Exam 2 Flashcards
(267 cards)
1
Q
Which G-protiens do Alpha 1 - Receptors (A-1-R) stimulate?
A
Stimulates Gq Proteins- that stimulates IP3 , DAG, PKC
increases Ca+ influx
2
Q
What effects will Alpha-1-R have on the cardiovascular system ?
A
A-1-R are located on the arteries and vein of the heart
increase Vasoconstriction
Increase SVR = increase BP
Increase venous return = Increase SVR =Increase in CO = increase in BP
3
Q
What effects will A-1-R have on other parts of the body ?
A
Eye - vasodilate - like bella donna
Nasal - increase nasal constriction
decreases secretions and epitaxsis
4
Q
Which G-protein does A-2-R stimulate ?
A
Alpha 2 - Receptors stimulate Gi (inhibitory)
decreases adenylyl cyclase = decrease in cAMP
increases K+ efflux
5
Q
What effects will A-2-R have on the cardiovascular system ?
A
A2 is Gi protein - Presynaptic receptor =v asodilation
decrease RR - depth
decrease HR , Contractility = decreased CO
Decrease SVR = Decrease BP
6
Q
What are the second messengers of Beta 1 Receptors?
A
Beta 1 - Gs Protein = Increases cAMP
HEART
increases HR , contractility , SV, HR , and CO
7
Q
What other parts of the body will Beta-1 stimulate ?
A
Kidneys
Increases JG -> RAAS -> ADH / Aldosterone & BP
8
Q
What is Methalcholine used to diagnose ?
A
Asthma dx
Direct cholinomimetic
9
Q
What’s dose Carbachol do?
A
Increases occlar pressure
Direct cholinomimicts.
Also resistant to hydrolysis
10
Q
What is Bethanechol
A
direct acting cholinomimetic
Muscarinic agonist
Used for Postop urinary retention
11
Q
Muscarinic alkaloid for eyes
A
Pilocarpine
Decreases IOP
12
Q
Edrophonium
A
diagnosis of myasthenia gravis
indirect acting
13
Q
Neostigmine
A
MG treatment and Pyridostigmine
14
Q
Ecothiophate
A
Tx of glaucoma
Cholinesterase inhibitors - takes 100s of hours to breakdown
15
Q
Atropine treats what kind of toxicity
A
organophosphate poisioning
Carbamate insecticides
16
Q
What is Tropicamide used for ?
A
mydriasis and cycloplegia (Dx)
17
Q
Scopolamine
A
Tx : Motion sickness
18
Q
What is Ipratropium used for ?
A
asthma, COPD
Bronchodilator - Opens airways
19
Q
What is Succinylcholine, and its stages ?
A
Depoloarizing NMJ
antinicotinic -NMJ blocker
Phase 1 - depoloarization with no reset
Phase 2 - desensitization of nACh-R
20
Q
What are derivatives of curare?
A
Pancuronium , atracurium , Mivacurium
anti-nicotinic NMJ Blockers
Competitive antagonist - do not depolarize
Suggama dex (revesal)
21
Q
What receptors do Epinepherine stimulate ?
A
A1, B1, B2 (mixed adrenergic agonist)
Sympathomimetic/catecholamine
Direct acting
+ inotropic and + chronotropic
opens airways
Tx: HOTN, anaphylaxis, cardiac and respiratory tx
22
Q
what receptors do Norephinephrine stimulate ?
A
A, B1- cardiac
Sympathomimetic
(adrenergic Agonist)/Catecholamine
Direct acting
Increases HR, BP, vasoconstriction
23
Q
what is Isoproterenol used for?
A
B1, B2 cardiac
Sympathomimetic/Catecholamine
Direct acting
increase contractility, HR, SV, and CO
decreases BP
24
Q
What does Dopamine do?
A
D, B1 Sympathomimetic (adrenergic Agonist)/Catecholamine
Direct acting
Positive Inotrope and chronotrop
Increased HR and contractility
25
What does Dobutamine do ?
D, B1 - cardiogenic schok
direct acting
Sympathomimetic
(adrenergic Agonist)/Catecholamine
Positive Inotrope
used for cardiogenic shock
26
What does Phenylephrine stimulate?
A1
direct acting
sympathomimetic
(adrenergic Agonist)
Non-catecholamine
Tetralogy of Fallot Increases BP and contractility
OTC - decongestant
27
what is Midodrine primarily used for ?
A1
Sympathomimetic
Direct (adrenergic Agonist)
Non-catecholamine
TX: orthostatic HOTN
28
Tell me about Clonidine (catapres)?
