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N929 Pharmacology II > Cardiovascular agents II > Flashcards

Cardiovascular agents II Flashcards

1
Q

Central nervous system neurotransmitters include

A

epinephrine, norepinephrine, dopamine, serotonin, GABA, acetylcholine

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2
Q

Naturally occurring neurotransmitters are known as

A

endogenous

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3
Q

Natural catecholamines include

A

epinephrine, norepinephrine, & dopamine

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4
Q

Synthetic catecholamines include

A

isoproterenol & dobutamine

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5
Q

Potency for alpha adrenergic agonists

A

norepinephrine>epinephrine>isoproterenol

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6
Q

Potency for beta adrenergic agonists

A

Isoproterenol> epi> norepi

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7
Q

Alpha 1 receptors are found in

A

Postsynaptic- vasculature, heart, glands, and guts

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8
Q

Alpha 1 agonist cause

A

vasoconstriction and relaxation of the GI tract

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9
Q

Alpha 2 receptors (presynaptic) are found in

A

presynaptic- peripheral vascular smooth muscle, coronaries, & the brain

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10
Q

Activation of presynaptic alpha 2 receptors causes

A

inhibition of norepi release and inhibition of sympathetic outflow leading to decreased BP, HR, and inhibition of CNS activity

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11
Q

Alpha 2 receptors (postsynaptic) are found in

A

coronaries & CNS

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12
Q

Activation of postsynaptic alpha 2 receptors cause

A

constriction, sedation, and analgesia

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13
Q

The sedation caused by dexemetedomidine is called

A

a negative feedback loop

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14
Q

Beta 1 receptors are found in

A

myocardium, SA node, ventricular conduction system, coronaries, & the kidney

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15
Q

The activation of beta 1 receptors causes

A

increase in inotropy, chronotropy, myocardial conduction velocity, coronary relaxation, and renin release

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16
Q

Beta 2 receptors are found in

A

vascular, bronchial & uterine smooth muscle; smooth muscle in the skin, myocardium, coronaries, kidneys, & GI tract

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17
Q

Activation of beta 2 receptors causes

A

vasodilation, bronchodilation, uterine relaxation, gluconeogenesis, insulin release, & potassium uptake by the cells

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18
Q

Direct vs. indirect acting synthetic catecholamines

A

direct- act directly at the receptor site

indirect- cause change in NT release or reuptake

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19
Q

Indirect acting synthetic catecholamines can cause

A

depletion of catecholamine stores & tachyphylaxis

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20
Q

Ephedrine acts as a

A

direct and indirect catecholamine

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21
Q

Phenylephrine is a

A 
pure alpha agonist--> vasoconstriction 
duration of action: 5-20 minutes
can cause reflex bradycardia 
bolus dose 50-100 mcg
infusion: 20-100 mcg
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22
Q

In a patient with a HR of 52 & BP of 70 what medication would you give?

A

ephedrine because it has room to increase the HR & blood pressure

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23
Q

B1 antagonists and calcium channel blockers work on

A

heart rate & contractility

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24
Q

Drugs that act on venous tone include

A

alpha 1 antagonists, ACEI, ARBs, and nitroprusside

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25
Q

Drugs that work on Na/H20 retention include

A

diuretics, ACEI, ARBs

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26
Q

Drugs that act via direct innervation in the peripheral vascular system include

A

alpha 1 antagonists & alpha 2 agonists

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27
Q

Drugs that act as circulating regulators of SVR include

A

alpha 1 antagonists, alpha 2 agonists, ACEI, & ARBS

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28
Q

Drugs that acta as local regulators of SVR include

A

endothelin antagonist, nitroprusside, ACEI, and ARBs

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29
Q

Alpha 2 agonists are used for

A

sedation and analgesia

30
Q

The best way to improve oxygenation through bronchodilation is by

A

giving more gas

can also give beta 2 agonists

31
Q

Adrenergic receptors are

A

all alpha & beta receptors are GPCR receptors

increase in CAMP causes a response

32
Q

Alpha 1 agonists acts on the

A

Vascular smooth muscle (blood vessels, sphincters & bronchi)–> contraction
Iris (radial muscle)–> contraction (dilates pupils)
Pilomotor smooth muscle–> erects hair
Prostate & uterus–> contraction
Heart–> increases force of contraction (B1 is more important though)

33
Q

Alpha 2 agonists act on

A

platelets–> aggregation
VSMC–> contraction (post-synaptic) OR dilation (presynaptic, CNS)
GI tract–> relaxation (presynaptic)
CNS–> sedation & analgesia via decreased SNS outflow from brain stem
adrenergic & cholinergic nerve terminals (presynaptic)–> inhibits transmitter release (decreased BP & HR)

34
Q

Dopaminergic 1 agonists act on

A

smooth muscle–> post synaptic location; dilates renal, mesenteric, coronary, & cerebral blood vessels

35
Q

Dopaminergic 2 agonists act on

A

nerve endings–> pre-synaptic- modulates transmitter release; N/V

36
Q

Beta 1 agonists act on

A

heart–> increase force & rate of contraction, chronotropy, & inotropy
kidneys–> stimulation of renin release

