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SNS Flashcards

1
Q

Steps of catecholamine synthesis

A

Tyrosine—>dopa—>dopamine—>norepinephrine—>epinephrine

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2
Q

What’s the rate limiting step for catecholamine synthesis

A

Tyrosine —> dopa

Catalysed by tyrosine hydroxylase

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3
Q

Potency of catecholamines on adrenergic receptors

A

a —> epinephrine > norepinephrine&raquo_space; isoproterenol
B —> isoproterenol > epinephrine ~ = norepinephrine
On B1 epinephrine ~ norepinephrine
On B2 epinephrine&raquo_space; norepinephrine

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4
Q

What are the effects of activating the adrenergic receptors on blood pressure

A

a1 - Vaso constriction - increases TPR - increasing BP
B1 - increases heart rate - increases cardiac output - increasing blood pressure
B2 - vasodilation- decreasing TPR - decreasing blood pressure

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5
Q

Phenylephrine which receptors

A

Selective a1 agonist

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6
Q

Phenylphrine indications

A

To cause mydriasis, nasal decongestant and for hypotension

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7
Q

Phenylphrine side effects

A

Hypertensive headache and arrhythmia

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8
Q

How can phenylphrine be used for its indications and for its side effects

A
  • patient with rhinitis and nasal congestion (vasoconstriction increase TPR and BP)
  • patient with hypotenuse during spinal anaesthesia (increases BP)
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9
Q

Naphzoline, oxymetazoline, xylometazoline way of administration

A

Topical

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10
Q

Naphzoline, oxymetazoline, xylometazoline receptors activity

A

selective a1 agonist

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11
Q

Naphzoline, oxymetazoline, xylometazoline indications

A

Nasal congestion and conjunctivitis

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12
Q

Naphzoline, oxymetazoline, xylometazoline adverse effects

A

Hypetenisve headache and arrhythmias

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13
Q

Drugs in the treatment of hypertension

A

Etilefrine and midodrine

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14
Q

Etilefrine receptors activity

A

acts on a1, B1, B2 (B1>B2)

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15
Q

Etilefrine indication

A

Causes an increase in heart rate, CO, TPR hence raising the blood pressure so it is used for hypotension

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16
Q

Etilefrine adverse effects

A

Tachycardia

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17
Q

Midodrine receptors activity

A

a1 only so no cardiac effect

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18
Q

Midodrine indication

A

Causes vasoconstriction increasing TPR and increasing BP hence used for hypotension

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19
Q

Midodrine adverse effects

A

Reflex bradycardia

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20
Q

Clonidine receptors

A

Selective a2 agonist (mainly presynaptic)