A2
Direct - Sympathomimetic (adrenergic Agonist)
Centrally acting Sympathoplegic
Rapidly enters brain
Back up antihypertensive
Sedation
tx - HTN, Hemodynamic instability, ADHD, Tourettes, withdrawal symptoms , Anxiety and PTSD
29
What is Dexmedetomidine used for and how ?
A2 Agonist
Direct Acting
Sympathomimetic
"Anesthesia"
30
How does Ephedrine work ?
Direct AND Indirect (mixed adrenergic agonist)
Sympathomimetic
Non-catecholamine
Tx: OTC - decongestant
HOTN , bronchial asthma
31
How are Amphetamine’s used?
indirect acting sympathomimetic (adrenergic agonist)
Non-catecholamine
displacement of NE , reverse NET, Block DAT
TX: Diet control , ADHD
32
What effects will Cocaine have on the body ?
indirect-acting (adrenergic Agonist) sympathomimetic
Non-catecholamine
Blocks NET, DAT
recreational use
33
Irreversible Sympatholytics ?
Phenoxybenzamine
used for pheochromocytoma
34
What is Propranolol used for ?
B1, B2 Blocker - nonselective
adrenoreceptor antagonist
beta antagonist - will lower constitutive activity
used for HTN and prevents reflex tachycardia
replaced by Metoprolol and Atenolol for their cardioselectivity
extensive first pass metabolism
35
What type of receptors does Labetalol stimulate?
Alpha and Beta Blocker
Racemic mixture
S,R - A1 & A2 blocker
R, R - Beta Blocker
used for HTN, preeclampsia, a
36
What is Phenolamine used for ?
A1, A2 Blocker
used for HTN , cardiac stimulant
37
Metorprolol is what kind of drug?
B1 Blocker - selective
adrenergic receptor blocker
Blocks NE on cardiac myocytes
Decreases slope of phase 4 and prolongs repolarization of phase three at node.
Decreases Ca influx in VG-L-type channel = Decreased HR and contractility
safer in asthma and diabetes
38
Esmolol effects ?
B1 Blocker - cardio selective
Fast-acting and lasting (20-30 mg)
TX: surgical tachycardia and HTN
39
What are the Antihypertensive Classes (4)
* Sympathoplegics (Sympatholytics) - decrease PVR , reduce CO
* Anti-Angiotensins - block activity or production
* Diuretics - deplete sodium
* Direct Vasodilators - relax vascular smooth muscle
ALL act on 1 or more of the four anatomic control sites
40
Methyldopa is what kind of drug?
Alpha Agonist against CNS
Centrally Acting Sympathoplegic
Analog of L-Dopa
not first line
tx - fall back for unresponsive HTN, PIH, Sedation
41
Clonidine acts on which receptors?
Alpha agonist at CNS
Partial agonist
brief rise w/ prolonged hypotension
Tx: ADHD, Tourettes, Withdrawal symptoms , Anxiety, PTSD
Prolongs anesthesia
42
MOA of Vasodilators
Relaxes SM of all arterioles and veins
given in conjunction with with other hypertensive treatments
decreased preload and after load
decreases blood pressure
Hydralazine
Minoxidil
Nitroprusside
Fenoldopam
CCB
Nitrates
43
Hydralazine is used when ?
Direct Vasodilator
K+ channel activation = hyperpolarization of smooth muscle
TX;Used for Hypertensive emergencies
Toxicity symptoms HA, nausea, sweating and flushing
Slow acetylators - SLE symptoms
44
Minoxidil does what to the body ?
K+ channel activation - hyperpolarization of smooth muscle
dilates arteries
TX: HTN
also helps hair grow back
45
Where does Sodium Nitroprusside act?
relaxes vascular SM
breaks down in the blood to release Nitric Oxide
increases intracellular cGMP
slowly eliminated by Kidney = Cyanide poisoning (tx thiosulfate) worse in renal insufficiency patients
Protect IV infusions form sunlight
TX: HTN emergencies & cardiac failure
46
What is nitroprusside's artery action?
increases blood flow to heart by increasing artery size to increase capacitance which increased oxygen delivery to heart
47
The effects Nitroprusside has on the Veins?
decresed blood return to heart , decreasing preload, decreasing oxygen demand on heart - lowering BP and HR
48
What kind of drug is Fenoldopam?
D1 receptor agonist - kidney perfusion
peripheral arteriolar dilator
Short term management of HTN
emergencies or post operative
49
What do CCBs do ?
bind to alpha subunit and block L-Type calcium channels to decrease contractility and BP
Tx: antianginal, anti arrhythmic
50
Verapamil's MOA?
