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Autonomic Pharm > Sympathetic Rx > Flashcards

Sympathetic Rx Flashcards

1
Q

Albuterol

A

Direct
B2 > B1
Acute asthma or COPD

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2
Q

Salmeterol

A

Direct
B2 > B1
Long-term asthma or COPD control

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3
Q

Dobutamine

A

Direct
B1 > B2 and alpha
Use: heart failure (inotropic > chronotropic), cardiac stress testing

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4
Q

Dopamine

A

Direct
D1 = D2 > Beta > alpha
Uses: unstable bradycardia, HF, shock
*inotropic and chronotropic effects at lower doses due to beta effects
*vasoconstriction at higher doses due to alpha effects

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5
Q

Epinephrine

A

Direct
Beta > alpha
Use: anaphylaxis, asthma, open-angle glaucoma
*Alpha effects predominate at higher dose (vasoconstriction)
*Significantly stronger effect at beta2-receptor than norepinephrine (means more vasodilator effects–PVR goes down, PP/CO/HR go up)

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6
Q

Fenoldopam

A 
Direct
D1
Use: postop HTN, hypertensive crisis
*Vasodilator (coronary, peripheral, renal, splanchnic)
*Promotes natriuresis
*SE: hypotension and tachycardia
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7
Q

Isoproterenol

A

Direct
B1 = B2
Use: electrophysiologic evaluation of tachyarrhythmias
*Can worsen ischemia
*B2 vasodilation = decreased MAP = reflex tachycardia
*B1 = increased heart rate
(Very increased heart rate, CO, and PP)

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8
Q

Midodrine

A

Direct
Alpha1
Use: autonomic insufficiency and postural hypotension
*May exacerbate supine hypertension

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9
Q

Mirabegron

A

Direct
Beta3
Use: urinary urge incontinence or overactive bladder

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10
Q

Norepinephrine

A 
Direct
A1 > A2 > B1
Use: hypotension, septic shock
*Increase both SBP and DBP = increased MAP = reflex bradycardia
(CO stays the same and PP widens)
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11
Q

Phenylephrine

A

Direct
A1 > A2
Use: hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

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12
Q

Amphetamine

A

Indirect general agonist
Reuptake inhibitor
Releases stored catecholamines
Use: narcolepsy, obesity, ADHD

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13
Q

Cocaine

A

Indirect general agonist
Reuptake inhibitor
Use: vasoconstriction and local anesthetic
*Never give beta-blockers if cocaine intoxication is suspected (leads to unopposed A1 and extreme hypertension)

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14
Q

Ephedrine

A

Indirect general agonist
Releases stored catecholamines
Use: nasal decongestion (pseudoephedrine), urinary incontinence, hypotension

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15
Q

Clonidine/guanfacine

A

Sympatholytics (A2 agonists)
Uses: hypertensive urgency (limited situations), ADHD, Tourette
SE: CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hypertension with abrupt cessation

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16
Q

A-methyldopa

A

Sympatholytic (A2 agonist)
Use: HTN in pregnancy
SE: direct Coombs positive hemolysis, SLE-like syndrome

17
Q

Phenoxybenzamine

A

Nonselective A blocker
Irreversible
Use: pheochromocytoma (preop) to prevent catecholamine (HTN) crisis
SE: orthostatic hypotension, reflex tachycardia

18
Q

Phentolamine

A

Nonselective A blocker
Reversible
Use: MAOI patients eating tyramine-rich foods
SE: orthostatic hypotension, reflex tachycardia

19
Q

Prazosin

A

A1 blocker
Use: urinary symptoms of BPH, PTSD
SE: 1st-dose orthostatic hypoTN, dizziness, HA

20
Q

Terazosin/doxazosin/tamsulosin

A

A1 blocker
Use: urinary symptoms of BPH, hypertension (except tamsulosin)
SE: 1st-dose orthostatic hypoTN, dizziness, HA

21
Q

Mirtazapine

A

A2 blocker
Use: depression
SE: sedation, increase serum cholesterol, increase appetite

22
Q

Beta-blockers: angina pectoris

A

Decrease heart rate and contractility = decreased oxygen consumption

23
Q

Beta-blockers: MI

A

Decreased mortality

24
Q

Beta-blockers: supraventricular tachycardia

A 
Decreased AV conduction velocity (class 2 antiarrhythmic)
*Metoprolol and esmolol
25
Q

Beta-blockers: HTN

A

Decreased cardiac output, decreased renin secretion (B1 block on JGA cells)

26
Q

Beta-blockers: HF

A

Decreased mortality

*Bisoprolol/carvedilol/metoprolol

27
Q

Beta-blockers: glaucoma

A

Decreased production of aqueous humor

*Timolol

28
Q

Beta-blockers: variceal bleeding

A

Decreased hepatic venous pressure gradient and portal HTN

*Nadolol/propranolol

29
Q

Beta-blockers: SE

A 
Erectile dysfunction
CV SE: bradycardia, AV block, HF
CNS SE: seizures, sedation, sleep alterations
Dyslipidemia (metoprolol)
Asthma/COPD exacerbations 
*Caution in cocaine users
30
Q

B1 selective antagonists (B1>B2)

A 
Acebutolol (partial agonist)
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
(A-M = 1st half of alphabet)
31
Q

Nonselective B-antagonists (B1 = B2)

A 
Nadolol
Pindolol (partial agonist)
Propranolol
Timolol
(N-Z = 2nd half of alphabet)
32
Q

Nonselective A and B antagonists

A

Carvedilol

Labetalol

33
Q

Nebivolol

A

Cardiac-selective B1 blockade + stimulation of B3 (activate NOS in vasculature and decrease SVR)

Autonomic Pharm (4 decks)

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