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Pharm Fall 2019 > Ex4 ANS Drugs > Flashcards

Ex4 ANS Drugs Flashcards

1
Q

Effect of acetylcholine on Heart

A

Decreased rate, force of contraction

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2
Q

Effect of acetylcholine on bronchial tree

A

bronchoconstriction

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3
Q

Effect of acetylcholine on GI tract

A

contraction

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4
Q

Effect of acetylcholine on Urinary bladder

A

Contraction of detrusor muscle, relaxation of trigone + sphincter

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5
Q

Receptor/ANS involved in acetylcholine response

A

muscarinic (M)

Parasympathetic NS

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6
Q

Agonist of muscarinic receptors on heart

A

decreased rate/force of contraction

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7
Q

agonist of muscarinic receptors on bronchial tree

A

bronchoconstriction

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8
Q

agonist of muscarinic receptors in GI tract

A

contraction

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9
Q

agonist of muscarinic receptors in urinary bladder

A

contraction of detrusor muscle

relaxation of trigone/sphincter

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10
Q

PNS is involved in ____ receptors, _____ neurotransmitter

A

muscarinic receptors

acetylcholine neurotransmitter

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11
Q

PNS effect on bronchial tree

A

bronchoconstriction d/t acetylcholine on muscarinic receptors

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12
Q

PNS effect on heart

A

decreased rate/force of contraction d/t acetylcholine on muscarinic receptors

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13
Q

PNS effect on GI tract

A

Contraction d/t acetylcholine on muscarinic receptors

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14
Q

PNS effect on GU

A

contraction of detrusor muscle
relaxation of trigone/sphincter
d/t acetylcholine on muscarinic receptors

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15
Q

SNS effect on heart, receptor involved

A

increase rate/force of contraction

d/t Beta1

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16
Q

SNS - alpha1 agonist leads to

A

vasoconstriction of arteries

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17
Q

SNS - beta2 agonist leads to

A

vasodilation of skeletal muscles

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18
Q

SNS - alpha2 agonist leads to

A

vasoconstriction of veins

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19
Q

SNS stimulation on bronchial tree leads to _____

d/t ______

A

bronchodilation

d/t beta2 agonism

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20
Q

SNS stimulation of GI tract leads to _____

d/t ______

A

relaxation

d/t alpha2 agonism

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21
Q

SNS stimulation of pancreas leads to _____

d/t ______

A

insulin release decreased

d/t alpha2 agonism

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22
Q

SNS effect on metabolic/endocrine from beta2 stimulation

A

glycogenolysis (muscle, liver)

gluconeogenesis

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23
Q

SNS effect on metabolic/endocrine from beta1 stimulation

A

lipolysis

insulin release

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24
Q

SNS effect on urinary bladder

A

Beta2-contraction of detrusor muscle

alpha1-relaxation of trigone and sphincter

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25
Q

Pure alpha1 agonist

A

Phenylephrine

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26
Q

Pure alpha2 agonist

A

Clonidine, Dexmedetomidine

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27
Q

Pure Beta1 agonist

A

Dobutamine

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28
Q

Dopamine2 receptors

A

May mediate N/V

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29
Q

Dopamine1 receptors

A

act on renal/mesenteric/splenic/coronary vasculature

=vasodilation strongest in renal arteries (increased GFR)

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30
Q

Common uses for Epinephrine

A

Cardiac arrest
Allergic rxn/anaphylaxis
severe asthma/bronchospasm
hemodynamic instability

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31
Q

asthma/bronchospasm with hypotension - drug to use?

A

Epinephrine

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32
Q

Epinephrine Dosing

A

increased dosages leads to less beta1 specificity, increasing alpha
can be used as infusion

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33
Q

Epinephrine most common use

A

inotropy

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34
Q

Aggressive tx of bronchospasm is resistant, what is DOC?

A

racemic epi

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35
Q

epi adverse effects

A

tachycardia, PVCs, tachyarrhythmias
renal injury/mesenteric/peripheral ischemia
hypokalemia

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36
Q

epi adverse effects from supratherapeutic doses

A

acute heart failure, pulm edema, arrhythmias, HTN, MI

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37
Q

epi precautions

A

CAD, advanced age, pHTN, tachycardia, Rchf

central line preferred

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38
Q

epi rx intxns

A 
cocaine/stimulants
alpha1 blockers (hypotension/tachycardia)
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39
Q

epi pharmacokinetics

A

fast on, fast off

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40
Q

why is vasopressin an ideal drug?

A

no effect on pulmonary vasculature

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41
Q

epi acts on

A

mainly b1/b2, a1

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42
Q

first line tx for septic shock

A

norepinephrine

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43
Q

common uses for norepi

A

increase PVR, MAP

44
Q

norepi acts on

A

b1, a1

45
Q

norepi leads to vasoconstriction d/t

A

alpha1

46
Q

norepi effect on cardiac output

A

unchanged

47
Q

norepi may effect

A

pulm vasoconstriction (alpha1)

48
Q

norepi adverse effects

A

tachycardia, tachyarrythmias, pvcs
renal injury/mesenteric/peripheral ischemia
HTN

49
Q

norepi precautions

A

heart failure, pHTN, R heart failure

50
Q

norepi pharmacokinetics

A

fast on/off

51
Q

ephedrine effects on ____ receptors

A

beta1 - myocardial contractility/heart rate
alpha1/beta2
same as norepi/epi

52
Q

ephedrine common clinical uses

A

bolus - hypotension (procedural)

IM (10x size dose) - emesis

53
Q

ephedrine AEs

A

same as epi/norepi

pretty low risk as only one time bolus most often used

54
Q

phenylephrine acts on

A

alpha1 ONLY

55
Q

advantage of phenylephrine

A

PIV option

56
Q

unique to phenylephrine

A

worsening heart failure, reflex bradycardia

57
Q

phenylephrine ONLY results in

A

increasing afterload, no help in “squeeze” of heart

58
Q

Who should you avoid when giving phenylephrine?