More Cardiac specific CCB
Class 4 antiarrhythmic
Slows SA nodal conduction
blocks both active and inactive Ca channels
Prolongs AV conduction
51
MOA of Diltiazem?
neutral CCB
52
What do Dihydropyridines
CCB that targets vessels
53
Angiotensin Inhibitors MOA?
reduce or block the conversion of angiotensin
54
examples of ACE inhibitors?
Captopril
Lisinopril
55
Examples of ARB (angiotensin Receptor Blockers)?
Losartan
Valsartan
56
Endothelin Receptor Antagonist example?
Bosentan
57
Nitroglycerin MOA?
Nitric Oxide release in vascular smooth muscle
causes head aches , short acting
used for anginal pain
58
Calcium tx's used for HF ?
Ca-Cholride
Ca- Gluconate
59
Digoxin MOA?
Cardiac glycoside
inhibits Na/K+ atpase
decrease Na gradient = decreased AP
Increases risk of arrhythmias due to hyperkalemia and hypomagnesia
60
Milrinone MOA?
Phosphodiesterase inhibitor
positive inotrope - decreases PVR
61
Levosimendan MOA ?
Calcium sensitizer
Available as Supplements only in US
positive inotrope
62
How is Quinidine used ?
Class IA
Used to restore normal sinus rhythm
TX afib, aflutter, and vetricular arrythmias
63
How is Procainimide used?
Class IA
Treats Ventricular arrythmias
64
other than anesthesia how is Lidocaine used?
Class IB
Low toxicity tx of arrythmias
65
Amiodarone will have what effect ?
All 4 classes of cardiac arrhythmia treatment
K+ channel blocker
Prolongs APD
long half-life (13-100 days)
toxicity - bradycardia or heart block , precipitate HF , fatal pulmonary fibrosis
66
Felcainide clas?
Class IC
67
Satolol is used for ?
Class 2 antiarrhythmic
Beta Blocker
prolongs APD = slows rate
68
Beta Blockers with Decreased Mortality ?
Bisoprolol , Carvedilol , Metorprolol
69
Main concern with Nitroprusside administration?
hypotension and Cyanide poison
70
Treatment of Cyanide Poison?
Thiosulfate
71
Meds to avoid in HF?
NDAIDS - worsen HF
Thiazolidinediones - fluid retention
Metformin - increases risk of lethal lactic acidosis
72
CNS is made of ?
Brain and Spinal cord
73
PNS is made of ?
peripheral nervous system
all neurons extend outward from the brain and spinal cord
74
Tell me about the ANS?
involuntary
SNS, PNS, Enteric
cell bodies in ganglia
spinal cord cardiac smooth muscle and glands
75
Sympathetic Activity at organs?
Fight of Flight
Heart - increases HR, and contractility, BP (B1 & B2)
Lungs - Bronchodilation (B2)
Blood vessels - Vasoconstriction (A1)
GI- relax wall (A2, B2) contracts sphincter (A1)
Kidney- Renin release ( B1) , relaxes bladder (B2)
contracts sphincter (A1)
shunts blood to vital organs
must be continuously stimulated
NT: mainly NE
ACh - sweat glands released - protective originally
76
Parasympathetic Activity at Organs?
"Rest & Digest"
Heart - Decreases HR and contractility (M2)
Blood Vessels - relax smooth muscle (M3)
Lungs - bronchoconstriction (M3)
GI - Increases secretions, contracts walls (M3)
Urinary - contracts bladder, relaxes sphincter - increasing urination (M3)
77
Enteric system ?
"gut feeling" / Second Brain
needs no instruction from brain to work
mainly PNS control,
SNS is mainly inhibitory
complex signaling mechanisms
pockets of Neuroendocrine cells
many NANC (non-adrenergic and non-cholinergic)
78
Losartan MOA?
Angiotensin 2 receptor blockers
competitively inhibits AT2-R1
decreases intracellular Ca levels
smooth vessel relaxation leading to vessel dilations
79
Furosemide is what ?
Loop Diuretic
blocks Na+/K+/Cl- re-uptake in loop of henley = increases volume
80
Blood flow through the heart?
APTM
Aortic
Pulmonic
Tricuspid
Mitral
81
BP equation
BP = CO x PVR
82
SVR is what ?
diameter of the vessel determines the resistance of blood flow through them
83
CO is what?
volume of blood per minute
SVR x HR
84
SV is what?
blood volume and contractility
85
Atenolol what what kind of drug ?
Beta1 selective blocker
86
Plant alkaloids
Muscarinic
Nitoctinic
87
Muscarinic plant alkaloids?
