Exam 3, Adrenergic Agonist Antagonist MArtin Flashcards Preview

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Flashcards in Exam 3, Adrenergic Agonist Antagonist MArtin Deck (69):
1

What are the alpha R antagonists

prazosin
phentolamine

2

What are the alpha R agonists

phenylephrine

3

what are the alpha 2 agonists

clonidine and methyldopa

4

what are the D1 agonists

dopamine
fenoldopam

5

what are the nonselective beta R antagonists

proparnolol, nadolol, timolol, pindolol, carteolol, sotalol

6

what are the cardioselective beta R antagonists

atenolol, acebutolol, metoprolol

7

what are the third generation beta R antagonists

labetolol, carvedilol, betaxolol, carteolol

8

what are the pre and post synaptic NT for sympathetic sweat glands

Ach and Ach

9

what are the B1 actions on the heart

stimulate HR and force

10

what are the muscarinic actions on the heart

decrease in heart rate

11

what are the alpha 1 effects on the heart

vasoconstriction

12

what are the beta 2 effects on the heart

vasodilation

13

what are the effects of dopamine on renal arteries

dilation of afferent aa increasing blood flow to kidneys

14

what increases MAP and TPR
epi, norepi or isoproterenol

Norepinephrine, decreases pulse rate

15

what increases pulse rate and decreases TPR
epi norepi or isoproterenol?

epi and isoproterenol

16

which has greater effect on decreasing TPR
norepi, epi or isoproterenol

isoproterenol

17

what are the CV uses for epi

during CPR for asystole
hemodynamic support after CABG surgery
anaphylaxis
local or topical hemostatic

18

what are the CV uses of NE

pressor agent of choice for septic shock and may be more appropriate than dopamine as first line Tx for other types shock
can be used to support BP in surgical care setting
decreases renal blood flow

19

What is phenylephrine used for

OTC nasal decongestant
IV vasopressor agent, maintain BP in hypotensive states like spinal anesthesia

20

what are the effects of phenylephrine

vasoconstriciton, increased TPR, increase BP
reflex bradycardia

21

what can block reflex bradycardia from phenylephrine

atropine

22

does phenylephrine cause atrial or ventricular tachy

atrial

23

what peripheral R does dopamine work on

D1>B1>a1

24

what are the pharmocological effects of dopamine

vasodilate renal, coronary and mesenteric vascular beds
increase blood flow to kidney
heart- mild increase in rate and force
high dose causes vasoconstriction of blood vessels

25

what are the clincal uses for dopamine

shock, unstable CHF
icnrease CO and increases renal perfusin
somtimes in acute crisis of chronic CHF

26

why must you monitor BP carefully with use of dopamine

higher infusion rate or doses can cause vasoconstriciton and decreased tissue perfusion

27

what are the effects of dobutamine

since B1 selective agonists
positive inotropic and some increase in rate
CO increases
little vascular effect

28

what are the clinical uses of dobutamine

cardiogenic shock, MI CHF

29

what are the adverse effects of dobutamine

potential arrhythmias
increase work and O2 requirement

30

what are the clincal uses of alpha 1 selective R blockers

2nd or 3rd line Tx for essential HTN

31

what are the effecs of alpha 1 selective antagonists

decrease venous return, dec preload
does not increase Hr or CO
normal NE release
dec LDL and TG, inc HDL

32

what are the adverse effects of alpha 1 selective antagonists

caus emarkerd postural hypotension and syncope, orthostatic hypotension
usually given at bedtime to minimize hypotensive effects

33

What are the clincal uses for beta blockersq

HTN, decrease CO and slow decrease in TPR
ischemic heart disease, angina, MI, acute coronary syndromes
CHF
arrhythmias

34

how do beta blockers help with MI and post MI prophylaxis

protect against arrhythmias and limits infarction size
assess LV function
5-12 days post MI reduces O2 demand and spread of infarct area

35

how are beta blockers helpful in thyrotoxicosis

hyperthyroid patients have increased beta R sensitivity
beta blockers reduce sensitivity of myocardium to adrenergic stimulation in hyperthyroid patients