A

Someone without a good heart

59
Q

Dopamine acts on

A

Dopamine1
Dopamine2
Beta1
Alpha1/Beta2

60
Q

Dopamine does not

A

make kidney function BETTER

just augments diuresis

61
Q

common uses of dopamine

A
  • decreased contraction, low bp, decreased urine output
  • augmentation of diuresis
  • bradycardia
62
Q

as dosage of dopamine increases, ____ occurs

A

dominance changes from dopa –> beta –> alpha receptors

*everyone is different! some may react to 1mcg, some to 10 mcg

63
Q

dopamine AE

A

tachyarrhythmias

64
Q

Solely a dopamine agonist

A

Fenoldopam

65
Q

Fenoldopam common uses

A

6-10x as potent as dopamine, potent vasodilator

  • augmentation of diuresis
  • HTN emergency/urgency
66
Q

Fenoldopam AEs

A

flushing, hypotension, H/A, nausea, hypokalemia, hypovolemia, tachycardia

67
Q

isoproterenol common uses

A

bradydysrhythmias, decreased inotropy

68
Q

isoproterenol acts on ____ receptors

A

beta1, beta2

*not used often d/t $

69
Q

synthetic catecholamine, 2-3x as potent as epi, 100x as potent as norepi

A

isoproterenol

70
Q

persistent bradycardia tx options

A

isoproterenol
low dose dopamine
epinephrine

71
Q

isoproterenol AEs

A

tachyarrhythmias, hypotension*

72
Q

Milrinone MOA

A

selective phosphodiesterase III Inhibitor

73
Q

Milrinone clinical uses

A

inotropy

weaning from cardiopulmonary bypass

74
Q

Negative aspect of Milrinone

A

Prolonged half life

75
Q

AE Milrinone

A

thrombocytopenia**, hypotension, tachyarrhythmias

76
Q

Rx intxns - Milrinone

A

Beta blockers, calcium channel blockers

77
Q

Unstable pt with renal dysfxn, hypotensive, needs inotropy, which Rx should be avoided?

A

Milrinone - it takes too long to work + prolonged clearance –> use dobutamine!

78
Q

Potential risk – Dobutamine

A

slight vasodilation d/t beta activity

enantiomer mix

79
Q

Dobutamine clinical uses

A

“cleaner version” of milrinone
inotropy
weaning from cardiopulmonary bypass

80
Q

dobutamine AEs

A

tachyphylaxis (need higher doses as time goes on ~3d)

eosinophilia*

81
Q

Medications used for inotropy

A

Isoproterenol
Milrinone
Dobutamine
(?dopa)

82
Q

any drug with effect on Beta1 will result in

A

increased heart rate

83
Q

any drug with effect on alpha1 will result in

A

increased SVR

84
Q

Pressor with no effect on PVR

A

vasopressin

85
Q

clonidine uses

A

HTN, pain control, sedation

86
Q

Clonidine therapeutic effects

A

vasodilation*

bradycardia, sedation, pain control

87
Q

clonidine receptors

A

alpha2: alpha1
200: 1

88
Q

clonidine AE

A

HTN crisis with abrupt w/d

89
Q

clonidine Rx intxns

A

concurrent agent w/ SA/AV node blocking

(dig, metoprolol, diltiazem, verapamil

90
Q

Dexmedetomidine receptors

A

alpha2: alpha1
1600: 1

91
Q

Reason > sedation in Dex vs. Clonidine

A

Localized to locus ceruleus (alpha2)

92
Q

Dex AEs

A

Bradycardia, hypotension

+ same as clonidine

93
Q

Vasopressin 1 receptors are located

A

in the periphery

94
Q

Vasopressin effect on CO/HR/BP/afterload

A

increased BP, afterload

decreased HR, CO

95
Q

Angiotensin II adverse effects

A

HTN, tissue ischemia, infxn, venous thromboembolism, delirium*

96
Q

Vasopressin vs. Norepi in cardiac surgery

A

Insignificant: pts not as sick, Vaso > norepi for LOS, AFib

VANCS study

97
Q

Vasopressin vs. Norepi in septic shock

A

Vasopressin could potentially improve outcomes as septic shock pts are depleted of this hormone. Must “finagle” data to prove so.
VASST study

98
Q

SOAP II study: dopa vs norepi

A

dopamine > norepi in terms of arrhythmias

99
Q

surviving sepsis recommendations

A

Norepi = 1

epi or vaso = 2

100
Q

angiotensin II use - what to keep in mind

A

MUST have DVT prophylaxis

101
Q

hypovolemic shock - effect on CO/Preload/Afterload

A

decreased preload, CO

increased afterload

102
Q

hypovolemic shock - tx

A

aggressive IV fluids
blood (if lost blood)
-phenyl, epi, norepi, vaso, dopa (“anything is fair game”)

103
Q

cardiogenic shock - effect on CO/Preload/Afterload

A

decreased CO

increased preload/afterload

104
Q

cardiogenic shock - tx

A

dobutamine, epi, milrinone, isoproterenol
dopa (although not ideal d/t arrhythmias)
norepi “in theory”

105
Q

septic shock - effect on CO/preload/afterload

A

increased CO

decreased pre/afterload

106
Q

septic shock tx

A

aggressive fluids

  1. norepi
  2. epi/vaso
  3. angio II, dopa, phenyl etc.

Pharm Fall 2019 (33 decks)

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