Muscarine
pilocarpine
88
Nicotinic plant alkaloids?
nicotine
arecoline (betel nut)
89
Cholinomimetics
(Parasympathomimetics)
direct - stimulate muscarinic and nicotinic receptors
Esters of choline
and Plant alkaloids
90
Esters of Choline examples?
Direct stimulants of muscarinic/nicotinic receptors
Permanently charged - insoluble in lipids
Bethanechol - bladder dysfunction, GERD
Methacholine - Asthma dx
ACh - miosis
Carbachol - decreases IOP
91
Indirect Cholinomimetics do what ?
Block AChesterase (inhibits hydrolysis of ACh)
Simple alcholol - Edrophonium
Carbamic acid esters of alcholol - Neostigmine, Pyridostigmine
Phosphoric acid - organophosphates, Echothiophate
92
Echothiophate treats what?
Glaucoma tx - days to break down
93
Neostigmine, Pyridostigmine are examples of ?
Cholinesterase inhibitors
MG tx, surgical paralysis reversal
94
Edrophonium is used for what ?
MG dx- fast break down
95
Cholinoceptor Blocker
(Parasympatholytics)
Antimuscarinics
Antinicotinics
96
Antimuscarinics examples?
Atropine
Scopolamine
Tropicamide
Ipratromine
main difference is duration of action
97
Atropine treats what ?
Belladonna Alkaloid - muscarinic antagonist
used for bradycardia and organophosphate poisoning ( with Pralidoxime)
NOT for CLOSED/narrow angle glaucoma
98
Scopolamine treats what?
Treatment of motion sickness
99
Tropicamide is used for what?
used for Mydriasis and cycloplegia dx
100
Iptratropium
tx of bronchospasms in COPD and asthma
101
Antinicotinics that are used in anesthesia?
NMJ Blockers - flaccid paralysis
Depolarizing and Non-Depolarizing
102
Depolarizing antinicotinics?
Succinylcholine
depolarization of nicotinic
receptors of skeletal. smooth muscle
103
Non-Depoloarizing antinicotinics?
Pancuronium (long),
Atracurium (mid) ,
Mivacurium (short)
Competitive antagonist block binding of ACh Derivatives of curare
reversed by Suggamdex
104
Sympathomimetics do what ?
mimic sympathetic (fight or flight) system
105
Sympatholytics
(Sympathoplegic)
Block Sympathetic (fight or flight ) system
106
Sympatholytic (Sympathoplegic) - alpha blockers
Phentolamine
Prazosin
Labetalol
107
Phentolamine acts on what receptor ?
A1 and A2 Blocker
Tx: HTN, Cardiac stimulant
108
Prazosin is used for what ?
A1 blocker (antagonist)
relaxes arterial and venous sm
most effective with B-blocker or diuretic
Tx: HTN and BPH
109
Sympatholytic (Sympathoplegic) - Beta Blockers (drugs)
Cardioprotective HTH
Propranolol
Metoprolol
Labetalol
Esmolol
110
Beta blocker effects
(- ) inotropic/chronotropic effects
increased airway resistance
decrease IOP
inhibits lipolysis and glycogenolysis
Increases VLDL decreases HDL
111
Where do antihypertensive agents act ?
All act on 1 or more of the four anatomic control sites
112
Anatomic control sites of Blood pressure
Kidney
Heart
resistance in Arterioles
capacitance in Venules
113
Sympathoplegics act where?
Centrally acting A2>A1
Adrenoceptor Antagonist A&B blockers
114
Centrally Acting Sympathoplegic drugs
Methyldopa
Clonidine
115
Adrenoceptor Antagonist examples?
Prazosin
Propranolol
116
Angina Pectoris- categories
Classic (Effort) Angina
Variant Angina
Unstable Angina
117
Tell me about Classic (effort Angina )
due to plaque
Coronary blood flow does not increase proportionately to increased O2 demands
Easier to treat pharmalogically
Hypertensive = CCBs and Beta blockers
normotensive = long acting nitrates
Non-Pharmalogical - surgical intervention - CABG , Cardiac cath , stent
118
Tell me about Variant Angina
RARE
Prinzmetal Angina
Vasospastic
TX: nitrate or CCB
119
Tell me about Unstable Angina
microvascular disease
angina at rest
120
NItrates and Nitrites do what ?
Nitroglycerin
release nitric oxide to relax vascular smooth muscle - act on myosin
Short-acting - onset 1-3 mins
t1/2 = 2-8 minutes
increase capacitance , decreases ventricular preload , heart size, and CO
121
CCBs in Angina?
decreases contractility, SA node pacemaker rate (HR), AV node conduction
Most effective tx for variant angina
Not for HF - will worsen HF
122
Beta Blockers in Angina?
decrease oxygen demand, HR, BP, and contractility
123
CHF tx exaplmes?
