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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?

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
What does alpha 1 receptors do? Beta 2?
- Vasoconstrict | - Vasodilate
26
What does an intermediate dose of epi do?
- Mostly beta 1 effects | - Increased HR, Contractility, CO and automaticity
27
What does high does epi do?
- Mostly Alpha 1 - Vasoconstricts cutaneous, splanchnic and renal beds - Maintain myocardial and cerebral perfusion
28
When is epi used?
- Asthma - Anaphylaxis - cardiac arrest - bleeding - prolong regional anesthesia - decrease absorption of LA
29
How does epi decrease renal blood flow?
- decrease renal blood flow (alpha 1) | - Stimulate renin release (indirect)
30
What happen to a patient taking Epi w/ an alpha blocker? Beta blocker?
- "Epi reversal" Beta 2 response (hypotension) | - Unopposed alpha response
31
What are the side effects of epi?
- Hyperglycemia - mydrasis - platelet aggregation - sweating - headache - tremor - nausea - arrhythmias
32
What is dopamine? and what receptors does it work on?
- Endogenous catecholamine | - Alpha/Beta/ and indirect NorEpi
33
What are 3 adverse effects of vasoconstrictors?
- Cardiac dysrhythmias (Beta) - Baroreceptor bradycardia and decrease CO (Alpha) - Antihypertensives may decrease response of indirect, and increase response of direct
34
Why are tricyclic antidepressants and MAOI problematic w/ vasoconstrictors?
- Increase endogenous NorEpi | - Exaggerated indirect response (don't use ephedrine)
35
Natural weight loss product may contain what? and cause what?
- Ephedrine or pseudoephedrine | - Tachyphylaxis, hemodynamic instability, CV collapse
36
What drug will treat extravasation?
-Phentolamine
37
What is phentolamine and what does it do?
Peripheral vasodilator to treat skin necrosis secondary to Epi, NorEpi, Dopamine through peripheral line.
38
What are the 3 posterior pituitary hormones that vaso constrict?
- Arginine vasopressin (AVP) - Oxytocin - DDAVP (desmopressin)
39
What is arginine vasopressin? And what does it do?
- Peptide - Stimulates V1 (intense arterial vasoconstriction) - Stimulates V2 (reabsorption of water)
40
Why is arginine vasopressin used?
- Advanced vasodilatory shock - Failed conventional vasopressor therapy - Effects are preserved w/ hypoxia and acidosis
41
What are the advantages of arginine vasopressin over Epi?
- Epi increases myocardial O2 consumption - Epi increases risk of post CPR MI and arrhythmias - Epi may not work well in acidic environment
42
arginine vasopressin is _______ to Epi in patients with _________.
- Superior | - Asystole

Pharm 2 (23 decks)

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