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DNURS 836 Advanced Pharmacology for Anesthesia II > Vasoconstrictors - Quiz 1 > Flashcards

Vasoconstrictors - Quiz 1 Flashcards

1
Q

What ocurrs w/ the Sympathetic Stimulation of the Adrenal Medulla?

A

ACh binds to Nicotinic Receptor in the Adrenal Medulla, which then releases Epinephrine into the Blood to bind to Adrenergic Receptors

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2
Q

How does Sympathetic Stimulation release Norepinephrine?

A

Ach binds to Nicotinic Receptor on the Postganglionic Neurons, releasing Norepi to bind to Adrenergic Receptors

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3
Q

What happens w/ Autonomic Parasympathetic Stimulation?

A

ACh binds to Nicotinic Receptors on the Postganglionic Neurons, and ACh is released to bind to Muscarinic Receptors.

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4
Q

What is the difference b/t Somatic & Autonomic Response?

A

With Somatic, ACh is released and binds to Nicotinic Receptors in muscles WITHOUT Ganglia involvement

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5
Q

Which enzyme breaks down Dopamine into Norepi?

A

Beta Hydroxylase

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6
Q

What causes a release of Norepi from the Synaptic Vessel?

A

An Action Potential

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7
Q

What are the ways in which the Norepi Signal is Terminated?

A

Reuptake - 80%

Dilution - 20%

Monamine Oxidase (MAO)

Catechol-o-Methyltransferase (COMT)

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8
Q

Where are Alpha-1 Receptors located?

A

Periphery

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9
Q

Where are Alpha-2 Receptors Located?

A

Central

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10
Q

Where are Beta-1 Receptors located?

A

Heart

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11
Q

Where are Beta-2 Receptors Located?

A

Smooth Muscle

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12
Q

What happens when the Alpha-1 Receptor is activated?

A

↑Intracellular Calcium

Contract Smooth Muscle

Vaso & Bronchoconstriction

Inhibit Insulin

Breaks Down Glycogen

Gluconeogenesis

Relaxes GI

Dilates Pupils

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13
Q

What happens w/ the activation of Alpha-2 Receptors in the Presynpatic PNS?

A

↓Calcium Entry

&

↓Norepi Release

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14
Q

What happens w/ the activation of Alpha-2 Receptors in the Postsynaptic CNS?

A

Sedation

↓Sympathetic Outflow

↓BP

Platelet aggregation

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15
Q

What happens when Beta-1 Postsynaptic Receptors are activated?

A

Increases HR, Contractility, and Conduction Velocity

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16
Q

What happens when Beta-2 Postsynaptic receptors are activated?

A

Relax Smooth Muscles

Vaso & Bronchodilation

↑Insulin

↑Glycogen Breakdown

↑Gluconeogenesis

↓GI Motility

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17
Q

Which Autonomic System does Acetylcholine activate?

A

BOTH SNS & PNS

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18
Q

What is Tachyphylaxis?

A

Diminishing response to successive doses of a drug - happens w/ over exposure to agonists

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19
Q

What is Receptor Uncoupling?

A

Receptor CANNOT bind to G Protein - happens fast

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20
Q

What is Sequestration in regards to Receptor Down Regulation?

A

Receptors move from Cell Surface to Inside the Cell - happens slower than Uncoupling

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21
Q

What is happens to the receptors during Downregulation?

A

Receptors move from Cell Surface to inside the cell, then DESTROYED - very slow process

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22
Q

What is Pheochromocytoma?

A

Uncontrolled release of Catecholamines d/t adrenal tumor

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23
Q

Catecholamines are considered BOTH ______ & ______ that act on adrenergic receptors

A

Catecholamines are considered BOTH Neutrotransmitters & Hormones that act on adrenergic receptors

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24
Q

How are Sympathomimetics different from Catecholamines?

