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Pharmacology II > SNS drugs > Flashcards

SNS drugs Flashcards

1
Q

Drugs that enhance or mimic the effects of sympathetic nerve stimulation. Agonist agents used as medication.

A

Sympathomimetics

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2
Q

3 types of sympathomimetic agents

A
  1. Direct-acting agents
  2. Indirect-acting agents
  3. Both direct and indirect acting agents
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3
Q

Sympathomimetic agents that mimic the actions of the naturally occuring catecholamines NE, E, and dopamine in the body.

A

Direc-acting agents

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4
Q

Catecholamine that acts mainly at alpha receptors to cause vasoconstriction.

  • doesn’t effect cardiac output but is a potent agonist at alpha receptors causing vasoconstriction (↑ BP)
  • ↑ peripheral resistance (↑BP) but ↓ BP in skeletal muscles
A

NE

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5
Q

Catecholamine that acts at both alpa and beta receptors to cause a mixture of vasodilation and vasoconstriction in the same way the neurohormone works. Primarily an emergency hormone.

  • Significantly increases myocardial contraction (positive inotropic effect) causing an influx of Ca++ into the myocardium.
  • ↑ HR, Stroke Vol., Cardiac Output, O2 consumption, atrioventricular conduction, Insulin secretion
  • Causes tachycardia
  • ↓ BP in low doses, ↑peripheral resistance (↑BP) in large doses
A

E

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6
Q

A precursor to NE and E but has a role of its own in the CNS. It acts both directly and indirectly by releasing norepinephrine

A

Dopamine

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7
Q

Direct-acting agents (6)

A

NE, E, Dopamine, Dobutamine, Isoproterenol, Mitodrine

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8
Q

Indirect Acting agents (3)

A

Ephedrine
Phenylephrine
Others

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9
Q

Sympathomimetic agents that trigger the release of NE and E from their storage sites. Dual acting, have both direct and indirect action.

A

Indirect-acting agents

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10
Q

Catecholamine releasing agent.

- naturally occuring monoamine compound and trace amine derived from amino acid tyrosine.

A

Tyramine

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11
Q

A clinical syndrome characterized by decreased blood supply to body tissues, which result in cellular hypoxia.

A

Shock

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12
Q

Corrective response to SHOCK
When body experiences decreased o2 supply, the SNS response via hormones ____ and ____, also _____ and _____ are formed.
1. Constriction of arterioles which in turn increases PVR
2. Constriction of veins and increase venous tone
3. Stimulation of cardiac beta-receptors which increases HR and force of myocardial contraction.
4. Activation of RAAC (renin-angiotensin-aldosterone system)

A

NE & E, angiotensin II and aldosterone

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13
Q

3 Types of Shock

A
  1. Hypovolemic
  2. Cardiogenic (pump failure)
  3. Distributive or vasogenic
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14
Q

Type of shock that involves a loss of intravascular fluid volume due to loss of blood or fluid shifting with compartments.

A

Hypovolemic

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15
Q

Type of shock where myocardium losses its ability to contract adequately and CO insufficient.

A

Cardiogenic (pump failure)

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16
Q

Type of shock that results from severe hypotension and impaired blood flow.

A

Distributive or vasogenic

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17
Q

3 types of distributive or vasogenic shock

A
  1. Anaphylactic
  2. Neurogenic
  3. Septic
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18
Q

Type of distributive or vasogenic shock that results from hypersensitivity.

A

Anaphylactic shock

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19
Q

Type of distributive or vasogenic shock that results from inadequate SNS stimulation.

A

Neurogenic shock

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20
Q

Type of distributive or vasogenic shock that results from ineffective organism in blood.

A

Septic shock

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21
Q

Drug management of shock and hypotension.

A

Adrenergic drugs or Sympathomimetic drugs

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22
Q

Adrenergic agents that cause an increase in peripheral resistance thus resulting in elevated BP.

A

alpha-adrenergic agents (ie. NE and phenylephrine)

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23
Q

Adrenergic agents that cause increase in BP by increasing myocardial contractility and HR.

A

beta-adrenergic agents (ie. dobutamine and isoproterenol)

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24
Q

Adrenergic agents that have both alpha and beta adrenergic activity and are the most commonly used agents for shock ang hypotension.

A

Dopamine and Epinephrine

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25
Q

The drug of choice for the Tx of cardiogenic shock because it increases blood flow to the kidney and prevents possible renal shutdown.

