Pharmacology General Flashcards
Define Chronotrope
Agent that affects heart rate
(+) increases HR and (-) decreases HR
Define Inotrope
Agent that affects myocardial contractility
(+) increases contractility
(-) decreases contractility
Define Inotrope
Agent that affects rate of conduction
(+) increases conduction rate
(-) decreases conduction rate
What action do Vasoactive drugs have?
Agents that effect the vessel tone
What action do Vasopressors have?
Agent that causes vasoconstriction, increasing systemic vascular resistance.
TDLR; Increase BP
What mechanism of action does: Catecholamine have?
Depends where they bind
sympathomimeteic action; similar to vasopressors
Increases (response to stimuli/stress)
- HR, BP, metabolic rate
- Vasodilation or vasoconstriction
- Regulation of mood/behaviour
- Regulation of Metabolic process
Which drug group are direct-acting?
aka have a mimicking or modifying affect?
Muscarinic receptor agonists
which drug group inhibits and is indirect-acting?
acetylcholinesterase inhibitors
(ach)
Agonist vs Antagonist drugs?
Agonist drugs: STIMULATE
- bind to receptor; producing/stimulating a response via chemical or receptor
Antagonist drugs: STOP
- bind to the receptor on the primary site which stops the receptor from producing a response
where are a-adrenergic receptors located
- What is their function?
Located in the peripheral vasculature
Regulate smooth muscle tone
Which neurotransmitters bind to a-adrenergic receptor sites?
Sympathetic: Norepinephrine and epinephrine.
Where are B-adrenergic receptors found?
Airways and Cardiac muscles
what function do B-andrenergic receptors have?
Inhibitory for airways
Excitatory for cardiac muscles
What are the 2 subtypes for B-adrenergic receptors?
B1 and B2
what does B-1 adrenergic receptors agonist stimulation do?
Excites.
- Increases heart rate
- myocardial contractility
- rate of conduction.
In the heart.
what does B2 adrenergic receptors agonist stimulation do?
Relax/stop
Lungs and smooth muscles relax
via bronchodilation
what happens when Dopaminergic receptors cause agonal stimulation ?
Agonist stimulation causes vasodilation and increased blood flow to the cerebral coronary and renal vascular beds
Where are dopaminergic receptors located?
Smooth muscle cells in the cerebral coronary and renal vascular beds
Function of Epinephrine (adrenalin)?
Stimulation.
Both an A and B agonist.
Combo of vasopressor, inotropic, chronotropic, and domotropic properties.
When would you use epinephrine?
Cardiac arrest: initial does 1mg (1:10,000 sol’n), repeat every 3-5 mins.
pulseless arrhythmias:
-Ventricular tachycardia
-V Fib
-PEA asystole
Why is epinephrine used for cardiac arrest?
increases both coronary and cerebral perfusion pressure (CPP) pressures
What is Cerebral perfusion pressure (CPP)
Pressure gradient causing cerebral blood flow to the brain.
must be maintained within narrow limits:
-Too little = brain tissue to become ischemic.
-Ttoo much = raised intracranial pressure.
why would you want a Hypotension action from epinephrine?
Anaphylaxis or severe allergic reactions.
its an infusion admin’d SQ or IM
Norepinephrine (NE) is also referred to as
Levophed
A powerful a and B1 receptor agonist.
What is the function of Levophed (NE)
hint what does B1 do?
Increases myocardial contractility (Inotrope)`
Too much can cause enough vasoconstriction to peripheries to the point where fingers and toes are at risk
What are the indications for Levophed use?
Severe hypotension due to low systemic vascular resistance (SVR)
What is the function of Dopamine (intropin)
- When would you use Dopamine?
Hypotension and Shock
Stimulates A, B1, and dopaminergic receptors.
- Its a precursor for NE
- Dose dependent (varying affects)
https://quizlet.com/ca/678582021/cardiac-pharmacology-flash-cards/
Left off at dopamine low dose slide.
