Pharm: ANS

Question 1

Epinephrine

Answer 1

MOA: alpha and beta receptor agonist

Use:
resuscitation from cardiac arrest, which both (+) inotropic and (+) chronotropic effects plus vasoconstriction

Anaphylactic shock to raise blood pressure by constricting arterioles

Adverse Effects: tachycardia, hypertensive crisis

Question 2

What are 3 contraindication for all sympathomimetic drugs?

Answer 2

Patients that use:
Cocaine and tricyclic antidepressants
MAO inhibitors
Thyroid hormones

Question 3

Reserpine

Answer 3

MOA: inhibits vesicular monoamine transporter (VMAT) in presynaptic neurons preventing NE formation.

Use:
Not used anymore but tested on boards

Adverse Effects: depression

Question 4

Norepinephrine

Answer 4

MOA: alpha-1, alpha-2, Beta-1 agonist (little beta-2 effect)

Use: resuscitation of cardiac arrest, hypotensive states

Adverse Effects: tachycardia, hypertensive crisis

Question 5

Isoproterenol

Answer 5

MOA: Beta-1 and Beta-2 agonist

Use: AV block, bradycardia (emergency situations in anticipation for pacemaker placement)

Question 6

Fenoldopam

Answer 6

MOA: D1 agonist

Use: severe hypertension (dilates coronary arteries to prevent heart attack)

Question 7

Dopamine

Answer 7

MOA: dose dependent (low to high) D1 agonist, beta-1 agonist, alpha-1 agonist

Use: hypertension, D1 receptor activation dilates renal arteries to increase GFR, dilates coronary arteries

Question 8

Dobutamine

Answer 8

MOA: selective Beta-1 agonist (slight alpha-1)

Use: Heart failure (increases Cardiac output without increasing heart rate)

Adverse Effects: because of its slight alpha-1 specificity, too much use can lead to intense vasoconstriction

Question 9

Phenylephrine

Answer 9

MOA: alpha-1 agonist

Use: hypotensive emergency to preserve cerebral and coronary blood flow, maintain blood pressure during anesthesia

Question 10

Methoxamine

Answer 10

MOA: alpha-1 agonist

Use: hypotensive emergency to preserve cerebral and coronary blood flow, maintain blood pressure during anesthesia

Question 11

Midodrine

Answer 11

MOA: alpha-1 agonist

Use: postural hypotension

Question 12

Clonidine

Answer 12

MOA: alpha-2 agonist

Use: hypertension

Adverse Effects: Dry mouth, sedation, Dose-related withdrawal syndrome

Question 13

alpha-methyldopa

Answer 13

MOA: alpha-2 agonist

Use: pregnancy-related hypertension

Adverse Effects: hepatotoxicity, hemolytic anemia, seation, Dose-related withdrawal syndrome

Question 14

Prazosin

Answer 14

MOA: alpha-1 antagonist

Use: hypertension

Adverse Effects: 1st dose hypotension (pts should take it before bed to avoid orthostatic hypotension and fainting)

Question 15

Doxazosin

Answer 15

MOA: alpha-1 antagonist

Use: hypertension

Adverse Effects: 1st dose hypotension (pts should take it before bed to avoid orthostatic hypotension and fainting)

Question 16

Terazosin

Answer 16

MOA: alpha-1 antagonist

Use: BPH (induces apoptosis in the prostate)

Adverse Effects: 1st dose hypotension, syncope

Question 17

Phenoxybenzamine

Answer 17

MOA: irreversible non-selective alpha blocker

Use: pheochromocytoma

Adverse Effects: reflex tachycardia (due to alpha-1 blockage leading to vasodilation), tachycardia (due to alpha-1 blockage leading to increased NE release binding beta-1)

Question 18

Phentolamine

Answer 18

MOA: reversible non-selective alpha blocker

Use: prevents hypertension during surgical excision of pheochromocytoma, Dx of pheochromocytoma

Adverse Effects: reflex tachycardia (due to alpha-1 blockage leading to vasodilation), tachycardia (due to alpha-1 blockage leading to increased NE release binding beta-1)

Question 19

Propranolol

Answer 19

MOA: non-selective Beta blocker

Use: Hypertension, Angina pectoris, Arrhythmias, Myocardial infarction, Acute treatment of MI, Secondary prevention following MI, Aortic dissection, Hypertrophic cardiomyopathy (CHF), Dumb

Adverse Effects: insomnia, nightmares, hallucinations, bronchoconstriction

Question 20

Timolol

Answer 20

MOA: non-selective Beta blocker

Use: Hypertension, Angina pectoris, Arrhythmias, Myocardial infarction, Acute treatment of MI, Secondary prevention following MI, Aortic dissection, Hypertrophic cardiomyopathy (CHF), Dumb

Adverse Effects: insomnia, nightmares, hallucinations, bronchoconstriction

Question 21

Pindolol

Answer 21

MOA: non-selective Beta blocker (has intrinsic sympathomimetic activity and can act as partial agonist, so can provide low level of cardiac stimulation)

Use: Hypertension, Angina pectoris, Arrhythmias, Myocardial infarction, Acute treatment of MI, Secondary prevention following MI, Aortic dissection, Hypertrophic cardiomyopathy (CHF), Dumb

Adverse Effects: insomnia, nightmares, hallucinations, bronchoconstriction

Question 22

Atenolol

Answer 22

MOA: beta-1 blocker

Use: angina, tachycardia, (not very lipophilic so doesn’t cross BBB easily)

Adverse Effects: bradycardia, AV block, Raynaud phenomenon, rebound excitation if discontinued

Question 23

Metoprolol

Answer 23

MOA: beta-1 blocker

Use: angina, tachycardia

Adverse Effects: bradycardia, AV block, Raynaud phenomenon, rebound excitation if discontinued

Question 24

Esmolol

Answer 24

MOA: beta-1 blocker (very short 1/2 life)

Use: hypertensive emergency, acute arrhythmia

Adverse Effects: bradycardia, AV block, rebound excitation

Question 25

Labetolol

Answer 25

MOA: alpha and beta blocker

Use: hypertensive emergency

Adverse Effects: orthostatic hypotension

Question 26

Carvediolol

Answer 26

MOA: alpha and beta blocker

Use: hypertensive emergency, heart failure

Adverse Effects: orthostatic hypotension

Question 27

Mecamylamine

Answer 27

MOA: ACh receptor blocker

Use: hypertension in patients refractory to other antihypertensives

Adverse Effects: Parasympathoplegia and Sympathoplegia