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RT General Review > Pharmacology General > Flashcards

Pharmacology General Flashcards

1
Q

Define Chronotrope

A

Agent that affects heart rate

(+) increases HR and (-) decreases HR

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2
Q

Define Inotrope

A

Agent that affects myocardial contractility

(+) increases contractility
(-) decreases contractility

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3
Q

Define Inotrope

A

Agent that affects rate of conduction

(+) increases conduction rate
(-) decreases conduction rate

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4
Q

What action do Vasoactive drugs have?

A

Agents that effect the vessel tone

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5
Q

What action do Vasopressors have?

A

Agent that causes vasoconstriction, increasing systemic vascular resistance.

TDLR; Increase BP

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6
Q

What mechanism of action does: Catecholamine have?

A

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
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7
Q

Which drug group are direct-acting?

aka have a mimicking or modifying affect?

A

Muscarinic receptor agonists

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8
Q

which drug group inhibits and is indirect-acting?

A

acetylcholinesterase inhibitors
(ach)

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9
Q

Agonist vs Antagonist drugs?

A

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
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10
Q

where are a-adrenergic receptors located

  • What is their function?
A

Located in the peripheral vasculature

Regulate smooth muscle tone

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11
Q

Which neurotransmitters bind to a-adrenergic receptor sites?

A

Sympathetic: Norepinephrine and epinephrine.

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12
Q

Where are B-adrenergic receptors found?

A

Airways and Cardiac muscles

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13
Q

what function do B-andrenergic receptors have?

A

Inhibitory for airways

Excitatory for cardiac muscles

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14
Q

What are the 2 subtypes for B-adrenergic receptors?

A

B1 and B2

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15
Q

what does B-1 adrenergic receptors agonist stimulation do?

A

Excites.

  • Increases heart rate
  • myocardial contractility
  • rate of conduction.

In the heart.

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16
Q

what does B2 adrenergic receptors agonist stimulation do?

A

Relax/stop

Lungs and smooth muscles relax

via bronchodilation

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17
Q

what happens when Dopaminergic receptors cause agonal stimulation ?

A

Agonist stimulation causes vasodilation and increased blood flow to the cerebral coronary and renal vascular beds

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18
Q

Where are dopaminergic receptors located?

A

Smooth muscle cells in the cerebral coronary and renal vascular beds

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19
Q

Function of Epinephrine (adrenalin)?

A

Stimulation.

Both an A and B agonist.

Combo of vasopressor, inotropic, chronotropic, and domotropic properties.

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20
Q

When would you use epinephrine?

A

Cardiac arrest: initial does 1mg (1:10,000 sol’n), repeat every 3-5 mins.

pulseless arrhythmias:
-Ventricular tachycardia
-V Fib
-PEA asystole

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21
Q

Why is epinephrine used for cardiac arrest?

A

increases both coronary and cerebral perfusion pressure (CPP) pressures

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22
Q

What is Cerebral perfusion pressure (CPP)

A

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.

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23
Q

why would you want a Hypotension action from epinephrine?

A

Anaphylaxis or severe allergic reactions.

its an infusion admin’d SQ or IM

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24
Q

Norepinephrine (NE) is also referred to as

A

Levophed

A powerful a and B1 receptor agonist.

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25
Q

What is the function of Levophed (NE)

hint what does B1 do?

A

Increases myocardial contractility (Inotrope)`

Too much can cause enough vasoconstriction to peripheries to the point where fingers and toes are at risk

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26
Q

What are the indications for Levophed use?

A

Severe hypotension due to low systemic vascular resistance (SVR)

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27
Q

What is the function of Dopamine (intropin)

  • When would you use Dopamine?
A

Hypotension and Shock

Stimulates A, B1, and dopaminergic receptors.
- Its a precursor for NE
- Dose dependent (varying affects)

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28
Q

https://quizlet.com/ca/678582021/cardiac-pharmacology-flash-cards/

Left off at dopamine low dose slide.

A
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29
Q

Function of Vasopressin?

hint non-andrenergic peripheral vasopressor

A

Used on patients w/hypotension due to distributive shock.

treats diabetes insipidus

PIPE - injected via vein.

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30
Q

what is the function of: phenylephrine (neo-synephrine)

A

Hypotension

Alpha agonist w/minimal B stim.

similar to epinephrine but longer acting.

used as a pre med if RSI or BP is dropping.

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31
Q

what is the primary difference for epinephrine and norepinephrine?

A

Both affect the heart.

Norepinephrine has more of an affect on blood vessels.

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32
Q

What does PIPE mean?

A

A popular route of admin for injection via a vein.

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33
Q

what is the function of: Inarione and milirone?

A

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.

