Drugs #2 Flashcards Preview

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Flashcards in Drugs #2 Deck (19):
1

Epinephrine
P/T/I

stimulates a1, a2, b1, b2
-short half life
P:
Low dose
-lower diastolic BP (b2)
-Increase CO (b1)
Higher Dose
-Increase TPR and CO (a1+a2+b1)
-bronchodilation (b2)
-decreased bronchial secretions (a1)

T:
Arrhythmias

I:
Anaphylaxis
Cardiac Arrest
Bronchospasm

2

Norepinephrine
PTIC

stimulates a1, a1, b1
-short half life-give by controlled infusion

P:
Increase CO (b1)
Increase TPR (a1+a2)
Decrease HR (baroreflex)
Overall increase MAP

T:
Ischemia

I:
limited to shock

C:
pre-existing vaso-constriction or ischemia

3

Dopamine
PTIC

D1, D2, b1, a1, a2
-metabolized readily
P:
Low
decreased TPR (D1)
Medium
Increased cardiac contractility and HR (b1)
High
increased BP and TPR (a1,a2)
T:
low infusion rates=hypotension
high infusion rates=ischemia

I:
Hypotension due to low cardiac output during cardiogenic shock-may be advantageous due to vasodilatory effect in renal and mesenteric vascular bed

C: uncorrected tachyarrhythmias

4

Isoproterenol
PTIC

synthetic catecholamine B1 and B2
-susceptible to degradation

P
1. peripheral vasodilation (b2) -decreased diastolic bp

2. positive inotropy and chronotropy (b1)-transient increased systolic BP BUT overcome by vasodilatory effect

*small decrease in MAP
-->may contribute to further reflex HR increase

3. bronchodilation (b2)

T:
Tachyarrhythmias

I:
cardiac stimulation during bradycardia or heart block when peripheral resistance is high

C: arrhythmias

5

Dobutamine
PTIC

B1 selective agonist
rapidly degraded by COMPT

P
1. more ionotropic than chronotropic
-nice increase in CO without big reflex in HR

I:
short term Rx for CHF or cardiogenic shock

T
Hypotension
**high dose-->B2 act-->low bp

6

Terbutaline and Albuterol

B2-agonist
P:
Bronchodilation
Uterine relaxation

I:
Bronchospasm
Chronic Rx of obstructive airway

T:
Tachycardia (B1)
Muscle tremor (b2)-activation of b2 receptors expressed on pre-synaptic nerve terminals of cholinergic somatomotor neurons
Tolerance (b2)

7

Phenylephrine
PTIC

NOT a catecholamine, not subject to COMT degradation

A1 agonist

P:
Increase TPR and MAP
Decrease HR (baroreflex)
Pupillary dilation
Decrease bronchiole and sinus secretions

T:
hypertension

I:
-hypotension during anesthesia
-SV tachycardia
-mydriatic agent in opthalmis Rx
-nasal congestion

C:
hypertension

8

Clonidine
PTIC

a2 agonist
-can cross bbb-->decrease in sympathetic

P:
-acute increase in BP (peripheral effect)
---reduced BP (central effect)

T:
dry mouth
hypertensive crisis (after acute withdrawal)

I:
Hypertension due to sympathetic activation

9

What are 6 indirect acting sympathomimetics?

1. amphetamine
2. methamphetamine
3. methylphenidate
4. ephedrine
5. pseudoephedrine
6. tyramine

10

What are the PTIC for indirect acting sympathetics?

P:
1. Increased TPR and diastolic BP (a1+a2)
2. Positive ionotrophic and chronotropic effects, increased systolic pressure (B1)
3. CNS stimulant (probably increased NE)
4. Anorexia (probably increased DA)

T:
Tachycardia (b1)

I:
Attention Deficit Disorder
Narcolepsy
Nasal congestion

C:
Rx with MAO inhibitors within 2 weeks

11

What are 3 Non-selective B-blockers?

1. Propranolol
2. Nadolol
3. Timolol

12

Non-selective B-blockers
PTIC

P:
Decreased HR
Decreased contractility
Decreased renin release
Reduced sympathetic activation
Inhibition of aqueous humor production

T:
Bronchospasm
Mask symptoms of hypoglycemia
Bradycardia

I:
Hypertension
Angina
Glaucoma
Early to moderate heart failure
Arrhythmia
Thyrotoxicosis
Anxiety

C:
Bronchospasm during asthma
Sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock

13

What are 3 cardioselective B1 blockers?

metoprolol, atenolol, esmolol

14

cardioselective B1-blockers
PTIC

P:
decreased HR
decreased contractility
decreased renin release
decreased sympathetic activation

T:
hypotension
bradycardia

I:
hypertension
angina
arrhythmia

C:
sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock

15

Pindolol
PTIC

partial agonist b-blocker
P:
decrease BP
decrease contractility
decrease renin release
decreased sympathetic activation

T:
Hypotension

I:
Hypertension

C:
sinus bradycardia
2nd and 3rd degree heart block
cardiogenic shock

16

What are two non-selective alpha blockers?

Phentolamine (reversible)
Phenoxybenzamine (irreversible)

17

Non-selective alpha blockers?
PTIC

P:
Decreased BP
(alpha blockade +unmasks b effects)
Increased chronotropy and inotropy
-->increased release of NE and reflex increase in NE release in response to hypotension
-unmasks vasodilator effect of EPI
(which has both alpha and beta effects)

T:
Prolonged hypotension
reflex tachycardia
nasal congestion

I:
hypertension associated with pheochromocytoma, vasoconstrictor induced extravasation

18

What are three selective alpha 1 adrenergic blockers?

1. prazosin
2. doxazosin
3. terazosin

19

Alpha 1 adrenergic blockers
PTIC

P
Inhibits vasoconstriction
prostate smooth muscle relaxation

T
orthostatic hypotension

I
hypertension
Benign prostatic hyperplasia