Pharmacology - Shock Part 1

Question 1

define shock

Answer 1

inadequate tissue perfusion due to hypotension. ultimately leads to organ system failure

Question 2

in shock, there is an imbalance between what 2 things

Answer 2

oxygen supply and oxygen demand

Question 3

name 4 types of shock

Answer 3

hypovolemic
distributive
obstructive
cardiogenic

Question 4

formula for blood pressure

how do each of the components relate to shock

Answer 4

BP = CO * SV

in shcok patients, vasopressors work to increase the stroke volume and inotropes work to increase the heart rate and thus increase cardiac output

Question 5

3 classes of pharmacotherapy used for shock

Answer 5

catecholamines
vasopressin
PDE inhibitors (milrinone)

Question 6

“inotrope” means increase in ____

Answer 6

contractility

Question 7

result of ligand binding to a1 vs a2

Answer 7

a1 - Gq couples. IP3, DAG, increase intracelllar calcium

a2 – Gi coupled. inhibition of AC and decreased cAMP

Question 8

true or false

a1 receptors are mainly located in the smooth muscle

Answer 8

true

Question 9

result of ligand binding to B1 vs B2 vs B3

Answer 9

B1 - increased AC and cAMP

B2 - increased AC and cAMP

B3 - Increased AC and increase cAMP

Question 10

result of ligand binding to D1 and D5 dopamine receptors

what about all other dopamine receptors

Answer 10

increased AC and increased cAMP

all other - inhibition of AC

Question 11

where are D1 and D5 receptors mainly located

Answer 11

in the renal (kidney) vasculatorue

Question 12

true or false

ligand binding to a2 decreases blood pressure

Answer 12

true

Question 13

true or false

ligand binding to b1 causes smooth msuscle relaxation

Answer 13

true

Question 14

what occurs with ligand binding to b1

Answer 14

increased force and rate of contractility of the heart

also stimulates the release of renin

Question 15

rate limiting step of NE synthesis

Answer 15

conversion of tyrosine to dopa by tyrosine hydrxylase

Question 16

name 2 NE reuptake inhibitors

what is their effect on blood pressure

Answer 16

cocaine, tricyclic antidepressants

increased BP because NE is staying in the synaptic cleft for longer and exerting its effect

Question 17

how do cocaine and the tricyclic antidepressants inhibit the reuptake of NE

Answer 17

by inhibiting NET (nor epi transporter)

Question 18

effect of reserpine on blooc pressure

Answer 18

decreased blood pressure bc reserpine inhibits VMAT – the transporter that takes dopamine into the vesicle. ultimately the synthesis of NE is inhibited

Question 19

in most sympathetic postganglionic neurons, _____ is the final product

in what places is it sometimes converted into something else

Answer 19

NE

in the adrenal medulla and some areas of the brain - NE is converted to epinephrine (bc NE is too hydrophilic to cross BBB ! CH3 is added to form epi)

Question 20

effect of amphetamine on norepinephrine

Answer 20

enhances NE and dopamine neurotransmission
by inhibiting MAO

Question 21

name 3 indirectly acting mixed sympathomimetics

Answer 21

tyramine, amphetamines, ephedrine

Question 22

what is COMT and can it be taken orally

Answer 22

catechol-O-methyltransferase - an enzyme that breaks down catecholamines

cannot be taken orally bc it will be oxidized

Question 23

2 methods in which noradrenergic transmission is terminated

Answer 23

-simple diffusion away from the receptor site and to the liver/plasma for metabolism

-reuptake into the nerve terminal through NET (cocaine blocks!)

Question 24

name 2 alpha agonists — 1 is more selective for alpha 1 and one is more selective for alpha 2

Answer 24

alpha 1 - phenylephrine

alpha 2 - clonidine

Question 25

name 2 MIXED ALPHA AND BETA AGONISTS which doesnt affect B2 (the lungs) as much

Answer 25

norepinephrine and epinephrine norepi doesnt affect B2 as much

Question 26

name 2 b agonists state their selectivity

Answer 26

dobutamine isoproterenol dobutamine is a more selective B1 agonist isoroterenol is a more selective B2 agonist

Question 27

true or false dopamine is a dopamine agonist

Answer 27

true

Question 28

true or false dopamine is much more selective for the D1 receptor over D2

Answer 28

false - equal D1 and D2

Question 29

rank the following according to their affinity to the alpha receptor: epinephrine isoproterenol norepinephrine

