ANS Pharmacology Flashcards
Study on shuffle (219 cards)
1
Q
Identify the class to which the drugs belong: epinephrine, norepinephrine, dopamine
A
Adrenergic agonists
2
Q
Identify the class to which the drugs belong: isoproterenol, dobutamine
A
Synthetic catecholamine
3
Q
Identify the class to which the drugs belong: ephedrine, phenylephrine
A
Synthetic noncatecholamine
4
Q
Identify the class to which the drugs belong: albuterol, salmeterol
A
Selective beta-adrenergic agonists
5
Q
Identify the class to which the drugs belong: clonidine, dexmedtomidine
A
Selective alpha 2 agonists
6
Q
Identify the class to which the drugs belong: propanolol, esmolol
A
Beta 1 and 2 antagonists
7
Q
Identify the class to which the drugs belong: labetalol, carvedilol
A
Mixed function alpha and beta antagonists
8
Q
Identify the class to which the drugs belong: nicotine, bethanechol, physostigmine
A
Cholinergic agonists
9
Q
Identify the class to which the drugs belong: atropine, scopolamine, glycopyrrolate
A
Antimuscarinics
10
Q
Identify the class to which the drugs belong: verapamil, diltiazem
A
Calcium channel blockers
11
Q
Identify the class to which the drugs belong: milrinone, slidenafil
A
Phosphodiesterase inhibitors
12
Q
Identify the class to which the drugs belong: vasopressin
A
Arginine vasopressin
13
Q
Identify the class to which the drugs belong: nitroprusside, nitroglycerin, hydralazine
A
Direct vasodilators/ nitrodilators
14
Q
Identify the class to which the drugs belong: lisinopril, captopril, enalopril
A
ACE inhibitors
15
Q
Identify the class to which the drugs belong: valsartan, olmesartan, losartan
A
ARBs
16
Q
Identify the class to which the drugs belong: volatile agent, propofol, local anesthetics
A
Anesthetic agents
17
Q
Three alpha-selective drugs
A
Phenylephrine (alpha 1)
Clonidine (alpha 2)
Dexmedetomidine (alpha 2)
18
Q
Phenylephrine metabolism
A
MAO
19
Q
Phenylephrine dosing
A
0.15-0.75 mcg/kg/min
20
Q
Clonidine metabolism
A
50% liver
50% renal unchanged
21
Q
Clonidine PO dosing
A
0.1-0.6 mg/day
22
Q
Clonidine primary uses
A
HTN
23
Q
Clonidine adverse effects
A
Rebound HTN with abrupt cessation
May cause sedation
24
Q
Dexmedetomidine metabolism
A
CYP liver
25
Dexmedetomidine dosing
1 mcg/kg over 10 min (bolus)
0.2-0.8 mcg/kg/hr
26
Dexmedetomidine uses
Sedation
Analgesia without respiratory depression
27
Why are beta blockers contraindicated for phenylephrine overdose?
May induce pulmonary edema and irreversible cardiac collapse
28
Location of postsynaptic alpha 2 receptors
Smooth muscles
Several organs
29
Location of nonsynaptic alpha 2 receptors
Platelets
30
Alpha-2 stimulation in: medulla
Decrease SNS tone
31
Alpha-2 stimulation in: vagus nerve
Increase PNS tone
32
Alpha-2 stimulation in: locus coeruleus
Sedation, hypnosis
33
Alpha-2 stimulation in: dorsal horn of spinal cord
Analgesia
34
Alpha-2 stimulation in: vasculature
Vasoconstriction
35
Alpha-2 stimulation in: renal tubules
Inhibits ADH
36
Alpha-2 stimulation in: pancreas
Decrease insulin release
37
Alpha-2 stimulation in: platelets
Increase platelet aggregation
38
Alpha-2 stimulation in: salivary glands
Dry mouth
39
Alpha-2 stimulation in: GI tract
Decrease gut motility
40
Clonidine or Dexmedetomidine: 1600: 1 affinity for Alpha 2: Alpha 1
Dexmedetomidine
41
Clonidine or Dexmedetomidine: Partial alpha-2 agonist
Clonidine
42
Clonidine or Dexmedetomidine: Mild reduction in volatile and IV anesthetic requirement
Clonidine
43
Clonidine or Dexmedetomidine: 50% protein binding
Clonidine
44
Clonidine or Dexmedetomidine: 94% protein binding
Dexmedetomidine
45
Clonidine or Dexmedetomidine: 2 hour elimination half life
Dexmedetomidine
46
Clonidine or Dexmedetomidine: no respiratory depression
Both
47
Clonidine or Dexmedetomidine: 8 hour elimination half life
Clonidine
48
Clonidine or Dexmedetomidine: near total hepatic transformation to inactive metabolites
Dexmedetomidine
49
Clonidine or Dexmedetomidine: distribution half life >10 minutes
Clonidine
