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Apex Review > ANS Pharmacology & Pathophysiology 2 > Flashcards

ANS Pharmacology & Pathophysiology 2 Flashcards

1
Q

Which is NOT an endogenous sympathomimetic?
a. ephedrine
b. dopamine
c. norepinephrine
d. epinephrine

A

a. ephedrine

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2
Q

Endogenous catecholamines include

A

epinephrine, norepinephrine, and dopamine

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3
Q

Synthetic catecholamines include

A

dobutamine
isoproterenol

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4
Q

Endogenous and synthetic catecholamines may produce

A

hypertension
arrhythmias
myocardial ischemia

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5
Q

The effects of endogenous and synthetic agonists are dependent on their

A

specificity for alpha and beta adrenoreceptors and dopaminergic subtypes

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6
Q

What is the classification of ephedinre?

A

synthetic noncatecholamine
sympathomimetic

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7
Q

Administration of beta 2 adrenoreceptors agonists in aerosolized form minimizes

A

side effects such as anxiety, tremor, and restlessness

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8
Q

Isoproterenol and dobutamine have _________ activity

A

beta 1 and some beta 2

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9
Q

Epinephrine and norepinephrine undergo metabolism by

A

catechol-O-methyl transferase and monoamine oxidase to yield vanillymandelic acid

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10
Q

_________ is assayed as part of the diagnostic work-up of pheochromocytoma

A

VMA or vanillymandelic acid

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11
Q

Adrenergic agonists mimic ___________ effects via

A

SNS; direct receptor activation or by encouraging endogenous catecholamine release

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12
Q

What is the receptor and dosing of epinephrine?

A

B1>B2, alpha 1
0.01-0.2 mcg/kg/min.

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13
Q

What is the receptor and dosing of norepinephrine?

A

alpha 1, beta 1>beta 2
0.01-0.2 mcg/kg/min.

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14
Q

What is the receptor and dosing of dopamine?

A

beta 1>beta 2, alpha 1
2-20 mcg/kg/min.

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15
Q

What is the receptor and dosing of isoproterenol?

A

B1>B2
0.015-0.15 mcg/kg/min.

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16
Q

What is the receptor and dosing of dobutamine?

A

B1>B2>A1
2-20 mcg/kg/min

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17
Q

What is the receptor and dosing of ephedrine?

A

a, beta indirect
bolus 5-25 mg IV
up to 50 mg IM

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18
Q

What are the systemic effects of catecholamines?

A

decreased digestive system activity
dilation of bronchioles
increased heart rate
liver converts glycogen to glucose
high blood pressure

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19
Q

Epinephrine has more potency at beta receptors than

A

norepinephrine

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20
Q

The net effect of epi depends on the balance of the receptor types in the individual tissues and organs. Organs with a higher incidence of B2 receptors such as skeletal muscle will see

A

vasodilation

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21
Q

With epinephrine, organs with a higher incidence of alpha 2 receptors such as the mesentery and kidneys will experience

A

vasoconstriction

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22
Q

The net effect of epinephrine depends on the

A

dose

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23
Q

Low doses of epinephrine favor

A

beta stimulation (increased HR, CO, inotropy, and pulse pressure, and a decrease in SVR)

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24
Q

High doses of epinephrine favor

A

alpha effects (increased SVR and decreased CO)

25
Q

Significant metabolic changes related to epinephrine administration include

A

increase in blood glucose
hypokalemia occurs due to a transcellular potassium shift

26
Q

Norepinephrine has mostly_________ effects and minimal _______ effects

A

alpha 1 and beta 1; beta 2

27
Q

Describe the differences in receptor affinity with high doses of norepinephrine versus low.

A

low doses favor B1 stimulation
high doses favor beta 1 and alpha effects

28
Q

The systemic vasoconstriction effect of norepinephrine is _________ epinephrine

A

greater

29
Q

Describe how the does of dopamine stimulates different receptors.

