Cardio Autonomic pharmacology

Question 1

Epinephrine selectivity

Answer 1

a1 agonist
a2 agonist
B1 agonist
B2 agonist

(Mixed alpha beta receptor agonist)

Question 2

Epinephrine uses

Answer 2

1: drug of choice for anaphylactic shock
2: prolong duration of local anesthetic

Question 3

Describe how epinephrine acts in anaphylactic shock

Answer 3

1: Supports BP (increased vasoconstriction -a1, decreased fluid loss and edma- a1, increased cardiac output- increased HR and contractility- B1)
2: Supports breathing (bronchial smooth muscle relaxation - B2, decreased mucous secretion- a1, decreased pulmonary edema- a1)
3: inhibit release of mediators of anaphylaxis (B2)

Question 4

Norepinephrine selectivity

Answer 4

a1
a2
B1

(mixed alpha beta agonist)

Question 5

Norepinephrine

Answer 5

a1- vascular resistance

B1- increased cardiac contractility

(both work together to increase bp)

Question 6

Norepinephrine uses

Answer 6

1: Cardiogenic shock
2: Septic shock

Question 7

Side effects of mixed alpha beta agonists

Answer 7

Extension of pharmacological effects

1: Tachy (B1)
2: Arrhythmia (B1)
3: Hypertensive crisis (a1)
4: Dry mouth, mild depression, sedation (a2)
5: Closed angle glaucoma

Question 8

Name the a1 selective agonists

Answer 8

Phenylephrine**
Methoxamine
Midodrine

Question 9

a1 selective agonist MOA

Answer 9

vasoconstriction

Question 10

a1 selective agonist uses

Answer 10

1: Reduce Bleeding
2: Hypotensive crisis
3: Nasal decongestion

Question 11

a2 selective agonists

Answer 11

Methyldopa

Clonidine

Question 12

Methyldopa MOA

Answer 12

prodrug (can be used in hypertension during pregnancy)

acts ONLY on the CNS to increase sympathetic outflow and lower blood pressure

Question 13

Clondine MOA

Answer 13

works on both the CNS (lower sympathetic outflow) and PNS (lower NE release)

Question 14

Uses of a2 selective agonists

Answer 14

Hypertension

Question 15

Methyldopa side effects

Answer 15

Positive direct coombs & Hemolytic anemia

lupus erythematosus

Question 16

B1 selective agonists

Answer 16

Dobutamine

Dopamine

Question 17

Dobutamine uses

Answer 17

Failed cardiac pump function

• Severe Congestive heart failure
• Cardiogenic shock

Question 18

Dobutamine MOA

Answer 18

increase cardiac output and contractility

Question 19

Dopamine low dose

Answer 19

activation of D1 on kidneys resulting in increases diuresis

Question 20

Domamine intermediate dose

Answer 20

Activation of B1 in the heart to increase contractile force

Question 21

Dopamine high dose

Answer 21

acts on A1 receptors to increase peripheral resistance resulting in increase in HR

Question 22

Dopamine uses

Answer 22

1: Septic Shock
2: Severe Congestive heart failure
3: Cardiogenic shock

Question 23

Nonselective Beta receptor agonist

Answer 23

Isoproterenol

Question 24

Isoproterenol uses

Answer 24

AV block (speed up conductance)

Bradycardia

Strokes-Adams attack (loss of cardiac output)

Question 25

Dopamine 1 agonist

Answer 25

Fenoldopam

Question 26

Fenoldopam uses

Answer 26

Hypertensive crisis (especially in those in renal failure)

Question 27

Fenoldopam MOA

Answer 27

bind DA1 receptors on coronary and renal artery to cause vessel relaxation

Question 28

Fenoldopam side effects

Answer 28

reflex tachycardia (due to stimulation of baroreflex)

Question 29

Fenoldopam contraindication

Answer 29

Glaucoma (open or closed angle) - increases intraoccular pressure

Question 30

Mixed alpha beta antagonists

Answer 30

Labetalol | Carvediol

Question 31

Latetalol uses

Answer 31

1: Hypertension 2: Hypertensive crisis 3: Ischemic heart disease

Question 32

Labetalol MOA

Answer 32

Competitive and reversibel binding to a1, B1, and B2 higher potency for BETA receptors

Question 33

Carvedilol MOA

Answer 33

Competive and reversible binding to a1, B1, and B2 higher potency for BETA receptors

Question 34

Carvediol uses

Answer 34

Hypertension Ischemic heart disease Chronic heart failure (preferred drug) (other: antioxidant, antiproliferative, NO production)

Question 35

Mixed alpha beta antagonist Adverse effects

Answer 35

Bradycardia Precipitation of acute heart failure Bronchospasm Cold extremities Raynauds disease CNS- mental depression, insomnia, fatigue

Question 36

Metabolic effects of mixed alpha beta antagonists

Answer 36

decreased blood glucose plasma levels altered plasma lipid levels (worsened profile)

Question 37

Contraindications of Beta receptor antagonists

Answer 37

Asthma (nonselective should be avoilded) AV block (can worsen condition)

Question 38

Nonselective alpha antagonists

Answer 38

Phenoxybenzamine | Phentolamine

Question 39

Phenoxybenzamine uses

Answer 39

Pheochromocytoma

Question 40

Phenoxybenzamine MOA

Answer 40

competitive IRREVERSIBLE vasodialation Cardiac stimulation

Question 41

Phenoxybenzamine AE

Answer 41

reflex tachycardia

Question 42

Phenoxybenxamine Drug- drug interactions

Answer 42

High doses can block seratonin, histamine, and AcH

Question 43

Phentolamine uses

Answer 43

1: reversal of anesthesia 2: Hypertensive crisis associated with MOA inhibitor

Question 44

Phentolamine MOA

Answer 44

competitive REVERSIBLE, dose dependent Vasodilation Cardiac stimulation

Question 45

Alpha 1 selective antagonist

Answer 45

Prazosin

Question 46

Prazosin pharmacological effects

Answer 46

reduce LDL and TG and increase HDL suppress release of NE Dilate arteries and veins (decrease BP)

Question 47

Prazosin clinical uses

Answer 47

Pheochromocytoma Chronic hypertension with benighn prostatic hyperplasia (BPH) Urinary retention in men with BPH Chronic hypertension (not commonly used)

Question 48

Prazosin adverse effects

Answer 48

First dose syncope (30-90 minutes after first dose) hypotension, dizziness, fainting, reflex tachycardia Nasal stuffiness, impotence, polyuria, water retention

Question 49

nonselective beta antagonist

Answer 49

Propranolol

Question 50

Propranolol uses

Answer 50

Infantile hemangioma hypertension ischemic heart disease Arrhythmia (Supraventricular and ventricular) Chronic heart failure

Question 51

Beta antagonist MOA (selective and non-selective)

Answer 51

decrease cardiac output (target SA and AV nodes to slow rate and O2 requirements of the heart)

Question 52

Beta antagonist AE (selective and non-selective)

Answer 52

Bradycardia

Question 53

Beta antagonist discontinuation (selective and non-selective)

Answer 53

requires tapering

Question 54

Beta antagonist drug-drug interaction (selective and non-selective)

Answer 54

insulin

Question 55

Beta antagonist contraindication (selective and non-selective)

Answer 55

Asthma and AV block