50
Clonidine or Dexmedetomidine: ~50% excreted unchanged, inactive metabolites
Clonidine
51
Clonidine or Dexmedetomidine: distribution half life 5-6 minutes
Dexmedetomidine
52
Epinephrine: effect on renal blood flow
Decreases
53
Epinephrine: effect on MAP
Moderately increases
54
Epinephrine: Airway resistance
Decreases
55
Epinephrine: metabolism
Reuptake
MAO and COMT
56
Epinephrine: receptor
B1> B2, A1
57
Epinephrine: infusion dose
0.01-0.2 mcg/kg/min
58
Epinephrine: primary uses
Shock
Anaphylaxis
ACLS
59
Norepinephrine: renal blood flow
Significantly decreases
60
Norepinephrine: MAP
Significantly increases
61
Norepinephrine: airway resistance
No change
62
Norepinephrine: metabolism
Reuptake
MAO and COMT
63
Norepinephrine: receptor agonism
A1, B1 > B2
64
Norepinephrine: infusion dosing
0.01-0.2 mcg/kg/min
65
Norepinephrine: primary uses
Shock
Vasoplegia
66
Dopamine: renal blood flow
Significantly increases
67
Dopamine: MAP
Moderately increases
68
Dopamine: airway resistance
No effect
69
Dopamine: metabolism
Reuptake
MAO and COMT
70
Dopamine: adrenergic receptor agonism
B1> B2, A1
71
Dopamine: infusion dosing
2-20 mcg/kg/min
72
Dopamine: primary uses
Shock
73
Isoproterenol: renal blood flow
Moderately decreases
74
Isoproterenol: MAP
Moderately increases
75
Isoproterenol: airway resistance
Significantly decreases
76
Isoproterenol: metabolism
COMT
77
Isoproterenol: adrenergic receptor agonism
B1>B2
78
Isoproterenol: infusion dosing
0.015-0.15 mcg/kg/min
79
Isoproterenol: primary uses
Drug pacing
80
Dobutamine: renal blood flow
Increases
81
Dobutamine: MAP
Moderately increases
82
Dobutamine: airway resistance
No effect
83
Dobutamine: metabolism
COMT
84
Dobutamine: adrenergic receptor agonism
B1 > B2 > A1
85
Dobutamine: infusion dosing
2-20 mcg/kg/min
86
Dobutamine: primary use
Cardiogenic shock
Stress testing
87
Ephedrine: renal blood flow
Decreases
88
Ephedrine: MAP
Increases
89
Ephedrine: airway resistance
Decreases
90
Ephedrine: metabolism
Liver
Most renal- unchanged
91
Ephedrine: adrenergic receptor agonism
A, B, indirect
92
Ephedrine: bolus dosing
5-25 mg IV
Up to 50 mg IV
93
Ephedrine: primary uses
Hypotension
94
Low dose epinephrine effects vs high dose effects
Low doses favor beta stimulation (increased HR, CO, inotropy, and pulse pressure, and a decrease in SVR)
High doses favor alpha effect (increased SVR and decreased CO)
95
Epinephrine effects on local anesthestics
Prolongs duration
96
Dopamine <3 mcg/kg/min effects
D1 stimulation --> vasodilation and increased renal and splanchnic blood flow
97
Dopamine 3-8 mcg/kg/min effects
A1 and B1 stimulation (heart and periphery) --> increased contractility and BP
98
Dopamine >10 mcg/kg/min effects
Pure A1 agonist --> increased BP
99
Post synaptic D1 receptor stimulation
Vasodilation of renal, GI coronary, and cerebral vessels
100
Presynaptic D2 stimulation
Inhibit norepinephrine release = vasodilation
101
Location of D2 receptors
Pituitary gland
Emetic center
Kidney
102
Isoproterenol potency vs epinephrine
2-3x more potent than epinephrine
103
Indirect action of ephedrine
Endocytosis of ephedrine into adrenergic presynaptic terminal > NE is displaced from secretory vesicles >NE activates target A1 and B1
104
Beta-2 agonists with black box warning
Salmeterol
Formoterol
105
Noncompetitive alpha antagonist that block the alpha- mediated activity of NE and epinephrine
Phenoxybenzamine
106
How is the effect of phenoxybenzamine terminated?
The synthesis of new receptors; its bond is permanent
107
Phenoxybenzamine indication
Preoperative management of pheochromocytoma
108
Common complication of phenoxybenzamine administraton
Orthostatic hypotension
109
Best treatment for hypotension in patients who have been taking phenoxybenzamine
Vasopressin
Fluids
110
Competitive nonselective alpha receptor antagonist
Phentolamine
111
Half-life of phentolamine
< 10 minutes
(much shorter than phenoxybenzamine)
112
In what patients should phentolamine be used cautiously?