Function of Vasopressin?
hint non-andrenergic peripheral vasopressor
Used on patients w/hypotension due to distributive shock.
treats diabetes insipidus
PIPE - injected via vein.
what is the function of: phenylephrine (neo-synephrine)
Hypotension
Alpha agonist w/minimal B stim.
similar to epinephrine but longer acting.
used as a pre med if RSI or BP is dropping.
what is the primary difference for epinephrine and norepinephrine?
Both affect the heart.
Norepinephrine has more of an affect on blood vessels.
What does PIPE mean?
A popular route of admin for injection via a vein.
what is the function of: Inarione and milirone?
PIPE
Inodilators; cause inotropic effects in the heart and vasodilatation in the periphery. Decreases after load.
Treats severe CHF or cardio genie shock refractory to medical therapy.
What is Atropine used for?
symptomatic bradycardias
( 1mg IV bolus and repeat every 3-5min)
A parasympatholytic that enhances both SA and AV node conduction
What are affects does Dobutamine (Dobutrex) have?
B1 effects, net change on BP is varying.
used for patients with pump problems who have good systolic blood volume (cardiogenic shock)
What are affects does Isoproterenol (Isuprel)
A pure B agonist (Potent inotrope and chronotrope)
-but decreased BP due to B2 stimulation
Never an agent of choice anymore -may be used in refractory bradycardia or B-blocker OD
What is the trade name, Drug class, (action + use) for: Propofol?
Trade name: Diprivan
Drug class: Anesthetic; sedative; hypnotic and induction agent.
Onset of action and duration for:
Propofol (Diprivan)?
Onset: 15-30 seconds
Duration: 5-10 minutes
Dose: 0.005-0.05 mg/kg/min (ICU); 1-2.5 mg/kg (induction)
Pro and Cons for: Propofol (Diprivan)?
Pros:
-decreases ICP,
-rapid emergence,
-anti-nausea properties
Cons:
-Respiratory/CVS depressant (breathing and BP drop)
-propofol infusion syndrome (PRIS) leads to persistent bradycardia leading to asystole,
-pain at site of admin. no analgesic properties.
What is the trade name, Drug class, (action + use) for: Ketamine
Drug class: Anesthetic, sedative, hypnotic, and induction agent.
Mechanism of Action: Multiple.
-Produces a dissociative anesthesia results in analgesia, reduced, sensory perception, immobility, and amnesia.
Hypnotic effects mediated by
-blockade of NMDA receptors
Pros and cons for: Ketamine?
Commonly Used for children.
Pro:
minimal respiratory depression, increases blood pressure, bronchodilation.
Con:
-Hallucinations on emergence (dim lights, minimize sound in room)
-can cause delirium
What are hypnotic effects for drugs?
TLDR: Sedation:Induce drowsiness & aid sleep
-Hypnotics typically have quicker onset & less duration
Sedatives and hypnotics are often the same drugs, just higher doses for hypnotic purposes.
● Used mainly to treat insomnia or for anesthesia purposes.
● IV Anesthetic-Hypnotics are fast acting agents used for pre-sedation or to induce general anesthesia/procedural anesthesia
What is a analgesic?
Drug used to relieve pain.
What is the trade name, Drug class, (action + use) for: Phenobarbital
Drug class: Barbiturate; hypnotic
Use: Anti-anxiety
-control seizures
-manage addiction (mimics the feel)
What are barbiturates?
hypno-sedative
They relieve seizures, insomnia, anxiety, and can be used as anesthesia (prevent pain).
can also induce coma for increased ICP
Pros and Cons for: Phenobarbital
Pro: prevent seizures and reduce anxiety
-long acting
Con:
respiratory and cardiovascular depression
What is the trade name, Drug class, (action + use) for: Lorazepam?
Trade name: Ativan
Drug class: Benzodiazepine; sedative; hypnotic, anxiolytic
Use: anti-anxiety
-treats alcohol withdrawal
-preop sedation
Pros and Cons for: Lorazepam?
