Cardio Adrenergic Agents

Question 1

Use during CPR for asystole
Hemodynamic support after CABG
Anaphylaxis
Local/topical hemostatic

Answer 1

Epinephrine

Question 2

Pressor agent of choice in septic/cardiogenic shock

Answer 2

NE

Question 3

NE does what to renal BF

Answer 3

Decreases it

Question 4

Phenylephrine

Answer 4

IV vasopressor agent
Over the counter nasal decongestant
Increases TPR, BP with reflex brady

Question 5

Maintains BP in hypotensive states

Answer 5

Phenylephrine

Question 6

Tx for Paroxysmal atrial tachycardia

Answer 6

Baroreceptor reflex slowing

Question 7

Vasodilates renal, coronary, and mesenteric vascular beds

Answer 7

Dopamine via D1 receptors

Question 8

Dopamine

Answer 8

Acts at D1 receptors causes mild increase in rate and force
Enhances kidney perfusion
High doses cause vasoconstriction and increased BP –> not a good thing in shock

Question 9

Tx for shock, cardiogenic shock and unstable CHF

Answer 9

Dopamine

Must monitor carefully because too high of doses causes vasoconstriction and decreased tissue perfusion

Question 10

Dobutamine

Answer 10

B1 selective agonist
Positive inotropic, and some chronotropic effects
CO increases
Little vascular effect

Question 11

Dobutamine is used to treat

Answer 11

Cardiogenic shock, MI and CHF

Question 12

Adverse effects of Dobutamine

Answer 12

May increase size of infarct, cause arrhythmia and increase work/O2 requirement of the heart (b1)

Question 13

Clinical Use of A1 blockers

Answer 13

2nd/3rd line treatment of essential HTN

Question 14

A1 Antagonist Effects

Answer 14

Decrease PVR, VR and Preload
Do not increase HR or CO
Do not increase NE release (no A2 block)
Decrease LDL and trigly while increasing HDL

Question 15

Adverse Effects of A1 Antagonists

Answer 15

Marked postural hypotension and syncope, orthostatic hypotenison
Admin at bedtime

Question 16

Most popular A1 Antagonist

Answer 16

Prazosin

Question 17

Very short acting B blocker

Answer 17

Esmolol

Question 18

Partial agonist B blocker with ISA

Answer 18

Acebutolol

Question 19

Both A and B blockers

Answer 19

Labetolol & Carvediol

Question 20

6 Clinical Uses of Cardioselective B Blockers

Answer 20

1) HTN: Decrease CO and TPR (SLOWLY OVER WEEKS)
2) Ischemic Heart Disease: Decreases cardiac work and O2 consumption
3) MI & Post MI Prophylaxis: protects against arrhythmias and limits infarct size (5-10days after)
4) CHF: Improves morbidity and mortality**
5) Arrhythmias: Sinus tachy and super ventricular beat suppressed
6) Thyrotoxicosis: block increased sensitivity of myocardium to betas

Question 21

What are B blockers role in treating CHF?

Answer 21

Improve morbidity and mortality **

Question 22

What are B blockers role in treating hyperthyroid pts?

Answer 22

Treats thyrotoxicosis
Hyperthyroid pt have increased B receptor sensitivity
Blockers reduce the sensitivity of myocardium to adrenergic stimulation

Question 23

Pharmacological Effects of B Blockers Depends on

Answer 23

Existing SNS tone

Question 24

B Blockers Effects on CO HR and PVR

Answer 24

Short term decrease in CO/HR
PVR increases to maintain BP as a result of B2 blocking/reflexes
Long term PVR returns to initial values or deceases in pt with HTN

Question 25

Long term effect so B/A blockers

Answer 25

CO maintained with greater decrease in PVR

Question 26

B blocker effects on rhythm and automaticity

Answer 26

Decrease sinus rate, decreases spontaneous depol of ectopic pacemakers, slow conduction velocity in atria/AV node Increase function refractory period of AV node

Question 27

B Blocker Effects on Exercise

Answer 27

Blunt increase in HR and contractility, CO less affected Decrease work capacity DECREASE EXERCISE TOLERANCE

Question 28

B1 selective agent effect on exercise tolerance vs. nonselective agents

Answer 28

B1 have lesser effects on exercise tolerance vs nonselective agents

Question 29

B blockers do what to myocardial O2 demand?

Answer 29

They decrease it! | Net effect is improving relationship btw cardiac supply/demand

Question 30

B blockers increase exercise tolerance in which pt?

Answer 30

Pt with angina

Question 31

What blocks the reflex bradycardia of a A1 agonist?

Answer 31

Atropine

Question 32

High doses of Dopamine can cause

Answer 32

VC via A1 receptors and increased BP which would be undesirable in the treatment of shock as it would lead to decreased perfusion

Question 33

What receptors mediate catecholamine stimulation of renin release?

Answer 33

B1 receptors, increase in renin is blocked by B blockers

Question 34

B blockers also provide these effects which are helpful in chronic HTN or after stent placement

Answer 34

Antiproliferative effects and antioxidant activity

Question 35

B Blocker peripheral VD also results in decreased incidence of

Answer 35

``` Bronchospasm Withdrawl Sx Insulin resistance DM Metabolic syndrome ```

Question 36

Contraindications for B Blockers

Answer 36

Asthma & COPD | Mask hypoglycemia in DM pt

Question 37

Sudden withdrawal of B blockers can cause

Answer 37

Rebound HTN, anginal attack and MI due to increased B receptor synthesis

Question 38

Atenolol and Metoprolol

Answer 38

B1 selective blockers

Question 39

Esmolol

Answer 39

B1 selective blocker with rapid onset and short duration of action

Question 40

Labetolol

Answer 40

A1 selective blocker Nonselective B1/B2 Partial agonist B2

Question 41

Carvediol

Answer 41

Nonselective B/A blocker Very lipid soluble (CNS permeable) Antioxidant properties Dramatic CHF clinical results (reduce mortality by 65%)

Question 42

A2 receptor agonist MOA

Answer 42

Centrally acting anti-HTN agents working on brain stem A2 receptors to inhibit SNS outflow to the periphery and decreases SNS tone

Question 43

Methyldopa

Answer 43

False NT concept (stored in vesicles instead of NE) A2 agonist Treat HTN in pregnancy Side effects include sedation, dry mouth and sexual dysfunction

Question 44

Clonidine

Answer 44

A2 agonist | SUDDEN WITHDRAWAL CAUSES HYPERTENSIVE CRISIS

Question 45

When admin via IV Clonidine causes

Answer 45

An increase in BP from peripheral A2 stimulation and then a decrease in BP due to central A2 stimulation