Pts with flow-limited coronary artery disease (d/t rapid vasodilation resulting in reflex tachycardia)
113
Used to treat infiltration of epinephrine or norepinephrine
Phentolamine
114
Used to treat refractory hypertension d/t abrupt discontinuation of clonidine
Phentolamine
115
Alpha antagonist that has an affinity for 5-HT receptors = stimulates stomach acid secretion and induces mast cell degranulation
Phentolamine
116
Highly selective A1 receptor antagonist with 1000:1 A1:A2 affinity
Prazosin
117
Side effects of prazosin
Orthostatic hypotension
118
Prazosin analogs
Terazosin
Doxazosin
Tamsulosin
119
Beta blocker indications
Hypertension
Supraventricular tachycardia
Atrial fibrillation
Blunting an acute hemodynamic response
CHF and ischemic heart disease
Reducing myocardial O2 consumption and improving perfusion
120
What is membrane stabilizing activity?
Inhibits or abolishes action potential propagation across the cell membrane
121
Nonselective B-adrenergic antagonist prototype
Propranolol
122
Class of drugs that competes with B1 and B2 to prevent the action of epinephrine, norepinephrine, dopamine, dobutamine, and isoproterenol
Nonselective beta adrenergic antagonists
123
List nonselective beta adrenergic antagonists
Carvedilol
Pindolol
Propranolol
Sotalol
Timolol
Nadolol
124
Longest half-life of nonselective beta adrenergic antagonists
Nadolol
125
Nonselective beta adrenergic antagonist that has some weak B-agonist effects (ISA) and is associated with less HR slowing and less impact on BP
Pindolol
126
Selective beta adrenergic antagonist that has some weak B-agonist effects (ISA) and is associated with less HR slowing and less impact on BP
Acebutolol
127
Cardioselective B-adrenergic antagonists (list)
Metoprolol
Atenolol
Acebutolol
Esmolol
Bisoprolol
128
Relationship between dose of medication and beta selectivity
Inverse correlation: as dose increases, selectivity decreases
129
Beta blocker that is metabolized in the bloodstream
Esmolol
130
Beta blocker that is metabolized in the kidneys
Atenolol
131
Site of metabolism for most beta blockers
Liver
132
Metoprolol indications
Angina
Heart failure
MI
A fib
HTN
133
Beta blocker that is metabolized in the kidneys
Atenolol
134
Metoprolol IV dosing
2.5- 5mg increments to a maximum of 15mg
135
First line drug for rapid and perioperative control of HR and BP
Esmolol
136
Esmolol duration of action
<15 minutes
137
Bolus dose of esmolol
10-80 mg
138
Infusion dose of esmolol
50-300 mcg/kg/min
139
Name the drug
Propanolol
140
Name the drug
Esmolol
141
Atenolol indications
HTN
Chronic angina
Follow-up post MI
142
Name the drug
Labetalol
143
Labetalol primary indication
Acute HTN
144
Beta blocker with antioxidant and anti-inflammatory properties
Carvedilol
145
Carvedilol indications
Heart failure
Left ventricular dysfunction
HTN
Acute MI
146
Carvedilol dosing
12.5- 50mg PO in two doses
147
Carvedilol adverse effects
Orthostatic hypotension
148
Name the drug
Ephedrine
149
Name the drug
Phenylephrine
150
Used to identify reactive airway disease in pts who do not have clinically significant asthma
Methacholine
151
Receptor that methacholine activates
M3
152
Antimuscarinic that does not cross the BBB
Glycopyrrolate
153
Antimuscarinics' effect on HR in descending order
Atropine > Glycopyrrolate > Scopolamine
154
Antimuscarinics' effect as antisialagogue in descending order
Scopolamine > glyco > atropine
155
Antimuscarinics' effect as sedative in descending order
Scopolamine > atropine > glyco (no effect)
156
Antimuscarinics' mydriasis effect in descending order
Scopolamine > atropine > glyco (no effect)
157
Antimuscarinics' effect on motion sickness in descending order
Scopolamine > atropine > glyco (no effect)
158
Effect of low dose atropine (<0.1 mg)
Worsening bradycardia d/t blocking M1 receptors on preganglionic parasympathetic fibers
159
Scopolamine and atropine toxicity symptoms
Increased HR
Dry mouth
Anhidrosis
Thirst
Palpitations
Mydriasis
Cycloplegia
Restlessness
Confusion
Hot, flushed skin
Fever
Hallucinations
Coma
Death
160
Treatment for scopolamine or atropine toxicity
Physostigmine 1-2mg IV (may need to be repeated)
161
Type of Ca++ channels that CCB block?