Con: associated with dependence (addiction)
What is the trade name, Drug class, (action + use) for:
Midazolam?
Trade: Versed
Drug class: Benzo, sedative, hypnotic, anxiolytic, induction
Use: anti-anxiety
-anesthesia
-preop sedation/amnesia
-treat acute seizures
Pros and cons for: Midazolam?
Pro: used in conscious sedation for critical care when propofol is not available (in tandem with morphine)
-NOT AN ANALGESIC
-MIN respiratory and cardiovascular depression
Con: nausea/vomiting
little hangover effect
What is reversal agent for benzodiazepines or overdoses?
Flumazenil
What is the trade name, Drug class, (action + use) for:
Flumazenil?
Drug class: Benzodiazepine antagonist
Use: used to reverse benzos or overdoses.
Antagonist for benzo receptor sizes on GABA receptors
What is the use and drug class for Clonidine?
Drug class: A2 receptor agonist
Use: activates A2 receptors causing vasodilation.
Commonly used for CNS side effects such as:
-drowsiness and sedation
-indicated to assist night time sleep in critical care
What are ace inhibitors and what is their use?
ACE inhibitors are angiotensin converting enzymes (ACE)
Use: Prevent vasodilation
-First line treatment for pulmonary hypertension
-They inhibit the creation of angiotensin II w/ACE enzyme.
What does angiotensin II cause and why is it bad?
Vasoconstriction; increases blood pressure.
What are common ACE inhibitors or drugs w/similar affects?
Ramipril (altace)
Captopril
Clonidine
Enalapril (vasotec)
hydralazine
Nitroglycerin
nitroprusside
Prazosin
are all vasodilators
What is the trade name + use for: Dexmedetomidine
Trade name: Precedex
Drug class: sedative
Use: Short acting alpha 2 adrenergic agonist
-inhibits the release of norepinephrine
-sedation of intubated patients (during or postop)
-IV anesthetic
Autonomic nervous system branches
Sympathetic: fight or flight response
Parasympathetic: Discrete, finely tuned control of daily functions
What are neurotransmitters for the sympathetic nervous system?
Acetylcholine at ganglionic
Norepinephrine at receptor
What are neurotransmitters for the parasympathetic nervous system?
Acetylcholine at all sites
Receptors for the sympathetic nervous system?
Alpha, beta, and dopaminergic
Receptors for the parasympathetic nervous system?
Muscarinic and nicotinic
What are cholinergic receptors?
Nicotinic
Muscarinic
Where are nicotinic receptors found?
autonomic ganglia, neuromuscular junctions , and CNS
What are non-depolarizing neuromuscular blockers commonly used as?
Muscle relaxants
3 common Neuromuscular blocking agents (NMB) agents?
what is their use?
(needs edit but not wrong)
NMB = Neuromuscular blocking agents aka muscle relaxants = paralyzing agents
-Cisatracurium (nimbex)
-rocuronium (Zemuron)
-Succinycholine (Anectine) - not polarizing
Methadone class and use?
Drug class: synthetic opioid analgesic
Morphine drug class and use?
Drug class: natural occurring opioid analgesic
for moderate to severe pain, often used for end of life to decrease refractory pain and dyspnea
what is the trade name, class and use for: Naloxone
Drug class: Opioid antagonist
Use: Reverses opioid overdose.
What drug reverses opioid overdose?
naloxone (Narcan)
What is the trade name, class, and use for: Fentanyl?
Trade name: Sublimaze
Class: synthetic opioid analgesic
Use: prevents pain (mod-sev)
-fast onset
What is the trade name, class and use for: Meperidine?
Trade name: Demerol
Class: synthetic opioid analgesic
Use: Prevents pain
-mild relief
-used during and postop
What is the trade name, class, and use for: Haloperidol?
Trade name: Haldol
Class: antipsychotic
Use: Treat acute psychosis when hallucinations and delirium present
-primary use blocks dopamine receptors
What are functions of anti-psychotic drugs?