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34
Q

What is Atropine used for?

A

symptomatic bradycardias
( 1mg IV bolus and repeat every 3-5min)

A parasympatholytic that enhances both SA and AV node conduction

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35
Q

What are affects does Dobutamine (Dobutrex) have?

A

B1 effects, net change on BP is varying.

used for patients with pump problems who have good systolic blood volume (cardiogenic shock)

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36
Q

What are affects does Isoproterenol (Isuprel)

A

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

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37
Q

What is the trade name, Drug class, (action + use) for: Propofol?

A

Trade name: Diprivan
Drug class: Anesthetic; sedative; hypnotic and induction agent.

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38
Q

Onset of action and duration for:
Propofol (Diprivan)?

A

Onset: 15-30 seconds

Duration: 5-10 minutes

Dose: 0.005-0.05 mg/kg/min (ICU); 1-2.5 mg/kg (induction)

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39
Q

Pro and Cons for: Propofol (Diprivan)?

A

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.

40
Q

What is the trade name, Drug class, (action + use) for: Ketamine

A

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

41
Q

Pros and cons for: Ketamine?

A

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

42
Q

What are hypnotic effects for drugs?

A

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

43
Q

What is a analgesic?

A

Drug used to relieve pain.

44
Q

What is the trade name, Drug class, (action + use) for: Phenobarbital

A

Drug class: Barbiturate; hypnotic

Use: Anti-anxiety
-control seizures
-manage addiction (mimics the feel)

45
Q

What are barbiturates?

A

hypno-sedative

They relieve seizures, insomnia, anxiety, and can be used as anesthesia (prevent pain).

can also induce coma for increased ICP

46
Q

Pros and Cons for: Phenobarbital

A

Pro: prevent seizures and reduce anxiety
-long acting

Con:
respiratory and cardiovascular depression

47
Q

What is the trade name, Drug class, (action + use) for: Lorazepam?

A

Trade name: Ativan
Drug class: Benzodiazepine; sedative; hypnotic, anxiolytic

Use: anti-anxiety
-treats alcohol withdrawal
-preop sedation

48
Q

Pros and Cons for: Lorazepam?

A

Con: associated with dependence (addiction)

49
Q

What is the trade name, Drug class, (action + use) for:
Midazolam?

A

Trade: Versed
Drug class: Benzo, sedative, hypnotic, anxiolytic, induction

Use: anti-anxiety
-anesthesia
-preop sedation/amnesia
-treat acute seizures

50
Q

Pros and cons for: Midazolam?

A

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

51
Q

What is reversal agent for benzodiazepines or overdoses?

A

Flumazenil

52
Q

What is the trade name, Drug class, (action + use) for:
Flumazenil?

A

Drug class: Benzodiazepine antagonist

Use: used to reverse benzos or overdoses.

Antagonist for benzo receptor sizes on GABA receptors

53
Q

What is the use and drug class for Clonidine?

A

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

54
Q

What are ace inhibitors and what is their use?

A

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.

55
Q

What does angiotensin II cause and why is it bad?

A

Vasoconstriction; increases blood pressure.

56
Q

What are common ACE inhibitors or drugs w/similar affects?

A

Ramipril (altace)
Captopril
Clonidine
Enalapril (vasotec)
hydralazine
Nitroglycerin
nitroprusside
Prazosin

are all vasodilators

57
Q

What is the trade name + use for: Dexmedetomidine

A

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

58
Q

Autonomic nervous system branches

A

Sympathetic: fight or flight response

Parasympathetic: Discrete, finely tuned control of daily functions

59
Q

What are neurotransmitters for the sympathetic nervous system?

A

Acetylcholine at ganglionic

Norepinephrine at receptor

60
Q

What are neurotransmitters for the parasympathetic nervous system?

A

Acetylcholine at all sites

61
Q

Receptors for the sympathetic nervous system?

A

Alpha, beta, and dopaminergic

62
Q

Receptors for the parasympathetic nervous system?

A

Muscarinic and nicotinic

63
Q

What are cholinergic receptors?

A

Nicotinic

Muscarinic

64
Q

Where are nicotinic receptors found?

A

autonomic ganglia, neuromuscular junctions , and CNS

65
Q

What are non-depolarizing neuromuscular blockers commonly used as?

A

Muscle relaxants

66
Q

3 common Neuromuscular blocking agents (NMB) agents?

what is their use?

(needs edit but not wrong)

A

NMB = Neuromuscular blocking agents aka muscle relaxants = paralyzing agents

-Cisatracurium (nimbex)
-rocuronium (Zemuron)
-Succinycholine (Anectine) - not polarizing

67
Q

Methadone class and use?

A

Drug class: synthetic opioid analgesic

68
Q

Morphine drug class and use?