A

Dopamine

26
Q

The drug of choice for management of anaphylactic shock. It is also used to manage other kinds of shock because it increases BP and heart contractility, and its the primary Tx for broncospasms.

A

Epinephrine.

27
Q

Used to manage cardiogenic and septic shock but, like epinephrine may contribute to renal shutdown.

A

Norepinephrine

28
Q

Nursing Implication for Tx of shock and hypotension

A

Monitor BP and pulse every 5-15 min during acute shock and hypotension therapy. Assess fror therapeutic effect. (systolic BP 80-100) and adverse effects (bradycardia, tachycardia, dysrythmias, etc.)

29
Q

Children (<18) are at greater risk for complication with Adrenergic Blockers (A-B). Complications include: (3)

A

Bradycardia, Difficulty breathing, glucose metabolism changes

30
Q

3 approved A-B drugs for Children

A
  1. Guanethidine and 2. prazosin (Tx HTN)

3. Phentolamine (Tx pheochromocytoma or tumor of the adrenal glands)

31
Q

Elderly pts may exp. adverse effects when using A-B drugs such as:

A

CNS, CVS, GI & Respiratory tract adverse effects.

32
Q

Why does elderly pts more likely to have toxicity when using A-B drugs?

A

Bc of impaired liver and renal function

33
Q

In elderly pts this drug is prescribed. It belongs to the class of medications called beta-blockers. Beta-blockers reduce the workload of the heart and help it to beat more regularly by blocking the effects of certain hormones. Bisoprolol is used for the control of mild to moderate high blood pressure but does not cure the condition.

A

Bisprolol

34
Q

Class of drugs that blocks alpha-1 and alpha-2 receptors, causing action at both arterial and venous blood vessels. It causes direct relaxation of vascular smooth muscles and lowers total peripheral resistance.

  • Used to prevent and control HTN episodes in pt with pheochromocytoma.
  • Antidote for reversing vasoconstrictive action of an overdose or an excessive response to IV administered NE or dopamine.
  • Adverse effects include tachycardia, diarrhea, dizziness, N&V
A

Alpha-adrenergic blockers (Adrenergic antagonists)

ROGITINE (PHENTOLAMINE)

35
Q

3 Drugs that are specific in blocking Alpha1-adrenergic receptors.

  • Inhibits NE reuptake by smooth muscle cells and reduce vasoconstriction and PVR.
  • In other words, causes dilation of arterioles and veins.
  • Increased blood flow and decrese BP. Constriction of pupil and increase GI motility. Vasodilation in both arterioles and veins leads to decreased supine and standing BP.
  • Prevents contraction of smooth muscles in internal organ including the prostate thus useful for treating urine retention.
  • Decrease vascular tone that causes vasodilation result in decrease BP
  • DOES NOT BLOCK PRESYNAPTIC-RECEPTOR SITES hence tachycardia does not occur.
  • Metabolized in the liver, excreted in urine.
  • Cross placenta barrier and enter breast milk.
A

Alpha-adrenergic blockers

  • Alpha1-adrenergic antagonists
    1. prazosin (Minipress) PO P1-3hr D4-6hr protein bound tx HTN
  • Doxazosin (Cardura) PO P1-3hr, D4-6hr protein bound Tx BPH
  • Tamsulosis (Flomax)
36
Q

Adverse effect of Alpha1-adrenergic antagonists

A
  1. First dose phenomenon (flushing, headache, dizziness, fainting, weakness, dysrythmias)
  2. Dry mouth, GI upset, visual disturbances
  3. Hypotension and hypothermia in the elderly
  4. Vasodilation caused by drug can cause flushing, rhinitis, nasal congestion and priaprism ( the erect penis does not return to its flaccid state)
37
Q

Contraindications for Alpha1-adrenergic antagonists

A

Allergy, Pregnancy and lactation, CHF, Renal and hepatic impairment, children

38
Q

Activation of this receptor lowers BP not by acting on the heart or blood vessels or the kidneys. When this receptor is activated, it directly triggers in the brain to act on the SNS, turning of the sympathetic outflow to the heart and blood vessels. The end result of this action is a drop in HR, decrease PVR and BP.

