Sympathetic Rx

Question 1

Albuterol

Answer 1

Direct
B2 > B1
Acute asthma or COPD

Question 2

Salmeterol

Answer 2

Direct
B2 > B1
Long-term asthma or COPD control

Question 3

Dobutamine

Answer 3

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

Question 4

Dopamine

Answer 4

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

Question 5

Epinephrine

Answer 5

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)

Question 6

Fenoldopam

Answer 6

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

Question 7

Isoproterenol

Answer 7

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)

Question 8

Midodrine

Answer 8

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

Question 9

Mirabegron

Answer 9

Direct
Beta3
Use: urinary urge incontinence or overactive bladder

Question 10

Norepinephrine

Answer 10

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

Question 11

Phenylephrine

Answer 11

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

Question 12

Amphetamine

Answer 12

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

Question 13

Cocaine

Answer 13

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)

Question 14

Ephedrine

Answer 14

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

Question 15

Clonidine/guanfacine

Answer 15

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

Question 16

A-methyldopa

Answer 16

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

Question 17

Phenoxybenzamine

Answer 17

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

Question 18

Phentolamine

Answer 18

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

Question 19

Prazosin

Answer 19

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

Question 20

Terazosin/doxazosin/tamsulosin

Answer 20

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

Question 21

Mirtazapine

Answer 21

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

Question 22

Beta-blockers: angina pectoris

Answer 22

Decrease heart rate and contractility = decreased oxygen consumption

Question 23

Beta-blockers: MI

Answer 23

Decreased mortality

Question 24

Beta-blockers: supraventricular tachycardia

Answer 24

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

Question 25

Beta-blockers: HTN

Answer 25

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

Question 26

Beta-blockers: HF

Answer 26

Decreased mortality | *Bisoprolol/carvedilol/metoprolol

Question 27

Beta-blockers: glaucoma

Answer 27

Decreased production of aqueous humor | *Timolol

Question 28

Beta-blockers: variceal bleeding

Answer 28

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

Question 29

Beta-blockers: SE

Answer 29

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

Question 30

B1 selective antagonists (B1>B2)

Answer 30

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

Question 31

Nonselective B-antagonists (B1 = B2)

Answer 31

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

Question 32

Nonselective A and B antagonists

Answer 32

Carvedilol | Labetalol

Question 33

Nebivolol

Answer 33

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