Calcium Chloride or gluconate
Cardiac Glycosides
PDE Inhibitors
Catecholamines
Diuretics
ACE Inhibitors
ARBs
Calcium Sensitizers
Vasodilators
Beta Blockers
124
Afferent
towards CNS
Somatic, Visceral, sensory information
125
Efferent
Away from CNS
Motor
Somatic and Autonomicc Systems
126
what are Ganglia?
Groups of nerve cell bodies apart of the PNS that carry information to and from the CNS
127
What is a Ganglia Chain?
Sympathetic chain
series of nerve clusters that travel from the base of the skull to the coccyx
128
Thoracolumbar describes which nervous system?
Sympathetic
129
Craniosacral describes which nervous system?
Parasympathetic
130
Autonomic Plexus?
network of nerve cells and fibers of the ANS
131
CN 10?
vagus nerve
132
Sympathetic Origins of fibers
Thoracolumbar
Short Pre-ganglion / Long Post-ganglion
Ganglia close to spinal cord
133
Sympathetic Drugs
Sympathomimetics (NE , EPI)
Sympathoplegics (Phentolamine, propranolol)
134
Parasympathetic origin of fibers
Cranio Sacral
(brain and sacral spinal cord)
Long preganglionic / Short postganglionic
Ganglia in the visceral effector organs
135
Parasympathetic Drugs
Cholinomimetic (direct & indirect)
Anticholinergics
(Atropine, curare)
136
Autonomic Feedback loop ( HTN)
increase in BP induces Broreceptors to signal Vagus nerve & vasomotor center
activation: Parasympathetic system
inhibits: sympathetic system
Para - releases ACh - decreases HR at SA node
inhibiting
SNS - decreases HR, SV, and causes vasodilation of blood vessels to decrease BP
137
Autonomic Feedback loop ( Low BP)
A decrease in BP induces
Baroreceptors to signal Vagus nerve & vasomotor center
Inhibiting : Parasympathetic system
Activates: sympathetic system to vasoconstric and increase BP
138
Hormonal feedback loop
Decrease in BP -> decreased Renal Blood flow -> renin is released -> Angiotensin stimulates Aldosterone-> increase in Blood volume, Venous return, SV, CO, and BP
Neural Stimulation
139
Types of Synapse?
Electrical
Chemical
en passant
140
Electrical Synapse use what to communicate?
use gap junctions to transfer ions
141
Chemical Synapse communicate how?
release neurotransmitters from presynaptic termianl and affect receptors on postsynaptic terminal
142
En Passant Synapses are what ?
axon swellings that can release neurotransmitters and effect multiple synapses
143
Neurotransmitter fate (4) at synapses ?
Degraded by enzymes
Diffuses away from Synapse
Uptake into presynaptic cells (recycled )
uptake into surrounding cells
144
Stages of Synaptic transmission
AP cause vesicles to bind to presynaptic cell membrane and release Neurotransmitters
Neurotransmitters interact with post-synaptic cell receptors and can cause action to occur in postsynaptic
145
Neurotransmitter Classes
Esters - (ACh)
Monoamines- (NE, Serotonin, Dopamine)
Amino Acids - (Glutamate, GABA)
Purines- (Adenosine, ATP)
Peptides- (Substance P, Endorphins)
Inorganic gases- made as needed ( Nitric Oxide)
146
Cholinergic Transmission
Release is dependent on extracellular calcium
CHT - choline transporter into neuron
ChAT - Acetyl-CoA + Choline = ACh
VAT - transports ACh into vesicle
147
SNARE complex
ANCHOR (dockinfg )
Anchor vesicles near release site
- Syntaxin
- SNAP 25 - in presynaptic membrane
- VAMP - on vesicle
- Synaptogamin - Ca sensor
148
Priming?
ATP dependent
Supports rapid exocytosis
149
Fusion?
Ca induced (synaptogamin)
Fusion of membrane
Fusion pore
150
Glaucoma definition ?
Open angle - 90% - drainage at canal of schlemm is partially blocked - increases IOP
Closed/narrow - iris buldged forward - atropine will worsen this
151
Myasthenia Gravis DIagnostics
Edrophonium
2mg IV - watch for negative reaction
8mg IV - improvement lasting 5 minutes = indicative of MG
152
Organophosphate exposure
SLUDGE-M
Tx: atropine, Pralidoxime
153
Atropine OD
BRAND (blind, red, absent bowel sounds, nuts, dry )
Tx: physostigmine, neostigmine
154
Catecholamines chemical structure ?