A

low dose dopamine (<3 mcg/kg/min) stimulates D1 receptors
moderate doses of dopamine (3-8 mcg/kg/min) stimulate alpha1 and beta 1 adrenergic receptors in the heart and periphery
high dose dopamine (>10 mcg/kg/min) acts a a pure alpha 1 agonist

30
Q

Postsynaptic D1 receptors cause

A

vasodilation of renal, GI, coronary, and cerebral vessels

31
Q

Presynaptic D2 receptors

A

inhibit norepinephrine release and thus cause vasodilation

32
Q

Dopamine ___________ prevent or reverse AKI or failure

A

Does NOT

33
Q

Dopamine undergoes what kind of metabolism?

A

metabolic degradation by catechol-O-methyl transferase and MAO (same as norepi & epi!)

34
Q

The end product of dopamine metabolism is

A

homovanillic acid

35
Q

Isoproterenol is derived from

A

dopamine

36
Q

IV infusion dose of isoproterenol is

A

0.015-0.15 mcg/kg/min.

37
Q

What is the MOA of isoproterenol?

A

potent sympathomimetic with B1 and B2 activity (2-3x potency of epinephrine)

38
Q

What can isoproterenol precipitate?

A

supraventricular and ventricular arrhythmias

39
Q

What does dobutamine do?

A

enhances myocardial contractility and reduces vascular tone

40
Q

What is the IV infusion dose of dobutamine?

A

2-20 mcg/kg/min.

41
Q

Uses of dobutamine include:

A

inotropic agent in those with pulmonary hypertension (beta 2 stimulation reduces pulmonary vascular resistance)
potent inotrope that may be used in select cases of heart disease, MI, and depressed myocardial states
dobutamine stress echo to assess heart function during exertion

42
Q

What is the MOA of dobutamine?

A

selective b1 agonist with mild B2 effects

43
Q

Adverse effects of dobutamine include

A

extending cardiac muscle infarction
increasing AV conduction which can trigger rapid ventricular rate in those with A-fib

44
Q

What is the drug class of ephedrine?

A

synthetic, noncatecholamine sympathomimetic

45
Q

What receptors does ephedrine stimulate?

A

both alpha and beta receptors (indirect agent as well)

46
Q

_______________ is seen with repeat administrations of ephedrine due to ____________

A

tachyphylaxis; due to depletion of presynaptic norepinephrine

47
Q

Ephedrine has mild stimulating effects because

A

it crosses the BBB

48
Q

Short-acting beta 2 agonist drugs include

A

albuterol
terbutaline
levalbuterol

49
Q

Long-acting B2 agonist drugs include

A

salmetrol
formoterol

50
Q

An FDA “black box” warning is attached to the

A

longer-acting B2-selective agents (salmeterol & formoterol) d/t risk of asthma-related death
-possibly d/t development of airway hyperresponsiveness

51
Q

What effect does beta 2 agonists have on the uterus?

A

increased cAMP leading to decreased Ca2+ levels–> uterine smooth muscle relaxation and a tocolytic effect

52
Q

With escalated doses of B2 agonists over time, the B2

A

selectivity wanes, and B2 effects such as tachycardia and arrhythmias may become apparent

53
Q

Chronic B2 agonist therapy can lead to

A

down-regulation of the target receptors resulting in tachyphylaxis
also evidence of airway hyperresponsiveness

54
Q

What potent alpha agonist is the chemical precursor of epinephrine?

A

norepinephrine

55
Q

Which adrenoreceptor agonist is metabolized by the liver?

A

ephedrine

56
Q

Which synthetic catecholamine is derived from dopamine?

A

isoproterenol

57
Q

Which drug has the greatest increase in MAP?

A

norepinephrine

58
Q

Which drug is the precursor of norepinephrine?

A

dopamine

59
Q

Which drug results in a large increase of renal blood flow?

A

dopamine

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