Drugs #2 Flashcards

1
Q

Epinephrine

P/T/I

A
stimulates a1, a2, b1, b2
-short half life 
P: 
Low dose
-lower diastolic BP (b2) 
-Increase CO (b1)
Higher Dose
-Increase TPR and CO (a1+a2+b1)
-bronchodilation (b2)
-decreased bronchial secretions (a1)

T:
Arrhythmias

I:
Anaphylaxis
Cardiac Arrest
Bronchospasm

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2
Q

Norepinephrine

PTIC

A

stimulates a1, a1, b1
-short half life-give by controlled infusion

P:
Increase CO (b1)
Increase TPR (a1+a2)
Decrease HR (baroreflex)
Overall increase MAP 

T:
Ischemia

I:
limited to shock

C:
pre-existing vaso-constriction or ischemia

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3
Q

Dopamine

PTIC

A
D1, D2, b1, a1, a2
-metabolized readily 
P:
Low 
decreased TPR (D1)
Medium 
Increased cardiac contractility and HR  (b1)
High
increased BP and TPR (a1,a2)
T:
low infusion rates=hypotension 
high infusion rates=ischemia 

I:
Hypotension due to low cardiac output during cardiogenic shock-may be advantageous due to vasodilatory effect in renal and mesenteric vascular bed

C: uncorrected tachyarrhythmias

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4
Q

Isoproterenol

PTIC

A

synthetic catecholamine B1 and B2
-susceptible to degradation

P
1. peripheral vasodilation (b2) -decreased diastolic bp

  1. positive inotropy and chronotropy (b1)-transient increased systolic BP BUT overcome by vasodilatory effect
  • small decrease in MAP
  • ->may contribute to further reflex HR increase
  1. bronchodilation (b2)

T:
Tachyarrhythmias

I:
cardiac stimulation during bradycardia or heart block when peripheral resistance is high

C: arrhythmias

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5
Q

Dobutamine

PTIC

A

B1 selective agonist
rapidly degraded by COMPT

P

  1. more ionotropic than chronotropic
    - nice increase in CO without big reflex in HR

I:
short term Rx for CHF or cardiogenic shock

T
Hypotension
**high dose–>B2 act–>low bp

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6
Q

Terbutaline and Albuterol

A

B2-agonist
P:
Bronchodilation
Uterine relaxation

I:
Bronchospasm
Chronic Rx of obstructive airway

T:
Tachycardia (B1)
Muscle tremor (b2)-activation of b2 receptors expressed on pre-synaptic nerve terminals of cholinergic somatomotor neurons
Tolerance (b2)

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7
Q

Phenylephrine

PTIC

A

NOT a catecholamine, not subject to COMT degradation

A1 agonist

P:
Increase TPR and MAP
Decrease HR (baroreflex)
Pupillary dilation 
Decrease bronchiole and sinus secretions 

T:
hypertension

I:

  • hypotension during anesthesia
  • SV tachycardia
  • mydriatic agent in opthalmis Rx
  • nasal congestion

C:
hypertension

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8
Q

Clonidine

PTIC

A

a2 agonist
-can cross bbb–>decrease in sympathetic

P:

  • acute increase in BP (peripheral effect)
  • –reduced BP (central effect)

T:
dry mouth
hypertensive crisis (after acute withdrawal)

I:
Hypertension due to sympathetic activation

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9
Q

What are 6 indirect acting sympathomimetics?

A
  1. amphetamine
  2. methamphetamine
  3. methylphenidate
  4. ephedrine
  5. pseudoephedrine
  6. tyramine
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10
Q

What are the PTIC for indirect acting sympathetics?

A

P:

  1. Increased TPR and diastolic BP (a1+a2)
  2. Positive ionotrophic and chronotropic effects, increased systolic pressure (B1)
  3. CNS stimulant (probably increased NE)
  4. Anorexia (probably increased DA)

T:
Tachycardia (b1)

I:
Attention Deficit Disorder
Narcolepsy
Nasal congestion

C:
Rx with MAO inhibitors within 2 weeks

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11
Q

What are 3 Non-selective B-blockers?

A
  1. Propranolol
  2. Nadolol
  3. Timolol
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12
Q

Non-selective B-blockers

PTIC

A
P:
Decreased HR
Decreased contractility 
Decreased renin release 
Reduced sympathetic activation 
Inhibition of aqueous humor production 

T:
Bronchospasm
Mask symptoms of hypoglycemia
Bradycardia

I:
Hypertension
Angina
Glaucoma
Early to moderate heart failure
Arrhythmia
Thyrotoxicosis
Anxiety 
C:
Bronchospasm during asthma
Sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock
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13
Q

What are 3 cardioselective B1 blockers?

A

metoprolol, atenolol, esmolol

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14
Q

cardioselective B1-blockers

PTIC

A
P:
decreased HR
decreased contractility
decreased renin release
decreased sympathetic activation 

T:
hypotension
bradycardia

I:
hypertension
angina
arrhythmia

C:
sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock

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15
Q

Pindolol

PTIC

A
partial agonist b-blocker
P:
decrease BP 
decrease contractility 
decrease renin release
decreased sympathetic activation 

T:
Hypotension

I:
Hypertension

C:
sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock

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16
Q

What are two non-selective alpha blockers?

A

Phentolamine (reversible)

Phenoxybenzamine (irreversible)

17
Q

Non-selective alpha blockers?

PTIC

A
P: 
Decreased BP 
(alpha blockade +unmasks b effects)
Increased chronotropy and inotropy 
-->increased release of NE and reflex increase in NE release in response to hypotension 
-unmasks vasodilator effect of EPI 
(which has both alpha and beta effects) 

T:
Prolonged hypotension
reflex tachycardia
nasal congestion

I:
hypertension associated with pheochromocytoma, vasoconstrictor induced extravasation

18
Q

What are three selective alpha 1 adrenergic blockers?

A
  1. prazosin
  2. doxazosin
  3. terazosin
19
Q

Alpha 1 adrenergic blockers

PTIC

A

P
Inhibits vasoconstriction
prostate smooth muscle relaxation

T
orthostatic hypotension

I
hypertension
Benign prostatic hyperplasia