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Apex Review > ANS pharmacology & pathophysiology 3 > Flashcards

ANS pharmacology & pathophysiology 3 Flashcards

1
Q

A common side effect of prazosin is:
a. diuresis
b. severe bradycardia
c. orthostatic hypotension
d. excessive energy

A

c. orthostatic hypotension

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2
Q

Alpha 1 adrenoreceptor antagonists

A

reduce arterial BP but can also trigger reflex tachycardia and orthostatic hypotension

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3
Q

Examples of nonselective alpha antagonists are

A

phenoxybenzamine and phentolamine

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4
Q

Examples of selective alpha antagonists are

A

prazosin
tamsulosin
yohimbine

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5
Q

Beta-blockers are used to manage

A

hypertension
CAD
MI
heart failure

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6
Q

The prototypical B-adrenoreceptor antagonist nonselective is

A

propranolol

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7
Q

The alpha receptor antagonist are used to treat

A

HTN
HF
BPH
pheochromocytoma

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8
Q

Phenoxybenzamine is a (moa

A

noncompetitive a antagonist
blocks the alpha mediated activity of NE and EPI resulting lower peripheral vascular resistance and BP

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9
Q

What is used exclusively in the preoperative management of pheochromocytoma to normalize BP and prevent episodic hypertension?

A

phenoxybenzamine

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10
Q

Phenoxybenzamine produces an irreversible block rendering ______________ ineffective in treating phenoxybenzamine-induced severe hypotension

A

norepinephrine and phenylephrine

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11
Q

The best treatment for phenoxybenzamine-induced severe hypotension is

A

vasopressin and fluids

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12
Q

What is the MOA of phentolamine?

A

competitive nonselective alpha receptor antagonist

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13
Q

Unlike phenoxybenzamine, the receptor interaction with phentolamine can be overcome by

A

using an alpha receptor agonist such as phenylephrine or norepinephrine

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14
Q

Phentolamine should be used with extreme caution in patients with

A

flow-limited coronary artery disease b/c it causes baroreceptor mediated reflex tachycardia

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15
Q

What is the half-life of phentolamine?

A

<10 minutes

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16
Q

Phentolamine may have a benefit in treating otherwise

A

refractory HTN that may be seen with abrupt clonidine discontinuation

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17
Q

_________ can be used as a local infiltration injection after IV extravasation of a vasoconstrictor to prevent tissue necrosis.

A

Phentolamine

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18
Q

What is the MOA of prazosin?

A

highly selective alpha 1 receptor antagonist

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19
Q

Is there a change in HR with prazosin?

A

No

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20
Q

Side effects of prazosin include

A

postural/orthostatic hypotension

21
Q

The following three drugs are analogs of prazosin:

A

terazosin
doxazosin
tamsulosin

22
Q

The main uses of terazosin, doxazosin, and tamsulosin are to treat

A

BPH

23
Q

Terazosin, doxazosin, and tamsulosin anesthetic complications:

A

these drugs can exacerbate anesthetic-induced hypotension

24
Q

Yohimbe (MOA)

A

selective alpha 2 adrenergic antagonist

25
Q

What is yohimbe used for?

A

erectile dysfunction
athletic performance
weight loss
hypertension
diabetic neuropathy

26
Q

Yohimbe can diminish the

A

antihypertensive effect of other antihypertensive medications

27
Q

Indications for a beta-blocker include

A

hypertension
supraventricular tachycardia
afib
blunting an acute hemodynamic response, CHF, and conditions of ischemic heart disease
reducing myocardial O2 consumption and improving perfusion

28
Q

Concerns with beta blockers include

A

bradyarrhythmias
obtunding the CV response to hypovolemia
progressive heart block
heart failure
bronchoconstriction

29
Q

Abrupt discontinuation of long-term use of beta blockers can result in

A

rebound tachycardia and hypertension

30
Q

Some beta blockers (propranolol and acebutolol) have

A

membrane stabilizing activity–> act as antiarrhythmics

31
Q

Some beta blockers (pindolol, labetalol, & acebutolol) possess _________

A

intrinsic sympathomimetic activity (has a partial stimulating action while also blocking endogenous catecholamines)

32
Q

Antagonism of B2 receptors can produce

A

bronchoconstriction
hypoglycemia
peripheral vascular constriction (can aggravate Raynauds or PVD)

33
Q

_________ has a very long half-life

A

Nadolol

34
Q

___________ has some weak beta agonist effects and is associated with less slowing of HR and less of an impact on BP

A

Pindolol

35
Q

Examples of nonselective B-adrenergic antagonists include

A

carvedilol
nadolol
pindolol
sotalol
timolol
propranolol

36
Q

Beta 1 blockers include

A

metoprolol
atenolol
esmolol
bisoprolol
acebutolol

37
Q

_________has some weak beta agonist effects and is associated with less slowing of HR and less of an impact on BP

A

acebutolol

38
Q

What is the MOA of metoprolol?

A

competitive, cardioselective B1 receptor antagonist

39
Q

What is the dose of metoprolol?

A

administered IV 2.5-5 mg increments to a max dose of 15 mg

40
Q

What is the first-line drug for rapid perioperative control of HR & BP?

A

esmolol
swift onset & brief duration of action (<15 minutes)

41
Q

Esmolol is metabolized by

A

nonspecific esterases found in the RBC

42
Q

What is the dose of esmolol?

A

bolus: 10-80 mg or an infusion (50-300 mcg/kg/min.)

43
Q

What is the MOA of labetalol?

A

adrenergic antagonist with alpha 1 and nonselective beta adrenergic antagonist effects

44
Q

The primary indication of labetalol is

A

acute hypertension

45
Q

The B2 antagonism of labetalol can produce

A

bronchospasm in patients with asthma or COPD

46
Q

Carvedilol MOA:

A

antagonist at alpha 1 and B1 & B2 adrenergic receptors

47
Q

Which beta-blocker has intrinsic sympathetic activity (ISA)?

A

labetalol

48
Q

Which beta receptor antagonist undergoes renal metabolism?

A

atenolol

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