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Spring '20/ L. Pharm Exam 3 - sympatholytics/mimetics, LAs, antiarrhythmics, vaso > sympathomimetic "drugs to read" > Flashcards

sympathomimetic "drugs to read" Flashcards

1
Q

dobutamine at higher does exerts its affects on which receptor

A

alpha

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2
Q

isoproterenol acts on which receptors

A

beta 1 beta 2

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3
Q

which medication is the most potent of all sympathomimetics

A

isoproterenol

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4
Q

what is the dose is isoproterenol IV infusion

A

1-5mcg/min

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5
Q

what are the effects seen with isoproterenol

A

increases hr, myocardial contractility, cardiac automaticity

and

vasodilation in skeletal muscles decreases SVR

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6
Q

myocardial oxygen requirements of isoproterenol

A

increased by tachycardia and contractility.

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7
Q

adverse effects of isoproterenol

A

vasodilation

decrease BP

tachyarrhythmias

MI (decrease BP, increase HR)

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8
Q

isoproterenol- uses

A

bradycardia

pul HTN

bronchodilator

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9
Q

which medication is derived from isoproterenol consisting of 50:50 racemic mixture

A

dobutamine

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10
Q

dobutamine (-) enantiomer receptors

A

potent alpha 1 agonist

weak beta 1 beta 2 agonist

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11
Q

dobutamine (+) enantiomers receptors

A

antagonist at alpha 1

potent b1 b2 agonist

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12
Q

at higher doses where does dobutamine exert its effects

A

on alpha receptors

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13
Q

dobutamine how does it increase cardiac output

A

positive inotropic agent

increases cAMP increasing calcium from SR

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14
Q

adverse effects of dobutamine

A

tachyarrhythmias

ST, ventricular arrhythmias

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15
Q

dobutamine prolonged continuous infusion concerns

A

eosinophilic myocarditis and peripheral eosinophilia

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16
Q

dobutamine clinical uses

A

CHF

weaning from bypass

PUL HTN

stress test

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17
Q

dobutamine half life

A

2 minutes

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18
Q

dobutamine infusion dose

A

2-10mcg/kg/min

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19
Q

dobutamine metabolism

A

biotransformation in the liver inactive glucoronide conjugates and 3-0 methyldobutamine- most of which is excreted in the liver

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20
Q

does tachyphylaxis occur with dobutamine

A

may occur as it acts on B-adrenergic receptors.

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21
Q

dopamine receptors

A

d1, d2, a and b

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22
Q

DOPAMINE EFFECTS

d1=
d2=
a1=
b1=

A

d1- vasodilation
d2- vasodilation
a1 vasoconstriction
b1- increases co

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23
Q

which receptors is associated with the reward receptor with dopamine

A

d2

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24
Q

dopamine at dose 0.5-3mg/kg/min

what is this dose used for

A

d1 & d2= vasodilation, decreased arterial BP,

diuresis and natriuresis

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25
Q

dopamine at 3-10mcg/kg/min

A

beta 1 and alpha receptors

norepinephrine release

increased cardiac output increasing chronotropy and contractility

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26
Q

dopamine > 10mcg/kg/min

A

acts similar to pure alpha agonist.

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27
Q

dobutamine renal blood flow effects

A

increases renal blood flow due to increase in cardiac output.

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28
Q

dobutamine effects less than 5mcg/kg/min

A

beta adrenergic agonist effects. increasing myocardial contractility and peripheral vasodilation.

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29
Q

how much variability does dopamine have

A

10-75 fold variability in plasma dopamine concentrations .

30
Q

dopamine half life

A

1-2 minutes

31
Q

how do we treat extravasion of dopamine

A

local infiltration of phentolamine

32
Q

does dopamine cause CNS effects

A

no it does not cross the blood brain barrier

33
Q

protein binding of dopamine

A

partially protein bound

34
Q

is the “renal dose of dopamine” really protecting the kidneys?

A

diuretic effect-but not protective in the setting of low cardiac output. it does not improve creatinine clearance.

35
Q

is dopamine recommended in right heart failure

A

no

36
Q

what is concerning about a patient with glaucoma receiving dopamine infusion?

