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Flashcards in Sympathetic Rx Deck (33):
1

Albuterol

Direct
B2 > B1
Acute asthma or COPD

2

Salmeterol

Direct
B2 > B1
Long-term asthma or COPD control

3

Dobutamine

Direct
B1 > B2 and alpha
Use: heart failure (inotropic > chronotropic), cardiac stress testing

4

Dopamine

Direct
D1 = D2 > Beta > alpha
Uses: unstable bradycardia, HF, shock
*inotropic and chronotropic effects at lower doses due to beta effects
*vasoconstriction at higher doses due to alpha effects

5

Epinephrine

Direct
Beta > alpha
Use: anaphylaxis, asthma, open-angle glaucoma
*Alpha effects predominate at higher dose (vasoconstriction)
*Significantly stronger effect at beta2-receptor than norepinephrine (means more vasodilator effects--PVR goes down, PP/CO/HR go up)

6

Fenoldopam

Direct
D1
Use: postop HTN, hypertensive crisis
*Vasodilator (coronary, peripheral, renal, splanchnic)
*Promotes natriuresis
*SE: hypotension and tachycardia

7

Isoproterenol

Direct
B1 = B2
Use: electrophysiologic evaluation of tachyarrhythmias
*Can worsen ischemia
*B2 vasodilation = decreased MAP = reflex tachycardia
*B1 = increased heart rate
(Very increased heart rate, CO, and PP)

8

Midodrine

Direct
Alpha1
Use: autonomic insufficiency and postural hypotension
*May exacerbate supine hypertension

9

Mirabegron

Direct
Beta3
Use: urinary urge incontinence or overactive bladder

10

Norepinephrine

Direct
A1 > A2 > B1
Use: hypotension, septic shock
*Increase both SBP and DBP = increased MAP = reflex bradycardia
(CO stays the same and PP widens)

11

Phenylephrine

Direct
A1 > A2
Use: hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

12

Amphetamine

Indirect general agonist
Reuptake inhibitor
Releases stored catecholamines
Use: narcolepsy, obesity, ADHD

13

Cocaine

Indirect general agonist
Reuptake inhibitor
Use: vasoconstriction and local anesthetic
*Never give beta-blockers if cocaine intoxication is suspected (leads to unopposed A1 and extreme hypertension)

14

Ephedrine

Indirect general agonist
Releases stored catecholamines
Use: nasal decongestion (pseudoephedrine), urinary incontinence, hypotension

15

Clonidine/guanfacine

Sympatholytics (A2 agonists)
Uses: hypertensive urgency (limited situations), ADHD, Tourette
SE: CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hypertension with abrupt cessation

16

A-methyldopa

Sympatholytic (A2 agonist)
Use: HTN in pregnancy
SE: direct Coombs positive hemolysis, SLE-like syndrome

17

Phenoxybenzamine

Nonselective A blocker
Irreversible
Use: pheochromocytoma (preop) to prevent catecholamine (HTN) crisis
SE: orthostatic hypotension, reflex tachycardia

18

Phentolamine

Nonselective A blocker
Reversible
Use: MAOI patients eating tyramine-rich foods
SE: orthostatic hypotension, reflex tachycardia

19

Prazosin

A1 blocker
Use: urinary symptoms of BPH, PTSD
SE: 1st-dose orthostatic hypoTN, dizziness, HA

20

Terazosin/doxazosin/tamsulosin

A1 blocker
Use: urinary symptoms of BPH, hypertension (except tamsulosin)
SE: 1st-dose orthostatic hypoTN, dizziness, HA

21

Mirtazapine

A2 blocker
Use: depression
SE: sedation, increase serum cholesterol, increase appetite

22

Beta-blockers: angina pectoris

Decrease heart rate and contractility = decreased oxygen consumption

23

Beta-blockers: MI

Decreased mortality

24

Beta-blockers: supraventricular tachycardia

Decreased AV conduction velocity (class 2 antiarrhythmic)
*Metoprolol and esmolol

25

Beta-blockers: HTN

Decreased cardiac output, decreased renin secretion (B1 block on JGA cells)

26

Beta-blockers: HF

Decreased mortality
*Bisoprolol/carvedilol/metoprolol

27

Beta-blockers: glaucoma

Decreased production of aqueous humor
*Timolol

28

Beta-blockers: variceal bleeding

Decreased hepatic venous pressure gradient and portal HTN
*Nadolol/propranolol

29

Beta-blockers: SE

Erectile dysfunction
CV SE: bradycardia, AV block, HF
CNS SE: seizures, sedation, sleep alterations
Dyslipidemia (metoprolol)
Asthma/COPD exacerbations
*Caution in cocaine users

30

B1 selective antagonists (B1>B2)

Acebutolol (partial agonist)
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
(A-M = 1st half of alphabet)

31

Nonselective B-antagonists (B1 = B2)

Nadolol
Pindolol (partial agonist)
Propranolol
Timolol
(N-Z = 2nd half of alphabet)

32

Nonselective A and B antagonists

Carvedilol
Labetalol

33

Nebivolol

Cardiac-selective B1 blockade + stimulation of B3 (activate NOS in vasculature and decrease SVR)