Autonomics and Anti-HTN

Question 1

Alpha 1

Answer 1

Arterial and venous vasoconstriction –> increase MAP; mydriasis

Question 2

Alpha 2

Answer 2

Sympatholytic (inhibits NT release)

Decrease lipolysis, insulin release, aqueous humor production

Question 3

Beta 1

Answer 3

Increase HR and cardiac contractility

Increase renin release (RAAS)

Question 4

Beta 2

Answer 4

Bronchodilation
Vasodilation in heart and skeletal musicle
Decrease SVR
Increase lipolysis, insulin release, gluconeogenesis, aqueous humor production, cellular uptake of K (leads to hypokalemia)

Question 5

Alpha 1 agonist

Answer 5

Phenylephrine (pressor for septic shock, reflex bradycardia)

Question 6

Alpha 1-2, Beta 1 agonist

Answer 6

Norepinephrine (increases systolic, diastolic, MAP, pulse pressure)

Question 7

Beta 1-2 agonist

Answer 7

Isoproterenol (increase HR and contractility, decreases MAP, decreases diastolic, increases pulse pressure)

Question 8

Beta 1 (»Beta 2 agonist)

Answer 8

Dobutamine (cardiogenic shock, increases HR/contractility, increase systolic, can increase diastolic, increases pulse pressure)

Question 9

Beta 2 agonists

Answer 9

Asthma (-rol): albuterol, salmetrol

Tocolytic: ritadrine, terbutaline

Question 10

Alpha 2 agonist

Answer 10

Clonidine (HTN)

Question 11

Alpha nonselective blocker

Answer 11

Phentolamine (reversible)

Phenoxybenzamine (irreversible)

Question 12

Alpha 1 selective blocker

Answer 12

“zosins”: prazosin, terazosin, tamsulosin (HTN, BPH)

Question 13

Beta non-selective blocker

Answer 13

[O-Z]-olol: propranolol, nadolol, timolol, pindolol sotalol

Question 14

Beta 1 selective blocker

Answer 14

[A-M]-olol: metoprolol, atenolol, acebutolol esmolol

- Trx HTN after MI or CHF

Question 15

Mixed alpha-beta blockers

Answer 15

Carvedilol (chronic heart failure mgmt), labetalol (HTN emergency, pregnancy, IV, vasodilation)

Question 16

Muscarinic agonists (cholinomimetics)

Answer 16

• Bethanecol (non-obstructive GI dysmotility, urinary retention
• Pilocarpine (acute angle glaucoma - causes pupil constriction)
• Methacholine (challenge for testing asthma)

Question 17

Cholinergic agonists (indirect cholinomimetics= acetylcholinesterase inhibitors=anticholinesterase)

Answer 17

• Neostigmine, pyridiostigmine (trx myasthenia gravis)
• Edrophonium (tensilon test for MG)
• Physostigmine (reverse anticholinergic (i.e. atropine, belladonna) poisoning)
• Organophosphates

Question 18

Cholinergic toxicity (anticholinesterase toxicity)

Answer 18

DUMBBELS

• Diarrhea
• Urination
• Miosis (pupillary constriction)
• Bradycardia
• Bronchoconstriction
• Excitation
• Lacrimation
• Salivation

Question 19

Muscarinic antagonists (anticholinergics)

• Effects
• Drugs

Answer 19

Blind as a bat (mydriasis), red as a beet (vasodilation), mad as a hatter (CNS effects), hot as a hare (hyperthermia), dry as a bone (dry skin). Bladder and bowel lose their tone as the heart goes on alone (ileus, urinary retention, tachycardia)

• Atropine: used in codes; + pralidoxime – used in anticholinesterase poisoning)
• Ipratropium, tiotropium: COPD
• Scopolamine: motion sickness, post-op nausea/vomiting
• Glycopyrrolate: decrease secretions
• Oxybutinin: trx overactive bladder
• Tropicamide: eye dilation

Question 20

Sweaty

Dry

Answer 20

Sweaty: sympathomimetics, cholinomimetics
Dry: Anticholinergics, opioids

Question 21

Mydriasis

Miosis

Answer 21

Mydriasis (pupil dilation): sympathomimetics, anticholinergics
Miosis (pupil constriction): cholinomimetic, opioids

Question 22

Sweaty, mydriasis

Answer 22

Sympathomimetic

Question 23

Dry, miosis

Answer 23

Opioids

Question 24

Sweaty, miosis

Answer 24

Cholinomimetics

Question 25

Dry, mydriasis

Answer 25

Anticholinergic

Question 26

Dopamine - Low dose - Medium - High

Answer 26

- Low: D1 activity = increased renal and mesenteric blood flow - Medium: increased Beta 1 activity = increased cardiac output - High: Increased alpha 1 activity = vasoconstriction, increased MAP