Benzene ring with hydroxyl groups at position 3&4 (catechol) and amine group on side chain
inactivated by COMT
155
COMT
Catechol - O - methyltransferase
inactivate catecholamines
except Amphetamines and Cocaine
156
MAO
monoamine oxidase
breaks down neurotransmitters
especially in brain (ephedrine and amphetamines)
157
how to make Beta Antagonist Selection ?
selective B1
- HTN
- angina
- Cardiace Arrythmias
- obstrcutive cardiomyopathy
- aortic aneurysm
158
Hydraulic Equation
BP = CO x PVR
159
Yohimbine
Primarily presynaptic subtype of A2 - antagonist
Possible future drug - increases sex drive
160
Dopamine Receptors
D1, D5- brain and kidneys
D2 - brain and presynaptic nerve terminals
D3 - brain
D4 - Brain and Cardiovascular system
161
RAAS pathway
Renin -> Angiotensinogin (precusor) -> AT 1 (inactive ) + ACE -> AT 2 ->
- Aldosterone -> increase re-uptake of Na+ and H20 = Increased BP
- and increases vasoconstriction = increased PVR = Increase BP
162
ACE inhibitors
inhibit ACEnzyme from converting AT 1 to AT 2
Captopril
Lisinporil
These drugs increase Bradykinins
163
How do Bradykinin's cause cough
Bradykinin's increase prostaglandins which cause inflammation which increases secretions and cough
prostoglandins also vasodilate
164
Pulmonary HTN dx and causes
Diagnosed with Echocardiogram and/or cardiac cath
caused by HBP , congenital, emphysema, Clots, HF
Poor prognosis
165
Treatment of Pulmonary HTN
Prostaglandins
- Prostacyclin
Endothelin Receptor antagonist
- Bosentan
166
Hypertensive Crisis
Hypertensive Urgency
>180/110 without end organ damage
-lower BP in hours to days
Hypertensive Emergency
>180/110 WITH EOD (kidney failure, infarct etc)
- need immediate lowering of BP
167
Hypertensive Crisis treatment
Sodium nirrtroprusside
Fenoldopam
168
Vascular Tone is made of ?
Arteriolar tone - thicker layers , most common issue with HTN
Capillary tone
Venous tone - 70% of blood
169
Coronary Blood flow determines ?
directly related to perfusion pressure and duration of diastole
No flow during Systole
Perfusion during diastole
inversley proportional to vascular bed resistance
170
Vascular smooth muscle reactions?
NO, Nitrates, Nitrites = increase CGMP = RElaxation
Beta 2 Agonist - GPCR - cAMP - Relaxation (respiratory )
CCBs = less Ca = relaxation
171
Sildenafil
Blocks PDE5 - increases cGMP = relaxation
172
Mononitrio drugs
isosorbide dinitrate
higher oral bioavailabilty (100%)
173
Nitrite & Nitrate Ugly
reflex tachycardia and hemoglobin interactions (
174
pFOX inhibitor
Fatty Acid Oxidation
Ranolazine - not available in the states
175
Types of HF
Diastolic - reduced filling
Systolic - reduced function
Congestive - LV
176
Systolic HFailure
decreased CO , decreased EF
177
Diastolic HFailure
decreased CO , normal EF
178
Congestive HFailure
increased LV pressure and End Diastole = increased pulmonary pressure (edema)
179
Cardiac Performance is inclusive of ?
preload
afterload
contractility
heart rate
180
Stroke Volume means?
Preload
afterload and contractility
EDV (140mL) - ESV (50mL) = 90mL
181
Preload means?
measure of stretch not volume = end diastolic pressure that stretches ventricles
182
Left Ventricle numbers
Passive filling (65mL) + atrial contraction (25mL) + ESV (50mL) = EDV (140mL
183
Afterload means?
resistance the heart must pump blood through
increases as CO decreases
184
Altered Preload numbers ?
>20-25 mmHg - pulmonary congestion
Increases HF , Blood volume, and venous tone
185
Decreasing preload interventions?
salt restriction , diuretics, venodilation (nitroglycerin)
186
Calcium sensitizer
Levosimendan
187
Tell me about Digitalis glycosides
Cardiac glycosides
Foxglove plant
Digoxin , Digitoxin
positive inotropic, narrow TI
only oral + inotropic agent for HF
188
Tell me about Digoxin
very narrow TI - pro arrhythmogenic
oral bioavailabilty - 65-80%
T1/2 - 36-40 hrs
2/3 excreted unchanged by kidneys
189
what are PDE3 Inhibitors?
enzymes that inactivate cAMP and cGMP
+ inotropic effect
vasodilation
Milrinone
190
beta adrenergic Stimulants in HF
positive inotropy
B1 selective
- dopamine
- dobutamine - increase CO , decreased ventricular filling
191
M and H-Gate (Resting, activated, Inactivated)
resting = H gate open (M closed_
Activated = both gates open
Inactivated = H gate closed (M open)
192
Arrhythmias Classifications ( 2)
Disturbance in Impulse Formation
Disturbance in impulse Conduction
193
Disturbance in Impulse Formation
SA/AV node abnormalties
Ion changes
SNS stimulation
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Disturbance in Impulse Conduction
Block
Reentry
195
Acceleration of SA is a?
