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Quiz 1 Flashcards

1
Q

Norepi originates from

A

CNS

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2
Q

Epi originates from

A

adrenal medulla

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3
Q

___________ secrete norepinephrine

A

Postganglia

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4
Q

Big target for these meds – _________ nervous system at the ________ receptors.

A

sympathetic

adrenergic

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5
Q

______________________ converts dopamine to NE

A

Dopamine beta hydroxylase

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6
Q

Metabolism of NE

A
  • Monamine oxidase (MAO)

- Catechol-o-methyltranserase (COMT)

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7
Q

Adrenergic Receptors

A

alpha-1: periphery
alpha-2: central
beta-1: heart
beta-2: other smooth muscle

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8
Q

Alpha-1 Postsynaptic Receptor

A 
Activation increases intracellular calcium
Smooth muscle contraction
Peripheral vasoconstriction
Bronchoconstriction
Inhibits Insulin secretion
Stimulates glycogenolysis and gluconeogenesis
Mydriasis
GI relaxation
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9
Q

Alpha-2 Receptors: Pre/Post synaptic

A

Presynaptic in the PNS

  • Decreases entry of calcium into the cell
  • Limits the release of norepinephrine

Postsynaptic in the CNS

  • Sedation
  • Decreased sympathetic outflow
  • Decreased BP
  • Platelet aggregation
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10
Q

Beta-1 Postsynaptic Receptor:

A
  • Increases HR
  • Increases conduction velocity
  • Increases myocardial contractility
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11
Q

Beta-2 Postsynaptic Receptor:

A
  • Stimulation leads to smooth muscle relaxation
  • Peripheral vasodilitation
  • Decreases BP
  • Bronchodilation
  • Increases insulin secretion
  • Increases glycogenolysis and gluconeogenesis-
  • Decreases GI mobility
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12
Q

Look at slide 17-19

A

.

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13
Q

extended exposure to agonists reduces the number, but not their response. Results in tachyphylaxis.

A

Down regulation

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14
Q

chronic depletion of catecholamines or use of antagonists increases the number of receptors, but not their sensitivity. May account for withdrawal syndrome with beta blockers.

A

Up regulation

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15
Q

Occurs rapidly, Inability of the receptor to bind G protein (alter the function of the receptor)

A

Receptor Uncoupling

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16
Q

Occurs more slowly, Movement of receptors from the cell surface to intracellular compartments

A

Sequestration

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17
Q

Prolonged process, Movement of receptors from the cell surface to intracellular compartments, but then destroyed.

A

Downregulation

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18
Q

Disease of uncontrolled release of catecholamines due to an adrenal gland tumor. Constant SNS stimulation

A

Pheochromocytoma

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19
Q

Catecholamines are both _______________ and __________

A

neurotransmitters

hormones

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20
Q

All are sympathomomymetics, but all are not _____________

A

catecholomines

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21
Q

Compounds that resemble catecholamines except that hydroxyl groups are not present in both the __ and __ positions of the benzene ring.

A

Sympathomimetics

3

4

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22
Q

All sympathomimetics are derived from:

A

β phenylethylamine

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23
Q

Structures: Catechole, amine

A

OH

CN

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24
Q

Other uses of sympathomimetics:

