Rx Flashcards
epinephrine
Class: Adrenergics
catecholamines
A1&A2&B1&B2&B3 agonist
sympathetic stimulation = inc heart rate, contractility, BP and CO
low doses: B preferred
uses: cardiac arrest, cardiogenic shock, severe hypotension, anaphylaxis, respiratory distress, urticaria, keep anesthetic “local”
side effect: hyperglycemic effect, tachycardia, arrhythmia, MI
~adrenaline
norepinephrine
Class: Adrenergics
catecholamines
A1&A2>B1 agonist
stimulates peripheral vasoconstriction and inc BP
use: shock, severe hyoptension
side effect: MI due to increased cardiac work
isoproterenol
Class: Adrenergics catecholamines B1 & B2 agonist inc HR, contractility and cardiac output use: bradycardia, asthma, bronchitis, and emphysema. side effects: tachycardia, MI
dopamine
Class: Adrenergics catecholamines low dose: D1&D2&B1 agonist high dose: A1&A2 agonist (act as vasopressor) increase contractility and HR use: cardiogenic shock, CHF *causes renal vasodialtion side effect: arrhythmias
dobutamine
Class: Adrenergics
catecholamines
B1 agonist
uses: cardiogenic shock, congestive heart failure
(increases contractility w/o increase HR) increases cardiac output
side effect: arrhythmias, hypotension
phenylephrine
adrenergic Agonists/ sympathomimetics
direct agents
A1>A2
vasopressor
uses: rhinitis, decongestion, SVT, hypotension, shock
*big vasoconstriction= increase systemic resistance= inc BP=vagal stimulation= slows heart rate
side effect: rebound mucous swelling
midodrine
Agonists/ sympathomimetics
direct agents
A1
uses: hypotension, retinal exams (dilates pupils)
brimonidine
presynaptic anti-adrenergic
direct, Agonist A2
causes dec NE and suppresses sympathetic
uses: glaucoma (decreases aqueous humor formation)
clonidine
presynaptic anti-adrenergic direct, Agonist A2 causes dec NE and suppresses sympathetic uses: HTN, (inhibits sympathetic outflow) side effect: sedation (CNS active)
oxymetazoline (Afrin)
Agonists/ sympathomimetics
direct agents
A1 & A2
use: decongestion
albuterol/salmeterol/terbutaline (proventil/ventolin)
adrenergic Agonists/ sympathomimetics direct agents B2 causes bronchiodilation use: asthma, COPD side effects: tachycardia, tremor
fenoldopam
adrenergic Agonists/ sympathomimetics direct agents D1 use: severe HTN rapid renal and splanchnic vasodilating effects
amphetamine
adrenergic Agonists/ sympathomimetics
Indirect acting agents
mechanism: inhibits MAO, releases endogenous NE from storage vesicles= inc NE binding to adrenergic receptors
CNS excitation (can cross BBB)
stimulant: increases heart rate and blood pressure and decreases appetite
ephedrine
adrenergic Agonists/ sympathomimetics
Mixed agent
Indirect acting: inc NE release from neuron and binding to adrenergic receptor
DIRECTLY stimulates A1&B2
use: asthma, nasal decongestion, hypotension
side effect: HTN
phenoxybenzamine
adrenergic Antagonists/ adrenergic receptor blockers
A1 & A2,
noncompetitive, binds irreversibly
use: HTN
side effect: reflex tachycardia, increased insulin
phentolamine
Antagonists/ adrenergic receptor blockers
A1 & A2, competitive
causes: dilation of smooth muscle and dec BP
Uses: HTN
side effects: reflex tachycardia and arrhythmias
prazosin
Antagonists/ adrenergic receptor blockers
A1 selective
competitive
causes blood vessel vasodilation and dec BP
use: HTN (does not cause tachycardia)
side effect: hypotension and dizziness
“minipress”
tamsulosin
Antagonists/ adrenergic receptor blockers
A1a selective (GU tract)
use: benign prostatic hypertrophy and bladder obstruction
side effect: floppy iris syndrome
terazosin
Antagonists/ adrenergic receptor blockers A1a selective (GU tract) use: benign prostatic hypertrophy, HTN
pindolol
Antagonists/ adrenergic receptor blockers
B1 & B2, weak
intrinsic sympathomimetic activity (less effect on resting HR)
use: HTN
side effect: bronchoconstriction
propranolol
Antagonists/ adrenergic receptor blockers,
Antiarrhythmic: class 2
B1 & B2, strong
effect: prolongs AV conduct and refract; decreases HR and contractility
use: angina pectoris, HTN, MI, SVT, ventricular arrhythmia, tachycardia, Afib, Aflutter
side effect: bronchoconstriction, heart failure
metoprolol
Antagonists/ adrenergic receptor blockers
Antiarrhythmic: class 2
B1 selective
(-) inotropy, (-) chronotropy
use: HTN, MI, SVT, CP, tachycardias, IHD, CHF
less likely to cause bronchoconstriction
side effect: bradycardia, enters brain (CNS sedation)
labetalol
Antagonists/ adrenergic receptor blockers
causes vasodilation
Mixed: A1 & B
use: HTN, angina pectoris, CHF
side effects: hypotension, fatigue, bradycardia
carvedilol
Antagonists/ adrenergic receptor blockers
Mixed: A1 & B
use: HTN, angina pectoris, tachycardia, CHF
(inc ejection fraction)
guanethidine
