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Year 2 CV > Exam 3, Adrenergic Agonist Antagonist MArtin > Flashcards

Exam 3, Adrenergic Agonist Antagonist MArtin Flashcards

1
Q

What are the alpha R antagonists

A

prazosin

phentolamine

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2
Q

What are the alpha R agonists

A

phenylephrine

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3
Q

what are the alpha 2 agonists

A

clonidine and methyldopa

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4
Q

what are the D1 agonists

A

dopamine

fenoldopam

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5
Q

what are the nonselective beta R antagonists

A

proparnolol, nadolol, timolol, pindolol, carteolol, sotalol

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6
Q

what are the cardioselective beta R antagonists

A

atenolol, acebutolol, metoprolol

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7
Q

what are the third generation beta R antagonists

A

labetolol, carvedilol, betaxolol, carteolol

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8
Q

what are the pre and post synaptic NT for sympathetic sweat glands

A

Ach and Ach

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9
Q

what are the B1 actions on the heart

A

stimulate HR and force

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10
Q

what are the muscarinic actions on the heart

A

decrease in heart rate

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11
Q

what are the alpha 1 effects on the heart

A

vasoconstriction

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12
Q

what are the beta 2 effects on the heart

A

vasodilation

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13
Q

what are the effects of dopamine on renal arteries

A

dilation of afferent aa increasing blood flow to kidneys

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14
Q

what increases MAP and TPR

epi, norepi or isoproterenol

A

Norepinephrine, decreases pulse rate

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15
Q

what increases pulse rate and decreases TPR

epi norepi or isoproterenol?

A

epi and isoproterenol

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16
Q

which has greater effect on decreasing TPR

norepi, epi or isoproterenol

A

isoproterenol

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17
Q

what are the CV uses for epi

A

during CPR for asystole
hemodynamic support after CABG surgery
anaphylaxis
local or topical hemostatic

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18
Q

what are the CV uses of NE

A

pressor agent of choice for septic shock and may be more appropriate than dopamine as first line Tx for other types shock
can be used to support BP in surgical care setting
decreases renal blood flow

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19
Q

What is phenylephrine used for

A

OTC nasal decongestant

IV vasopressor agent, maintain BP in hypotensive states like spinal anesthesia

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20
Q

what are the effects of phenylephrine

A

vasoconstriciton, increased TPR, increase BP

reflex bradycardia

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21
Q

what can block reflex bradycardia from phenylephrine

A

atropine

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22
Q

does phenylephrine cause atrial or ventricular tachy

A

atrial

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23
Q

what peripheral R does dopamine work on

A

D1>B1>a1

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24
Q

what are the pharmocological effects of dopamine

A

vasodilate renal, coronary and mesenteric vascular beds
increase blood flow to kidney
heart- mild increase in rate and force
high dose causes vasoconstriction of blood vessels

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25
Q

what are the clincal uses for dopamine

A

shock, unstable CHF
icnrease CO and increases renal perfusin
somtimes in acute crisis of chronic CHF

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26
Q

why must you monitor BP carefully with use of dopamine

A

higher infusion rate or doses can cause vasoconstriciton and decreased tissue perfusion

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27
Q

what are the effects of dobutamine

A

since B1 selective agonists
positive inotropic and some increase in rate
CO increases
little vascular effect

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28
Q

what are the clinical uses of dobutamine

A

cardiogenic shock, MI CHF

29
Q

what are the adverse effects of dobutamine

A

potential arrhythmias

increase work and O2 requirement

30
Q

what are the clincal uses of alpha 1 selective R blockers

A

2nd or 3rd line Tx for essential HTN

31
Q

what are the effecs of alpha 1 selective antagonists

A

decrease venous return, dec preload
does not increase Hr or CO
normal NE release
dec LDL and TG, inc HDL

32
Q

what are the adverse effects of alpha 1 selective antagonists

A

caus emarkerd postural hypotension and syncope, orthostatic hypotension
usually given at bedtime to minimize hypotensive effects

33
Q

What are the clincal uses for beta blockersq

A

HTN, decrease CO and slow decrease in TPR
ischemic heart disease, angina, MI, acute coronary syndromes
CHF
arrhythmias

34
Q

how do beta blockers help with MI and post MI prophylaxis

A

protect against arrhythmias and limits infarction size
assess LV function
5-12 days post MI reduces O2 demand and spread of infarct area

35
Q

how are beta blockers helpful in thyrotoxicosis

A

hyperthyroid patients have increased beta R sensitivity

beta blockers reduce sensitivity of myocardium to adrenergic stimulation in hyperthyroid patients

