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cardiology > Autonomic Pharmacology > Flashcards

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
Q

isoprotenol mainly acts on

A

beta 1 and beta 2

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26
Q

nonselective beta agonst

A

isoproternol

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27
Q

beta 2 agonists

A

terbutaline, metaproterenol, albuterol, ritrodrine

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28
Q

beta 1 agonsts

A

dobutamine

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29
Q

alpha 1 agonst

A

phenylephrine, methoxamine

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30
Q

alpha 2 agonist

A

clonidine, methylnorepinpehrine

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31
Q

mixed alpha and beta agonists

A

NE and Epi

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32
Q

ionotropic drugs (increase strength of contraction) and act at

A

cardiac beta 1 receptors

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33
Q

two inotropic drugs used to treate acute, severe heart failure

A

dopamine and dubutamine

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34
Q

what are the two main uses for epinphrine

A

resucitation from cardiac arrest and anaphylactic shock

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35
Q

whats a potential problem of epinephrine administration in cardiac arrest patients

A

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

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36
Q

adverse affects of epinephrine

A

tachycardia

hypertensive crisis, hyperglycemia

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37
Q

effects of epinephrine (all sympathomimetic agonist drugs) are increased by

A

cocain and tricyclic antidepressants
MAO inhibitors
thyroid hormones

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38
Q

cocaine inhibits

A

selective NE transporter that releases NE back into presynaptic terminal

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39
Q

alpha methyltyrosine inhibits

A

tyrosine hydroxylase (rate llimiting step in catecholamine synthesis)

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40
Q

reserpine

A

inhibits vMAT involved in filling or refilling of synpatic vesicles with dipamine or NE respectively

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41
Q

stimulates presynaptic autoreceptor resulting in decreased release of NE

A

clonidine

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42
Q

what receptors does NE stimulate

A

alpha 1, alpha 2 and beta 1

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43
Q

NE is used for

A

cardiac arrest and hypotensive states

44
Q

what are the adverse effects of NE

A

angina, tachyarrhthmias, and bradycardia

45
Q

NE with MAOI’s may cause

A

hypertension

46
Q

what receptors does isoproterenol act on

A

stimulates the beta 1 and beta 2 receptors

47
Q

what is the effect of isoproterenol on CV

A

potent vasodilator, increased CO,

48
Q

what are the clinical indications for isoproterenol

A

AV block, bradycardia emergency

49
Q

what are the adverse effects of osoproterenol

A

angina, hyper or hypotension, tachy, ventricular arrhthmia, adams stokes attack

50
Q

what are contraindications for isoproterenol

A

pts with angina, tachycardia, tachyarrhthmias, ventricular arrhthmias, hyperthroid and diabetes, elederly

51
Q

what is the one drug interaction with isproternol

A

COMT inhibitors

52
Q

low dose dopaine affects

A

D1 (renal vasc)

53
Q

mid dose dopamine affects what receptors

A

beta 1 (cardiac)

54
Q

high dose dopamine affects a

A

alpha 1

55
Q

______is a D1 agonist used for severe hypotension

A

fenoldapam

56
Q

adverse effects of dopamine at high doses

A

tachycardia and tachyarrhthmias

57
Q

what are the contraindications for dopamine

A

pheochromocytoma, ventribular fibrillation and post MI and high doses with Cardiac failure

58
Q

_____is a synthetic seletive beta agonist that increases cardiac contractility

A

dobutamine

59
Q

action of dobutamine

A

increases Cardiac output with little or no effect on HR, does NOT increase peripheral resistance

60
Q

what is dobutamine used for

A

heart failure

61
Q

what are the adverse effects of dobutamine

A

tachyarrhythmias, ventricular ectopy and hypotension

62
Q

contraindications of dobutamine

A

elderly (start with a low dose)

63
Q

what is the maximum amount of time dopamine and dobutamine should be give

A

only for about a week, longer use associated with increased mortality

64
Q

what are the three alpha 1 agonists

A

phenylephrine, methoxamine and midodrine

65
Q

is an alpha 1 agonist used to raise BP

A

phenylephrine

66
Q

is associated with prolonged increase in BP due to vasoconstriction

A

methoxamine

67
Q

what are the adverse effects of midodrine

A

supine hypertension, urinary urgency, retenion or polyuria, dysuria

68
Q

midodrine is contraindicated in

A

pheochromocytoma, thyrotoxicosis, persistent and significant supine hypertension

69
Q

what are the indications for phenylephrine and methoxaine

A

hypotensive emergencies to preserve cerebral and coronary blood flow; BP during anesthesia and midodrine (postural hypotension)

