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Misc Sweatman Pharm Flashcards

Did these quickly as I studied, sorry if some are bizzarre half-thoughts

1
Q

Effects of beta-1 and -2 receptor activation?

A

accelerates SA node, increases contractility, accelerates ectopic pacemakers IN HEART

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2
Q

Effects of alpha-1 receptor activation?

A

contract vessels by increasing DAG and IP3, which results in an increase of Ca++

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3
Q

What receptors act via NE?

A

alpha 1, alpha 2, beta 1

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4
Q

What receptors act via epi?

A

alpha 1, alpha 2, beta 1, beta 2

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5
Q

What receptor would you block to treat BPH?

A

alpha 1

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6
Q

What class of drugs cause 1st dose orthostatic hypotension? What specific drug is the most prominent?

A

alpha blockers

prazosin

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7
Q

Effects of alpha 2 receptors?

A

decrease cAMP production, which blocks further release of NE (feedback inhibition)

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8
Q

Effects of alpha-1 antagonists?

A

antagonist circulating NE and epi, which prevents vasoconstriction

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9
Q

Effects of alpha-2 antagonists?

A

block feedback inhibition, which increases NE release

increases CO, “tempering” BP lowering

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10
Q

Treatment for pheochromocytoma?

A

phenoxybenzamine
phentolamine
(alpha blocker)

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11
Q

Why does phenoxybenzamine cause nasal congestion and drowsiness?

A

minor action = blocking histamine, serotonin and ACh

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12
Q

What treats hypertensive emergency?

A

phentolamine

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13
Q

What is the difference between a small versus a large dose of alpha 2 antagonist?

A

small: increases BP
large: decrease BP (due to periph vasodil)

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14
Q

What limits the use of phentolamine in essential HTN?

A

postural hypotension, reflex tach ppt arrhythmias

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15
Q 
Epi causes (increased/decreased) BP); treatment with an alpha blocker will....
Treatment with a beta blocker will...
A

increased BP
decrease BP
no effect

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16
Q 
NE causes (increased/decreased) BP; treatment with an alpha blocker will....
Treatment with a beta blocker will...
A

increased BP
slight decrease in BP
no effect

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17
Q

What drug class affects renin release?

A

B1 agonists (on JG cells)

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18
Q

Intrinsic sympathomimetic activity?

A

pure: propranolol

partial:
pindolol

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19
Q

Drugs with membrane stabilizing ability?

A

propranolol
cervedilol

class 1 antiarrhythmics

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20
Q

How do drugs stabilize membranes?

A

bind/block fast Na channels which are responsible for rapid depol (decrease phase 0 slope)

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21
Q

What is intrinsic sympathomimetic activity?

A

activate receptors in the absence of catecholamines

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22
Q

What is inverse sympathomimetic activity?

A

selectively bind to inactive form of receptor and behave like competitive antagonists (“off”)

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23
Q

B antagonists that block Ca entry:

What does this do?

A

carvedilol
betaxolol

prevents contraction

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24
Q

B antagonist that produces NO:

