Konorev, Clinical Uses Flashcards by Elise Wolff

Adrenergic Agonists - Cardiovascular conditions

To increase BP in hypertensive emergencies - hemorrhagic shock, overdose of antihypertensives, CNS depressants

Norepinephrine (a1,2 B1)
Phenylephrine (a1)
Methoxamine (a1)

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Adrenergic Agonists - Cardiovascular conditions

Chronic hypOTension

Ephedrine (indirect - releases stores catas and direct adrenergic agonist)

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Adrenergic Agonists - Cardiovascular conditions
Cardiogenic shock - due to massive acute myocardial infarction

Peripheral mimetic action? Y/N
Beta1 mimetic aciton? Y/N

Dopamine (D1, D2)
Dobutamine (B1)

Peripheral mimetic action? No
Beta1 mimetic action? Yes

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Adrenergic Agonists - Cardiovascular conditions

Heart failure - drug for short term use in acute HF

Dobutamine (B1)

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Adrenergic Agonists - Cardiovascular conditions

Heart failure - ___ in severe CHF with reduced renal perfusion

Dopamine (D1, D2)

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Adrenergic Agonists - Cardiovascular conditions

HTN - long term tx

alpha 2 agonists

clonidine

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Adrenergic Agonists - Cardiovascular conditions

HTN emergencies

fenoldopam (D1)

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Adrenergic Agonists - Cardiovascular conditions

Emergency therapy for complete AV block and cardiac arrest

Epinephrine (all adrenergic)

Isoproterenol (B1, B2)

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Adrenergic Agonists - Cardiovascular conditions

Decongestion of mucous membranes

Phenylephrine (a1)

Ephedrine and Pseudoephedrine (indirect - releases stores catas and direct adrenergic agonist)

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Adrenergic Agonists - Bronchial asthma

Beta-2 selective agonists

Albuterol (B2)

Terbutaline (B2)

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Adrenergic Agonists - Anaphylaxis (type I) intermediate allergic reaction with respiratory and CV componenets

Epinephrine (all adrenergic)

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Adrenergic Agonists - Anaphylaxis

Respiratory component

bronchospasm and upper airway congestion

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Adrenergic Agonists - Anaphylaxis

CV component

severe hypOTension, cardiac depression

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Adrenergic Agonists - ophthalmic applications

Examination of retina - induction of mydriasis

Phenylephrine (a1)

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Adrenergic Agonists - ophthalmic applications

Glaucoma - alpha-2 selective agonist

Apraclonidine (a2)

Brimonidine (a2)

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Adrenergic Agonists - GI

Suppression of premature labor - beta-2 agonist

Terbutaline (B2)

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Indirect Adrenergic Agonists - GI

Stress incontinence

Ephedrine

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Adrenergic Agonists - GI

Priapism - alpha-1 agonist (injeciton into penis)

Phenylephrine (a1)

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Indirect Adrenergic Agonists - CNS conditions

Narcolepsy

Amphetamines

Methylphenidate

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Indirect Adrenergic Agonists - CNS conditions

ADHD

Methylphenidate

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Adrenergic Agonists - CNS conditions

Obesity - inhibition of appetite and increased energy expenditure

Phentermine
Ephedrine
Amphetamines

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Adverse Effects of Adrenergic Agonists

CV adverse effects

Elevated BP
MI, HF - esp elderly
Sinus tach, vent arrhythmia
Direct myocardial damage
Cardiac DEATH

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Age group to be cautious with adrenergic agonists

elderly and pts with HTN, CAD, CHF

Adverse Effects of Adrenergic Agonists

CNS toxicity

Amphetamine

Cocaine

What types of agonist drugs do not cause CNS toxicity

Polar (dont cross BBB) | Catecholamines

Amphetamine CNS toxicity causes:

Insomnia Lack of appetite Anxiety, restlessness Psychoses (apranoid, hallucinations)

Cocaine CNS toxicity causes:

Convulsions Arrhythmias Hemorrhagic stroke

Alpha Antagonists - Pheochromocytoma presents with

tachy, arrhythmia, HTN

Alpha Antagonists - Pheochromocytoma Tx

Phentolamine | Phenoxybenzamine

Alpha Antagonists - chronic HTN tx

Prazosin Terzosin Doxazosin

Conditions under which you use: Prazosin, Terzosin, Doxazosin

Chronic HTN - Moderate HTN - Nonselective alpha-blockers NTO used

Prazosin, Terzosin, Doxazosin are selective for what receptor

alpha1

Alpha Antagonists - erectile dysfunction

Phentolamine | Paverine

Alpha Antagonists - BHP

``` Tamsulosin Silodosin (also prazosin doxazosin, terazosin) ```

Alpha Antagonists - Silodosin (for BPH): Selectivity greater for alpha-1A or alpha-1B?

alpha-1A

Alpha Antagonists - Silodosin (for BPH): What does alpha-1A mediate? What effect does it have on BP?

prostate smooth muscle contraction | *with little effect on BP

Adverse effects of alpha antagonists Seen most in what system? Seen less in what antagonist?

CVS | Alpha1 selective antagonist

Adverse effects of alpha antagonists - | What conditions does it cause?

Tachy Retention of fluid and salt Impaired ejaculation Nasal stuffiness

Beta Blocker - | For HTN

Labetalol (alpha1 and B-blocker)

Beta Blocker - | For angina pectoris

block cardiac B-receptors

``` Beta Blocker - For MI (long term use post-MI) ```

Long term = Timolol, Propranolol, Metoprolol

Beta Blocker - | For MI - acute phase contraindications

``` Bradycardia HypOTension acute HF AV block active airway disease ```

Beta Blocker - | Effective in what cardiac arrhythmic conditions?

ventricular and supraventricular arrhythmias (A.Fib and vent ectopic beats)

Beta Blocker - | For heart failure (CHF)

Metoprolol Bisoprolol Carvedilol

Beta Blocker - | Galucoma (decrease aqueous humor production by clilary body)

Timolol | Betaxolol

Beta Blocker - | Hyperthyroidism

Propranolol

Adverse effects of Beta Blockers - | CNS effects?

Sedation Sleep disturbances Depression

Adverse effects of Beta Blockers - | To avoid CNS effects, what should you switch to?

A more hydrophilic drug - cannot cross BBB.

Adverse effects of Beta Blockers - | Respiratory effects?

Increase airway resistance | Trigger bronchospasm and asthma attack (esp in COPD, chronic asthma, chronic bronchitis)

Adverse effects of Beta Blockers - | To avoid respiratory effects, what should you switch to?

beta-1 selective

Adverse effects of Beta Blockers - | CV effects?

Depression of HR, contractility, excitability | Exacerbation of peripheral vascular disease

Adverse effects of Beta Blockers - | Effects on lipid profiles.

increases VLDL and decrease HDL (HDL/LDL ratio decreases)

Adverse effects of Beta Blockers - | To avoid effect on lipid profiles, what should you switch to?

partial agonist drug

Adverse effects of Beta Blockers - | hypoglycemic episodes

Delay recovery form insulin indicued hypoglycemia Blunt perception of hypoglycemia Increased hypoglycemic episode incidence

Adverse effects of Beta Blockers - To avoid effect hypoglycemic episodes what should you switch to? To avoid exacerbation of peripheral vascular disease, what should you switch to?

beta 1 selective

Abrupt or gradual taper of beta blockers most effective?

Gradual taper