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87 Cards in this Set

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This receptor is located in vascular smooth muscle and causes vasoconstriction
Alpha1
This receptor is located in presynaptic adrenergic nerve terminals and vascular smooth muscle and causes inhibition of NE release and vasoconstriction
Alpha2
This receptor is located in heart and causes increase in heart rate, increase in contractility and increase in speed of AV node conduction
Beta1 receptors
This receptor is located in JG cells in kidney and causes renin release
Beta1
Activation of this receptor in presynaptic adrenergic nerve terminals causes increase in NE release
Beta1
Activation of this receptor in adipose tissue causes lipolysis
Beta1
This receptor is located in vascular smooth muscle and causes vasodilation, in bronchial smooth muscle causing bronchodilation and in liver stimulating glycogenolysis, also in skeletal muscle vascular bed causing vasodilation
Beta2
This receptor is located in renal blood vessels and causes vasodilation
D1
Sympathomimetic drugs are used for treatment of _
Hypotension
Shock
Acute heart failure
Sympatholytics are used for treatment of _
Hypertension
Angina pectoris
Cardiac arrhythmias
CHF
This drug is used for resuscitation from cardiac arrest and anaphylactic shock - IV - whats the mechanism?

What would be common adverse effects?
Epinephrine

Increase inotropic and chronotropic effects plus alpha mediated vasoconstriction

Tachycardia (most common) and HTN crisis
Which drugs increase effect of epinephrine
Cocaine
TCA
MAO inhibitors
Thyroid hormones
This drug stimulates alpha1, alpha2, beta 1 receptors and has relatively little effect on beta 2 - only indicated for cardiac arrest and hypotensive states
NE
This drug stimulates beta 1 and beta 2 receptors and is used in AV block, bradycardia and emergency situations ( in anticipation of inserting cardiac pacemaker)
Isoproterenol
D1 agonist used for severe hypertension
Fenoldopam
At low dose (less than 2 micrograms) dopamine binds which receptor and whats its action
D1 receptor --> mesenteric and renal artery dilation (facilitates diuresis)
At medium dose (2-10) micrograms dopamine binds what receptor and whats the action
Beta 1 receptor --> inotropic effect, severe CHF
At high dose (over 10 micrograms) dopamine binds what receptor and whats the action
Alpha 1 receptor --> peripheral vasoconstriction, hypotensive state (shock)
Synthetic beta 1 agonist, can activate alpha 1 receptors, increases CO with little or no effect on HR (selectively activates myocytes), only used IV for heart failure
IV dobutamine
Dopamine and dobutamine are used for treatment of _
Acute CHF
Name 3 alpha 1 agonists
Phenylephrine
Methoxamine
Midodrine (prodrug)
Clinical use of phenylephrine and methoxamine
Hypotensive emergencies - preserve cerebral and coronary flow, also used to maintain BP during anesthesia
This alpha 1 agonist is used for posture hypotension
Midodrine
This drug releases NE and is a mixed beta/alpha agonist, causes mild CNS stimulation and has potential for abuse although form of it is used as OTC decongestant
Ephedrine
Name 2 alpha 2 agonists
Clonidine
Alpha methyldopa
Which drugs bind to receptors in CV control centers of CNS and decrease sympathetic outflow from the brain
Alpha 2 agonists - clonidine, alpha methyldopa
This drug is indicated for hypertension, it is very lipid soluble and also available as transdermal patch, alpha 2 agonist
Clonidine
This prodrug is indicated for pregnancy related HTN and is an alpha 2 agonist

What are the potential side effects
Alpha methyldopa

Positive Coombs test - complicated cross matching of blood, can cause hemolytic anemia

Potential for serious hepatotoxicity
What are the major side effects of alpha 2 agonists
Sedation in 50% of patients, sexual dysfunction in males, nausea, dizziness and sleep disturbances, dose related withdrawal
What is the main precaution in clonidine
DO NOT WITHDRAW SUDDENLY --> can cause rebound HTN
Name alpha 1 selective blockers
Prazosin
Doxazosin
Terazosin
Name non-selective alpha blockers
Phenoxybenzamine

Phentolamine
What is the main indication for use of alpha 1 blockers
Hypertension - decrease sympathetic tone of arteries and veins - decrease TPR
What are the adverse effects of alpha 1 blockers
MILD TACHYCARDIA (reflex tachycardia)
1st dose hypotension
Salt and water retention
Irreversible nonselective alpha blocker which is indicated for treatment of pheochromocytoma (pre op)
Phenoxybenzamine
Competitive reversible non selective alpha blocker, prevents hypotension during surgical excision of pheochromocytoma, also used for diagnostic purposes
Phentolamine
Name non selective beta blockers
Propranolol
Timolol
Pindolol
Prototype non selective beta blocker, highly lipid soluble, high 1st pass effect - used for HTN, angina, arrhytmias, MI, aortic dissection, hypertrophic cardiomyopathy
Propranolol
Name beta 1 selective blockers
Atenolol
Metoprolol
Esmolol
Multiple large studies indicate long term use of _ in patients who have had MI prolongs survival
Propranolol
Timolol
Metoprolol
Adverse effects of beta 1 blockade
Bradycardia
Decreased CO
AV block
Can precipitate heart failure
Arrhythmias
Sodium water retention
Rebound cardiac excitation if discontinued suddenly
May worsen peripheral vascular disease
Adverse effects of beta 2 blockade
Bronchoconstriction
Inhibition of glycogenolysis - detrimental for diabetics
Masks tachycardia
Vasoconstriction
Name two alpha/beta blockers
Labetalol

Carvedilol
This drug depletes sympathetic neurons of NE, prevents NE from vesicular packaging - decreases HR, CO, vasodilation --> decreases BP
Reserpine
What is THE MOST SERIOUS side effect of reserpine that limits its use
DEPRESSION (can lead to SUICIDE)
This drug is transported into membrane of sympathetic nerve terminals by the uptake 1 system and prevents release of NE in response to AP's

What is the main side effect
Guanethidine

Orthostatic hypotension
Ganglionic blocker that has rare use in treatment of essential hypertension in patients refractory to other antihypertensives
Mecamylamine
Name class of drugs

First line treatment of HTN through Na excretion and fluid volume reduction

What are the adverse effects
Diuretics

Hypokalemia, volume depletion
3 classes of Ca channel blockers with examples
Benzothiazepines - DILTIAZEM

Phenylalkylamines - VERAPAMIL

Dihydropyridine - NIFEDIPINE
Name class of drug

First or second line drugs, selective inhibitors of L type Ca channel, work through natriuresis
Ca channel blockers
Side effects of Ca channels blockers
Cardiac arrest
Bradycardia
AV block
Constipation
Edema (peripheral)
MOA of Diltiazem
Negative inotropic effect and decreased AV node conduction
Ca channel blocker recommended in LVH, diastolic dysfunction and/or arrhythmias
Diltiazem
Diltiazem interacts with what other drug?
Cyclosporine
Ca channel blocker of choice in CHF
Nifedipine
This Ca channel blocker is smooth muscle selective, adjunctive to beta blocker or ACE inhibitor
Nifedipine
Nifedipine interacts with _
Grapefruit juice
Adverse effect of nifedipine
Acute MI
Verapamil is contraindicated in _
Heart block and CHF
Adverse effect of Verapamil
Constipation
This direct vasodilator is indicated in pregnancy related HTN and HF with ACE inhibitors intolerance, severe HTN
Hydralazine
Side effects of hydralazine
Headache
Nausea
Anorexia
Palpitation
Sweating
Flushing
Lupus like fever
This direct vasodilator opens K channels in smooth muscle membrane and is indicated in case of refractory HTN
Minoxidil
Side effect of Minoxidil
Hirsutism in women
MOA of sodium nitroprusside
Direct and indirect stimulation of guanylyl cyclase
Side effects of sodium nitroprusside
Decreased BP
Cyanide accumulation
Metabolic acidosis
Arrhythmia
Indications for sodium nitroprusside
Pheochromocytoma (in operation)
This direct vasodilator increases K conductance in smooth muscle - indicated occasionaly in hypertensive emergencies and hypoglycemia
Diazoxide
Adverse effects of diazoxide
Excessive hypertension
Renal salt and water retention
D1 agonist that is indicated for post op HTN and HTN emergencies

What is the contraindication?
Glaucoma

Fenoldopam
Third line drugs for HTN indicated for conocomitant BPH, adjunct to ACE inhibitors or CCB for resistant hypertension

What is the toxicity?
Alpha 1 blockers - prazosin, doxazosin, terazosin

Fluid retention, tachycardia, fatigue, ORTHOSTATIC HYPOTENSION
Contraindication for alpha methyldopa
Depression
Side effects alpha methyldopa
Sedation
Nightmares
Depression
Vertigo
Lactation
This drug is indicated for labile hypertension needing multiple drugs, mainstay in hypertensive urgencies
What is the toxicity it can cause?
Clonidine

Dry mouth

Withdrawal syndrome
Which anti HTN drug causes delayed or retrograde ejaculation
Guanethidine
Which drugs decrease TPR with no tachycardia, indicated in pre operative management of pheochromocytoma, chronic kidney disease, HTN emergencies and clonidine withdrawal

What are the side effects
Carvedilol and Labetalol - combined alpha and beta blockers

SE --> Heart block, heart failure, bronchospasm, postural hypertension
This class of drugs is indicated in concomitant heart failure and angina and high renin hypertension - decrease CO and inhibit renin production
Beta blockers
2 contraindications for beta blockers
Concomitant asthma + insulin dependent diabetes
Side effects of beta blockers
Bradycardia
Asthma
Increase triglycerides
Depression
Patient has concomitant asthma, ischemic heart disease and cardiac arrhythmias - which anti HTN would you give
Metoprolol (atenolol, esmolol) - cardioselective beta blockers
Side effects of beta 1 blockers
Bradycardia
Heart block
Asthmatic symptoms at high doses
Patient has HTN, concomitant migraines, esential tremors and reflex tachycardia - which HTN drug would you give
Propranolol (timolol, pindolol, carteolol, nadolol, penbutolol)
What are the contraindications non selective beta blockers
Bronchospasic pulmonary disease
Insulin dependent diabetes
Side effects of non selective beta blockers
Bronchospasm
Heart block
Name class of drugs which decrease TPR, no reflex sympathetic activation and save in ischemic heart disease
ACE inhibitors - enalapril, captopril, fosinopril
Patient has HTN and concomitant heart failure, KIDNEY DISEASE and diabetes, also resistant HTN - which anti HTN drug would you give
ACE inhibitor
ACE inhibitors are contraindicated in ?
2nd and 3d trimester of pregnancy