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Pharm 2 > Class 2 Deck 2 > Flashcards

Class 2 Deck 2 Flashcards

1
Q

Norepinephrine has minimal effects on airway resistance, why?

A

-Bronchial smooth muscle are mostly Beta 2, NorEpi does not stimulate Beta 2

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2
Q

What 2 sympathomemetics have strong Beta 2 activation and therefore are potent bronchodilators?

A
  • Epinepherine

- Isoproterenol

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3
Q

All drugs containing the 3,4 dihydroxybenzene (catecholamines) structure are rapidly inactivated by what 2 enzymes.

A
  • MAO (Liver, kidney, GI)

- COMT

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4
Q

Inhibition of what mechanism produces a greater potentiation of epinepherine than inhibition of enzymes. and is evidenced by what?

A
  • Reuptake

- Minimal presence of chatecholamines in urine

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5
Q

Why are synthetic non-catecholamines slower to degrade then other catecholamines?

A

-They are not metabolized by COMT

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6
Q

Patients on an MAOI may have and exaggerated response to what type of catecholamine?

A

synthetic non-catecholamines

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7
Q

How does ephedrine work?

A
  • Has direct and indirect action primarily through release of NorEpi
  • Works on Alpha 1 and Beta receptors
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8
Q

What is ephedrine’s principle mechanism of action?

A

-Increased myocardial contractility

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9
Q

How does ephedrine increase mycardial contractility?

A

-Greater venoconstriction than arterial constriction leads to increased preload, paired w/ increased HR increases CO

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10
Q

3 Other ephedrine tidbits.

A
  • Tachyphylaxis can occur
  • Preserves uterine blood flow
  • Bronchial smooth muscle relaxor
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11
Q

What is the onset and duration of ephedrine and Phenylepherine?

A
  • Onset = 1 min

- Duration = 5-10 minutes

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12
Q

How does phenylepherine work?

A
  • Synthetic non-catecholamine
  • Venoconstriction greater than arterial constriction (increased preload)
  • Increase PVR
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13
Q

What drug May be used to improve coronary perfusion pressure without chronotropic side effects.

A

Phenylepherine

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14
Q

What 3 problems are seen with Phenylepherine?

A
  • Reflex bradycardia
  • Decreased renal and splanchnic blood flow
  • Increase pulmonary artery resistance
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15
Q

What drug can reverse the R to L shunt associated with tetrology of fallot

A

Phenylepherine

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16
Q

Phenylepherine is like ____________ but less potent and longer lasting.

A

-NorEpi

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17
Q

Ephedrine is like __________ but BP response is less intense and last longer

A

Epinepherine

18
Q

What is NorEpi? And what does it do?

A
  • Endogenous neurotransmitter responsible for maintaining BP by adjusting SVR
  • primarily Acts on Alpha 1
19
Q

NorEpi is a potent vasconstrictor of what? and what does this lead to?

A
  • Renal (oliguria)
  • Mesenteric (Mesenteric infarct)
  • Cutaneous (Gangrene of digits)
20
Q

NorEpi primarily works on what receptor?

A

-Alpha 1

21
Q

How does NorEpi effect CO?

A
  • Increase at low doses

- Decrease at high doses

22
Q

How do you titrate NorEpi?

A

-To flow no BP (By blood gas base deficit)

23
Q

What is epinepherine? and what receptors does it work on?

A
  • Prototypical catecholamine

- Alpha 1, Beta 1, Beta 2

24
Q

What is the most potent activator of Alpha 1 receptors?

A

-Epinepherine

25
Q

What does alpha 1 receptors do? Beta 2?

A
  • Vasoconstrict

- Vasodilate

26
Q

What does an intermediate dose of epi do?

A
  • Mostly beta 1 effects

- Increased HR, Contractility, CO and automaticity

27
Q

What does high does epi do?

A
  • Mostly Alpha 1
  • Vasoconstricts cutaneous, splanchnic and renal beds
  • Maintain myocardial and cerebral perfusion
28
Q

When is epi used?

A
  • Asthma
  • Anaphylaxis
  • cardiac arrest
  • bleeding
  • prolong regional anesthesia
  • decrease absorption of LA
29
Q

How does epi decrease renal blood flow?

A
  • decrease renal blood flow (alpha 1)

- Stimulate renin release (indirect)

30
Q

What happen to a patient taking Epi w/ an alpha blocker? Beta blocker?

A
  • “Epi reversal” Beta 2 response (hypotension)

- Unopposed alpha response

31
Q

What are the side effects of epi?

A
  • Hyperglycemia
  • mydrasis
  • platelet aggregation
  • sweating
  • headache
  • tremor
  • nausea
  • arrhythmias
32
Q

What is dopamine? and what receptors does it work on?

A
  • Endogenous catecholamine

- Alpha/Beta/ and indirect NorEpi

33
Q

What are 3 adverse effects of vasoconstrictors?

A
  • Cardiac dysrhythmias (Beta)
  • Baroreceptor bradycardia and decrease CO (Alpha)
  • Antihypertensives may decrease response of indirect, and increase response of direct
34
Q

Why are tricyclic antidepressants and MAOI problematic w/ vasoconstrictors?

A
  • Increase endogenous NorEpi

- Exaggerated indirect response (don’t use ephedrine)

35
Q

Natural weight loss product may contain what? and cause what?

A
  • Ephedrine or pseudoephedrine

- Tachyphylaxis, hemodynamic instability, CV collapse

36
Q

What drug will treat extravasation?

A

-Phentolamine

37
Q

What is phentolamine and what does it do?

A

Peripheral vasodilator to treat skin necrosis secondary to Epi, NorEpi, Dopamine through peripheral line.

38
Q

What are the 3 posterior pituitary hormones that vaso constrict?

A
  • Arginine vasopressin (AVP)
  • Oxytocin
  • DDAVP (desmopressin)
39
Q

What is arginine vasopressin? And what does it do?

A
  • Peptide
  • Stimulates V1 (intense arterial vasoconstriction)
  • Stimulates V2 (reabsorption of water)
40
Q

Why is arginine vasopressin used?

A
  • Advanced vasodilatory shock
  • Failed conventional vasopressor therapy
  • Effects are preserved w/ hypoxia and acidosis
41
Q

What are the advantages of arginine vasopressin over Epi?

A
  • Epi increases myocardial O2 consumption
  • Epi increases risk of post CPR MI and arrhythmias
  • Epi may not work well in acidic environment
42
Q

arginine vasopressin is _______ to Epi in patients with _________.

A
  • Superior

- Asystole

Pharm 2 (23 decks)

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