36
Q

What is the mechanism for propanolol

A

competitive antagonist at B1 B2 and B3 R

37
Q

hwo do B blockers differ

A

their bioavailability, biotransofrmation and pharmokinetics

38
Q

what are the pharmacological general effects of beta blockers

A

block existing sympathetic tone

effects are greater if sympathetic tone is high (druing MI or exercise)

39
Q

what are the effects on heart by beta blockers

A 
dec HR and CO
dec exercise tolerance
dec depolarization extopic pacemakers
dec O2 demand
dec AV nodal conduction
dec infarct size
40
Q

how do beta blockers decrease exercise tolerance

A

blunt increase in HR and contractility that normally occurs with exercise
CO less affected because SV increased
decrease work capacity
increased catecholamines during exercise increase work of heart and oO2 demand

41
Q

what are the effects of beta blockers on myocardial O2 demand

A

decrease it

42
Q

What are the effects of beta blockers in people with normal BP

A

does not lower BP, just in HTN patients

43
Q

what are the effects of beta blockers on plasma renin levels

A

beta blockers block the normal catecholamine driven release of renin
therefore decrease renin

44
Q

what beta blockers have non selective vasodilatory effects

A

carteolol, carvedilol, bucindolol, labetolol

45
Q

what b1 selective antagonisls have vasodilatory effects

A

betaxolol, celoprolol, nebivolol

46
Q

what are teh peripheral vasodilatory effects of some beta blockers

A 
increase NO
activate B2 R
block alpha 1
block Ca entry
open K channels
antioxidant activity
antiprolfierative effects
47
Q

what normal side effects of beta blockers are decreased with the vasodilating beta blockers

A

bronchospasm, imparied lipid metabolism, impotence, reduced regional blood flow, icnreased TPR, withdrawal Sx

48
Q

which type of angina are beta blockers not helpful in

A

vasospastic angina

49
Q

what is the main effect of beta blockers that helps in Tx of IHD and agina and MI

A

decrease in myocardial oxygen demand

50
Q

why should most patients be put on beta blocker after MI

A

shown to decrease morbidity and mortality from MI by 25%

51
Q

betablockers prevent HF in what percent of people

A

50%

52
Q

what are relative contraindicaitons for beta blockers

A

asthma and cOPD because block bronchodilation
blocks lipolysis and glycogenolysis
cautisouly in DM becausre mask signs of hypoglycemia
delays recovery from insulin induced hypoglycemia

53
Q

what are side effects of beta blockers

A

dizziness, fatigue, diarhhea, constipation, nausea, depression, sexual dysfunction, bizarre dreams
severe but rare purpura, rash and fever

54
Q

what tests may beta blockers interfere with

A

SGOT and BUN tests

55
Q

what are the effects on cholesterol long term use beta blockers

A

increase VLDL and decrease HDL

56
Q

what occurs with sudden withdrawal of beta blockers

A

rebound HTN, anginal attack and possibly MI if drug suddenly withdrawn after chronic therapy.
beta R up regulation

57
Q

what are major contraindications for beta blockers

A

acute Tx decompensated HF, 2nd and 3rd degree Heart block, cardiogenic shock

58
Q

what other hypotensive medications do beta blockers have drug interactions with

A

reserpine, guanethidine, methyldopa

59
Q

what other antiarrhthmic agents do beta blockers have interactions with

A

CCB and lidocaine

60
Q

beta blockers mask signs of what

A

hypoglycemia and hyperthyroidism

61
Q

what cardioselective beta blocker has very rapid onset and short duration of action

A

esmolol

62
Q

when is esmolol used

A

IV infusion for peri-operative tachycardia and HTn and arrhythmias

63
Q

What type of antagonist is labetolol and what are its clinical uses

A

selective alpha 1 blocker
nonselective B1 B2 blocker
HTN and pheochromocytoma

64
Q

which beta blocker has been very useful in CHF clinical trials

A

carvedilol

65
Q

how do alpha 2 receptor agonists work

A

at brainstem
inhibit sympathetic outglow to periphery
decrease sympathetic tone
decrease Ne release via feedback

66
Q

what are the side effects of methlydopa

A

sedation, dry mouth, sexual dysfunction

67
Q

what is the preferred anti HTN drug in pregnancy

A

methyldopa

68
Q

what is clonidine used for

A

rarely essential HTN

more for narcotic, alcohol and tobacco withdrawal

69
Q

what are the sideeffects of clonidine

A

dry mouth, sedation, impotence

sudden withdrawal causes HTN crisis

Year 2 CV (31 decks)

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