Drug review Flashcards
Epinephrine mech?
activate a1, a2, B1, B2, B3 [B2 > a1]
Epinephrine effect on: HR SBP DBP MAP TPR
in low dose vs normal dose
Low dose → decrease diastolic and mean BP
o Increase HR/SBP/slightly MAP and decrease TPR/DBP
Normal dose
o Increase all HR/SBP/DBP/MAP/TPR
Norepinephrine mech?
activates a1, a2, B1 [NOT B2]
Norepinephrine effect on: HR SBP DBP MAP TPR
increase DBP/MAP/SBP/TPR; decrease HR
o Strong baroreceptor decreases HR
o Increases BP more than Epi due to lack of B2
Use of norepinephrine?
cardiogenic shock, septic/hypovolemic shock
adverse of norepi?
severe hypertension
Isoproterenol mech?
activates B1/B2/B3 [not As]
B agonist
Isoproterenol effect on: HR SBP DBP MAP TPR
decrease DBP/MAP/TPR; increase SBP slightly/HR
o Biggest increase HR b/c direct same direction as reflex
Dobutamine mech?
selective B1 agonist
Dobutamine effect?
increase HR and contractility
Dopamine mech?
low dose = D1
moderate = D1 + B1
high = D1 + B1 + a1
Dopamine effect at low, medium high dose?
low = more renal flow + urine output, decrease BP a little moderate = decrease BP a little, increase HR/CO, no change in TPR high = increase BP, a1 effect outweighs D1 effect
Fenoldopam mech?
selective D1 agonist
Fenoldopam effect?
decrease BP –> used to treat severe HTN
Albuterol Mech?
selective B2 agonist
Albuterol effect?
vasodilate + bronchodilate + increase HR
Side effects/adverse of albuterol?
tachycardia, N/V, hypokalemia, hypotension
Phenylephrine mech?
a agonist, slightly selective for a1
Clonidine mech?
a2 agonist = sympatholytic adrenergic agonist
What is action of tyramine?
NE releaser = indirect sympathomimetic
in aged cheese/meat/fish/wine
avoid with MAO inhibitor
What is mech of propanolol?
non-selective B blocker also a class II anti-arrhythmic
What is use of B blockers?
- angina, SVT, slowing ventricular rate during AFib/flutter
- HTN
- MI
What is mech of nadolol?
non-selective B blocker
What is mech of metoprolol?
selective B1 blocker
What is mech of atenolol?
selective B1 blocker
What is mech of bisoprolol?
selective B1 blocker
What is mech of action of pindol?
partial B1/B2 agonist
- in absence of normal physiologic agonist it is an agonist
when high sympathetic drive –> its a beta antagonist
What is black box warning with B blockers?
don’t withdraw quickly b/c upregulated B receptors cause unsafe increase in HR and contractility
What B blocker does not have black box warning?
pindol
WHat is mech carvedilol?
antagonist at B1, B2
partial antagonist at a1
What is effect of carvedilol?
vasodilate, inhibits cardiac remodeling
use in HF
What is mech of labetalol?
antagonist at B1/a1
partial agonist at B2 with ISA activity [aka antagonist when high intrinsic sympathetic activity]
What is mech of phentolamine?
competitive a antagonist
What is effect of phentolamine?
decrease BP due to a1 blockade
What is mech of acetylcholine?
full agonist at M and N receptors
higher affinity for M than N
What is effect of ACh with small vs large dose?
small = quick drop in BP, reflex tachycardia big = direct effect on SA node --> drop in BP + bradycardia
What is mech of bethanechol?
M agonist
What is mech of nicotine?
N agonist –> at ganglia activates sympathetic/parasympathetic branches whichever is dominant for the most part
What is effect of nicotine?
- increase BP
- increase HR [in part due to Epi released from adrenal]
at high dose –> ANS activation then depolarizing blockade
What is mech of neostigmine? does it cross BBB?
AChe inhibitor
does not cross BBB
What is mech of physostigmine? does it cross bbb?
AChe Inhibitor
crosses BBB
What is mech of donepezil?
AChe inhibitor, relatively selective for brain ACh
What is mech of rivastigmine?
AChe inhibitor, relatively selective for brain ACh
What is mech of galantamine?
AChe inhibitor
What is use of donepezil/rivastigmine/galantamine?
used to treat dementia
What is mech of atropine?
M receptor antagonist
What is mech of scopalamine?
M receptor antagonist
What is mech of ipratroprium?
competitive non-selective muscarinic antagonist
inhalational only
What is use of ipratroprium?
acute asthma exacerbation
bronchospasm w/ COPD
What type of drug is quinidine?
class 1A
What type of drug is lidocaine?
class iB
What type of drug is flecainide?
class 1C
What type of drug is amiodarone?
class 3
What type of drug is sotolol?
class 3
What type of drug is dilitiazem?
class 4
What type of drug is procainamide?
class 1A
What type of drug is propafenone?
class 1C
What type of drug is dofetilide?
class 3
What type of drug is verapamil?
class 4