Disturbance of Impulse Formation
increases phase 4 depolarization slope
caused by beta agonist, fiber stretchm acidosis
196
Vagal discharge has what effect on heart rate?
Disturbance of Impulse Formation
SA slows - reduces phase 4 slope
197
Disturbance of Conduction examples
1st, 2nd, 3rd degree block
Reentry
198
Reentry is ?
- scar tissue/obstacle
- unidirectional block
- conduction time long enough to reenter same area after refractory period
199
Antiarrhythmic Agents(4 classes)
Class 1 - Na+ channel blockade
Class 2 - Sympatholytic
Class 3 - prolong action potential duration ( K+ channels )
Class 4 - block in cardiac calcium channel currents
200
Class 1A Antiarrhythmic
1A - Prolong APD = increases ERP
Decreases slope of P-0
Quinidine
Procainimide
Disopyramide
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APD
action potential Duration
202
ERP
effective refractory period
203
Class 1b Antiarrhythmic
Sodium Channel Blockers
Shorten APD = decreases ERP
Decreases slope at P-0
Lidocaine , Mexilitine
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Class 1C Antiarrhythmic
Na+ channels blocked
Slow dissociation , minimal APD effect
Depolarizes the most, stronger effect
Flecainide, Propafenone
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Drugs that prolong AP
Amiodarone
Dronedarone
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Adenosine does what ?
Does not fit in conventional antiarrhythmic classes
enhanced K+ conductance
inhibition of cAMP = increases Ca influx
used for SVT - 6mg bolus
T1/2 10 seconds in blood
207
Magnesium can be used for ?
for digitalis induced arrhythmias
208
Potassium can be used for ?
antiarrhythmic directed to towards normalizing K+ levels
209
Bradycardia treatment
treat underlying cause/ DC meds
Symptomatic Atropine 1st
epi & dopamine 2nd
chronic: pacemaker
210
1st degree Heart Block treatment
1st degree - usually asymptomatic and not treated
Symptomatic: Atropine , transcutaneous pacing
Chronic: Pacemaker
211
SVT treatment
Assess cause
Symptomatic: Adenosine
Chronic: CCBs, Beta blockers
212
Sinus Tach treatment
Assess cause
Symptomatic: Adenosine , CCB, Cardioversion
Chronic: Catheter ablation
213
Vtach (wide complex) treatment
Symptomatic: Amiodarone
Chronic: amiodarone, satolol
214
Afib treatment
Symptomatic: Diltiazem , Verapamil
Chronic: Beta blockers, Amiodarone
215
Vfib treatment
Symptomatic: CPR, Dfibrilation
Chronic: Amiodarone, Lidocaine
216
Ergotropic
Energy Expenditure - Movement related responses - sympathetic nervous system
217
Trophotropic
Moving away form source of nutrition
Works in opposition to ergotropic response to create a state of relaxation and clam.
“Leading to growth”
PARASYMPATHETIC
218
Synapse
Connections between neurons , muscles, and effector organs
Targets for drugs
219
Structures of Neuron
Soma - cell body
Synaptic buttoons - neurotransmitters stored
Dendrites - receiving information
Axon Hillock - generates AP
Axon - where depolarization happens
220
Saltatory condition happens where
Mostly in somatic nervous system to speed up reactions / AP
221
Chemical Synapses
Release NT (ACh, Epi, GABA, etc.) at presynaptic membrane
Affect receptors of post synaptic
Broken down by enzymes or recycled into pre-synapse
222
Electrical Synapses
Use gap junctions between adjacent cells
223
En Passant Synapses
CNS - axon swelling that can release NT itself
Give us additional synapses to effect multiple different effector cells
224
Stages of Synaptic Transmission
AP in synaptic Boutton -> opening VG Ca+ channels -> Ca+ influx - > release of Ca+ from ER -> secretions of NT-> activation to inactivation.
This leads to opening of ion channels -> increases permeability to Na+ (depolarize) or Cl- (Hyper-polarization)
225
Is nitric oxide stored?
No,it’s made as needed then released.