A
  • Treatment of bronchospasm
  • Management of anaphylaxis.
  • Addition to local anesthetic to slow systemic absorption
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25
Catecholamines metab’d by both, non-catecholamines by:
MAO | Both are COMT and MAO
26
Look at slide 34
.
27
Inhibition of the reuptake of catecholamines uptake mechanism produces a ______ potentiation of effects of epinephrine than does inhibition of either enzyme.
greater
28
Parkinsons utilize MAOIs, can be med interactions. Will exibit what response to synthetic non-catecholamines?
exaggerated
29
vasoconstrictors direct hemodynamic effects
-Increase arterial resistance and afterload (Increase SVR and usually MAP) -Increase venous return (Increase preload and C.O.)
30
Hemodynamic Effects: reflex changes
- Decreased heart rate - Decreased conduction - Occasionally, decreased contractility
31
Non-cardiac effects of vasoconstrictors
- Bronchodilate - Glycogenolysis - Insulin, renin, pituitary hormone - CNS stimulation (low lipid solubility)
32
Risk of end organ damage and mortality increases with time:
MAP < 65 mmHg for 13-28 minutes | MAP < 50 mmHg for 1 minute
33
Contraindications/Complications of vasoconstrictors:
- Can worsen LV Failure - Can exacerbate RV Failure - Can decrease renal blood flow - Can mask hypovolemia
34
Most potent activator of Alpha-1 receptors
Epinephrine
35
Epinephrine Stimulates
Alpha-1, Beta-1, and Beta-2 receptors
36
Which pressor has highest risk of S/E's
Epinephrine
37
Epi low dose stimulates? Net effect?
Alpha-1 receptors in the skin, mucosa, and hepatorenal system while Beta-2 receptors are stimulated in skeletal muscle Net Effect: - decreased SVR and distribution of blood to skeletal muscle - MAP remains essentially the same
38
Epinephrine Intermediate doses
- Beta-1 - Increased H.R. and contractility and increased C.O. - Increased automaticity (May lead to dysrrhythmias)
39
Epi increases ____ better than NE
rate
40
Epinephrine high doses
- Potent vasoconstrictor including cutaneous, splanchnic and renal vascular beds - Used to maintain myocardial and cerebral perfusion - Reflex bradycardia can occur
41
Epinephrine
- Hyperglycemia - mydriasis - platelet aggregation* - sweating - headache - tremor - nausea - arrhythmias
42
Norepi increases
systolic, diastolic, and mean arterial pressure
43
Norepinephrine C.O.
- Cardiac output may increase at low doses, Higher doses - C.O. may decrease because of increased afterload and baroreceptor-mediated reflex bradycardia - Refractory hypotension
44
Look at 60-65
.
45
Ephedrine works at what receptors
Works at Alpha-1 and Beta receptors
46
Ephedrine Principle mechanism is increased __________________.
myocardial contractility
47
Ephedrine: ___________ greater than _________ constriction increases ________ and with increased heart rate and myocardial contractility, increases cardiac output (Beta-1 receptor action). Increases what as a result?
Venoconstriction arteriolar preload Increases Systolic and Diastolic BP as a result
48
Ephedrine: _____________ can occur – negative feedback loop at adrenergic receptors, no more N.E. (can be in first 24 hours).
Tachyphylaxis
49
Ephedrine preserves or increases ________ blood flow.
uterine
50
Which non-catecholamine is a bronchial smooth muscle relaxant?
Ephedrine
51
Phenylephrine Increases
preload > afterload
52
Phenylephrine causes
- reflex bradycardia - Decreased renal and splanchnic blood flow - Increased pulmonary artery resistance and pressure - No dysrrhythmias as a direct effect - but heart can respond to whats happening in periphery
53
look at slide 79
.
54
Vasopressin effects
- Stimulates vascular V1a receptors causing intense arterial vasoconstriction. - In the renal-collecting ducts increases the permeability of cell membranes resulting in the passive reabsorption of water (V2 effect).
55
Vasopressin tidbits
- AQP2 (auquporin) is a channel allowing fluid back to blood stream from collecting duct - V1 receptors increase aldosterone which also increases BP
56
Unlike _____________, effects of _________________ are preserved during hypoxia and severe acidosis.
catecholamines arginine vasopressin
57
Pts on MAOIs do what to the response of vasoconstrictors?
exxagerated response
58
treatment for pt on cocaine?
Beta blocker and combine wit alpha blocker (labetalol/Coreg)
59
Phentolamine is what?
alpha 1 and 2 antagonist
60
what to do if norepi extravasates?
phentolamine elevate extremity warm compress

My Pharm II (8 decks)

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