70
Q

what is the name of indirect acting sympathetomimetics

A

ephedrine

71
Q

what is the action or use for ephedrine

A

releases NE and is a mixed alpha/beta agonist causing mild CNS stimulation but has potential for abuse

72
Q

examples of alpha 2 agonists

A

clonidine and alpha methyldopa

73
Q

how do alpha 2 agonists work

A

sympathetic tone decreases and vagal tone increases (decreased BP and HR)

74
Q

what is the indication for clonidine

A

hypertension

75
Q

drug incidated for pregnancy related hypertension

A

alpha methyldopa

76
Q

what are some side effects of alpha 2 agonists

A

sedation, sexual dysfunction in males, nausea, dizziness, sleep disturbances and dose related withdrawal syndrome

77
Q

alpha 1 selective blockers

A

prazosin, doxazosin, terazosin and tamsulosin (1a)

78
Q

mechanism for alpha blockers

A

relaxes arteroles and venous vascular smooth muscle, less reflex tachy but can cause orthostatic hypertension, syncope, dizziness

79
Q

contraindications of alpha blockers

A

sidelnafil, tadalafil or veradenafil

80
Q

two drugs used to treat benign prostatic hyperplasia

A

terazosin and doxazosin

81
Q

what are the treatments for phenochromosytoma

A

phenoxybenzamine and phentolamine

82
Q

what is the occasional adverse effect of alpha 1 selective blockers

A

1st dose hypertension

83
Q

blocking alpha 2 presynaptic receptors increases _____- onto cardiac beta 1 receptors

A

NE release triggering arrhthmias and angina

84
Q

all therapeutic effects are due to

A

blockade of beta 1 leading ot decrease HR, decreased velocity of conduction through AV node and decrease force of contraction

85
Q

what are the primary indications for beta blockers

A

hypertension, angina pectoris, arrhthmias, congestive heart failure

86
Q

what are the nonselective beta blockers

A

propranolol, timolol and pindol

87
Q

side effect of propranolol

A

lipid soluble so additional Se is insomnia, depression, nightmares and hallucinations

88
Q

what are the beta 1 selective antagonists

A

atenolol, metoprolol and esmolol

89
Q

what are some adverse effects of beta 1 blockade

A

rebound cardiac excitation if discontinued suddenly and may worsen peripheral vascular disease

90
Q

effects of beta 2 blockade

A

bronchoconstriction, vaosconstriction, inhibit glycogenolysis,

91
Q

alpha beta blockers

A

labetalol and carvedilol

92
Q

what is carvedilol used for

A

hypertension and heart failure (preferred over metoprolol succinate)

93
Q

what are the two indirect acting sympatholytics

A

reserpine and guanethidine

94
Q

what is a side effect of reserpine

A

severe depression

95
Q

______-is transported into membrane of the symathetic nerve terminals by the uptake 1 system and prevents release of NE in response to action potentials

A

guanethidine

96
Q

major side effect of guanethidine

A

severe orthostatic hypetension

97
Q

what is mecamylamine

A

ganglionic blocker agent

98
Q

what is mecamylamine used for

A

essential hypertension in patients refractory to other hypertensives

99
Q

what are the alpha 2 agonists

A

clonidine, methyldopa

100
Q

what are the alpha 1 agonist

A 
epi
nE
Dopamine
phenylephrine
midodrine
101
Q

what are the beta 2 agonists

A

epi
isoproterenol
dobutaine

102
Q

what are the beta 1 agonists

A 
epi
nE
isoproterenol
dopamine
dobutaine
ephedrine
103
Q

what are the nonselective beta blockers

A

propranolol
nadolol
pindolol
timolol

104
Q

what are the mixed beta blockers

A

carvedilol

labetalol

105
Q

alpha 1 antagonists

A 
Doxazosin
Phentolamine
Prozosin
Terazosin
Labetalol
106
Q

beta 1 antagonists

A 
metoprololol
atenolol
nebivolol
esmolol
betaxolol
acebutolol

cardiology (11 decks)

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