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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
What is the final metabolite of NE & Epi metabolism?
Vanillylmandelic acid (VMA)
26
(t/f) NE hits B1 receptors less than Epi
False (allegedly they are the same but they aren't in real life)
27
(t/f) NE has less effects on B2 than Epi
True
28
NE dosing
2-4mcg/min starting gTT *you could loose 2-4 limbs w/ norepinephrine
29
V1 receptors are located in the _________ and cause __________
Vasculature Vasoconstriction
30
V2 receptors are located in the __________ and cause _________
Kidney Fluid reabsorption
31
Vasopressin is released from the _______ ________
posterior pituitary
32
The V2 receptor can also release clotting factors _______ & ________
vWF VIII
33
Cell signaling of vasopressin
Gq activates Phospholypase C activates IP3/DAG Increased Ca++ release activates Myosin-light-chain kinase & phosphodiesterase
34
Vaso can do what to ur coags
Decrease platelet count
35
Vasoplegia is what
Super dilated vessels
36
Vasoplegic syndromes w/ concominant ACEI and ARB administration unresponsive to phenylephrine
Vasopressin
37
Vasopressin dosing
Resuscitation dose 40 units Infusion 4-6 units/hour IVP 1-2 units
38
What is Methylphenidate
Amphetamine derivative; abuse potential
39
Normal byproduct of tyrosine metabolism; readily metabolized by MAO in the liver Issue with concomitant MAOIs
Tyramine
40
Levodopa and Fenoldopam are in what broad drug category?
Indirect acting sympathomimetics
41
(t/f) Inotropes activate phosphodiesterase
False They inhibit it
42
Dopaminergic stimulation = _______and _________ vasodilation
renal mesenteric
43
What is lusitropy
Loosey goosey ventricles that fill better
44
Inotrope slective for B1 activation
Dobutamine
45
Dobutamine metabolism
COMT
46
Dobutamine & isoproterenol plasma half life is what
2 min IMPORTANT!!!
47
(t/f) dobutamine has less tachycardia than Isuprel or Dopamine
true
48
PDE degrades what
CAMP
49
B/c PDE degrades CAMP, you get __________ in the vessels when PDE is stimulated
vasoconstriction
50
Inotropes ________ PDE
inhibit
51
When dobutamine is given to β- blocked patients a(an) __________ in SVR may occur
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
What med do you use with stress echocardiography
Dobutamine
53
The decreased SVR from dobutamine is mediated from _____ receptor effects
B2
54
Dobutamine dosing
2-20 mcg/kg/min
55
Endogenous catecholamine, precursor to NE/Epi
Dopamine
56
what drug has a dose-responsive direct action on all adrenoreceptors
Dopamine
57
With dopamine at low doses, you stimulate on the ______ receptor which causes what?
DA1 Increased renal and mesenteric blood flow
58
Dopamine metabolism
MAO and COMT
59
Dopamine inhibits aldosterone which equals __________
Naturesis Eliminating Na+
60
Extremely potent β effects; very little/no α effects
ISOPROTERENOL *ISOlates the B receptor
61
Isoproterenol metabolism
MAO & COMT
62
(t/f) Isoproterenol has no risk for CAD pts
False Caution in CAD pts
63
Isoproterenol dosing
2-5 mcg/min
64
What drug (not epi) that is a inotrope can be nebulized for reactive airway mgmt
Isoproterenol
65
What drug is used for beta blocker overdose
Isoproterenol *glucagon is better
66
Epi metabolism
MOA & COMT
67
1mg = _______ mcg
1000
68
PDE Type ___ is the isoenzyme targeted by current inotropic medications
type 3 (PDE3I)
69
Milronone is what class of drug
PDE3 inhibitor
70
Milronone metabolism
Unchanged in urine
71
This drug retains efficacy when NE stores are depleted (chronic CHF)
Milronone
72
Milronone dosing
Loading dose: 50 mcg/kg TRO 10 minutes Infusion: 0.5 mcg/kg/min
73
___________ is Necessary for cardiac muscle contraction
Ca++
74
Treatment of beta-blockade overdose due to increase cAMP in the myocardium Bypasses the inhibitory effect of beta-blockade
Glucagon
75
Peptide hormone Increases intracellular cAMP
Glucagon
76
Glucagon dosing
1-5mg IV slowly
77
Indirect acting vasodilator: ____________
Nitroglycerin
78
Direct acting vasodilator: ____________
Nitroprusside
79
Nitroprusside can cause _______ toxicity
cyanide toxicity
80
Nitroprusside work more on ______ vessels
arterial
81
(t/f) Nitroglycerin has tachyphylaxis
True
82
NTG and NTP work by increasing _______ (NO)
Nitric oxide
83
What 2 ways does NO work?
1. NO activates guanylyl cyclase to active cGMP. This decreases Ca++ which cause relaxation 2. Activates K+ channels causing hyperpolarization causing relaxation
84
Increased in cGMP = ___________ in platelet aggregation
decrease
85
Nitrites react to form _____________
methemoglobin
86
Cyanide toxicity treatment
Stop the NTP 100% O2 Sodium thiosulfate (150 mg/kg over 15 minutes)
87
Selective DA1 agonist w/ 6x greater potency than Dopamine
Fenaldopam
88
What is fenaldopam used for?
Sever HTN tx

Cooper AFN Pharm II (5 decks)

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