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Pharmacology Test #3 > First Aid Autonomic/Cardiac Pharmacology > Flashcards

First Aid Autonomic/Cardiac Pharmacology Flashcards

1
Q

Major functions of alpha1 q receptor

A

increase vascular SM contraction
increase pupillary dilator muscle contraction (mydriasis)
increase intestinal and bladder sphincter muscle contraction

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2
Q

Major functions of alpha2 i receptor

A 
decrease sympathetic outflow
decrease insulin release
decrease lipolysis
increase platelet aggregation
decrease aqueous humor production
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3
Q

Major functions of beta1 s receptor

A

increase heart rate
increase contractility
increase renin release
increase lipolysis

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4
Q

Major functions of beta2 s receptor

A 
vaodilation, bronchodilation
increase lipolysis
increase insulin release
decrease uterine tone
ciliary muscle relaxation
increase aqueous humor production
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5
Q

Major functions of M1 q receptor

A

CNS

enteric nervous system

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6
Q

Major functions of M2 i receptor

A

decrease heart rate and contractility of atria

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7
Q

Major functions of M3 q receptor

A

increased exocrine gland secretions
increase gut peristalsis
increase bladder contraction
bronchoconstriction
increase pupillary sphincter muscle contraction
ciliary muscle contraction (accommodation)

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8
Q

Major function of D1 s receptor (dopamine)

A

relaxes renal vascular smooth muscle

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9
Q

Major function of D2 i receptor (dopamine)

A

modulates transmitter release especially in brain

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10
Q

Major function of H1 q receptor

A

increased nasal and bronchial mucus production
increased vascular permeability
contraction of bronchioles
pruritus, pain

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11
Q

Major function of H2 s receptor

A

increased gastric acid secretion

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12
Q

Major function of V1 q receptor (vasopressin)

A

increased vascular SM contraction

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13
Q

Major function of V2 s receptor (vasopressin)

A

increased H2O permeability and resorption in collecting tubules of kidney

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14
Q

Sympathetic receptors

A

alpha1
alpha2
beta1
beta2

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15
Q

Parasympathetic receptors

A

M1
M2
M3

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16
Q

Cholinomimetic agents/direct agonists

A

carbachol
methacholine
pilocarpine
bethanechol

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17
Q

Cholinomimetic agents/indirect agonists/anticholinesterases

A 
Donepezil, galantamine, rivastigmine
edrophonium
neostigmine
physostigmine
pyridostigmine
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18
Q

Bethanechol

A

postoperative ileus, neurogenic ileus, urinary retention

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19
Q

Carbachol

A

constricts pupil and relieves intraocular pressure in glaucoma (carbon copy of acetylcholine)

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20
Q

Methacholine

A

challenge test for the diagnosis of asthma (stimulates muscarinic receptors in airway)

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21
Q

Pilocarpine

A

potent stimulator of sweat, tears and saliva
open angle and closed angle glaucoma
contracts ciliary muscle of eye; pupillary sphincter
resistant to AChE

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22
Q

Donepezil, galantamine, rivastigmine

A

Alzheimer disease

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23
Q

Edrophonium

A

Historically used for diagnosis of myasthenia gravis

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24
Q

Neostigmine

A

postoperative and neurogenic ileus and urinary retention
myasthenia gravis
reversal of neuromuscular junction blockade

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25
Q

Physostigmine

A

Anticholinergic toxicity; crosses BBB

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26
Q

Pyridostigmine

A

myasthenia gravis (long acting); does not penetrate BBB

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27
Q

Cholinesterase inhibitor poisoning often due to

A

organophosphates that irreversibly inhibit AChE

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28
Q

Cholinesterase inhibitor poisoning (insecticides etc)

A 
DUMBBELSS:
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal muscle and CNS
Lacrimation
Sweating
Saliva
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29
Q

Muscarinic antagonists

A 
atropine, homatropine, tropicamide
benztropine
scopolamine
ipratropium, tiotropium
oxybutynin, darifenacin, and solifenacin
glycopyrrolate
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30
Q

Atropine, homatropine, tropicamide

A

eye; produces mydriasis and cyloplegia

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31
Q

Benztropine

A

CNS; Parkinson disease

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32
Q

Scopolamine

A

CNS; Motion sickness

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33
Q

Ipratropium, triotropium

A

Respiratory; COPD, asthma

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34
Q

Oxybutynin, darifenacin, and solifenacin

tolterodine, fesoterodine, trospium

A

GU; reduce urgency in mild cystitis and reduce bladder spasms

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35
Q

Glycopyrrolate

A

GU, respiratory; parenteral: preoperative use to reduce airway secretions
oral: drooling, peptic ulders

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36
Q

Atropine

A

muscarinic antagonist; used to treat bradycardia and for ophthalmic application

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37
Q

Atropine is the antidote for

A

cholinesterase inhibitor poisoning

insecticides

38
Q

Direct sympathomimetics

A 
Epinephrine
Norepinephrine
Isoproterenol
Dopamine
Dobutamine
Phenylephrine
Albuterol, salmeterol, terbutaline
39
Q

Indirect sympathomimetics

A

Amphetamine
Ephedrine
Cocaine

40
Q

Epinephrine

A

beta > alpha
(alpha effects predominate at high doses)
anaphylaxis, open angle glaucoma, asthma, hypotension

41
Q

Norepinephrine

A

alpha1 > alpha2 > beta1

hypotension (but decreases renal perfusion)

42
Q

Isoproterenol

A

beta1 = beta2
electrophysiologic evaluation of tachyarrhythmias
can worsen ischemia

43
Q

Dopamine

A

D1=D2 > beta > alpha

unstable bradycardia, heart failure, shock; inotropic and chronotropic alpha effects predominate at high doses

44
Q

Dobutamine

A 
beta1 > beta2, alpha
heart failure (inotropic > chronotropic), cardiac stress testing
45
Q

Phenylephrine

A

alpha1 > alpha2

hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

46
Q

Albuterol, salmeterol, terbutaline

A

beta2 > beta1
albuterol for acute asthma; salmeterol for long-term asthma or COPD control; terbutaline to reduce premature uterine contractions

47
Q

Amphetamine

A

indirect general agonist, reuptake inhibitor, also releases stored catecholamines
narcolepsy, obesity, ADD

48
Q

Ephedrine

A

indirect general agonist, releases stored catecholamines

nasal decongestant, urinary incontinence, hypotension

49
Q

Cocaine

A

indirect general agonist, reuptake inhibitor

causes vasoconstriction and local anesthesia

50
Q

What would you never give if cocaine intoxication is suspected?

A

never give a beta-blocker if cocaine intoxication is suspected because it can lead to unopposed alpha1 activation and extreme hypertension

51
Q

Sympatholytics (alpha2-agonists)

A

Clonidine

alpha-methyldopa

52
Q

Clonidine

A 
hypertensive urgency (limited); does not decrease renal blood flow
ADHD, severe pain, and a variety of off-label indications (ethanol and opioid withdrawal)
53
Q

alpha-methyldopa

A

hypertension in pregnancy

safe in pregnancy

54
Q

Nonselective alpha-blockers

A

Phenoxybenzamine (irreversible)

Phentolamine (reversible)

55
Q

alpha1 selective alpha-blockers

A

Prazosin
Terazosin
Doxazosin
Tamsulosin

56
Q

alpha2 selective alpha-blocker

A

Mirtazapine

57
Q

Phenoxybenzamine (irreversible)

A

Pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis

58
Q

Phentolamine (reversible)

A

give to patients on MAO inhibitors who eat tyramine-containing foods

59
Q

Prazosin, terazosin, doxazosin, tamsulosin

A

Urinary symptoms of BPH; PTSD (prazosin); hypertension (except tamsulosin)

60
Q

Mirtazapine

A

Depression

61
Q

beta-blockers

A

Metoprolol, acebutolol, betaxolol, carvedilol, esmolol, atenolol, nadolol, timolol, pindolol, labetalol

62
Q

Application of beta-blockers

A

angina pectoris, MI, SVT (metoprolol, esmolol), hypertension, CHF, glaucoma (timolol)

