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SUM '20 - Pharm II > Week 1 Cardiac Pharmacology and Autonomic 1 of 4 > Flashcards

Week 1 Cardiac Pharmacology and Autonomic 1 of 4 Flashcards

1
Q

Sympathomimetic Amines

  • Name Naturally occurring catecholamines:
  • Name synthetic agents:
A

-Naturally occuring:
Epinephrine, norepinephrine, and dopamine

  • synthetic agents:
    Phenylphrine and dobutamine
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2
Q

Epinephrine Strongly stimulates

A
  • both B1 and B2 receptors
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3
Q

Epinephrine Treats:

A

Treatment:

  • Anaphylaxis
  • Cardiopulmonary resuscitation
  • Treatment of shock with poor tissue O2 delivery and hypotension are combined (this is b/c of its alpha and beta effects)
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4
Q

____ May be useful as a sympathomimetic agent in patients unresponsive to indirect-acting agents and in those in whom simultaneous Beta 1 (cardiac stimulation) and Beta 2 receptor stimulation (vasodilation).

A

Epinephrine

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5
Q

Dominance of alpha or beta effects is dose related in what sympathomimetic?

A

epi

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6
Q

Epi Beta 1 produces + or - :

  • inotropic
  • Chronotropic
  • dromotropic
A

+ inotropic
+ chronotropic
+ dromotropic

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7
Q

inotropic

A

(force of contraction)

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8
Q

chronotropic

A

(heart rate)

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9
Q

dromotropic

A

(conduction velocity)

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10
Q

As HR, LV Stroke work, SV, and CO increase, what also increases?

A

Myocardial O2 consumption

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11
Q

Because of increased automaticity of all foci (including those that are ectopic) there is a possibility of:

A

arrhythmia

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12
Q

to ensure that an imbalance of myocardial oxygen supply and demand does not occur requires:

A

vigilance

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13
Q

Epi Beta 2 stimulation:

A
  • Bronchodilation
  • Vasodilation
  • Stabilization of mast cells (resulting in decreasing histamine release)
  • Concurrent alpha stimulation promotes a decrease in bronchial secretion. Net effects are a decrease in airway resistance with an improvement in oxygenation
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14
Q

-Stabilization of mast cells results in

A

decreasing histamine release

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15
Q

-Concurrent alpha stimulation promotes a decrease in bronchial secretion. Net effects are

A

a decrease in airway resistance with an improvement in oxygenation

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16
Q

Epinephrine - Low Doses 10 mcg/min:

The peripheral vasculature promotes the redistribution of blood flow to skeletal muscle, thus producing

A

a decrease in SVR

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17
Q

As epinephrine doses increase, alpha effects

A

predominates

-resulting in vasoconstriction and increased SVR

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18
Q

increasing epi doses do what do SBP, DBP and Pulse Pressure

A
  • SBP increases
  • DBP remains relatively unchanged
  • Pulse Pressure increasesq
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19
Q

(in regards to Epi) If coronary arteries are not obstructed, autoregulation

A

increases O2 delivery to meet the increase in demand

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20
Q

(in regards to Epi) If coronary arteries are obstructed

A

O2 delivery may be insufficient to meet demand resulting in myocardial ischemia

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21
Q

(Epi) increases in alpha effect also causes what in relation to abdominal organ blood flow and renal blood flow?

A
  • Splanchnic vasoconstriction

- Renal vasoconstriction: Renal vascular resistance and ultimately renal blood flow are decreased

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22
Q

Beta stimulation (with epi) leads to activation of: (think kidneys)

A

the renin-angiotensin system

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23
Q

Beta Stimulation (with epi) increases what metabolic effects?