36

What is the mechanism for propanolol

competitive antagonist at B1 B2 and B3 R

37

hwo do B blockers differ

their bioavailability, biotransofrmation and pharmokinetics

38

what are the pharmacological general effects of beta blockers

block existing sympathetic tone
effects are greater if sympathetic tone is high (druing MI or exercise)

39

what are the effects on heart by beta blockers

dec HR and CO
dec exercise tolerance
dec depolarization extopic pacemakers
dec O2 demand
dec AV nodal conduction
dec infarct size

40

how do beta blockers decrease exercise tolerance

blunt increase in HR and contractility that normally occurs with exercise
CO less affected because SV increased
decrease work capacity
increased catecholamines during exercise increase work of heart and oO2 demand

41

what are the effects of beta blockers on myocardial O2 demand

decrease it

42

What are the effects of beta blockers in people with normal BP

does not lower BP, just in HTN patients

43

what are the effects of beta blockers on plasma renin levels

beta blockers block the normal catecholamine driven release of renin
therefore decrease renin

44

what beta blockers have non selective vasodilatory effects

carteolol, carvedilol, bucindolol, labetolol

45

what b1 selective antagonisls have vasodilatory effects

betaxolol, celoprolol, nebivolol

46

what are teh peripheral vasodilatory effects of some beta blockers

increase NO
activate B2 R
block alpha 1
block Ca entry
open K channels
antioxidant activity
antiprolfierative effects

47

what normal side effects of beta blockers are decreased with the vasodilating beta blockers

bronchospasm, imparied lipid metabolism, impotence, reduced regional blood flow, icnreased TPR, withdrawal Sx

48

which type of angina are beta blockers not helpful in

vasospastic angina

49

what is the main effect of beta blockers that helps in Tx of IHD and agina and MI

decrease in myocardial oxygen demand

50

why should most patients be put on beta blocker after MI

shown to decrease morbidity and mortality from MI by 25%

51

betablockers prevent HF in what percent of people

50%

52

what are relative contraindicaitons for beta blockers

asthma and cOPD because block bronchodilation
blocks lipolysis and glycogenolysis
cautisouly in DM becausre mask signs of hypoglycemia
delays recovery from insulin induced hypoglycemia

53

what are side effects of beta blockers

dizziness, fatigue, diarhhea, constipation, nausea, depression, sexual dysfunction, bizarre dreams
severe but rare purpura, rash and fever

54

what tests may beta blockers interfere with

SGOT and BUN tests

55

what are the effects on cholesterol long term use beta blockers

increase VLDL and decrease HDL

56

what occurs with sudden withdrawal of beta blockers

rebound HTN, anginal attack and possibly MI if drug suddenly withdrawn after chronic therapy.
beta R up regulation

57

what are major contraindications for beta blockers

acute Tx decompensated HF, 2nd and 3rd degree Heart block, cardiogenic shock

58

what other hypotensive medications do beta blockers have drug interactions with

reserpine, guanethidine, methyldopa

59

what other antiarrhthmic agents do beta blockers have interactions with

CCB and lidocaine

60

beta blockers mask signs of what

hypoglycemia and hyperthyroidism

61

what cardioselective beta blocker has very rapid onset and short duration of action

esmolol

62

when is esmolol used

IV infusion for peri-operative tachycardia and HTn and arrhythmias

63

What type of antagonist is labetolol and what are its clinical uses

selective alpha 1 blocker
nonselective B1 B2 blocker
HTN and pheochromocytoma

64

which beta blocker has been very useful in CHF clinical trials

carvedilol

65

how do alpha 2 receptor agonists work

at brainstem
inhibit sympathetic outglow to periphery
decrease sympathetic tone
decrease Ne release via feedback

66

what are the side effects of methlydopa

sedation, dry mouth, sexual dysfunction

67

what is the preferred anti HTN drug in pregnancy

methyldopa

68

what is clonidine used for

rarely essential HTN
more for narcotic, alcohol and tobacco withdrawal

69

what are the sideeffects of clonidine

dry mouth, sedation, impotence
sudden withdrawal causes HTN crisis