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Advanced Pharmacology ANE 8433 (Spring 2023) > Exam 4 Adjuncts > Flashcards

Exam 4 Adjuncts Flashcards

1
Q

Beta receptors activate ____ to produce ___?

A

Adenylyl cyclase & cAMP

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2
Q

Chronic use of beta antagonists leads to?

A

Upregulation of receptors

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3
Q

Besides decreasing CO, beta antagonists also ____?

A

Inhibit renin release

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4
Q

Which phase of the cardiac cycle do beta blockers affect?

A

Phase 4, decrease the in slope

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5
Q

What medication would be given for thyrotoxicosis?

A

Beta antagonist

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6
Q

Under the SCIP, who receives a beta blocker & when would they not?

A
  • Pt’s at risk for MI & already on beta blocker.
  • Do not give if HR <60
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7
Q

75% of beta receptors are ___ & located in ___?

A

B1 & myocardium

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8
Q

Which beta blocker is not cardiac selective?

A

Propranolol

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9
Q

Which B1 antagonist is cleared via plasma hydrolysis?

A

Esmolol

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10
Q

Metoprolol is cleared via___ & atenolol is cleared via___?

A
  • Hepatic
  • renal
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11
Q

Which beta blocker has the longest E1/2 & what is it?

A

Atenolol & 6-7hrs

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12
Q

Which beta blocker has the smallest volume of distribution?

A

-Propranolol.
- It has high protein binding.

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13
Q

What are the IVP doses for Metoprolol, Atenolol & Esmolol?

A
  • Metoprolol: 1 mg q5min for 5mg total (repeat PRN)
  • Atenolol: 5-10 mg q 10min
  • Esmolol: 10-80 mg
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14
Q

How does Inderal affect opioids & LA’s?

A

It decreases their clearances

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15
Q

What lasts longer with Inderal, negative inotropy or negative chronotropy?

A

Negative chronotropy

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16
Q

What is the most selective B1 blocker?

A

Atenolol

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17
Q

What is the onset & offset of Esmolol?

A

5mins & 30mins

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18
Q

What meds can lead to negative side effects with Esmolol, or other beta blockers & what are they?

A

Cocaine & epinephrine. Can lead to pulmonary edema & CV collapse

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19
Q

What secondary messenger is synthesized with alpha-1 agonists?

A

IP3

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20
Q

Alpha-1 agonists determine what 3 things?

A
  • Arteriolar resistance
  • venous capacity
  • BP
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21
Q

Alpha-2 agonists do what with norepinephrine?

A

Decrease presynaptic NE release in the brain stem

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22
Q

Where does phenylephrine have its affects?

A
  • Venous constriction
  • Indirectly releasees NE
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23
Q

Increased amounts of Neo could lead to?

A

Reflex bradycardia

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24
Q

Labetalol has what kind of ratio?

A

7:1 beta to alpha blocking

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25
Q

What receptors are affected by Labetalol?

A
  • Selective alpha-1
  • Beta-1 & 2
26
Q

What is the IVP dose for Labetalol?

A

2.5 - 5 mg

27
Q

What can possibly increase the time for a Pt to come off bypass?

A

Prolonged beta-1 blockage

28
Q

What receptors & how (+/-) does dobutamine affect?

A
  • Alpha-1 & 2 (+)
  • beta-1 (++++)
  • beta-2 (++)
29
Q

Sympathomimetics lacking Beta-1 specificity may lead to?

A

Reflex-mediated bradycardia

30
Q

What are the direct acting sympathomimetics?

A

Epi, NE, phenylephrine, dopamine

31
Q

What are the indirect-acting sympathomimetics?

A

Ephedrine & Neo just a bit

32
Q

Which sympathomimetic has the highest alpha selectivity?

A

Phenylephrine

33
Q

Which sympathomimetic results in the highest CO?

A

Epinephrine

34
Q

Which sympathomimetic results in the highest PVR increase?

A

Neo

35
Q

What affects does vasopressin have on CO, HR & PVR?

A
  • Increases CO & PVR.
  • No effect on HR
36
Q

What is a downside to ephedrine?

A

Increased tachyphylaxis

37
Q

What is the preferred sympathomimetic in pregnancy & why?

A
  • Ephedrine
  • Does not affect uterine blood flow
38
Q

How does vasopressin assert its affects?

A

Causes arterial vasoconstriction

39
Q

What two hypotension examples is vasopressin ideal for?

A
  • Catecholamine-resistant hypotension
  • ACEi resistant hypotension
40
Q

What are the side effects of vasopressin?

A
  • Coronary artery constriction
  • Abd pain, N/V
  • decreased Plt count
41
Q

What secondary messenger is released from nitric oxide?

A

cGMP inhibits calcium entry into smooth muscle

42
Q

How do nitro-vasodilators assert their effects?

A

Decreasing SVR & venous return

43
Q

What kind of vasodilator would be beneficial in someone with pulmonary congestion?

A

Nitroglycerin or nitroprusside

44
Q

What is the infusion dose for nitroprusside?

A
  • 0.3 mcg/kg/min
  • up to 2 mcg/kg/min
45
Q

Where does nitroprusside work?

A

Mostly arterial smooth muscle but also venous smooth muscle

46
Q

What are some signs of cyanide toxicity?

A
  • Increased SvO2
  • metabolic acidosis
  • CNS dysfunction/LOC changes
47
Q

Where does nitroglycerin act on?

A

Venous capacitance vessels & large coronary arteries

48
Q

What are 4 indications for nitroglycerin use?

A
  • Acute MI
  • controlled HTN
  • sphincter of Oddi spasm
  • retained placenta
49
Q

What is the onset, ½ life & initial IV dose for hydralazine?

A
  • Onset 1hr
  • ½ life: 3-7hrs
  • dose 2.5 mg IV
50
Q

Which CCB type is selective for arteriolar beds?

A

Dihydropyrimidines

51
Q

What are the effects of CCB’s?

A
  • Decrease SVR & systemic BP
  • increase coronary blood flow
  • decrease dromotropy thru AV node
52
Q

Which 2 CCB’s could potentially increase the HR?

A

Nifedipine & Nicadipine

53
Q

Which CCB causes the least myocardial depression?

A

Nicardipine

54
Q

What CCB causes the most SA node depression?

A

Verapamil

55
Q

Which CCB has marked AV node depression?

A

Verapamil

56
Q

Which CCB causes the highest degree of coronary artery dilation?

A

Nicardipine

57
Q

Which 2 CCB cause marked peripheral artery dilation?

A

Nifedipine & Nicardipine

58
Q

Which vasodilator can worsen someone’s PaO2?

A

Nitroprusside

59
Q

Which type of beta blocker is best suited for COPD patients?

A

Beta-1 selective to prevent bronchospams & ventilatory depression

60
Q

Which type of beta blocker is preferred in diabetics?

A

Beta-1, this way it does not interfere with glycogenolysis

Advanced Pharmacology ANE 8433 (Spring 2023) (16 decks)

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