A

Drug class: natural occurring opioid analgesic

for moderate to severe pain, often used for end of life to decrease refractory pain and dyspnea

69
Q

what is the trade name, class and use for: Naloxone

A

Drug class: Opioid antagonist

Use: Reverses opioid overdose.

70
Q

What drug reverses opioid overdose?

A

naloxone (Narcan)

71
Q

What is the trade name, class, and use for: Fentanyl?

A

Trade name: Sublimaze
Class: synthetic opioid analgesic

Use: prevents pain (mod-sev)
-fast onset

72
Q

What is the trade name, class and use for: Meperidine?

A

Trade name: Demerol
Class: synthetic opioid analgesic

Use: Prevents pain
-mild relief
-used during and postop

73
Q

What is the trade name, class, and use for: Haloperidol?

A

Trade name: Haldol
Class: antipsychotic

Use: Treat acute psychosis when hallucinations and delirium present
-primary use blocks dopamine receptors

74
Q

What are functions of anti-psychotic drugs?
+ common drugs?

A

Reduce/control psychotic symptoms such as:
-paranoia
-delusion
-anxiety
-agitation

Common drugs:
-risperidone
-quetiapine (Seroquel)
-olanzapine (Zyprexa)
-paliperidone (Invega)
-aripiprazole (Abilify)
-clozapine (Clozaril).

75
Q

Does succinylcholine (anectine) have a reversal agent?

A

No.

76
Q

What is the drug class and use for: Neostigmine (prostigmin)?

A

Class: Indirect-acting cholingergic
-inhibits acetylcholinesterase (ACH breakdown)

Use: improve muscle tone (enable movement)
-antimuscarinic (prevent activation)
-Can activate all cholinergic sites

77
Q

What is the reversal agent for muscle relaxants?

A

Neostigmine

78
Q

What is the trade name, class and use for: lidocaine

A

Class: local anesthetic

Use: prevent pain
-short term use
-usually combined with epi for local anesthesia
-blocks sodium channels preventing depolarization of signal transmissions

79
Q

What are the 4 classes of anti-arrhythmic drugs?
what do they do?

A

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

80
Q

What is a class 1 anti-arrhythmic?

A
81
Q

what is the use of: succinylcholine (Anectine)?

A

Paralytic; usually used for intubation because it has a rapid onset and short duration.

Onset: 30-60s

duration: 3-5 mins

82
Q

Generally, what does Beta I, II, and, III stimulation affect?

A

B1 = Heart + Kidneys

B2 = Lungs + smooth muscles

B3 = Adipose Tissue

83
Q

What is the function of cholinesterase?

A

Breakdown ACh (acetylcholine)

84
Q

what is the main benefit of acetylcholinestarse inhibitors [AChE]?

A

By preventing the enzyme cholinesterase enzyme from breaking down ACh;

Both level and duration of neurotransmitter action increases

85
Q

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 ?

A
  1. Muscle contraction
  2. Regulation of autonomic system; controls involuntary action such as breathing, HR, digestion
  3. Attention & Arousal; regulation of sleep-wake cycles
  4. Pain perception (sensitivity)
86
Q

Which Target receptors do norepinephrine and epinephrine target

(hint they’re not the same)

A

norepinephrine: Alpha and Beta-1 adrenergic receptors

epinephrine: Beta 1 and Beta 2 adrenergic receptors

87
Q

Where are norepinephrine and epi released from?

A

N: Brain

E: adrenal glands

88
Q

what Effects on the body do: norepinephrine [NE] and epi have?
What is the difference?

A

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

89
Q

What are combo inhalers comprised of?

A

LABA + inhaled corticosteroid for long-term control of asthma

90
Q

What action does a inotrope have?

A

The factor that increases/decreases the strength of contraction

91
Q

How does epinephrine increase coronary pressure/help w/cardiac arrest?

A
  1. Increased HR and strength of contraction
  2. Vasodilation (increased blood flow)
  3. sympathetic response (increase HR, force of contraction, and increased vascular resistance)
92
Q

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?

A

vasoconstriction of blood vessels which helps reduce swelling.

decreased release of inflammatory mediators (like histamine)

93
Q

Tobramycin use/class?

A

Antibiotic

  • in our case, used for CF caused by bacterial infection.
94
Q

What is sympathomimeteic action?

A

stimulates sympathetic nerves

95
Q

Which response does stimulation have dopaminergic receptors have?

A

Both agonist and antagonist response.
- Depends where they interact/bind

96
Q

when would you use dopamine?

A

As a precursor for NE.

  • Used for hypotension
  • it stimulates [a],[B1], and dopaminergic receptors

RT General Review (42 decks)

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