226
All neurons leaving the CNS release what?
ACh
227
Nicotine channels , slow or fast?
Super fast ION channels
228
Muscarinic binding slow or fast?
g-protein - adds too lag - slower than nicotinic
229
Nearly all fibers leaving CNS, efferent or afferent ?
EFFERENT
230
Precursor in adrenergic transmission ?
Tyrosine
231
Precursor to Dopa, dopamine, norepinephrine?
TYROSINE
232
NET
Transport NE from synapse back into pre-synaptic neuron
233
What transporter is used in adrenergic transmission into vesicles?
VMAT - Vesicle mono-amine transport
234
Adrenergic Inhibitors
Cocaine , tricyclic antidepressants - inhibit NET and serotonin reuptake
MAOI’s - inhibit NE degradation
235
Cholinergic Receptors Respond to which NT ?
ACh
236
Adrenergic Receptors respond to which NT ?
NE and Epi
237
NANC Neurons
Non adrenergic / Non cholinergic
Nitric Oxide
Substance P
Somastatin
GUT (ENS)
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What kind of neurotransmitter is GABA and Glutamate
Amino Acids
239
Examples of Peptide Neurotransmitters
Substance P and Endorphins
240
Examples of Purine neurotransmitters
ATP and adenosine
241
What is CHT, and what kind of transport does it facilitate?
Choline transporter
Transport Choline into cell via facilitated diffusion with Na+
(Down Cholines gradient)
242
What does ChAT do in the cell ?
In the presynaptic cell, this is the joining of Acetyl-CoA with Choline to create ACh.
243
What does VAT do?
transports ACh into vesicles
244
What is the function of Synaptogamin?
Ca+ sensor
Joins vesicle to cell wall to perform exocytosis
245
Priming is dependent on what?
ATP
Supports rapid exocytosis
246
Drugs for CLOSED angle Glaucoma
PILOCARPINE
Timolol
247
example of organophosphate
Sarin
Ecothiophate
248
What is Cycloplegia?
Paralysis of Ciliary Muscle = loss of accommodation
249
Triphasic effect of dopamine
Low = D1 - Kidney - vasodilation
Med = B1 - Vasoconstriction at Heart
High = A1 - Vasoconstriction
250
Where is Tyramine mostly found ?
Fermented foods
MAO will increase BP after eating fermented foods on Tyramine
251
RVLM
Rostral Ventricle Lateral Medulla
“Vasomotor center”
252
If a A2-Receptors on NE neuron causes what ?
Alpha 2 receptors antagonism
A2- R is a Heteroreceptor on NE neuron
A2 would naturally cause negative feedback
Clonidine and Dex would shut down the naturally occurring negative feedback system of A2, increasing HR and BP
253
How does long term use of Beta Blocker increase weight gain ?
Inhibits Lipolysis via B3 and glycogenolysis
254
Is Propranalol a partial , full, or inverse agonist ?
FULL agonist works on B1 and B2
255
Venous Capacitance Venules mean what ?
PRELOAD of BP
256
Blood vessel diameter is a target for what?
Alpha blockers = decreases peripheral vascular resistance
257
Aliskiren is what kind of drug ?
Renin inhibitor
258
ACE (angiotensin-converting enzyme) is found where ?
In the lungs - converts active AT 1 into active AT 2 to stimulate vasoconstriction and aldosterone release
259
NTS
Nucleus of the tractus Soliarius - Stimulates Vagus nerve
Portion of the brain stem that has a large affect on blood pressure and CO
260
How does Hydralazine increase Nitric Oxide production ?
Hydralzine is a vasodilator that stimulates the endothelial cells that line the blood vessels to release their own nitric oxide
261
How is Fendoldapam a depressor ?
Stimulates D receptors of kidneys
262
How is renin released ?
Epinephrine binds to Beta receptors in the kidneys to stimulate the release of renin .
Or when low pressure is sensed in renal tubules .
263
ACE Inhibition also inhibits what?
Inhibit Brake down of bradykinins
Increases prostaglandins -> increases inflammation and secretions = Dry cough
264
What proliferates smooth muscle in the lungs ?
Endothelin ETa-R and ETb-R binding to ET-1
And vasoconstriction which increases pulmonary blood pressure
265
What creates ET -1 in the lungs ?
Combination over time of low shear stress, ANG 2 cytokines, thrombin , and peripheral hypertension
266
What inhibits endothelin production in the lungs?
High shear stress, Nitric Oxide , Prostaglandin 2, and ANP
267
What is the negative feedback of Endothelin ?
Binds to ET cells themselves which stimulates production and release of Nitric oxide
This causes vasodilation in the lungs without proliferation.
