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Spring '20/ L. Pharm Exam 3 - sympatholytics/mimetics, LAs, antiarrhythmics, vaso > Sympathomimetic- Epinephrine > Flashcards

Sympathomimetic- Epinephrine Flashcards

1
Q

direct acting synthetic non catecholamines

A

phenylephrine

methoxamine

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2
Q

indirect acting synthetic non-catecholamines

A

ephedrine
mephentermine
amphetamine
metaraminol

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3
Q

synthetic catecholamine

A

isoproterenol

dobutamine

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4
Q

what drug is the prototype of all sympathomimetics

A

epinephrine

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5
Q

where is epi synthesized, stored, and release from

A

the adrenal medulla

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6
Q

epinephrine regulates 6 things. name these 6 things

A 
myocardial contractility
heart rate
vascular smooth muscle tone
bronchial smooth muscle tone
glandular secretions
metabolic process (glycogenolysis, lipolysis)
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7
Q

is Epi a CNS stimulant

A

no

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8
Q

what make up of epi makes it a poor CNS stimulant

A

poorly lipid soluble

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9
Q

what receptor activation accounts for EPI cardiovascular effects

A

alpha and beta

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10
Q

how does epi affect renal blood flow

A

substantially decreased- even in the absence of systemic blood pressure changes

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11
Q

how much more potent is epi to NE as a real vasoconstrictor

A

2-10x

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12
Q

higher doses of EPI affect which receptor

A

alpha receptors

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13
Q

lower doses of epi affect which receptor

A

beta receptor

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14
Q

high doses of epi- alpha activity create what

A

vasoconstriction increased afterload

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15
Q

epi HR effects

A

initial tachycardia followed by HR decrease due to baroreceptor reflexes

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16
Q

increase CI & SVR from EPI leads to

A

increase blood pressure

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17
Q

EPI stimulates b1 receptors which increases 3 things

A

HR contractility and co

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18
Q

what happens to diastolic BP in the presence of EPI

A

mild decrease reflects vasodilation in skeletal muscle vasculature due to stimulation of beta 2 receptors

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19
Q

increases in HR associated with EPI accelerates which phase

A

phase 4

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20
Q

which epi stimulates phase 4 what are you at risk for

A

cardiac dysrhythmias

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21
Q

is tachyphylaxis seen with epi

A

no

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22
Q

what effects does EPI have through the heart

A

increases conduction velocity, decreases refractory period in AV node, bundle of HIS, purkinje fibers and ventricular muscle

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23
Q

EPI causes what effect to myocardial oxygen consumption

A

increased with enhanced LV preload, increase contractility increased after load and tachycardia

24
Q

epi and diastolic function?

A

improved diastolic function by increasing the rate of myocardial relaxation

25
Q

EPI effects of coronary blood flow

NE effects of coronary blood flow

Phenylephrine effects of coronary blood flow

A

epi increases-do not alter systemic bp

NE- no affect on coronary blood flow

phenylephrine- increases coronary blood flow

26
Q

how to you block the hemodynamic effects of EPI

A

administration of alpha or beta adrenergic receptor antagonist

27
Q

name the 5 things supra therapeutic doses of EPI can lead to

A 
pulmonary edema
acute heart failure
arrhythmias
hypertension
myocardial ischemia
28
Q

what is the EPI effect of beta 2 activation

A

smooth muscles of the bronchi relaxaing

29
Q

when epi stimulates beat 2 in relation to asthma - what release is decreased?

A

vasoactive mediators.

30
Q

if the patient is beta blocked and given EPI what effects are seen in the lungs

A

bronchoconstriction - from stimulation of bronchial alpha receptors.

31
Q

of all catecholamines EPI has the most significant effect on _____

A

metabolism

32
Q

epi beta receptor effect on metabolsim

A

increase liver glcogenolysis and adipose tissue lipolysis

33
Q

Epi and alpha 1 receptor affects on metabolism

A

inhibits release of insulin

34
Q

EPI infusion usually increases the concentration of what 4 things

A

glucose
cholesterol
phospholipids
low density lipoproteins

35
Q

why do patients experience perioperative hyperglycemia

A

endogenous epi release results in inhibition of insulin secretion and glycogenolysis and inhibits peripheral glucose uptake

36
Q

Epi induced hypokalemia may contribute to what?

A

cardiac dysrhythmias

37
Q

EPI is also responsible for the release of what electrolyte from the liver

A

potassium- tending to offset the decrease in extracellular concentration of potassium produced by entrance into the skeletal muscle

38
Q

explain the two different reasons for increase concentration of lactate as seen with EPI administration

A
  1. may reflect epi induced glycogenolysis in skeletal muscles
  2. transient increase due to inhibition of pyruvate dehydrogenase and has no relationship with cellular hypoxia and tissue perfusion nor is it associated with metabolic acidosis
39
Q

what is the reason for low potassium levels associated with EPI

A

beta 2 adrenergic agonist activate the sodium potassium pump

40
Q

during induction what does the endogenous release of EPI do to your electrolytes

A

decrease potassium level

41
Q

what can we give preop to prevent hypokalemia

A

propranolol may prevent hypokalemia

42
Q

what is the concern with cardioselective beta 1 antagonist atenololol

A

may cause hypokalemia

43
Q

what two things do you see with the eye when administering EPI

which receptor is responsible for this

A

mydriasis and exophthalmos

alpha receptors

contraction of radial muscle of the iris producing mydriasis
contraction of the orbital muscles produces and appearance of exopthalmos

44
Q

what three medication produce gi relaxation of the smooth muscles

A

EPI, NE, isoproterenol

45
Q

Epi activates beta adrenergic receptor to do what with the bladder

A

relaxes the detrusor muscle of the bladder

46
Q

EPI activation of alpha receptors contracts the trigone and sphincter muscles. meaning what exactly

A

stretch muscles signaling the brain the need to empty

47
Q

what coagulation effects are seen with EPI

A

platelet aggregation and increase factor V activity- hypercoaguable state in intro and post op reflect stress associated release of EPI

48
Q

what labs on the CBC are changed with EPI

A

increases leukocyte count

eosinopenia

49
Q

EPI effects of the Liver

A

hepatosplanchnic vasoconstriction

50
Q

renal effects with EPI

A

impaired renal blood flow as co is diverted to dilated skeletal muscles.

51
Q

stimulates renal beta receptors resulting in what

A

increase secretion of renin

52
Q

EPI receptors

A

a1 a2 b1 b2

53
Q

EPI general uses (from chart)

A

Anaphylaxis, glaucoma (open angle) asthma, hypotension with LA

54
Q

EPI administration forms

A

Sub q, Iv or IM

55
Q

absorption of EPI sub q

A

slow

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

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