Pharm: ANS Flashcards
Epinephrine
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
What are 3 contraindication for all sympathomimetic drugs?
Patients that use:
Cocaine and tricyclic antidepressants
MAO inhibitors
Thyroid hormones
Reserpine
MOA: inhibits vesicular monoamine transporter (VMAT) in presynaptic neurons preventing NE formation.
Use:
Not used anymore but tested on boards
Adverse Effects: depression
Norepinephrine
MOA: alpha-1, alpha-2, Beta-1 agonist (little beta-2 effect)
Use: resuscitation of cardiac arrest, hypotensive states
Adverse Effects: tachycardia, hypertensive crisis
Isoproterenol
MOA: Beta-1 and Beta-2 agonist
Use: AV block, bradycardia (emergency situations in anticipation for pacemaker placement)
Fenoldopam
MOA: D1 agonist
Use: severe hypertension (dilates coronary arteries to prevent heart attack)
Dopamine
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
Dobutamine
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
Phenylephrine
MOA: alpha-1 agonist
Use: hypotensive emergency to preserve cerebral and coronary blood flow, maintain blood pressure during anesthesia
Methoxamine
MOA: alpha-1 agonist
Use: hypotensive emergency to preserve cerebral and coronary blood flow, maintain blood pressure during anesthesia
Midodrine
MOA: alpha-1 agonist
Use: postural hypotension
Clonidine
MOA: alpha-2 agonist
Use: hypertension
Adverse Effects: Dry mouth, sedation, Dose-related withdrawal syndrome
alpha-methyldopa
MOA: alpha-2 agonist
Use: pregnancy-related hypertension
Adverse Effects: hepatotoxicity, hemolytic anemia, seation, Dose-related withdrawal syndrome
Prazosin
MOA: alpha-1 antagonist
Use: hypertension
Adverse Effects: 1st dose hypotension (pts should take it before bed to avoid orthostatic hypotension and fainting)
Doxazosin
MOA: alpha-1 antagonist
Use: hypertension
Adverse Effects: 1st dose hypotension (pts should take it before bed to avoid orthostatic hypotension and fainting)
Terazosin
MOA: alpha-1 antagonist
Use: BPH (induces apoptosis in the prostate)
Adverse Effects: 1st dose hypotension, syncope
Phenoxybenzamine
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)
Phentolamine
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)
Propranolol
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
Timolol
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
Pindolol
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
Atenolol
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
Metoprolol
MOA: beta-1 blocker
Use: angina, tachycardia
Adverse Effects: bradycardia, AV block, Raynaud phenomenon, rebound excitation if discontinued
Esmolol
MOA: beta-1 blocker (very short 1/2 life)
Use: hypertensive emergency, acute arrhythmia
Adverse Effects: bradycardia, AV block, rebound excitation
Labetolol
MOA: alpha and beta blocker
Use: hypertensive emergency
Adverse Effects: orthostatic hypotension
Carvediolol
MOA: alpha and beta blocker
Use: hypertensive emergency, heart failure
Adverse Effects: orthostatic hypotension
Mecamylamine
MOA: ACh receptor blocker
Use: hypertension in patients refractory to other antihypertensives
Adverse Effects: Parasympathoplegia and Sympathoplegia
