Lecture 26: CV effects of Autonomic ANTAGONIST drugs Flashcards Preview

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Flashcards in Lecture 26: CV effects of Autonomic ANTAGONIST drugs Deck (42):
1

What are the parasympathetic agonists? Antagonists?

Parasympathetic agonists
i. Acetylcholine
ii. Edrophonium
Parasympathetic antagonists
i. Atropine
ii. Scopolamine

2

What is the MoA for Atropine?

Competitive antagonist for the muscarinic receptor’s acetylcholine binding site

3

What is the difference between atropine and scopolamine?

Both are competitive antagonists for muscarinic receptors
However, scopolamine acts on CNS
Atropine cannot act on CNS

4

What are the circulatory effects of atropine?

Increases heart rate by withdrawal of vagal influence
i. Decreases AV nodal refractoriness
ii. increases SA node conduction
Decreases parasympathetic systemic arteriolar vasodilation (in areas such as the skin and GI tract)
Decreases vasodilation

5

What are the clinical uses for atropine?

1. Prevention of vagal reaction
2. Restore AV conduction in conditions with prolonged AV nodal refractoriness such as inferior wall MI and digitalis intoxication

6

What are the side effects for atropine?

1. Dry mouth/skin
2. delirium
3. Tachycardia
4. flushing

7

What are the sympathetic antagonists?

i. Prazosin
ii. Carvedilol
iii. Atenolol
iv. Metoprolol
v. Propanolol

8

What are the alpha adrenergic antagonists?

1. Prazosin (prazocin)a
2. Doxazosin
3. Terazosin

9

What is the MoA of Prazosin?

Alpha 1 receptor antagonist >> alpha 2 antagonist
Results in decreased SVR and decreased blood pressure
Inhibition of vasoconstriction

10

What are the indications for use of Prazosin/Prazocin?

Hypertension (to decrease peripheral vascular resistance by vasodilation)
Urinary bladder obstruction

11

What are the side effects of Prazocin?

Hypotension
Dizziness
Headache
Fatigue

12

What are the characteristics of doxazosin and terazosin?

Similar to prazosin but are pure alpha1 blockers and have no alpha2 activity

13

What are the Beta adrenergic antagnoists?

1. Propranolol
2. Metoprolol
3. Atenolol
4. Esmolol
5. Carvedilol

14

What are the classification schemes for beta adrenergic antagonists?

1. Beta1 selectivity
-B2 blockers can cause bronchoconsriction
2. Intrinsic sympathomimetic activity (ISA)
-B-blockers with ISA are partial agonists that may produce blocked by shielding receptors from more potent agonists
3. lipid solubility
4. duration of activity

15

What beta blockers are lipid soluble? Significance?

1. Propranolol
2. Metoprolol
Readily absorbed by GI tract
Metabolized by liver
Short half life

16

What beta blockers are water soluble? Significance?

Atenolol
Not as readily absorbed or metabolized
Longer halflifes and metabolized in kidney

17

What are the effects of beta blockers?

1. Decrease HR, impulse conduction and contractility
2. Decreases myocardial demand
3. used to treat heart failure, MI/angina, arrhythmias, HTN

18

What are the adverse effects of beta blockers?

1. Sinus bradycardia, sinus arrest, AV block
2. Reduced LV contractility
3. bronchoconstriction
4. sexual dysfunction
5. mental depression, nightmares
6. May precipitate Raynaud’s phenomenon

19

What is the MoA of Propranolol?

Non-selective B1 and B2 antagonist
Lipophilic, decreases HR and contractility
That means this motherfucker can lead to bronchoconstriction

20

What are the indications for propranolol?

1. SVT
2. Ventricular arrhythmias
3. angina/MI
4. HTN
CHEAP AS FUCK

21

What is the MoA of metoprolol?

Beta1 Selective antagonist
Lipophilic, decreases HR and contractility
Does not lead to bronchoconstriction

22


When is metoprolol indicated?

1. stable CHF
2. MI
3. angina
4. HTN

23

What is the MoA of atenolol?

Beta 1 selective
Hydrophilic
Decreases HR and contractility

24

What are the indications for atenolol?

1. HTN
2. Angina
3. MI
4. stable CHF

25

What are the characteristics of Esmolol?

Beta1 selective
Decreases heart rate and does nothing to contractility
Applicable to patients with pulmonary disease
VERY fucking expensive
Used for tachy, atrial fib, and tachycardia

26

What are the characteristics of Carvedilol?

Nonselective beta1 and beta2 antagonist
Also blocks alpha1 receptors
Decreases HR and conractility
Used for heart failure and hypertension

27

Which beta blockers are beta1 selective?

1. Metoprolol
2. Atenolol

28

Which beta blockers are non-selective?

1. Carvedilol
2. Propanolol

29

For a patient in cardiogenic shock, would you use beta-blockers?

No, patient needs inotropic support
Therefore, give this patient dobutamine

30

Once patient with cardiogenic shock stabilizes, would it be a good time to give beta-blockers?

Yes, in order to counteract the negative effect of NE on remodeling
Increased filling time and decreased demand

31

What are the effects of muscarinic activation in the heart?

Decrease automaticity of SA node
Decreased inotropy in the atrial myocardium
Increase refractoriness in the AV node

32

What are the effects of muscarinic activation in the vasculature?

Increase in vasodilation in the systemic arterioles

33

What is the CV response to a generalized parasympathetic discharge (vagal reaction or faint)?

Bradycardia
Decreased SVR

34

Why is beta1 receptor indicated for congestive heart failure?

Decreases renin production from kidney
Decreases myocyte hypertrophy/myocyte injury due to inappropriate downregulation of beta1 receptors
Improves supply and decreases demand

35

What would you use to treat a patient with complete heart block and acute inferior MI (as shown by ST eleations)?

No, you never want to give betablockers to someone in complete heart block!
Give Atropine instead (in order to improve CO)

36

When the patient is stabilized (no more heart block), would you then give beta blockers?

Yes
Betablockers are indicated for MI as it decreases the size of the infarcted tissue
This is because it decreases demand of the heart and increases supply (by allowing greater diastolic filling)

37

What would you use to treat a patient with chronic stable angina?

Beta-blockers are indicated because it reduces ischemic damage

38

What does ischemia result from? Significance?

Mismatch between O2 supply and demand
Can be corrected by beta-blockers

39

What are the major determinants of myocardial?

Heart rate
Heart contractility
Double product (HR x systolic pressure)
Preload
Afterload

40

What are the benefits of beta-blockade in the treatment of ischemia?

1. Improve myocardial O2 supply
-decreasing HR will prolong diastole and improve subendocardial perfusion
2. Decrease myocardial O2 demand
-suppresses both HR and contractility as well as sympathetic reflex
-reduces BP
-leads to less O2 demand
-blocks sympathetic reflex

41

What are beta-blockers ideal therapies for?

1. Prominent relationship of physical activity to attacks of angina
2. Coexistent hypertension
3. History of supraventricular or ventricular arrhythmias
4. Previous myocardial infarction (STANDARD OF CARE)
5. Left ventricular systolic dysfunction
6. Mild to moderate heart failure symptoms
7. Prominent anxiety state

42

What are poor candidates for beta-blockers?

1. Asthma or reversible airway component in chronic lung disease patients (because beta-blockers will lead to narrowing of airways)
2. Severe left ventricular dysfunction with heart failure (Class IV heart failure)
3. History of severe depression
4. Raynaud phenomenon (beta-blockers would reduce blood flow to already blue tissue lol)
5. Symptomatic peripheral vascular disease
6. Severe bradycardia or heart block
7. brittle diabetes