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Cardiology > Cardiovascular Effects of Autonomic Agents > Flashcards

Cardiovascular Effects of Autonomic Agents Flashcards

1
Q

Name an indirect parasympathetic agonist

A

Edrophonium

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2
Q

What is edrophonium?

A

Short lasting ACh-esterase inhibitor that stimulates strong parasympathetic discharge for about 30 seconds

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3
Q

Side effects of edrophonium?

A

Profound abdominal cramping by stim smooth muscle contractions in GI

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4
Q

What are the clinical uses of edrophonium?

A

Used to inc AV refractoriness for brief periods

  • Diagnose supravent tachyc
  • Breaks supravent tachycs
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5
Q

What is a muscarinic agonist?

A

Agonist for parasympathetic NS (ACh)

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6
Q

List 3 adrenergic endogenous agonists

A

Epineph, norepi, dopamine

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7
Q

List 3 sympathetic adrenergic agonists

A

Phenylephrine, dobutamine, isoproterenol

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8
Q

Alpha 1: locations and actions

A

Vasc smooth m–constriction (mainly at skin, kidney, GI where they are most densely populated and also at large veins)

Genitourinary smooth m—constriction

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9
Q

Alpha 2: locations and actions

A

Vasc smooth m–constrict

Platelet aggregation

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10
Q

Beta 1: locations and actions

A

Heart–inc in inotropy and chronotropy (inc in HR, velocity of impulse, metabolic rate, inotropy, dec in refractoriness)

Kidney–renin secretion

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11
Q

Beta 2: locations and actions

A

Vasc smooth m—vasodilation (arteriolar vasodilation)

Airway smooth m–dilation

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12
Q

What receptors does epinephrine work on?

A

It is a mixed alpha, beta 1 and beta 2 agonist

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13
Q

What does epinephrine do to the SVR?

A

Stays the same because alpha constricts, but beta vasodilates

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14
Q

What does epinephrine do to the HR?

A

Increases it because beta 1 activity overrides baroreceptor mediated slowing which was stimulated due to inc in BP–>increase in inotropy

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15
Q

What does epinephrine do to the CO?

A

Increases CO which is redistributed away from skin, GI, kidney due to alpha mediated vasoconstriction

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16
Q

What does epinephrine do to the BP?

A

Increased CO leads to inc in BP=CO X SVR

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17
Q

What receptors does norepi work on?

A

Mixed alpha and beta 1 with little beta 2 activity

18
Q

What does norepinephrine do to the SVR?

A

Increases it due to alpha 1 vasoconstriction and lack of beta 2 offsetting vasodilation

19
Q

What does norepinephrine do to the HR?

A

Decrease it due to activation of baroreceptor reflex. SVR increase is so profound, that beta 1 cannot offset the baroreceptor reflex.

20
Q

What does norepinephrine do to the CO?

A

Unchanged or slight decrease. SVR increases LV afterload offsetting some of the inotropy (which would have inc SV). In addition, HR is going down due to the baroreceptor reflex.

Beta 1 activity opposed by the strong alpha activation on SVR and vagal discharge. CO is shunted away from kidneys, GI, skin

21
Q

What does norepinephrine do to the MAP?

A

Increased due to inc SVR

22
Q

What receptors does dopamine work on?

A

Mixed alpha, beta 1 agonist with little beta 2 activity

23
Q

What is special about the way dopamine works?

A

Its effects depend on its dosages

24
Q

Dopamine actions at low dose

A

Produces predominantly renal vasodilation

25
Q

Dopamine at intermediate dose

A

Beta 1 action combines with dopaminergic action (ie inc renal vasodilation) to inc CO with minimal effect of systemic vascular resistance

26
Q

Dopamine at high dose

A

Alpha action overwhelms dopaminergic action and the effect is similar to norepi with lots of vasoconstriction

27
Q

What do we use dopamine clinically for?

A

It is a good presser and at low to medium doses, does not reduce renal blood flow

28
Q

What is Phenylephrine?

A

Synthetic adrenergic agonist that is a predominant alpha agonist with little beta activity

29
Q

What does Phenylephrine do to the SVR?

A

Increase

30
Q

What does Phenylephrine do to the HR?

A

Decrease: activation of baroreceptors causes vagal discharge

31
Q

What does Phenylephrine do to the CO?

A

Small decrease due to increase in afterload

32
Q

What does Phenylephrine do to the MAP?

A

Increase

33
Q

What is Isoproterenol?

A

Synthetic beta agonist

34
Q

What does Isoproterenol do to the SVR?

A

Decrease

35
Q

What does Isoproterenol do to the HR?

A

Increase due to beta 1 chronotropic stimulation

36
Q

What does Isoproterenol do to the CO?

A

Increases due to inc in LV contractility and dec in SVR

37
Q

What does Isoproterenol do to the MAP?

A

Possible slight dec

38
Q

What is Dobutamine?

A

Synthetic predominant beta 1 agonist with modest beta 2 activity. PRedominant inotropic with moderate chronotropic activity

39
Q

What does Dobutamine do to the BP?

A

Little effect because of modest beta 2 activity

40
Q

When do we use Dobutamine?

A

Effective for circulatory support in severe congestive HF because it is a relatively pure myocardial inotrope with modest effect on HR and little effect on peripheral circulation

41
Q

When should you clinically use adrenergic agonists?

A

As an adjunctive therapy to support a pt hemodynamically while they are in shock

Cardiology (16 decks)

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