Long (L) type Ca++ channels
162
Three classes of CCB
1. Dihydropyridines
2. Benzothiazipines
3. Phenylalkylamines
163
Dihydropyridines (list)
Nifedipine
Nimodipine
Nicardipine
Clevidipine
164
Benzothiazipines
Diltiazem
165
Phenylalkylamines
Verapamil
166
Best CCBs for HR control
Verapamil
Diltiazem
167
Rank CCB from highest to lowest impact on contractility reduction
Verapamil > nifedipine > diltiazem > nicardipine
168
Best CCB for treatment of HTN from elevated SVR
Nifedipine
Nicardipine
169
CCB used as a coronary antispasmodic
Nicardipine
170
The only CCB proven to reduce morbidity and mortality from cerebral vasospasm
Nimodipine
171
CCB have a greater impact on arterial or venous smooth muscle?
Arterial
172
Verapamil effect on cardiac conductivity
Reduces SA node discharge and decreases AV node conduction, prolonging PR interval
173
Verapamil dose
2.5-10 mg over 2 minutes
174
Diltiazem dose
0.25mg/ kg over 2 minutes
175
Clevidipine half life
~2 minutes
176
CCB that is useful in treating acute HTN, even in setting of pheo and intracerebral hemorrhage
Clevidipine
177
Clevidipine dose
1-2 mg/hr
178
Most lipophilic CCB
Nimodipine
179
CCB that fosters cerebral vasodilation
Nimodipine
180
CCB with baroreceptor-mediated increases in HR
Nifedipine
181
CCB that may worsen mortality in those with MI
Nifedipine
182
CCB often prescribed for pt with Raynaud's
Nifedipine
183
Nifedipine dose
0.5 mg/hr
184
CCB that dilates coronary arteries with little effect on inotropy
Nicardipine
185
Nicardipine dose
5 mg/hr
186
Direct vasodilators (list)
Nitroglycerin
Nitroprusside
Hydralazine
187
Nitroglycerine primary action
Venodilator with reduced preload
188
Nitroprusside primary action
Reduces afterload and preload
189
Hydralazine primary action
Arterial smooth muscle dilator
190
Nitroglycerin dosing
5-100 mcg/min
191
Nitroglycerin onset
2-5 min
192
Nitroglycerin duration
5-10 min
193
Nitroglycerin site of artery dilation (possibly)
Coronary arteries
194
Nitroprusside dosing
0.3- 10 mcg/ kg/ min
195
Nitroprusside onset
Seconds
196
Nitroprusside duration
<5 minutes
197
Nitroprusside adverse effect
Potential for cyanide toxicity
198
Hydralazine dosing
2.5- 20 mg
199
Hydralazine onset
2- 20 min
200
Hydralazine duration
Up to 12 hours
201
NTG mechanism of action
Liberates nitric oxide = dilation
202
Why is nitroprusside not used in MI
It will induce coronary steal, taking blood flow away from ischemic tissue
203
PDE 5 inhibitors (list)
Slidenafil
Tadalafil
Vardenafil
204
PDE 5 inhibitors mechanism of action
Increase levels of cGMP by inhibiting its breakdown --> increase cGMP targets lungs and penis
205
PDE 5 inhibitors' effects
Pulmonary vasodilation
Decrease PAP
206
PDE 4 inhibitors (list)
Roflumilast
Apremilast
Ibudilast
207
PDE 4 inhibitors MOA
Increase levels of cAMP targeting the airways, skin, and immune system
208
PDE 4 inhibitors uses
Airway smooth muscles relaxation
Inflammatory disorders of the skin, bowel, and joints
209
PDE 3 inhibitors (list)
Milrinone
Cilostazol
210
PDE 3 inhibitors MOA
Increase levels of cAMP and cGMP
211
PDE 3 inhibitors uses
Cardiovascular disease
Intermittent claudication
Prevent platelet aggregation for thrombosis prophylaxis
CPBP weaning
212
Milrinone dosing
25-50 mcg/kg over 10 min
0.375 -0.75 mcg/kg/min infusion
213
Nonspecific PDE inhibitors (list)
Theophylline
Methylxanthine
214
Vasopressin effect on healthy, conscious person
Little effect on BP d/t reflex mediation
215
Vasopressin effect on pt with SNS or renin-angiotensin- aldosterone axis dysfunction
Activates V1 to restore BP
216
Vasopressin indications
Distributive shock, pulmonary HTN, anaphylaxis, ACLS
217
Vasopressin dose
1-2 unit bolus
0.01- 0.1 unit/ minute infusion
218
Side effects of ACEi
Dry cough
Hyperkalemia
Fatigue
Renal dysfunction
Angioedema
219
Treatment for ACEi hypotension
Vasopressin may be necessary d/t refractory hypotension
