Exam 2: Drugs affecting PNS

Question 1

• Therapeutic Use: anaphylaxis, vasoconstrictor in local anesthetics, topical hemostatic, cardiac rescue.
o peripheral excitatory - a1: vasoconstriction, pupil dilation
o Cardiac excitatory - b1: increase HR and contraction force
o Peripheral inhibitory - b2: vasodilator, bronchodilation, gut relaxation
o Metabolic Actions - a1, b2, b3: increase blood Glc, lactate, free fatty acids.
o CNS Stim - a and b: respiratory stim, wakefulness, reduced appetite.
• MOA : a1 a2 b1 b2, b3
• AE:
• Drug interactions:
• Notes: decreases TPR, increases HR, mean BP unchanged (systolic increases, diastolic decreases). Tyrosine monooxygenase is rate limiting step in Epi synthesis

Answer 1

Epinephrine alpha-1,2; Beta-1,2,3

Question 2

increases Blood pressure (systolic & diastolic), lowers HR, increases TPR. Alpha-1,2,Beta-2

Answer 2

Norepinephrine

Question 3

severe congestive heart failure, cardiogenic/septic shock.

Answer 3

Dopamine

Question 4

• Therapeutic use: HTN
• MOA: blockade of storage granules. Destroys NE => depletion. Blocks L-DOPA-> DA.
• AE / Toxicity:
• Notes: Blocks dopamine uptake into vesicle preventing vesicle from going to membrane.

Answer 4

Reserpine

Question 5

• Use: reverse drug induced hypotension

* MOA: NT release, sympathomimetic, mixed agonist.

Answer 5

Ephedrine

Question 6

• Use: HTN

* MOA: Prevent NT release in response to stimulus.

Answer 6

Guanethidine

Question 7

• MOA: NT release, Sympathomimetic, indirect agonist

Answer 7

Tyramine

Question 8

• Nonselective a agonist; vasoconstricts, increases TPR, decreases HR for nasal decongestion

Answer 8

Oxymetazoline

Question 9

• a1 selective, direct agonist; vasoconstricts, increases TPR, decreases HR for nasal decongestion

Answer 9

Phenylephrine

Question 10

• a2 selective agonist, Tx HTN, lowers BP and SNS activity.

* AE: dry mouth and sedation

Answer 10

Clonidine

Question 11

• Therapeutic use: Tx bronchoconstriction, asthma, COPD. Use for cardiac stimulation
• MOA: nonselective bagonists.
• AE / Toxicity: Tachycardia, skeletal m. tremor, restlessness, anxiety, increased plasma GLC, decreased plasma K+.
• Resistance:
• Notes: increases HR, unchanged mean BP, decreased TPR.

Answer 11

Isoproterenol & epinephrine

Question 12

• Therapeutic use: asthma
• MOA: Beta-2 agonists
• AE / Toxicity: tachycardia, skeletal muscle tremor, restlessness, apprehension and anxiety, increased plasma Glc, decreased plasma K+.
• Notes: Dose dependent stimulation with no cardiac effects.

Answer 12

Beta-2 agonists (Albuterol, Metaproterenol, Salmeterol, Terbutaline)