypotension
62
contraindications of dobutamine
elderly (start with a low dose)
63
what is the maximum amount of time dopamine and dobutamine should be give
only for about a week, longer use associated with increased mortality
64
what are the three alpha 1 agonists
phenylephrine, methoxamine and midodrine
65
is an alpha 1 agonist used to raise BP
phenylephrine
66
is associated with prolonged increase in BP due to vasoconstriction
methoxamine
67
what are the adverse effects of midodrine
supine hypertension, urinary urgency, retenion or polyuria, dysuria
68
midodrine is contraindicated in
pheochromocytoma, thyrotoxicosis, persistent and significant supine hypertension
69
what are the indications for phenylephrine and methoxaine
hypotensive emergencies to preserve cerebral and coronary blood flow; BP during anesthesia and midodrine (postural hypotension)
70
what is the name of indirect acting sympathetomimetics
ephedrine
71
what is the action or use for ephedrine
releases NE and is a mixed alpha/beta agonist causing mild CNS stimulation but has potential for abuse
72
examples of alpha 2 agonists
clonidine and alpha methyldopa
73
how do alpha 2 agonists work
sympathetic tone decreases and vagal tone increases (decreased BP and HR)
74
what is the indication for clonidine
hypertension
75
drug incidated for pregnancy related hypertension
alpha methyldopa
76
what are some side effects of alpha 2 agonists
sedation, sexual dysfunction in males, nausea, dizziness, sleep disturbances and dose related withdrawal syndrome
77
alpha 1 selective blockers
prazosin, doxazosin, terazosin and tamsulosin (1a)
78
mechanism for alpha blockers
relaxes arteroles and venous vascular smooth muscle, less reflex tachy but can cause orthostatic hypertension, syncope, dizziness
79
contraindications of alpha blockers
sidelnafil, tadalafil or veradenafil
80
two drugs used to treat benign prostatic hyperplasia
terazosin and doxazosin
81
what are the treatments for phenochromosytoma
phenoxybenzamine and phentolamine
82
what is the occasional adverse effect of alpha 1 selective blockers
1st dose hypertension
83
blocking alpha 2 presynaptic receptors increases _____- onto cardiac beta 1 receptors
NE release triggering arrhthmias and angina
84
all therapeutic effects are due to
blockade of beta 1 leading ot decrease HR, decreased velocity of conduction through AV node and decrease force of contraction
85
what are the primary indications for beta blockers
hypertension, angina pectoris, arrhthmias, congestive heart failure
86
what are the nonselective beta blockers
propranolol, timolol and pindol
87
side effect of propranolol
lipid soluble so additional Se is insomnia, depression, nightmares and hallucinations
88
what are the beta 1 selective antagonists
atenolol, metoprolol and esmolol
89
what are some adverse effects of beta 1 blockade
rebound cardiac excitation if discontinued suddenly and may worsen peripheral vascular disease
90
effects of beta 2 blockade
bronchoconstriction, vaosconstriction, inhibit glycogenolysis,
91
alpha beta blockers
labetalol and carvedilol
92
what is carvedilol used for
hypertension and heart failure (preferred over metoprolol succinate)
93
what are the two indirect acting sympatholytics
reserpine and guanethidine
94
what is a side effect of reserpine
severe depression
95
______-is transported into membrane of the symathetic nerve terminals by the uptake 1 system and prevents release of NE in response to action potentials
guanethidine
96
major side effect of guanethidine
severe orthostatic hypetension
97
what is mecamylamine
ganglionic blocker agent
98
what is mecamylamine used for
essential hypertension in patients refractory to other hypertensives
99
what are the alpha 2 agonists
clonidine, methyldopa
100
what are the alpha 1 agonist
``` epi nE Dopamine phenylephrine midodrine ```
101
what are the beta 2 agonists
epi isoproterenol dobutaine
102
what are the beta 1 agonists
``` epi nE isoproterenol dopamine dobutaine ephedrine ```
103
what are the nonselective beta blockers
propranolol nadolol pindolol timolol
104
what are the mixed beta blockers
carvedilol | labetalol
105
alpha 1 antagonists
``` Doxazosin Phentolamine Prozosin Terazosin Labetalol ```
106
beta 1 antagonists
``` metoprololol atenolol nebivolol esmolol betaxolol acebutolol ```

cardiology (11 decks)

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