A

Same benzene ring, but DOES NOT have Hydroxyl Groups at the 3 & 4 Position

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25
What enzyme can break down Sympathomimetics?
Only Monamine Oxidase (MAO) | (CANNOT go thru Reuptake)
26
The inhibition of which Signal Termination mechanism would cause the greatest potentiation of Epinephrine?
Reuptake
27
How does the metabolism rate of Synthetic Non-Catecholamines compare to that of Catechols?
Slower
28
What kind of reactions are involved w/ the metabolism of Catecholamines & Phenylephrine?
Sulfoconjugation Reactions
29
Vasoconstrictors _______ Venous Return, Preload, and Cardiac Output
Vasoconstrictors **INCREASE** Venous Return, Preload, and Cardiac Output
30
What are the *Reflex* changes caused by Vasoconstrictors?
↓HR ↓Conduction ↓Contractility
31
What are the Non-Cardiac effects of Vasoconstrictors?
Bronchodilation Glycogenolysis CNS & Endocrine Stimulation
32
How long can a person have a MAP of \<65 mmHG before having End Organ Damage?
13 - 28 min
33
How long can a person have a MAP of \< 50 mmHg before having End Organ Damage?
1 Minute
34
What are complications of using Vasoconstrictors?
Ventricular Failure ↓Renal Blood Flow Masks Hypovolemia
35
Which receptors does Epinephrine work on?
All of them - Alpha-1, Beta-1, Beta-2
36
How much more potent is Epinephrine than Norepi?
2-10x more potent
37
How does Epinephrine affect Blood Sugar?
↑Blood Sugar d/t decreased insulin secretion
38
How does Epinephrine affect the kidneys?
↓Renal Blood Flow & Stimulates Renin Release
39
Which receptor does Epinephrine act on at lower doses (1-2 mcg/min)?
Beta-2 in periphery, decreasing the SVR for better oyxgen exchange, but MAP stays the same
40
At what dose of Epinephrine are the Beta-1 receptors stimulated?
Intermediate dose - 4 mcg/min Increases HR, Contractility, CO, and Automaticity
41
What happens w/ High doses of Epinephrine?
Potent Alpha-1 Stimulation causing vasoconstriction & can override the other receptor effects Reflex Bradycardia No CNS effects
42
What are the risks of using Racemic Epinephrine?
Tachy Arrythmias & Rebound Airway Edema
43
Which receptors does Norepi work on?
**Alpha-1** \> Beta-1 No Beta-2
44
Why do Lower doses of Norepi increase Cardiac Output, but Higher doses decrease Cardiac Output?
Increased Afterload causes Reflex Bradycardia
45
What receptors does Ephedrine work on?
**Indirect** & Direct Alpha-1 & Beta Works on the Heart like Norepi w/ a little more HR effect ↑Contractility
46
What happens with continued use of Ephedrine?
Tachyphylaxis
47
How does Ephedrine affect the Uterus & Bronchial Smooth Muscle?
↑Uterine Blood Flow & Relaxes Bronchial Smooth Muscle
48
How does Ephedrine compare to Epinephrine regarding BP response?
Ephedrine's BP Reponse is Weaker, but Longer Lasting
49
What are Ephedrine side effects?
Insomnia Urinary Retention Tremor Psychosis Palpitations
50
How does Cocaine & Amphetamines affect Ephedrine?
Blocks Reuptake --\> Exaggerate HTN & Arrythmias
51
Which receptor does Phenylephrine work on?
Direct Alpha-1 to ↑Preload \> Afterload & Small Beta-1
52
Other than Blood Pressure, what else is Phenylephrine used for as treatment?
Priapism Nasal Decongestant Mydriasis - Pupil Dilation
53
How does Phenylephrine affect the Pulmonary Vasculature?
↑PA Pressure & Resistance
54
How does Phenylephrine compare w/ Norepi?
Phenylephrine is Weaker, but Longer Lasting
55
How does DDAVP compare to Vasopressin regarding Antidiuretic Effect & Pressor Effect?
DDAVP is a much stronger Antidiuretic & has No Pressor Effect
56
How is Vasopressin different from Catecholamines?
Vasopressin can work in Hypoxic & Acidic environments
57
Which receptors does Vasopressin work on?
V1a - Pressor Effect V2 - Antidiuretic Effect
58
What are the effects of Vasopressin in the setting of Cardiac Failure?
Cardiac Ischemia ↑Preload & ↑Afterload ↑Wall Stress LVH
59
What is the advantage of using Vasopressin over Epinephrine?
Vasopressin is just as effective, but has no direct effect on HR & O2 Consumption
60
How should weight loss products that contain Ephedrine be managed peri-operatively?
Tachyphylaxis - Hold for 24 hrs before surgery
61
What is the treatment for Vasoconstrictor Extravasation?
Phentolamine - Alpha 1 & 2 Antagonist
62
What does Giapreza (Angiotensin II) do?
Vasoconstriction & ↑Aldosterone Release
63
What are the complications of using Giapreza (Angiotensin II)?
DVT Tachycardia Delirium Thrombocytopenia

DNURS 836 Advanced Pharmacology for Anesthesia II (12 decks)

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