Antagonists/ block adrenergic neuronal function (peripheral pre-synaptic)
decreases NE in synaptic cleft
use: severe HTN, renal HTN
side effects: hypotension, fluid retention, impaired ejaculate, diarrhea, nerve toxicity
**not used anymore
hexamethonium (C6)
nonspecific Antagonist
adrenergic and nicotinic cholinergic receptors (nAChnR)
blocks all stimulation of pre-ganglionic neurons
stops release of NE and ACh
use: HTN
side effects: severe
not used clinically
atropine
anticholinergic
nonselective muscarinic Antagonist
use: bradycardia, vagal hyperactivity, bronchospasms, over-secretions
(treats DUMBBLSS)
side effect: “hot as a hare, dry as a bone, red as a beet, blind as a bat, and mad as a hatter”
flush, blurred vision, dec secretions, hyperthermia, delirium, hallucinations
big CNS effects
cocaine
adrenergic agonist; indirect sympathomimetic
block catecholamine reuptake by membrane transporter (NET)
increases NE in synapse
use: causes vasoconstriction, local anesthesia
side effect: MI
(+) inotropic drug
increase heart contractility
(+) chronotropic drug
increase heart rate
nicotine
nicotinic agonist
nicotinic acetylcholine receptors
stimulate both para- and sympathetic postganglionic neurons
causes skeletal muscle contraction
side effect: medullary depression, inc HR/BP/RR, spasms, toxic
succinylcholine (anectine)
nicotinic agonist
binds nicotinic acetylcholine receptors (Nm subtype)
causes prolonged neuromuscular depolarization
use: paralysis for surgery
side effect: malignant hyperthermia, hypotension, arrhythmias
depolarizing blockade- cannot be overcome by cholinesterase inhibitor
pancuronium, rocuronium
antinicotinic
competetive antagonist of nicotinic acetylcholine receptors (Nm)
use: paralysis for surgery
side effect: histamine release, hypotension, increase HR, edema
nondepolarizing blockade- can be overcome by cholinesterase inhibitor
ipratropium (atrovent)
antimuscarinic
nonselective antagonist acts on parasympathetic sites
inhaled to M3 acetylcholine receptors in bronchi
cause: dec bronchoconstrictions and secretions
use: COPD
Procainamide
Antiarrhythmic: class 1A: moderate Na channel blocker binds Na in active state slows conduction/prolong refractory period reduces ectopic foci automaticity use: reentry and ectopic; SVT, VT, VF, WPW side effect: SLE, long QT
Quinidine
Antiarrhythmic: class 1A: moderate Na channel blocker binds Na in active state slows conduction/prolong refractory period reduces ectopic foci automaticity use: reentry and ectopic; SVT, VT, VF side effect: long QT, thrombocytopenia, strong anti-cholinergic effect
Lidocaine
Antiarrhythmic: class 1B: WEAK Na channel blocker binds Na in both active/inactive state increase velocity at AV; decrease AP reduces ectopic foci automaticity may shorten QT use: VT, VF, WPW, use after MI side effects: CNS toxicity and cardiac depression IV only
Flecainide
Antiarrhythmic: class 1C: STRONG Na channel blocker
reduces SA node and ectopic foci automaticity
reduces all conduction velocity
prolongs refractory period, long (QT, QRS, and PR)
use: Afib
side effects: heart block, arrhythmias
atenolol
Antiarrhythmic: class 2, B-blockers B1 selective use: HTN, CP/MI, does not cross BBB decreases HR, output, renin release little resp. effects (no B2)
labetalol
Antiarrhythmic: mixed alpha and beta blocker
A1, B1, B2 antagonist
lowers BP (A1), no reflex tachycardia (B1)
use: HTN, CHF, CP
side effect: orthostatic hypotension, heart failure
carvedilol
Antiarrhythmic: mixed alpha and beta blocker
A1, B1, B2 antagonist
lowers BP (A1), no reflex tachycardia (B1)
use: CHF, HTN, CP
side effect: orthostatic hypotension
amiodarone
Antiarrhythmic: class 3, prolong K repolarization
decrease K efflux
reduce conduction velocity
prolongs refractory and AP
use: VT, Vfib, Afib, Aflutter
side effects: long half life, long (QT, QRS, PR), eye dysfunctions
CYP3A4: affects renal/hepatic elimination (must change warfarin and digoxin levels)
sotalol
Antiarrhythmic: class 3, prolong K repolarization AND nonselective B-blocker prolong AP and refract period use: VT *less side effects than amiodarone
ibutilide
Antiarrhythmic: class 3, prolong K repolarization prolong AP slow inward Na current use: Afib, Aflutter side effect: long QT IV only
bretylium
Antiarrhythmic: class 3, prolong K repolarization
blocks the release of norepi from nerve terminals
prolongs AP
use: HTN, only affects ventricle (VT, Vfib)
verapamil
Antiarrhythmic: class 4, slow inward Ca
Non-dihydropyridine calcium channel blocker
act on heart
reduce SA/AV conduction, prolong refractory (long PR)
use: SVT, atrial tachy, atrial flutter, Afib
side effects: bradycardia, hypotension, AV block, GI effects
do not use on WPW
CYP3A4: affects renal/hepatic elimination (must change warfarin and digoxin levels)