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21
Q

Clonidine actions

A

Vasodilation through central inhibition of norepinephrine release

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22
Q

Clonidine indications

A

Hypertension and withdrawal of opiates and benzodiazepines

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23
Q

Dobutamine receptors

A

B1 selective

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24
Q

Dobutamine actions

A

Causes an increase in cardiac output

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25
Dobutamine indication
Acute heart failure
26
Dobutamine contraindications
Atrial fibrillation
27
What are the B2 adrenergic agonists
SABA- short acting B agonists | LABA- long acting B agonists
28
SABA examples and uses
Albuterol and fenoterol | - quick relief of symptoms of asthmatic attacks
29
LABA examples and uses
Prevention of bonchospasm and asthma attacks Formoterol—> both Salmeterol
30
Epinephrine receptor activation and action at low does
B1, a1 increase CO and decrease TPR
31
Epinephrine receptor activation and action at high doses
B1, a1>B2 causing an increase in heart rate and stroke volume —> increase in CO and TPR (Can cause reflex bradycardia)
32
How is epinephrine administered
Subcutaneous, intramuscular or intravenous
33
What metabolises epinephrine
COMT AND MAO
34
epinephrine indications
- Hypersensitivity reactions (anaphylaxis) given i.m and S.C - Cardiac arrest I.V - prolongs duration of action of Anaesthesia(vasoconstriction -> ŁA absorption -> increase local effect)
35
Epinephrine adverse effects
Cardiac arrhythmias, haemorrhage and CNS disturbances (anxiety tremors)
36
Norepinephrine receptors
a1 and B1
37
Norepinephrine therapeutic uses
Shock(increases vascular resistance) and adjacent to local anaesthesia
38
Norepinephrine and epinephrine similarities
Used in cardiac arrest and adjacent to Local anaesthesia
39
Only epinephrine and not norepinephrine
Anaphylaxis and bronchospasm (due to B2 properties)
40
Dopamine receptors activation
At low doses D1, D2, At moderate doses B1 and at high doses a1
41
Dopamine at different doses with receptors activation and actions
a1 (higher than 10mg/kg/min)- vasoconstriction- increases blood pressure B1(5-10mg/kg/min) - increase in heart rate and cardiac output D1 and D1 (5mg/kg/min)- vasodilation in renal bed
42
Dopamine therapeutic uses
Cardiogenic and septic shock also hypotension and bradycardia
43
What is pseudoephedrine used for
Nasal decongestant
44
What is tachyphylaxis
Decreased in response to drug after repeated exposure
45
What are amphetamine and ephedrine used for and why are they not used
Used for asthma but they cause hypertension
46
Phenoxybenzamine receptor activity
Irreversible binding to a1 and a2 | Causes vasodilation-> reflex tachycardia
47
Phenoxybenzamine indications
Pheochromactoma
48
Phenoxybenzamine adverse effects
Postural hypotension, nasal stiffness and baroreceptor reflex tachycardia
49
Phentolamine receptors
Competitive a1 and a2
50
Phentolamine indications
Pheochromacytoma and reverses the actions of a - adrenomimetics
51
Phentolamine adverse effects
Postural hypotension nasal stiffness and baroreceptor reflex tachycardia
52
Prazosin, terazosin, oxazosin, alfuzosin and tamsulosin - receptor activation
Competitive a1 blockers
53
Prazosin, terazosin, oxazosin, alfuzosin and tamsulosin - adverse effects
Orthostatic hypotension and nasal congestion
54
Prazosin, terazosin, oxazosin, alfuzosin and tamsulosin actions and indications
Causes vasodilation and relaxation of smooth muscles in urinary tract Indications for - hypertension and BPH
55
Which a1 blockers are only used for BPH
Alfuzosin and tamsulosin
56
Which a1 blockers are used for both BPH and hypertension
Doxazosin and terazosin
57
How many generations of B blockers are there
4 generations
58
Why shouldn’t B blockers be stopped abruptly
Could lead to angina and rebound hypertension
59
What is the 1st generation B blockers
Non selective B blocker - prevents the effects of epinephrine in anaphylaxis It includes Propanolol Timolol —> used for glaucoma
60
What is the 2nd generation B blockers
``` B1 selective B blockers It includes :- Atenolol Bisoprolol Esmolol Acebutolol Metoprolol ```
61
What is the 3rd generation B blockers
Non selective B blockers + additional effects It includes :- Carvedilol Labetolol
62
What is the 4th generation B blockers
B1 selective B blocker + additional effects It includes :- Nebivolol Betaxolol
63
What is nebivolol additional effects
Increase NO production
64
What is celiprolol additional effects
B2 agonism
65
What is carvedilol and labetolol additional effects
a1 antagonism (used in amphetamine overdose)
66
What is carvedilol and betaxolol additional effects
Ca2+ enter blockade
67
Does propanolol penetrate the CNS
Yes it does
68
Propanolol actions
Non selective B blocker so causes decrease in CO and BP - cause peripheral vasoconstriction and bronchoconstriction - can cause a decrease in glycogenolysis and glucagon secretions —> hypoglycaemia
69
Propanolol indications
Migraine prophylaxis, hypertension, angina, MI and arrhythmias
70
Propanolol therapeutic uses
Migraine Hyperthyroidism Tremor Stage fright
71
Propanolol adeverse effects
Hypotension, bradycardia and decrease in cardiac contractility am an cause asthma attack and insomnia
72
Cardioselective B blockers uses
Can be used for asthma and diabetes (little effect on carbs metabolism)
73
B blocker with intrinsic sympthomimitic activity
Acebutolol and pindolol
74
B blockers with a1 blocking properties
Labetolol and carvedilol
75
a1 agonist ending
ZOLINE
76
a1 antagonist ending
ZOSIN
77
B2 agonist ending
TEROL
78
B1 antagonist ending
OLOL

Pharmacology (33 decks)

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