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Cooper AFN Pharm II > Exam V - CV > Flashcards

Exam V - CV Flashcards

1
Q

What is the cell signaling for Alpha 1 receptors?

A

Gq protein coupled

activates

Phospholipase C

activates

PIP2 –> IP3 + DAG (increases Ca++ –> contraction)

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2
Q

What is the cell signaling for Alpha 2 receptors?

A

Gi protein coupled

inhibits

Adenlyl Cyclase

inhibits

ATP –> CAMP (Less CAMP)

*just think Gi –> i for inhibitory and the Alpha 2 is a presynaptic inhibitory receptor

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3
Q

What is the cell signalling for Beta 1 & 2 receptors?

A

Gs protein coupled (stimulatory)

activates

Adenlyl Cyclase

activates

ATP –> CAMP (More CAMP)

*think s for stimulatory and the beta receptors are stimulatory

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4
Q

If you are giving a ton of pressors, what route of med administration should you be worried about working?

A

SQ

(vasoconstriction is shunting blood away from skin/superficial tissues)

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5
Q

CAMP in the smooth muscle causes what (contraction or relaxation?)

A

Relaxation

so decreased CAMP will cause vasoconstriction in the vascular smooth muscle

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6
Q

CAMP in the cardiac muscle causes what (contraction or relaxation?)

A

Contraction

Increased CAMP causes contraction of the cardiac muscle (Inotropy/chronotropy)

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7
Q

Phenylephrine acts primarily on _______ tone with some _______

A

arterial

venous

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8
Q

Phenylephrine is metabolized by ______ not _________

A

MAO

Not COMPT

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9
Q

Phenylephrine DOA

A

<5mins

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10
Q

Would you want to give phenylephrine w/ pulmonary HTN pts?

A

NO

*it increases PVR duh

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11
Q

(t/f) Phenylephrine RARELY may induce vasospasm: IMA, radial, gastroepiploic artery

A

True

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12
Q

Dosing for phenylephrine

A
  • IVP : 40-100 mcg
  • Infusion: 40-180mcg/min
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13
Q

Does phenylephrine cause a big direct increase in preload?

A

No

Minimal direct effect on preload (less venous effects)

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14
Q

Ephedrine metabolism

A

Neither MAO or COMT

Excreted unchanged renally

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15
Q

DOA of ephedrine

A

5-10mins

*relatively long compared to phenylephrine

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16
Q

Ephedrine dosing

A
  • 5-10mg IVP
  • 25-50 mg IM
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17
Q

What drug has a risk of malignant HTN with MAOIs

A

Ephedrine

*makes sense b/c we are double increasing NE in synapse

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18
Q

Is HR drastically increased or slightly increased w/ ephedrine?

A

Slightly

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19
Q

Vasopressor after spinal anesthesia sympathectomy in c-section pts study: Decreased risk of fetal acidosis associated with ______________ use.

A

phenylephrine

*give NEO w/ NEOnates

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20
Q

____________ is converted to DOPA by ___________ hydroxylase

(rate-limiting step for
NE synthesis)!!!

A

Tyrosine (Tyr)

tyrosine hydroxylase

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21
Q

DOPA is converted to dopamine (DA) by DOPA _____________.

A

decarboxylase

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22
Q

Dopamine is transported into vesicles then converted to _____________ by dopamine β-hydroxylase (DBH)

A

norepinephrine (NE)

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23
Q

Dopamine transport into the vesicle can by blocked by the
drug ___________.

A

Reserpine

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24
Q

Both NE & Epi are metabolized by what

A

MAO & COMT

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25
Q

What is the final metabolite of NE & Epi metabolism?

A

Vanillylmandelic acid (VMA)

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26
Q

(t/f) NE hits B1 receptors less than Epi

A

False

(allegedly they are the same but they aren’t in real life)

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27
Q

(t/f) NE has less effects on B2 than Epi

A

True

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28
Q

NE dosing

A

2-4mcg/min starting gTT

*you could loose 2-4 limbs w/ norepinephrine

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29
Q

V1 receptors are located in the _________ and cause __________

A

Vasculature

Vasoconstriction

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30
Q

V2 receptors are located in the __________ and cause _________

A

Kidney

Fluid reabsorption

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31
Q

Vasopressin is released from the _______ ________

A

posterior pituitary

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32
Q

The V2 receptor can also release clotting factors _______ & ________

A

vWF

VIII

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33
Q

Cell signaling of vasopressin

A

Gq

activates

Phospholypase C

activates

IP3/DAG

Increased Ca++ release

activates

Myosin-light-chain kinase & phosphodiesterase

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34
Q

Vaso can do what to ur coags

A

Decrease platelet count

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35
Q

Vasoplegia is what

A

Super dilated vessels

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36
Q

Vasoplegic syndromes
w/ concominant ACEI and ARB administration unresponsive to phenylephrine

A

Vasopressin

37
Q

Vasopressin dosing

A

Resuscitation dose 40 units

Infusion 4-6 units/hour

IVP 1-2 units

38
Q

What is Methylphenidate

A

Amphetamine derivative; abuse potential

39
Q

Normal byproduct of tyrosine metabolism; readily
metabolized by MAO in the liver

Issue with concomitant MAOIs

40
Q

Levodopa and Fenoldopam are in what broad drug category?

