Drugs #2 Flashcards
Epinephrine
P/T/I
stimulates a1, a2, b1, b2 -short half life P: Low dose -lower diastolic BP (b2) -Increase CO (b1) Higher Dose -Increase TPR and CO (a1+a2+b1) -bronchodilation (b2) -decreased bronchial secretions (a1)
T:
Arrhythmias
I:
Anaphylaxis
Cardiac Arrest
Bronchospasm
Norepinephrine
PTIC
stimulates a1, a1, b1
-short half life-give by controlled infusion
P: Increase CO (b1) Increase TPR (a1+a2) Decrease HR (baroreflex) Overall increase MAP
T:
Ischemia
I:
limited to shock
C:
pre-existing vaso-constriction or ischemia
Dopamine
PTIC
D1, D2, b1, a1, a2 -metabolized readily P: Low decreased TPR (D1) Medium Increased cardiac contractility and HR (b1) High increased BP and TPR (a1,a2) T: low infusion rates=hypotension high infusion rates=ischemia
I:
Hypotension due to low cardiac output during cardiogenic shock-may be advantageous due to vasodilatory effect in renal and mesenteric vascular bed
C: uncorrected tachyarrhythmias
Isoproterenol
PTIC
synthetic catecholamine B1 and B2
-susceptible to degradation
P
1. peripheral vasodilation (b2) -decreased diastolic bp
- positive inotropy and chronotropy (b1)-transient increased systolic BP BUT overcome by vasodilatory effect
- small decrease in MAP
- ->may contribute to further reflex HR increase
- bronchodilation (b2)
T:
Tachyarrhythmias
I:
cardiac stimulation during bradycardia or heart block when peripheral resistance is high
C: arrhythmias
Dobutamine
PTIC
B1 selective agonist
rapidly degraded by COMPT
P
- more ionotropic than chronotropic
- nice increase in CO without big reflex in HR
I:
short term Rx for CHF or cardiogenic shock
T
Hypotension
**high dose–>B2 act–>low bp
Terbutaline and Albuterol
B2-agonist
P:
Bronchodilation
Uterine relaxation
I:
Bronchospasm
Chronic Rx of obstructive airway
T:
Tachycardia (B1)
Muscle tremor (b2)-activation of b2 receptors expressed on pre-synaptic nerve terminals of cholinergic somatomotor neurons
Tolerance (b2)
Phenylephrine
PTIC
NOT a catecholamine, not subject to COMT degradation
A1 agonist
P: Increase TPR and MAP Decrease HR (baroreflex) Pupillary dilation Decrease bronchiole and sinus secretions
T:
hypertension
I:
- hypotension during anesthesia
- SV tachycardia
- mydriatic agent in opthalmis Rx
- nasal congestion
C:
hypertension
Clonidine
PTIC
a2 agonist
-can cross bbb–>decrease in sympathetic
P:
- acute increase in BP (peripheral effect)
- –reduced BP (central effect)
T:
dry mouth
hypertensive crisis (after acute withdrawal)
I:
Hypertension due to sympathetic activation
What are 6 indirect acting sympathomimetics?
- amphetamine
- methamphetamine
- methylphenidate
- ephedrine
- pseudoephedrine
- tyramine
What are the PTIC for indirect acting sympathetics?
P:
- Increased TPR and diastolic BP (a1+a2)
- Positive ionotrophic and chronotropic effects, increased systolic pressure (B1)
- CNS stimulant (probably increased NE)
- Anorexia (probably increased DA)
T:
Tachycardia (b1)
I:
Attention Deficit Disorder
Narcolepsy
Nasal congestion
C:
Rx with MAO inhibitors within 2 weeks
What are 3 Non-selective B-blockers?
- Propranolol
- Nadolol
- Timolol
Non-selective B-blockers
PTIC
P: Decreased HR Decreased contractility Decreased renin release Reduced sympathetic activation Inhibition of aqueous humor production
T:
Bronchospasm
Mask symptoms of hypoglycemia
Bradycardia
I: Hypertension Angina Glaucoma Early to moderate heart failure Arrhythmia Thyrotoxicosis Anxiety
C: Bronchospasm during asthma Sinus bradycardia 2nd and 3rd degree heart block cardiogenic shock
What are 3 cardioselective B1 blockers?
metoprolol, atenolol, esmolol
cardioselective B1-blockers
PTIC
P: decreased HR decreased contractility decreased renin release decreased sympathetic activation
T:
hypotension
bradycardia
I:
hypertension
angina
arrhythmia
C:
sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock
Pindolol
PTIC
partial agonist b-blocker P: decrease BP decrease contractility decrease renin release decreased sympathetic activation
T:
Hypotension
I:
Hypertension
C:
sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock
