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27 Cards in this Set
- Front
- Back
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Where is norepi and epi found in the ANS?
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post-ganglionic sympathetic fibers. collectively norepi and epi are catecholamines.
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Acetylcholinesterase is to Acetylcholine as what is to catecholamines?
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MAO (monoamine oxidase) and COMT (catechol-a-methyl transferase)
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What is the steps in the enzymatic synthesis of catecholamines?
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tyrosine -> dopa -> dopamine -> norepi -> epi
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What is the difference between the alpha and beta adrenergic receptors?
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alpha - primarily sympathetic peripheral vasculature
beta - primarily sympathetic heart (beta 1) and lungs (beta 2) |
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What is phenylephrine?
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alpha-agonist that causes vasoconstriction and decongestants
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What are some mixed alpha and beta agonists?
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epinephrine
dopamine ephedrine pseduoephedrine |
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What are alpha-only and mixed agonists used for?
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allergic reations, nasal and sinus decongestant, bronchodilation, cardiogenic shock
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What is rebound nasal congestion?
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follows overuse of intranasal decongestants and... cocaine! it occasionally occurs with the use of systemic decongestants and can be resolved with a short course of intranasal corticosteroids.
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In what demographic is it strongly discouraged to use OTC cough and cold products?
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children < 4
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How do beta-only agonists work?
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1. beta agonist is released into post synaptic cleft
2. beta receptors (MOA) are activated 3. intracellular cAMP increases |
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What are the physiological effects of beta agonists?
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keep in mind all these effects are encouraging a generalized sympathetic (fight or flight) response
1. cardiostimulation (careful. can be overstimulated.) 2. tremors in skeletal muscle 3. tocolysis (slows down) effect on uterine contractions 4. increase blood sugar 5. increase intracellular potassium -> hypokalemia |
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What are the pharmacological uses for beta agonists?
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1. albuterol - bronchodilation for asthma and COPD (beta 2)
2. dobutamine - cardiac stimulant (beta 1) 3. terbutaline - tocolytic action (uterine relaxant) (beta 2) keep in mind a good general rule is that beta 1 = heart because we have one heart; beta 2 = lungs because we have 2 lungs. |
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What is isoproterenol?
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non-selective beta agonist that is not used because it's not selective!
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What is dobutamine used for?
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selective beta 1 agonist used for cardiac failure
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*What are the three long-acting selective beta 2 agonists?*
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1. salmeterol
2. formoterol 3. arfomoterol on label must have: WARNING: increases the chances of severe asthma episodes and should be used after other medicines fail to control asthma |
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What should be combined with long-acting selective beta 2 agonists to reduce the labeled risk of inducing a severe asthma attack?
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beta 2 agonist + corticosteroid
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What are the uses of alpha blockers?
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1. dx and pre-op management of pheochromocytoma
2. reverse vasoconstrictive effects of sympathomimetics 3. hypertension 4. benign prostatic hyperplasia |
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Um.... what is a pheochromocytoma?
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Pheochromocytoma is a rare tumor of the adrenal gland that causes too much release of epinephrine and norepinephrine -- hormones that regulate heart rate and blood pressure.
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What are the side effects of alpha-blockers?
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1. orthostatic hypotension
dizziness... etc ya know... things that would be indicative of blocking sympathetics |
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How are beta-adrenergic blockers classified?
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ISA - intrinsic sympathomimetic activity
PAA - partial agonist activity selective/non-selective dual-acting (alpha/beta) so you can choose a selective or non-selective with or without ISA and/or PAA |
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What is the primary use of a non-selective beta-blocker with alpha-blocking effects without ISA?
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prevention of congestive heart failure
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How do dem beta blockas werk?
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um... they block beta receptors
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What is the effect of blocking beta-1 receptors?
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1. decrease cardiac output (control hypertension)
2. decrease heart rate 3. decrease renin release (control hypertension 4. decrease myocardial oxygen demand 5. ophthalmic decrease secretion of aqueous humor by ciliary body (glaucoma control) 6. decrease essential tremor 7. reduces anxiety 8. control symptoms of hyperthyroidism 9. prevent migraine prophylactically |
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How are beta-1 blockers used with myocardial ischemia?
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by slowing everything down, myocardial ischemia can be reduced and this should be used as the standard of care following an MI
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What are the adverse effects of beta blockers?
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dizziness, fatigue, depression, diarrhea, nausea/vomiting, bronchospasm, masks signs of hypoglycemia,
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Why is it a bad idea to give beta blockers to diabetics?
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beta blockers mask the signs of hypoglycemia, so for a diabetic is it particularly dangerous to let the blood sugar get too low.
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Why is it a bad idea to abruptly stop beta blockers?
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if the beta receptors have been blocked for a long time and they are suddenly available, then they will be super sensitive. once they are stimulated, especially in an exaggerated way, a pt could go into tachycardia and bad things
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