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Cardiology > CV Effects of Autonomic Agonists > Flashcards

CV Effects of Autonomic Agonists Flashcards

1
Q

End organ receptor for PS system

A

muscarinic

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2
Q

Ganglia receptor for PS system

A

nictonic

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3
Q

Ganglia receptor for sympathetic system

A

nicotinic

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4
Q

End organ receptor for sympathetic system

A

alpha and beta adrenergic

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5
Q

Action of muscarinic receptors in heart

A
  1. reduce SA node automaticity
  2. reduce atrial inotropy
  3. increase AV refractoriness
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6
Q

Action of muscarinic receptors in vessels

A

increase arterial vasodilation

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7
Q

What is the role of ACh as a clinical therapy?

A

none –> broken down rapidly by AChE –> used agonist is an inhibitor of ACh esterase

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8
Q

MOA Edrophonium

A

AChE inhibitor –> 30 second action= IV administration

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9
Q

Side effect of edrophonium

A

abdominal cramping

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10
Q

What are the clinical uses of edrophonium

A

increase AV node refractoriness to evaluate atrial activity in situations of ventricular tachycardia but use has been replaced mostly be adenosine which does same thing w/o GI side effects

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11
Q

Where is the receptor found and what does it do? alpha1

A

vascular smooth muscle constrictor

GU smooth muscle constrictor

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12
Q

Where is the receptor found and what does it do? alpha2

A

vascular smooth muscle constrictor

platelet aggregation

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13
Q

Where is the receptor found and what does it do? beta1

A

heart - myocardial inotrope

kidney - JG cell renin secretagogue

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14
Q

Where is the receptor found and what does it do? beta2

A

vascular smooth muscle dilator

bronchial dilator

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15
Q

Where is the receptor found and what does it do? beta3

A

adipose tissue - lipolysis

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16
Q

What kind of agonist is it? epinephrine

A

alpha, beta1, beta2

17
Q

What kind of agonist is it? norepinephrine

A

alpha, beta1, (and a teence of beta2)

18
Q

What kind of agonist is it? dopamine

A

alpha, beta1, (and a teence of beta2), delta1, delta2

19
Q

Effects of epinephrine

A

alpha: skin/gi/renal vasoconstriction
beta1: cardiac intropy and chronotropy
beta2: skeletal/cardiac vasodilation

systemic:

  1. increased HR b/c beta1 overcomes baroreceptor mediated slowing
  2. increased CO (redirected away from skin,gi, kidney)
  3. +/- SVR: alpha/beta2 cancel each other out
20
Q

Effects of norephinephrine

A

alpha: skin, GI, renal vasoconstriction
beta1: cardiac inotropy/chronotropy

systemic:

  1. increase SVR b/c alpha is unopposed –> increase SAP
  2. reduce HR due to baroreceptor reflex –> beta1 opposed by strong alpha without support from b2
21
Q

Does norepi change CO?

A

no –> beta 1 is opposed by a strong alpha action on SVR/vagal discharge

22
Q

Low dose effect of dopamine

A

isolated d1 action produces renal vasodilation AKA Renal Dose Dopamine

23
Q

Mid dose effect of dopamine

A

beta1 combines with delta1 action to increase CO w/o changing SVR

24
Q

High dose effect of dopamine

A

alpha action overcomes d1 action and looks generally like norepi

25
Q

What is the unique feature of dopamine’s clinical usefulness?

A

dopamine is an effective pressor which in low/intermediate doses does not reduce renal blood flow

26
Q

What kind of agonist is it? phenylephrine

A

alpha (and a teence of beta1 and beta2) –> synthetic

27
Q

What kind of agonist is it? dobutamine

A

beta1 > beta2 >alpha

28
Q

What kind of agonist is it? isoproterenol

A

beta1, beta2 (and a teence of alpha)

29
Q

Effects of phenylephrine

A

alpha: skin, GI, renal vasoconstriction

systemic:
1. increase SVR –> SAP
2. reduce HR b/c activation of baroreceptor reflex causes vagal discharge
3. reduce CO –> uncompensated increase in LV afterload due to SVR w/o beta-mediated inotropy

30
Q

Effects of isoproterenol

A

beta1: cardiac inotropy/chronotropy
beta2: skeletal/cardiac vasodilation

systemic:

  1. reduce SVR –> reduce SAP
  2. increase HR b/c of beta1 chronotropy+ baroreceptor reflex against low SAP
  3. increase CO b/c increase in LV contractility and reduced SVR
31
Q

Effects of dobutamine

A

beta1: inotropy w/modest chronotropy

systemic
1. increase myocardial strength w/ modest effect on everything else –> good for circulatory support in severe CHF

32
Q

Why does dobutamine have little alpha activity?

A

it is produced as a racemic mixture: + enantiomer is an antagonist and - enantiomer is an agonist –> cancel each other out

33
Q

Which of the sympathetic agonists would be best in tx of: septic shock

A

phenylephrine or norepinephrine

  • goal is to increase SVR which means you need an agent with a lot of alpha activity that is unopposed // further increasing HR or CO won’t do a whole lot without dealing with the underlying issue of SVR
34
Q

Which of the sympathetic agonists would be best in tx of: cardiogenic shock

A

dobutamine

need to increase CO by activating beta1 // can’t have alpha mediated vasoconstriction

Cardiology (41 decks)

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