Answer 29

most selective for alpha - norepinephrine epinephrine least selective for alpha - isoproterenol OPPOSITE FOR BETA -- isoproterenol is most selective for beata

Question 30

true or false a1 is gs-coupled

Answer 30

FALSE - GQ

Question 31

true or false all 3 beta receptors are Gs-coupled

Answer 31

true

Question 32

a2 receptor is ___ coupled

Answer 32

Gi

Question 33

substitution of _____ INCREASES beta receptor activity

Answer 33

nitrogen

Question 34

true or false substitution of N decreases beta receptor activity

Answer 34

false - increases dobutamine has

Question 35

name 2 inotropes

Answer 35

dobutamine milrinone

Question 36

name 3 vasopressors

Answer 36

phenylephrine vasopressin angiotensin II

Question 37

true or false NE can be called either a hormone or a neurotransmitter

Answer 37

true

Question 38

vasopressor of choice for septic/cardiogenic shock

Answer 38

norepinephrine

Question 39

structurally how does NE differ from epinephrine

Answer 39

NE has no methyl group on the nitrogen - epinephrine does

Question 40

true or false NE has a short half life therefore.....

Answer 40

true requires continuous IV infusion

Question 41

true or false NE constricts only ateriolar beds

Answer 41

false - both arteriolar and venous

Question 42

the NE IV infusion is titrated to....

Answer 42

blood pressure control

Question 43

true or false NE does not cross the placenta

Answer 43

FALSE - it does cannot give in pregnancy unless emergency

Question 44

does NE cross the BBB

Answer 44

no

Question 45

2 metabolic enzymes of NE which metabolite is still active and which is inactive

Answer 45

COMT - still active MAO - inactive

Question 46

2 liabilities of NE

Answer 46

local ischemia due to severe vasoconstriction hypertensive

Question 47

to give NE and other vasoconstrictors what vein should be used

Answer 47

large central veins - avoid local

Question 48

as mentioned, NE can cause ischemia. this could progress to what? what is treatment?

Answer 48

gangrene phentolamine

Question 49

2 contraindications NE

Answer 49

pheochromocytoma arrhythmias (can make worse)

Question 50

important consideration when giving NE for hypovolemic shock

Answer 50

dont give without fluid replacement

Question 51

MAO/tricyclic antidepressants + vaspressors like NE

Answer 51

increased NE/vasopressor response

Question 52

B blockers + vasopressors like NE

Answer 52

increased vasopressor response

Question 53

A blockers + vasopressors like NE

Answer 53

decreased vasopressor response

Question 54

true or false NE + ergot vasocontrictors woll increase the effect of NE

Answer 54

true

Question 55

sodium bicarb + pressors (like NE)

Answer 55

decreased response bc of acid-base interaction

Question 56

atropine + pressors like NE

Answer 56

good -- blocks the reflex bradycardia from NE. increases pressor response

Question 57

diuretics + vasopressors like NE

Answer 57

decreased pressor response

Question 58

cyclopropane and other general anesthetics + NE/vasopressors

Answer 58

enhanced arrhythmia liability

Question 59

phenylephrine is mostly a _____ ateriolar vasoconstrictor

Answer 59

a1

Question 60

phenylephrine is used systemically to do what what about topically?

Answer 60

elevate peripheral resistance in shock patients topically - decongestant (nasal and ophthalmic)

Question 61

true or false phenylephrine constricts eye pupils

Answer 61

false - dilates - for the retina to be visualized

Question 62

place in therapy for phenylephrine in septic shock patients

Answer 62

SECOND LINE to NE for septic shock

Question 63

AEs of phenylephrine

Answer 63

reflex bradycardia (bc increases BP!) hypertension, arrhythmias

Question 64

1 situation in which phenylephrine is CONTRAINDICATED

Answer 64

in patients with narrow angle glaucoma (wide is okay)

Question 65

true or false phenylephrine has no issue with diabetic patients

Answer 65

FALSE - use precaution. increases glucose

Question 66

phenylephrine should be used with precaution in hyper or hypothyroidism

Answer 66

hyper

Question 67

which dosage form of phenylephrine should be used in infants

Answer 67

nasal spray

Question 68

how should phenylephrine be stored? when can you not use it?

Answer 68

in a light resistant container dont use if discolered - forms adrenochromes (inactive)