63
Q

Toxicity of beta blockers

A

impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation), dyslipidemia (metoprolol), and asthmatic/COPD exacerbation

64
Q

beta1-selective antagonists

A 
acebutolol (partial agonist)
atenolol
betazolol
esmolol
metoprolol
65
Q

Nonselective beta antagonists

A

nadolol
pindolol (partial agonist)
propranolol
timolol

66
Q

Nonselective alpha and beta antagonists

A

carvedilol

labetalol

67
Q

Nebivolol

A

combines cardiac-selective beta1-adrenergic blockade with stimulation of beta3 receptors, which activate nitric oxide synthase in the vasculature

68
Q

Which drug class causes a dry cough?

A

ACE inhibitors

69
Q

Primary (essential) hypertension treatment

A

diuretics
ACE inhibitors
angiotensin II receptor blockers (ARBs)
calcium channel blockers

70
Q

Hypertension with CHF treatment

A

diuretics
ACEi/ARBs
beta-blockers (compensated CHF)
aldosterone antagonists

71
Q

Hypertension with diabetes mellitus treatment

A 
ACEi/ARBs
calcium channel blockers
diuretics
beta-blockers
alpha-blockers
72
Q

Calcium channel blockers

A

Amlodipine, nimodipine, nifedipine (DHP); diltiazem, verapamil (non-DHP)

73
Q

Mechanism of calcium channel blockers

A

block voltage-dependent L-type calcium channels of cardiac and smooth muscle, thereby reducing muscle contractility

74
Q

Calcium channel blockers with vascular smooth muscle selectivity

A

amlodipine = nifedipine > diltiazem > verapamil

75
Q

Calcium channel blockers with heart selectivity

A

verapamil > diltiazem > amlodipine = nifedipine

76
Q

Clinical uses of DHP calcium channel blockers

A

(except nimodipine): hypertension, angina (including Prinzmeal), Raynaud phenomenon

77
Q

Clinical uses of Non-DHP calcium channel blockers

A

hypertension, angina, Afib/Aflutter

78
Q

Clinical uses of nimidipine

A

subarachnoid hemorrhage (prevents cerebral vasospasm)

79
Q

Hydralazine mechanism

A

increases cGMP -> smooth muscle relaxation
vasodidlates arterioles > veins
afterload reduction

80
Q

Clinical uses of hydralazine

A

severe hypertension, CHF
first-line therapy for hypertension in pregnancy with methyldopa
frequently coadministered with a beta-blockers to prevent reflex tachycardia

81
Q

Toxicity of hydralazine

A

compensatory tachycardia (contraindicated in angina/CAD)
fluid retention, nausea, headache, angina
Lupus-like syndrome

82
Q

Commonly used drugs in a hypertensive emergency

A

nitroprusside, nicardipine, clevidipine. labetalol, and fenoldopam

83
Q

Nitroprusside

A

short actin, increases cGMP via direct release of NO

can cause cyanide toxicity

84
Q

Nitroglycerin, isosorbide dinitrate mechanism

A

vasodilates by increasing NO in vascular smooth muscle -> increases in cGMP and smooth muscle relaxation
dilates veins&raquo_space; arteries; decreases preload

85
Q

Clinical use of nitroglycerin and isosorbide dinitrate

A

angina, acute coronary syndrome, pulmonary edema

86
Q

Toxicity of nitroglycerin and isosorbide dinitrate

A 
reflex tachycardia (treat with beta blockers)
hypotension, flushing, headache, "Monday disease" in industrial exposure
87
Q

Antianginal therapy

A

nitrates (affect preload)

beta-blockers (affect afterload)

88
Q

Mechanism of cardiac glycosides

A

direct inhibition of Na+/K+ ATPase leads to indirect inhibition of Na+/Ca2+ exchanger
increase in Ca2+ -> positive inotropy
stimulates vagal nerve -> decreased heart rate

89
Q

Name a cardiac glycoside

A

digoxin

90
Q

Clinical use of digoxin/cardiac glycosides

A 
CHF (increase contractility)
atrial fibrillation (decrease conduction at AV node and depression of SA node)

Pharmacology Test #3 (13 decks)

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