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Year 2 Pharmacology > Autonomic pharmacology IV > Flashcards

Autonomic pharmacology IV Flashcards

1
Q

what are the three types of adrenergic agonists?

A
  1. direct acting
  2. mixed
  3. indirect acting
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2
Q

what are the two categories of direct acting adrenergic agonists?

A
  1. selective

2. non-selective

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3
Q

what are the selective direct acting adrenergic agonists?

A
  1. phenylephrine - a1
  2. clonidine - a2
  3. terbutaline - B2
  4. fenoldopam - D1
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4
Q

phenylephrine acts on what receptor?

A

a1

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5
Q

clonidine acts on what receptor?

A

a2

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6
Q

terbutaline acts on what receptor?

A

B2

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7
Q

fenoldopam acts on what receptor?

A

D1

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8
Q

what are the non-selective direct acting adrenergic agonists?

A
  1. isopreterenol
  2. dobutamine
  3. epinephrine
  4. norepinephrine
  5. dopamine
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9
Q

isopreterenol acts on what receptors?

A

B1 and B2

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10
Q

dobutamine acts on what receptors?

A

a1, B1, B2

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11
Q

epinephrine acts on what receptors?

A

a1, a2, B1, B2

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12
Q

NE acts on what receptors?

A

a1, a2, B1

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13
Q

dopamine acts on what receptors?

A

D1, D2, a1

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14
Q

are the effects of direct acting adrenergic agonists reduced by prior treatment with reserpine or guanethidine?

A

no (may be potentiated)

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15
Q

are the effects of mixed acting adrenergic agonists reduced by prior treatment with reserpine or guanethidine?

A

yes

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16
Q

what is the effect of phenylephrine on vascular smooth muscle? which receptor does it activate?

A
  1. increase BP, increase TPR

2. alpha adrenergic (a1)

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17
Q

what are the clinical indications for phenylephrine?

A
  1. hypotension, shock
  2. paroxysmal atrial tachycardia
  3. nasal decongestant
  4. mydriatic
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18
Q

what are the a2 selective adrenergic receptor agonists?

A
  1. clonidine
  2. a-methyldopa
  3. apraclonidine
  4. brimonidine
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19
Q

what is the mechanism of action for clonidine (a2 selective adrenergic receptor agonist)?

A

lowered BP due to decreased sympathetic outflow

20
Q

what are the clinical uses for clonidine (a2 selective adrenergic receptor agonist)?

A
  1. systemic hypertension

2. glaucoma

21
Q

what are the adverse effects of a2 selective adrenergic receptor agonists?

A
  1. dry mouth
  2. sedation
  3. hypotension
22
Q

apraclonidine and brimonidine are used for what purposes?

A

decrease aqueous humor production and intraocular pressure

23
Q

what are the B2 selective adrenergic receptor agonists?

A
  1. metaproterenol
  2. terbutaline
  3. albuterol
  4. ritodrine
24
Q

which B2 selective adrenergic receptor agonists are resistant to methylation by COMT?

A

metaproterenol and terbutaline

25
Q

what are the therapeutic uses for metaproterenol?

A
  1. long term treatment of obstructive airway diseases, asthma
  2. acute bronchospasm
26
Q

what are the therapeutic uses for terbutaline?

A
  1. long term treatment of obstructive airway diseases, asthma
  2. acute bronchospasm
  3. emergency treatment of status asthmaticus (IV)
27
Q

what are the therapeutic uses for albuterol?

A
  1. acute bronchospasm

2. delay preterm labor

28
Q

what are the therapeutic uses for ritodrine?

A
  1. uterine relaxant
  2. arrest preterm labor
  3. prolong pregnancy
29
Q

what are the adverse effects of excessive activation of B receptors?

A
  1. tachycardia
  2. increased plasma glucose
  3. increased plasma K+
30
Q

what is the best way to avoid adverse effects of excessive activation of B receptors?

A

inhalation therapy

31
Q

fenoldopam acts on what receptor?

A

D1 (some a2)

32
Q

what are the effects of D1 activation by fenoldopam?

A
  1. vasodilation in (renal, mesenteric, peripheral, coronary) vascular beds:
  2. renal blood flow maintained and natriuresis promoted
33
Q

what is the clinical use for fenoldopam?

A

hypertensive crisis

34
Q

what is the side effect of fenoldopam?

A

hypotension

35
Q

isopreterenol acts on which receptors?

A

B1 and B2

36
Q

what are the cardiovascular effects of isopreterenol?

A
  1. decrease TPR
  2. increase HR
  3. increase myocardial contractility
37
Q

what are the respiratory effects of isopreterenol?

A

bronchodilation

38
Q

what are the clinical uses of isopreterenol?

A
  1. bradycardia
  2. AV block
  3. torsades de pointes
39
Q

what is the reason for increase in HR following isopreterenol administration?

A

activation of B1 receptors

40
Q

at therapeutic doses, dobutamine acts mainly on what receptor?

A

B1

41
Q

does dobutamine affect release of NE from sympathetic nerve endings?

A

no

42
Q

what are the cardiovascular effects of dobutamine?

A
  1. positive inotropic (more so than isopreterenol)
  2. positive chronotropic - SA automaticity, AV conduction
  3. TPR unaffected (a1 - B2 balance)
43
Q

why is dobutamine considered the preferred agent for cardiac performance?

A
  1. increases contraction without increasing HR too much (no significant increase in oxygen consumption)
  2. a1 - B2 balancing leads to less impact on TPR
44
Q

what are the adverse effects of dobutamine?

A
  1. excessive increase in BP and HR
  2. increased ventricular response rate in pts with atrial fibrillation
  3. ventricular ectopic activity
  4. may increase size of myocardial infarct
  5. tolerance
45
Q

what are the therapeutic uses for dobutamine?

A
  1. short term treatment of cardiac failure
  2. longer term efficacy unclear
  3. stress test for pts with coronary artery disease

Year 2 Pharmacology (70 decks)

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