A

Indirect acting sympathomimetics

41
Q

(t/f) Inotropes activate phosphodiesterase

A

False

They inhibit it

42
Q

Dopaminergic stimulation = _______and _________
vasodilation

A

renal

mesenteric

43
Q

What is lusitropy

A

Loosey goosey ventricles that fill better

44
Q

Inotrope slective for B1 activation

A

Dobutamine

45
Q

Dobutamine metabolism

46
Q

Dobutamine & isoproterenol plasma half life is what

A

2 min

IMPORTANT!!!

47
Q

(t/f) dobutamine has less tachycardia than Isuprel or Dopamine

48
Q

PDE degrades what

49
Q

B/c PDE degrades CAMP, you get __________ in the vessels when PDE is stimulated

A

vasoconstriction

50
Q

Inotropes ________ PDE

51
Q

When dobutamine is given to β- blocked patients a(an) __________ in SVR may occur

A

Increase in SVR

*dobutamine may have alpha 1 effects so if the B1 receptor is block that it usually works on, A1 effects are the only action left

52
Q

What med do you use with stress
echocardiography

A

Dobutamine

53
Q

The decreased SVR from dobutamine is mediated from _____ receptor effects

54
Q

Dobutamine dosing

A

2-20 mcg/kg/min

55
Q

Endogenous catecholamine, precursor to NE/Epi

56
Q

what drug has a dose-responsive direct action on all adrenoreceptors

57
Q

With dopamine at low doses, you stimulate on the ______ receptor which causes what?

A

DA1

Increased renal and mesenteric blood flow

58
Q

Dopamine metabolism

A

MAO
and COMT

59
Q

Dopamine inhibits aldosterone which equals __________

A

Naturesis

Eliminating Na+

60
Q

Extremely potent β effects; very little/no α effects

A

ISOPROTERENOL

*ISOlates the B receptor

61
Q

Isoproterenol metabolism

A

MAO & COMT

62
Q

(t/f) Isoproterenol has no risk for CAD pts

A

False

Caution in CAD pts

63
Q

Isoproterenol dosing

A

2-5 mcg/min

64
Q

What drug (not epi) that is a inotrope can be nebulized for reactive airway mgmt

A

Isoproterenol

65
Q

What drug is used for beta blocker overdose

A

Isoproterenol

*glucagon is better

66
Q

Epi metabolism

A

MOA & COMT

67
Q

1mg = _______ mcg

68
Q

PDE Type ___ is the isoenzyme targeted by current inotropic medications

A

type 3 (PDE3I)

69
Q

Milronone is what class of drug

A

PDE3 inhibitor

70
Q

Milronone metabolism

A

Unchanged in urine

71
Q

This drug retains efficacy when NE stores are depleted (chronic CHF)

72
Q

Milronone dosing

A

Loading dose: 50 mcg/kg

TRO 10 minutes

Infusion: 0.5 mcg/kg/min

73
Q

___________ is Necessary for cardiac
muscle contraction

74
Q

Treatment of beta-blockade overdose due to increase cAMP in the myocardium

Bypasses the inhibitory effect of beta-blockade

75
Q

Peptide hormone

Increases intracellular cAMP

76
Q

Glucagon dosing

A

1-5mg IV slowly

77
Q

Indirect acting vasodilator: ____________

A

Nitroglycerin

78
Q

Direct acting vasodilator: ____________

A

Nitroprusside

79
Q

Nitroprusside can cause _______ toxicity

A

cyanide toxicity

80
Q

Nitroprusside work more on ______ vessels

81
Q

(t/f) Nitroglycerin has tachyphylaxis

82
Q

NTG and NTP work by increasing _______ (NO)

A

Nitric oxide

83
Q

What 2 ways does NO work?

A
  1. NO activates guanylyl cyclase to active cGMP. This decreases Ca++ which cause relaxation
  2. Activates K+ channels causing hyperpolarization causing relaxation
84
Q

Increased in cGMP = ___________ in platelet aggregation

85
Q

Nitrites react to form
_____________

A

methemoglobin

86
Q

Cyanide toxicity treatment

A

Stop the NTP

100% O2

Sodium thiosulfate (150 mg/kg over 15 minutes)

87
Q

Selective DA1 agonist w/ 6x greater potency than
Dopamine

A

Fenaldopam

88
Q

What is fenaldopam used for?

A

Sever HTN tx

Cooper AFN Pharm II (5 decks)

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