A
  1. lipolysis
  2. glycogenolysis
  3. gluconeogensesis
  4. ketone production
  5. lactate release by skeletal muscle
24
Q

alpha or beta stimulation effect:

Splanchnic vasoconstriction

A

alpha

25
Q

alpha or beta stimulation effect:

renin-angiotensin system

A

beta

26
Q

alpha or beta stimulation effect:

lipolysis

A

beta

27
Q

alpha or beta stimulation effect:

gluconeogensesis

A

beta

28
Q

alpha or beta stimulation effect:

renal vasoconstriction

A

alpha

29
Q

alpha or beta stimulation effect:

keytone production

A

beta

30
Q

alpha or beta stimulation effect:

lactate release

A

beta

31
Q

With epi, what receptor is stimulated to cause a decrease in insulin?

A

Beta 2 stimulation

32
Q

Epinephrine induced beta 2 stimulation can cause a transient :

A

hyperkalemia

as potassium follows glucose out of the hepatic cells

33
Q

Epinephrine induced beta 2 stimulation also causes a longer ____. Why?

A

hypokalemia

b/c beta 2 stimulation forces K (extracellular) into the RBC

34
Q

What is a:

  • Potent vasopressor
  • Not as potent as epi in stimulating alpha receptors in equal doses
  • Has little Beta 2 activity at low doses
  • Has for the most part unopposed alpha stimulation
  • Chronotropic activity seen with Beta 1 stimulation is generally absent in low doses
  • This is because of increase in SVR which includes reflex vagal activity
A

Norepinephrine

35
Q

Norepi’s adrenergic stimulation results in a decrease in

A

vital organ blood flow

36
Q

Coronary artery perfusion (with norepi) may be:

A

increased

-b/c of the increase in DBP

37
Q

Increased renal vascular resistance (with Norepi) may cause:

A

UOP to fall

38
Q

due to norepi’s vasoconstriction properties, preload may

A

increase

39
Q

Norepi is first line therapy for:

A

shock (as is dopamine)

40
Q

Norepi is generally used in patient with adequate:

A

Cardiac Output but low SVR

41
Q

Norepi may exacerbate what issues even though BP is adequate?

What is the cause of this?

A
  • Tissue perfusion oxygenation issues

- by intense peripheral vasoconstriction

42
Q

What might we see norepi do to insulin production?

A

decrease insulin production

43
Q

Metabolic effects of epi and norepi (greater and less)

A

epi > norepi

44
Q

Endogenous central and peripheral neurotransmitter

A

Dopamine

45
Q

is derived from dopa in the chain of catecholamine synthesis

A

Dopamine

46
Q

Dopamine Dose that dependently stimulates Dopamine receptors:

A

2 mcg/kg/min

47
Q

Dopamine Dose that dependently stimulates Beta receptors:

A

2-5 mcg/kg/min

48
Q

Dopamine Dose that dependently stimulates Alpha receptors:

A

10mcg/kg/min and above

49
Q

Dopamine also has indirect sympathomimetic effect eliciting the release of

A

norepinephrine via Beta-1 stimulation

50
Q

Dopamine has an indirect or direct sympathomimetic effect eliciting the release of norepinephrine?

A

indirect

51
Q

What receptor does dopamine stimulate to elicit norepi release?

A

beta-1

52
Q

Dopamine is often first chose for patients in:

A

shock

53
Q

Dopamine also inhibits what mineralcorticoidsteroid?

Resulting in an increase in:

A

inhibits: aldosterone

an increase in: sodium excretion and UOP

54
Q

Dopamine has been implicated in limb ischemia in: (patient population, patients with certain diseases)

A
  • Pediatric patients
  • vascular diseases: DM, Atherosclerosis, Raynaud’s
  • Art-line in affected limb also increases incidence of limb ischemia w/concurrent dopamine gtt
55
Q

Isoproterenol

  • MOA information
A
  • synthetic catecholamine

- Potent non-selective agonist of B1 and B2 receptors

56
Q

Has no agonist activity at alpha or dopamine receptors:

A

isoproterenol (and also dobutamine)

57
Q

Uses of Isoproterenol:

A
  • Brady w/HB
  • Torsades VT
  • after Heart transplant for chronotropic support (B2 stimulation)

*limited use since dobutamine and milrinone emergence

SUM '20 - Pharm II (30 decks)

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