37
Q

Beta 3 agonists act on

A

fat cells–> activates lipolysis; thermogenesis

38
Q

Beta 2 agonists act on

A

Respiratory, uterine, vascular, GI, GU (visceral smooth muscle)–> promotes smooth muscle relaxation
mast cells–> decreased histamine release
skeletal muscle–> potassium uptake, dilation of vascular beds, tremor, increase speed of contraction
liver–> glycogenolysis
pancreas–> increased insulin secretion
adrenergic nerve terminals–> increased release of NE

39
Q

Alpha 2 agonists are considered to be

A

inhibitory

cause decreased CAMP and decreased norepinephrine release

40
Q

Alpha 1 agonists are considered to be

A

excitatory

cause increased Ca2+ –> calmodulin activation–> smooth muscle contraction

41
Q

Major function of alpha 1 receptors includes

A

contraction of smooth muscle and sphincters

42
Q

Major function of alpha 2 receptors inludes

A

decreased transmitter release at nerve endings

43
Q

Major function of beta 1 receptors includes

A

increased heart rate & force on cardiac muscle & increased renin secretion of kidney

44
Q

Major function of beta 2 receptors includes

A

relaxed smooth muscle in the bronchi

gluconeogenesis, glycogenolysis of the liver

45
Q

Major function of beta 3 receptors includes

A

increased lipolysis of adipose

46
Q

Major function of dopamine 1 receptors include

A

relaxation of renal vascular smooth muscles (higher doses activates B1 & alpha 1 receptors)

47
Q

Classes of drugs to treat hypertension include:

A

sympathetic nervous system drugs, renin-angiotensin-aldosterone system, and endothelium derived mediator and/or ion channel modulators

48
Q

Drugs that treat hypertension in the sympathetic nervous system class include

A

Beta antagonists, alpha 1 antagonists, mixed alpha/beta antagonists, centrally acting alpha 2 agonists

49
Q

Drugs that treat hypertension in the renin-angiotensin-aldosterone system class include

A

angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics

50
Q

Drugs that treat hypertension in the endothelium derived mediator and/or ion channel modulators include

A 
direct vasodilators (nitroprusside, hydralazine)
calcium channel antagonists
potassium channel opener
51
Q

Goal of high blood pressure treatment is

A

age 60 or older<150/90 with no diabetes or kidney disease

Age 18-59 year old with no comorbidities and 60 and older with diabetes and/or chronic kidney disease <140/90

52
Q

First line treatment for high blood pressure is

A

thiazide diuretic unless there is a “compelling indication”

most patients will require at least 2 medications to reach goal

53
Q

Medications that treat hypertensive crisis include

A

nitroprusside, nitroglycerin, labetalol, and fenoldapam

54
Q

Hypertensive crisis is

A

diastolic pressure >120 w/ evidence of end organ failure

goal is to decrease DBP 100-105 asap

55
Q

Medications that treat hypertensive urgency include

A

clonidine

56
Q

Hypertensive urgency is considered to be

A

diastolic pressure >120 without evidence of end organ damage

goal is to decrease DBP to 100-105 within 24 hours

57
Q

Alpha antagonists work by

A

binding selectively to alpha receptors and interfere with the ability of catecholamines to cause a response

58
Q

Competitive alpha antagonists include

A

phentolamine, prazosin, Yohimibine

59
Q

Noncompetitive alpha antagonists include

A

phenoxybenzamine (binds covalently)

60
Q

Clinical uses of alpha 1 antagonists include

A

hypertension, BPH, & pheochromocytoma

cause smooth muscle relaxation, decreased PVR, and BP

61
Q

Mixed alpha and beta antagonists include

A

labetalol and carvedilol

B1= beta 2>alpha 1> alpha 2

62
Q

Beta antagonists that have a greater affinity for beta 2 than beta 1 include

A

butoxamine

63
Q

Beta antagonists that have equal affinity for beta 1 & beta 2 include

A

propranolol, nadolol, timolol

64
Q

Beta antagonists that have higher affinity for beta 1 than beta 2 include

A

metoprolol, atenolol, and esmolol

65
Q

Alpha antagonists that have higher affinity for alpha 1 than alpha 2 include

A

prazosin, terazosin, doxazosin alpha 1»»>alpha 2

phenoxybenzamine alpha 1> alpha 2

66
Q

Alpha antagonists that have equal affinity for alpha 1 and alpha 2 include

A

phentolamine

67
Q

Alpha antagonists that have higher affinity for alpha 2 than alpha 1 include

A

yohimbine, tolazoline

68
Q

CV affects of alpha 1 antagonism includes

A

decreases PVR and lowers BP

postural hypotension due to failure of venous vasoconstriction upon standing

69
Q

CV affects of alpha 2 antagonism include

A

increase norepinephrine release from nerve terminals results in tachycardia due to stimulation of beta receptors in the heart

70
Q

Alpha 2 antagonists effects include

A

miosis, increased nasal congestion, GU effects- blockade in prostate and bladder cause muscle relaxation and ease micturation

N929 Pharmacology II (16 decks)

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