A

nebivolol

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25
B antagonists that are also a-1 R antagonists?
carvedilol | labetolol
26
B antagonist that has antioxidant activity?
carvedilol
27
What results from long term administration of beta blockers?
drop in peripheral vasc resistance
28
Beta blocker with no effect on renin? Most effective if elevated renin?
pindolol propranolol
29
What effect does lipid solubility have on antihypertensives?
drugs that do NOT penetrate BBB (low sol) are effective anti-HTN
30
Who should NOT take beta blockers?
patients with: 1. compensated HF, acute MI, cardiomeg 2. AV conduction defects, as these drugs cause bradycardia 3. bronchospastic disease (due to bronchoconstriction via beta-2)
31
Beta blockers should not be stopped abruptly because:
they can exacerbate angina and increase risk of sudden death (receptors are upregulated)
32
Lipophilic beta blockers may cause:
CNS depression, causing mental disorders, fatigue, vivid dreams
33
How do beta blockers affect plasma lipids?
increase triglycerides | decrease HDL
34
What type of beta blockers reduce cholesterol and LDL?
those with intrinsic sympathomimetic activity and cardioselectivity
35
Activation of what receptors mediates lipolysis?
alpha1 | beta 1, 2, 3
36
What is the effect of using beta blockers post MI?
improved mortality
37
Non-CV uses for beta blockers?
``` tremor thyrotoxicosis anxiety migraines prevent bleeding from esoph varices glaucoma ```
38
Effects of ganglionic blockade on arterioles?
vasodilation | hypotension
39
Effects of ganglionic blockade on veins?
dilation/pooling | decreased venous return/CO
40
Effects of ganglionic blockade on heart?
tachycardia
41
Nicotinic receptors are ______ channels which mediate
``` post-synaptic ligand gated ion initial EPSP (caused by Na/K) ```
42
MOA of trimethaphan:
competes with ACh for ganglionic receptor binding
43
Causes dry mouth, vision problems, urinary retention, constipation?
ganglionic blockers
44
MOA of reserpine:
binds to NT storage vesicles and inhibits vesicle transporter VMAT2 =no storage/concentration of dopamine and NE
45
MOA of clonidine:
withdrawal of SNS tone resulting in decreased BP and decreased PVR
46
High, chronic overstimulation of alpha-2 recepors results in:
downregulation via beta-arr mediated endocytosis | i.e. during HF
47
Effects of alpha-2-autoreceptors
bradycardia | hypotension
48
Activation of central alpha-2-heteroreceptors
``` sedation hypothermia analgesia bradycardia* hypotension* ``` *due to vagal activation
49
Activation of peripheral, vascular alpha 2 receptors causes
vasoconstriction
50
Effects of central alpha 2 receptor agonists: (4)
decrease plasma renin activity regression of LV hypertrophy decreased PVR decreased BP
51
Side effect of central alpha 2 receptor agonists:
salt/water retention (*trx duiretics, too)
52
Chelated by concurrent iron
methyldopa
53
Should be given with caution to diabetics
beta blockers ``` mask warning tachycardia (1) cause hypoglycemia (2) ```
54
Helpful in blocking reflex tachycardia
clonidine (alpha 2 agonists)
55
Adverse effects of central acting alpha 2 agonists
somnolence | dry mouth
56
Used to treat HTN in pregnancy?
*methyldopa *labetalol (IV for HTN emergencies) pindolol/propranolol HCTZ (recently decided it was ok)
57
Do not give in pregnancy:
ACEI ARBs reserpine
58
Reserpine's effects:
central and peripheral anti-HTN
59
Side effects of reserpine
psychotic depression (suicide) CNS (sedation, inability to concentrate) Exacerbation of PUD ulcerative colitis
60
Why are old centrally acting drugs good modern options?
cheap | better adverse effect profile
61
alpha blockers end in: beta blockers end in: ACEI end in: ARBs end in:
- in/-ine - olol - pril - artan
62
Treat v-tach:
1. amiodarone 2. lidocaine 3. procainamide
63
MOA of class 1 antiarrhythmics:
na channel blocker
64
MOA of class 2 antiarrhythmics:
beta blocker
65
MOA of class 3 antiarrhythmics:
K channel blocker
66
MOA of class 4 antiarrhythmics:
Ca channel blocker
67
Effects of local epi?
vasoconstriction
68
Direct acting adrenergic agonists stimulate:
post-syn receptors
69
Indirect acting adrenergic agonists increase:
NE and epi availability
70
Cocaine is a (direct/indirect) adrenergic agonist
indirect (blocks reuptake of NE)
71
MAOI's are (direct/indirect) adrenergic agonists
indirect (blocks metabolism of enzymes)
72
Treatment with reserpine results in a loss of (direct/indirect) adrenergic agonist action
indirect
73
Epi will ______ CO, _____ HR, ___ contracility and _____BP.
increase, increase, increase, increase
74
NE will ____HR, _____CO, ____BP, ____TPR, ____SV
``` no effect (due to vagus) no effect/decrease increase increase increase ```
75
Increases SBP more than DBP; why?
Epi | B-2 mediated increase in peripheral resistance
76
Epi causes more vaso-(dilation/constriction); why?
dilation | more effect on beta-2 than alpha receptors
77
Where does epi cause vasoconstriction?
skin, kidney, veins
78
Small doses of epi may cause:
decreased BP (due to differential receptor sensitivity)
79
Where are beta-1 receptors?
myocardium, PM, conducting tissues
80
How does epi affect the heart? (4)
shortened systole, increased HR, increased CO, increased O2 consumption
81
What is a possible side effect that epi may have on the heart?
PVC's
82
How does epi affect the kidneys?
decreased renal bf by increasing vasc resistance this will NOT change GFR and will decrease Na/K/CL excretion
83
How does epi affect renin levels?
increase due to beta-1 receptors in JGA
84
Can restore cardiac rhythm in patients with cardiac arrest
epi
85
What should be monitored in patients given NE?
BP
86
How do you measure dopamine's effects?
urine
87
Dopamine acutely benefits patients with:
CHF | Renal failure
88
What receptors are activated by dopamine (in order of concentration)?
D1 > beta 1 > alpha 1
89
Effects of low dose dopamine?
renal, coronary, etc vasodilation | improves GFR
90
Effects of moderate dose dopamine?
vasodilation | increased CO
91
Effects of high dose dopamine?
increase PVR | renal vasoconstriction
92
Dobutamine will ____HR, ____SV, ____ contractility and ___CO
no effect increase increase increase
93
Dobutamine is used to treat:
post cardiac surgery after MI CHF
94
How does isoproterenol affect BP?
decreases DBP (by decreasing PVR)
95
Phenylepherine has a stronger effect on (alpha/beta)
alpha | no beta!
96
Effects of phenylepherine:
increase BP | REFLEX decrease in HR and CO
97
Side effects of phenylepherine:
anxiety hallucinations/psychosis HTN insomnia
98
Ephedrine affects what receptors?
alpha and beta
99
Effects of ephedrine:
increase HR increase CO increase BP
100
Side effects of ephedrine:
``` increases cardiac workload > angina ventricular dysfunction palpitations s-tach arrhythmia (*v-fib) ```
101
the parasympathetic nervous system = ______ receptors
muscarinic
102
M2 receptor activation leads to...
reduced contractility | SA node deceleration - decreased HR
103
M3 receptor activation leads to...
NO synthesis
104
Effects of ACh on CV system:
vasodilation decreased HR decreased AV node conduction decreased force of atrial contraction
105
Effects of M2 on cell channels?
activate K | inhibit Ca
106
IV ACh results in... | What is a possible negative effect?
transient decrease in BP reflex tachy bradycardia or AV node conduction block
107
Effects of atropine
increase resting HR (no effect or maximal HR) counteracts vasodilation + BP drop
108
What is an indirect action of atropine?
vasodilation of cutaneous vessels (atropine flush) *this offsets the heat-loss reduction caused by sweating inhibition
109
Prevents cardiac arrest from vagal stimulation
atropine
110
How does atropine benefit patients with MI's?
(if inferior or posterior wall) | relieves severe bradycardia or AV block
111
Dobutamine is a:
beta agonist with both alpha1 agonist and antagonist activity (cancels out!)

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