Cardio Autonomic pharmacology Flashcards Preview

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Flashcards in Cardio Autonomic pharmacology Deck (55):
1

Epinephrine selectivity

a1 agonist
a2 agonist
B1 agonist
B2 agonist

(Mixed alpha beta receptor agonist)

2

Epinephrine uses

1: drug of choice for anaphylactic shock

2: prolong duration of local anesthetic

3

Describe how epinephrine acts in anaphylactic shock

1: Supports BP (increased vasoconstriction -a1, decreased fluid loss and edma- a1, increased cardiac output- increased HR and contractility- B1)

2: Supports breathing (bronchial smooth muscle relaxation - B2, decreased mucous secretion- a1, decreased pulmonary edema- a1)

3: inhibit release of mediators of anaphylaxis (B2)

4

Norepinephrine selectivity

a1
a2
B1

(mixed alpha beta agonist)

5

Norepinephrine

a1- vascular resistance

B1- increased cardiac contractility

(both work together to increase bp)

6

Norepinephrine uses

1: Cardiogenic shock

2: Septic shock

7

Side effects of mixed alpha beta agonists

Extension of pharmacological effects

1: Tachy (B1)

2: Arrhythmia (B1)

3: Hypertensive crisis (a1)

4: Dry mouth, mild depression, sedation (a2)

5: Closed angle glaucoma

8

Name the a1 selective agonists

Phenylephrine**
Methoxamine
Midodrine

9

a1 selective agonist MOA

vasoconstriction

10

a1 selective agonist uses

1: Reduce Bleeding
2: Hypotensive crisis
3: Nasal decongestion

11

a2 selective agonists

Methyldopa
Clonidine

12

Methyldopa MOA

prodrug (can be used in hypertension during pregnancy)

acts ONLY on the CNS to increase sympathetic outflow and lower blood pressure

13

Clondine MOA

works on both the CNS (lower sympathetic outflow) and PNS (lower NE release)

14

Uses of a2 selective agonists

Hypertension

15

Methyldopa side effects

Positive direct coombs & Hemolytic anemia

lupus erythematosus

16

B1 selective agonists

Dobutamine
Dopamine

17

Dobutamine uses

Failed cardiac pump function

- Severe Congestive heart failure

- Cardiogenic shock

18

Dobutamine MOA

increase cardiac output and contractility

19

Dopamine low dose

activation of D1 on kidneys resulting in increases diuresis

20

Domamine intermediate dose

Activation of B1 in the heart to increase contractile force

21

Dopamine high dose

acts on A1 receptors to increase peripheral resistance resulting in increase in HR

22

Dopamine uses

1: Septic Shock

2: Severe Congestive heart failure

3: Cardiogenic shock

23

Nonselective Beta receptor agonist

Isoproterenol

24

Isoproterenol uses

AV block (speed up conductance)

Bradycardia

Strokes-Adams attack (loss of cardiac output)

25

Dopamine 1 agonist

Fenoldopam

26

Fenoldopam uses

Hypertensive crisis (especially in those in renal failure)

27

Fenoldopam MOA

bind DA1 receptors on coronary and renal artery to cause vessel relaxation

28

Fenoldopam side effects

reflex tachycardia (due to stimulation of baroreflex)

29

Fenoldopam contraindication

Glaucoma (open or closed angle) - increases intraoccular pressure

30

Mixed alpha beta antagonists

Labetalol
Carvediol

31

Latetalol uses

1: Hypertension

2: Hypertensive crisis

3: Ischemic heart disease

32

Labetalol MOA

Competitive and reversibel binding to a1, B1, and B2

higher potency for BETA receptors

33

Carvedilol MOA

Competive and reversible binding to a1, B1, and B2

higher potency for BETA receptors

34

Carvediol uses

Hypertension

Ischemic heart disease

Chronic heart failure (preferred drug)

(other: antioxidant, antiproliferative, NO production)

35

Mixed alpha beta antagonist Adverse effects

Bradycardia

Precipitation of acute heart failure

Bronchospasm

Cold extremities

Raynauds disease

CNS- mental depression, insomnia, fatigue

36

Metabolic effects of mixed alpha beta antagonists

decreased blood glucose plasma levels

altered plasma lipid levels (worsened profile)

37

Contraindications of Beta receptor antagonists

Asthma (nonselective should be avoilded)

AV block (can worsen condition)

38

Nonselective alpha antagonists

Phenoxybenzamine
Phentolamine

39

Phenoxybenzamine uses

Pheochromocytoma

40

Phenoxybenzamine MOA

competitive IRREVERSIBLE

vasodialation
Cardiac stimulation

41

Phenoxybenzamine AE

reflex tachycardia

42

Phenoxybenxamine Drug- drug interactions

High doses can block seratonin, histamine, and AcH

43

Phentolamine uses

1: reversal of anesthesia

2: Hypertensive crisis associated with MOA inhibitor

44

Phentolamine MOA

competitive REVERSIBLE, dose dependent

Vasodilation
Cardiac stimulation

45

Alpha 1 selective antagonist

Prazosin

46

Prazosin pharmacological effects

reduce LDL and TG and increase HDL

suppress release of NE

Dilate arteries and veins (decrease BP)

47

Prazosin clinical uses

Pheochromocytoma

Chronic hypertension with benighn prostatic hyperplasia (BPH)

Urinary retention in men with BPH

Chronic hypertension (not commonly used)

48

Prazosin adverse effects

First dose syncope (30-90 minutes after first dose)

hypotension, dizziness, fainting, reflex tachycardia

Nasal stuffiness, impotence, polyuria, water retention

49

nonselective beta antagonist

Propranolol

50

Propranolol uses

Infantile hemangioma

hypertension

ischemic heart disease

Arrhythmia (Supraventricular and ventricular)

Chronic heart failure

51

Beta antagonist MOA (selective and non-selective)

decrease cardiac output (target SA and AV nodes to slow rate and O2 requirements of the heart)

52

Beta antagonist AE (selective and non-selective)

Bradycardia

53

Beta antagonist discontinuation (selective and non-selective)

requires tapering

54

Beta antagonist drug-drug interaction (selective and non-selective)

insulin

55

Beta antagonist contraindication (selective and non-selective)

Asthma and AV block