Drug review

Question 1

Epinephrine mech?

Answer 1

activate a1, a2, B1, B2, B3 [B2 > a1]

Question 2

Epinephrine effect on:
HR
SBP
DBP
MAP
TPR

in low dose vs normal dose

Answer 2

Low dose → decrease diastolic and mean BP
o Increase HR/SBP/slightly MAP and decrease TPR/DBP

Normal dose
o Increase all HR/SBP/DBP/MAP/TPR

Question 3

Norepinephrine mech?

Answer 3

activates a1, a2, B1 [NOT B2]

Question 4

Norepinephrine effect on:
HR
SBP
DBP
MAP
TPR

Answer 4

increase DBP/MAP/SBP/TPR; decrease HR
o Strong baroreceptor decreases HR
o Increases BP more than Epi due to lack of B2

Question 5

Use of norepinephrine?

Answer 5

cardiogenic shock, septic/hypovolemic shock

Question 6

adverse of norepi?

Answer 6

severe hypertension

Question 7

Isoproterenol mech?

Answer 7

activates B1/B2/B3 [not As]

B agonist

Question 8

Isoproterenol effect on:
HR
SBP
DBP
MAP
TPR

Answer 8

decrease DBP/MAP/TPR; increase SBP slightly/HR

o Biggest increase HR b/c direct same direction as reflex

Question 9

Dobutamine mech?

Answer 9

selective B1 agonist

Question 10

Dobutamine effect?

Answer 10

increase HR and contractility

Question 11

Dopamine mech?

Answer 11

low dose = D1
moderate = D1 + B1
high = D1 + B1 + a1

Question 12

Dopamine effect at low, medium high dose?

Answer 12

low = more renal flow + urine output, decrease BP a little
moderate = decrease BP a little, increase HR/CO, no change in TPR
high = increase BP, a1 effect outweighs D1 effect

Question 13

Fenoldopam mech?

Answer 13

selective D1 agonist

Question 14

Fenoldopam effect?

Answer 14

decrease BP –> used to treat severe HTN

Question 15

Albuterol Mech?

Answer 15

selective B2 agonist

Question 16

Albuterol effect?

Answer 16

vasodilate + bronchodilate + increase HR

Question 17

Side effects/adverse of albuterol?

Answer 17

tachycardia, N/V, hypokalemia, hypotension

Question 18

Phenylephrine mech?

Answer 18

a agonist, slightly selective for a1

Question 19

Clonidine mech?

Answer 19

a2 agonist = sympatholytic adrenergic agonist

Question 20

What is action of tyramine?

Answer 20

NE releaser = indirect sympathomimetic

in aged cheese/meat/fish/wine

avoid with MAO inhibitor

Question 21

What is mech of propanolol?

Answer 21

non-selective B blocker
also a class II anti-arrhythmic

Question 22

What is use of B blockers?

Answer 22

• angina, SVT, slowing ventricular rate during AFib/flutter
• HTN
• MI

Question 23

What is mech of nadolol?

Answer 23

non-selective B blocker

Question 24

What is mech of metoprolol?

Answer 24

selective B1 blocker

Question 25

What is mech of atenolol?

Answer 25

selective B1 blocker

Question 26

What is mech of bisoprolol?

Answer 26

selective B1 blocker

Question 27

What is mech of action of pindol?

Answer 27

partial B1/B2 agonist - in absence of normal physiologic agonist it is an agonist when high sympathetic drive --> its a beta antagonist

Question 28

What is black box warning with B blockers?

Answer 28

don't withdraw quickly b/c upregulated B receptors cause unsafe increase in HR and contractility

Question 29

What B blocker does not have black box warning?

Answer 29

pindol

Question 30

WHat is mech carvedilol?

Answer 30

antagonist at B1, B2 | partial antagonist at a1

Question 31

What is effect of carvedilol?

Answer 31

vasodilate, inhibits cardiac remodeling use in HF

Question 32

What is mech of labetalol?

Answer 32

antagonist at B1/a1 | partial agonist at B2 with ISA activity [aka antagonist when high intrinsic sympathetic activity]

Question 33

What is mech of phentolamine?

Answer 33

competitive a antagonist

Question 34

What is effect of phentolamine?

Answer 34

decrease BP due to a1 blockade

Question 35

What is mech of acetylcholine?

Answer 35

full agonist at M and N receptors | higher affinity for M than N

Question 36

What is effect of ACh with small vs large dose?

Answer 36

``` small = quick drop in BP, reflex tachycardia big = direct effect on SA node --> drop in BP + bradycardia ```

Question 37

What is mech of bethanechol?

Answer 37

M agonist

Question 38

What is mech of nicotine?

Answer 38

N agonist --> at ganglia activates sympathetic/parasympathetic branches whichever is dominant for the most part

Question 39

What is effect of nicotine?

Answer 39

- increase BP - increase HR [in part due to Epi released from adrenal] at high dose --> ANS activation then depolarizing blockade

Question 40

What is mech of neostigmine? does it cross BBB?

Answer 40

AChe inhibitor does not cross BBB

Question 41

What is mech of physostigmine? does it cross bbb?

Answer 41

AChe Inhibitor crosses BBB

Question 42

What is mech of donepezil?

Answer 42

AChe inhibitor, relatively selective for brain ACh

Question 43

What is mech of rivastigmine?

Answer 43

AChe inhibitor, relatively selective for brain ACh

Question 44

What is mech of galantamine?

Answer 44

AChe inhibitor

Question 45

What is use of donepezil/rivastigmine/galantamine?

Answer 45

used to treat dementia

Question 46

What is mech of atropine?

Answer 46

M receptor antagonist

Question 47

What is mech of scopalamine?

Answer 47

M receptor antagonist

Question 48

What is mech of ipratroprium?

Answer 48

competitive non-selective muscarinic antagonist inhalational only

Question 49

What is use of ipratroprium?

Answer 49

acute asthma exacerbation | bronchospasm w/ COPD

Question 50

What type of drug is quinidine?

Answer 50

class 1A

Question 51

What type of drug is lidocaine?

Answer 51

class iB

Question 52

What type of drug is flecainide?

Answer 52

class 1C

Question 53

What type of drug is amiodarone?

Answer 53

class 3

Question 54

What type of drug is sotolol?

Answer 54

class 3

Question 55

What type of drug is dilitiazem?

Answer 55

class 4

Question 56

What type of drug is procainamide?

Answer 56

class 1A

Question 57

What type of drug is propafenone?

Answer 57

class 1C

Question 58

What type of drug is dofetilide?

Answer 58

class 3

Question 59

What type of drug is verapamil?

Answer 59

class 4