  • TX OF HTN
  • RELEASE NE IN THE BRAIN, THEREBY DECREASE THE EFFECT OF SNS STIMULATION THROUGH-OUT THE BODY
  • DECREASE BP
  • ACTIVATION OF THIS RECEPTOR IN THE PANCREAS SURPRESSES INSULIN SECRETION.
A

Alpha2-adrenergic agonists

39
Q

(2) Alpha2-adrenergic agonist agents

A
  1. Clonidine (Catapres)

2. Methyldopa

40
Q

Alpha2-adrenergic agonist agent used for Tx of HTN (PO) administered epidural route for relief of severe pain in cancer pts.

A

Clonidine (Catapres)

41
Q

Alpha2-adrenergic agonist agent used for Tx of HTN, available for adults and children. Contraindicated in pts with active liver disease

A

Methyldopa

42
Q

Class of drugs that interrupt transmission of stimuli through beta receptors in the body. They block both beta-1 and beta-2 receptors.

  • Reduce BP in young Caucasian HTN pts. with high CO
  • Tx of pts with normal PVR, normal blood vol.
  • Tx of pts with high plasma-renin levels, angina or previous MI
  • Increase exercise tolerance for pt with stable angina, prevents angina but is not used for immediate relief of an acute angina attack.
  • not approved for >80y/o pts or with sever HF
A

Beta-adrenergic blockers (Beta blockers)

43
Q

Beta blocker agents (2)

A

Propranolol (Inderal) P
Nadolol (Corgard)
- DRUGS WHICH END IN “LOL”

44
Q
  • Inhibits _____ receptors = ↓ HR, contraction, myocardial o2 demand, conductivity, cardiac output
A

beta-1

45
Q
  • Inhibits ____ = bronchoconstriction, prevents warning signs of hypoglycemia since it decreases metabolism of glucose when needed by the body esp. in persons taking anti-diabetic meds with beta-blockers.
A

beta-2

46
Q

Beta blocker agent that is used for Tx of HTN, angina, MI and ventricular dysrythmias

A

Propranolol (Inderal) P

47
Q

Beta blocker agent that is used for Tx of HTN, angina, and MI

A

nadolol (Corgard)

48
Q

Beta blocker agents that are used to supress sinus and atrial tachydysrhythmias

A

propranolol and esmolol

49
Q

Contraindications for beta blockers

A

DM, thyrotoxicosis, Cerebrovascular insufficiency, hepatic and renal dysfunction, bradycardia and heart block, asthma and conditions caused by bronchoconstriction

50
Q

Drugs that decrease Beta absorption

A

Antacids

51
Q

Beta and _____blocker has additive effect

A

Ca++ channel blocker

52
Q

Adverse effects of Beta blockers

A

Headache, flushing, dizziness, bradycardia, postural hypotension, confusion, bronchospasm, bronchoconstriction.
Caution should be taken with pts with asthma, COPS, bradycardia, valvular heart disease, systolic heart failure, peripheral vascular disease, and depression.

53
Q

Drugs that has an advantage over beta-blockers because they do not block beta-2 receptors.
- Tx with lung disease, allergic rhinitis, obstructive pulmonary disease, smokers and asthmatics

A

Beta1-adrenergic blockers (B1B)

54
Q

Beta1-adrenergic blocker agents (2)

- Tx for HTN, angina, and MI

A

Atenolol (Tenormin) and metroprolol (Lopressor)

55
Q

Drugs that combine the blocking of selecitve alpha receptors and non-selective beta-receptors.

A

Non-selective (alpha +beta) receptors

56
Q

Non-selective (alpha +beta) receptor agents (2)

- Tx of HTN

A

labetalol (Trandate, Normodyne)

Carvedilol (Corag)

57
Q

Blockage of ____ receptors affects vasomotor tone ans results in vasodilation and decreased peripheral vascular resistance.

A

alpha

58
Q

Blockage of _____ receptors lead to reduce HR, delay in AV conduction, and depressed cardiac contractility.

A

beta

59
Q

Non-selective (alpha +beta) receptor agent used to treat HTN. (ie.. eclampsia in pregnancy)
- Reduces BP rapidly

A

labetalol (Trandate, normodyne)

60
Q

Non-selective (alpha +beta) receptor agent that is used to treat HTN, it reduces risk of death or hospitalization in pt. with HF. Well tolerated even in pt with advance HF.

A

carvedilol (Corag)

61
Q

Non-selective (alpha +beta) receptor agents CAUTIONS

A

pts with DM, PVD, and COPD.
elderly bc more susceptible for hypotension.
contraindicated during pregnancy and lactation

Pharmacology II (11 decks)

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