A

dopamine continuous infusion increases ocular pressure- concerns for patients with glaucoma

37
Q

dopamine and respiratory effects

A

inhibitory NT to the carotid bodies- results in depression of ventilation and decreased 02

38
Q

dopamine endocrine and immunologic effects.

A

suppress the secretion and function of anterior pituitary hormones

aggravating catabolism & cellular immune function

induces central hypothyroidism

39
Q

what is the function of selective beta 2 adrenergic agonist

A

relax bronchiole and uterine smooth muscle.

40
Q

do selective beta 2 stimulate the heart, which drug is the exception

A

no, isoproterenol

41
Q

beta 2 agonist clinical uses

A

asthma, prevention of exercise induced asthma, COPD, stop premature uterine contractions

42
Q

how much of a beta 2 is delivered from a MDI vs tracheal intubation

A

12% MDI

decrease 50-70% with ETT

43
Q

how much more must be delivered for bronchodilation to occur for some intubated

A

6-10x what is used for an MDI

44
Q

side effects of beta 2 inhalation

A 
tremor
increased HR
hyperglycemia
hypokalemia
hypomagnesia
lactic acidosis
45
Q

albuterol - other name and dose

A

salbutamol

100mcg per puff
1-2 puff every 4-6 hours

46
Q

in relation to intubation, how is albuterol helpful

A

it blunts airway responses to tracheal intubation in asthmatic patients.

47
Q

metaproterenol- clinical uses

A

beta 2 agonist to treat asthma

48
Q

terbutaline

receptor?

admin routes

A

beta 2 agonist

PO, sub q, inhalation

49
Q

terbutaline sub q dose

A

0.25mg

50
Q

terbutaline mdi dose

A

200mcg

51
Q

3 examples of cardiac glycosides

A

digoxin, digitoxin, ouabain

52
Q

digitalis- what are cardiac glycosides made from

A

naturally occuring- foxglove plant

53
Q

digoxin clinical uses

A

svt, afib, aflutter,

uncommonly used for left ventricular contractility due to the availability of more potent less toxic drugs

54
Q

how does digoxin work

A

it slows conduction down in the av node

55
Q

what do we co administer with digoxin to limit the possibility of toxicity

A

propranolol or esmolol combined with digoxin

56
Q

if a patient has been taking digoxin and the doctor wants to do direct current cardio version what is our concern for the patient?

A

they will have an increased risk of developing cardiac dysrhythmias including vfib

57
Q

digoxin half life

peak after administration

A

1-2 days

2 hours

58
Q

in the absence of renal dysfunction, what is the most frequent cause of digitalis toxicity

A

diuretics that cause potassium depletion.

59
Q

during anesthesia what must we not do to avoid digitalis toxicity

A

hyperventilate the patient- when we hyperventilate the patient their potassium goes down0.5 per 10 decrease in pac02 leading to lethal arrhythmias.

60
Q

why is cardiopulmonary bypass dangerous with digitalis toxicity

A

impaired renal function and electrolyte changes such as hypokalmiea, hypomangesia prepose patient to digitalis toxicity

61
Q

early manifestation of digitalis toxicity

A

anorexia, nausea and vomiting

62
Q

what is the most common ecg finding associated with death from digitalis toxicity

A

ventricular fibrillation

63
Q

treatment of digitalis toxicity

A

correct hypokalemia, hypomangesia, hypoxemia

administer phenytoin, lidocaine, atropine to treat cardiac dysrhythmias

insert TVP if complete heart block present

64
Q

what is the effect of an antacid for digitalis absorption

A

decreases absorption

65
Q

fentanyl enflurane and isofnlurance do what in relation to digitalis

A

protect against digitalis enhanced cardiac automaticity

66
Q

what does quinidine do to digoxin

A

increases the plasma concentration of digoxin

67
Q

what do we consider calcium

A

potent inotrope

68
Q

normal calcium levels

A

8.5-10.5mg/dl

69
Q

normal ionized calcium

A

1-1.26

70
Q

levosimendan moa

A

increases the sensitivity of the myocardium to calcium

71
Q

levosimendan clinical uses

A

heart failure and preoperative reduces risk of kidney injury after cardiac surgery

Spring '20/ L. Pharm Exam 3 - sympatholytics/mimetics, LAs, antiarrhythmics, vaso (17 decks)

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