+ common drugs?
Reduce/control psychotic symptoms such as:
-paranoia
-delusion
-anxiety
-agitation
Common drugs:
-risperidone
-quetiapine (Seroquel)
-olanzapine (Zyprexa)
-paliperidone (Invega)
-aripiprazole (Abilify)
-clozapine (Clozaril).
Does succinylcholine (anectine) have a reversal agent?
No.
What is the drug class and use for: Neostigmine (prostigmin)?
Class: Indirect-acting cholingergic
-inhibits acetylcholinesterase (ACH breakdown)
Use: improve muscle tone (enable movement)
-antimuscarinic (prevent activation)
-Can activate all cholinergic sites
What is the reversal agent for muscle relaxants?
Neostigmine
What is the trade name, class and use for: lidocaine
Class: local anesthetic
Use: prevent pain
-short term use
-usually combined with epi for local anesthesia
-blocks sodium channels preventing depolarization of signal transmissions
What are the 4 classes of anti-arrhythmic drugs?
what do they do?
Class 1 - Sodium Channel blockers
Class 2 - Beta Blockers
Class 3 - Potassium channel blockers
Class 4 - Calcium channel blockers
Generally, they affect cardiac action potential
What is a class 1 anti-arrhythmic?
what is the use of: succinylcholine (Anectine)?
Paralytic; usually used for intubation because it has a rapid onset and short duration.
Onset: 30-60s
duration: 3-5 mins
Generally, what does Beta I, II, and, III stimulation affect?
B1 = Heart + Kidneys
B2 = Lungs + smooth muscles
B3 = Adipose Tissue
What is the function of cholinesterase?
Breakdown ACh (acetylcholine)
what is the main benefit of acetylcholinestarse inhibitors [AChE]?
By preventing the enzyme cholinesterase enzyme from breaking down ACh;
Both level and duration of neurotransmitter action increases
Acetylcholine [ACh] is a neurotransmitter involved w/functions in the nervous systems:
what are some functions that would be involved w/hemodynamics rather than neurological conditions ?
- Muscle contraction
- Regulation of autonomic system; controls involuntary action such as breathing, HR, digestion
- Attention & Arousal; regulation of sleep-wake cycles
- Pain perception (sensitivity)
Which Target receptors do norepinephrine and epinephrine target
(hint they’re not the same)
norepinephrine: Alpha and Beta-1 adrenergic receptors
epinephrine: Beta 1 and Beta 2 adrenergic receptors
Where are norepinephrine and epi released from?
N: Brain
E: adrenal glands
what Effects on the body do: norepinephrine [NE] and epi have?
What is the difference?
Both increase HR and BP; epi is more potent w/greater affect on the heart and blood vessels
Difference:
-Epi also bronchodilates, [NE] doesn’t
-Duration (Epi is longer, [NE] is shorter
What are combo inhalers comprised of?
LABA + inhaled corticosteroid for long-term control of asthma
What action does a inotrope have?
The factor that increases/decreases the strength of contraction
How does epinephrine increase coronary pressure/help w/cardiac arrest?
- Increased HR and strength of contraction
- Vasodilation (increased blood flow)
- sympathetic response (increase HR, force of contraction, and increased vascular resistance)
The main mech of action involved with epi in relation to anaphylaxis is bronchodilation of airways.
How else does epi help w/a anaphylaxis or allergic reactions?
vasoconstriction of blood vessels which helps reduce swelling.
decreased release of inflammatory mediators (like histamine)
Tobramycin use/class?
Antibiotic
- in our case, used for CF caused by bacterial infection.
What is sympathomimeteic action?
stimulates sympathetic nerves
Which response does stimulation have dopaminergic receptors have?
Both agonist and antagonist response.
- Depends where they interact/bind
when would you use dopamine?
As a precursor for NE.
- Used for hypotension
- it stimulates [a],[B1], and dopaminergic receptors
