Cology, Central/peripheral Sympatholytics

Front 1

at what level of the cns/hypothalamus/brainstem do bb work

Back 1

cardiac output

Front 2

at what level of the cns/hypothalamus/brainstem do kidney blockers work

Back 2

reanl retention:

aldosterone

adh

sns

anp

Front 3

at what level of the cns/hypothalamus/brainstem do acei work

Back 3

circulating regulation:

ang 2

catecholamine

Front 4

at what level of the cns/hypothalamus/brainstem do alpha blockers work

Back 4

direct innervation

a1 receptor

b2 receptor

Front 5

central sympatholytics is central mediated inhibition of ----- actiivity

Back 5

sympathetic

Front 6

what receptors are stimulated in central sympatholytics

Back 6

a2 receptors (a2a subtype)

possible inidazoline (I1, I2, I3)

Front 7

what does the endogenous subsrate do

Back 7

clonidine displacing substance

Front 8

t/f

central sympatholytics are 1st line meds cuz they're very potent

Back 8

f

last resort agents due to side effects

Front 9

where do the central sympatholytics work in the brain

Back 9

nucleus of solitary tract

ventral lateral medulla

Front 10

activation of the nucleus of solitary tract and the ventral lateral medulla ---- sympathetic nerve activity

Back 10

decreases

Front 11

majority of the a2 receptors are on the pre/post synaptic side

Back 11

postsynaptic

Front 12

clonidine will activate nts and rlvm which will ------ motor nucleus of vagus which activate the lowering of CO, hr and bp

Back 12

activate

Front 13

once the nts and rlvm are acitvated by clonidine, they will then deactivate the --- sympathetic contral centers

Back 13

brainstem

Front 14

the brainstem sympathetic control centers will ------ the intermediolaterial nucleus

Back 14

deactivate

Front 15

tthe deactivation ofthe intermediolateraol nucleus will deactivate the ---- ----

Back 15

sympathetic ganglia

Front 16

a decrease in the sympathetic ganglia will decrease --- release and that will relax --- -----

Back 16

NE

blood vessels

Front 17

what hemodynamics effects are decreased

Back 17

TPR

HR

CO

renin release

Front 18

what general hemodynapmic effect is increased

Back 18

slight increase in sodium retention

Front 19

due to a decrease in NE and increase in Ach, what will be decreased in general hemodynamics

Back 19

hr

co

Front 20

due to a block on NE release on the bl vessels what will be decreased

Back 20

tpr

Front 21

what will cause fluid retention

Back 21

slight increase in na retention

Front 22

what will cause a decrease in renin release

Back 22

effects on the alpha 2 receptors

Front 23

advantages:

decreased tpr w/ modest decrease in ------

Back 23

co

Front 24

advantages

efficacy --- of age, race, gender

Back 24

independent

Front 25

t/f

central symp are only suitable for combo tx

Back 25

f

monotherapy

Front 26

advantage:

sympatolytics work well in the ----

Back 26

elderly

Front 27

t/f

central sym. lytics increase lipids

Back 27

f

no effects on lipid

Front 28

why are we moving away from monotherapy

Back 28

cuz other agents have less SE

Front 29

general se of central sympatholytics

Back 29

drowsiness/sedation

dry mouth

decreased tear production

sexual dysfunction

narrow therapeutic range

abrupt withdrawal htn

Front 30

why shouldn't you d/c symptolytics abruptly

Back 30

withdrawal htn

prone to stroke and mi

Front 31

t/f

sympatholytics have a wide therapeutic range

Back 31

f

narrow therapeutic range

Front 32

t/f

men rather take sympathlytics because it can potentiate an erection

Back 32

f

sexual dysfunction

Front 33

what is a methyldopa metabolized to

Back 33

alpha methylnorepinephine

Front 34

what is alpha methylnorepinephine taken up by

Back 34

reuptake pump

Front 35

what is alpha methylnorepinephine converted to and by what

Back 35

converted by normal enzymes to NE

Front 36

alpha methyldopa is a potent --- agonist

Back 36

a2

Front 37

where is a methyldopa converted

Back 37

in neuron in brain

Front 38

what converts alpha methyldopa to alpha methadopamine

Back 38

dopa decarboxylase

Front 39

what's in the vesicles w/ ne

Back 39

alpha methyl NE

Front 40

what acts on the alpha 2 on the brain

Back 40

alpha methyl ne

Front 41

alpha metha dopa is converted to

Back 41

alpha methyl ne

Front 42

se of a methyldopa includes:

elevated -----, leading to fluid retention

Back 42

na

Front 43

t/f

hepatoxicity in methyldopa is irreversible

Back 43

f

reversible

Front 44

w/ a methyldopa you can have ---- ---- rxn

Back 44

allergic skin

Front 45

fever and ---- anemia are se of a methyldopa

Back 45

hemolytic

Front 46

which sympathlytic can be used during pregnancy and w/ breast feeding mom's

Back 46

alpha methyldopa

Front 47

t/f

alpha methyldopa is 1st line tx

Back 47

f

2-3 line therapy

Front 48

clonidine is a ---- agonist and an ----- agonist

Back 48

alpha 2a

imidazoline

Front 49

how does clonidine has acute pressor effects

Back 49

bl vessels have both alpha 1 and 2, so clonidin will act on the alpha 2 and cause a some constriction

Front 50

overall how does clonidine cause decrease bp

Back 50

it decreases nerve activity

Front 51

what predicts potency of clonidine

Back 51

lipid solubiltiy of analogues

Front 52

decrease in sns activity, increase --- activity

Back 52

pns

Front 53

how will clonidine increase bl glucose

Back 53

inhibits insulin secretion

Front 54

w/ clonidine the diabetic pt is prone to hyper/hypo glycemia

Back 54

hyperglycemia

Front 55

clonidine decreases ---- secretion

Back 55

ADH/AVP

Front 56

clonidine causes --- retention

Back 56

na

Front 57

if clonidine often causes na retention what's it's often given w/

Back 57

diuretic

Front 58

a central effect of clonidine

Back 58

dry mouth

sedation

Front 59

clonidine has --- activity in the spinal cord

Back 59

analgesic

so decreased dose of anesthetic required

Front 60

se of clonidine:

---- rxn

impotence

-----cardia

orthostatic hypotension

Back 60

withdrawal

bradycardia

Front 61

what's dangerous about bradycardia in clonidine

Back 61

too low other areas of the heart might take over, pacemakers, which migh cause arrhythmias

ischemia! due to low bl flow

Front 62

how is orthostatic hypotension caused

Back 62

decrease sympathetic response to a baroreflex

Front 63

off label uses of clonidine include:

--- opiate and --- withdrawal

Back 63

blunt

cocaine

Front 64

how are withdrawal effects diminshed w/ clonidine

Back 64

due to decreased sympathetic

most s/s are due to the sympathetic response

Front 65

t/f

clonidine can be used in adhd, migraines, dysmenorrhea

Back 65

t

Front 66

clonidine can be used for --- flushing

Back 66

menopausal

Front 67

clonidne can be used for ---- syndrome

Back 67

tourette's

Front 68

clonidine chronic ---- in dm w/ ---- ------

Back 68

diarrhea

autonomic neuropathy

Front 69

how does clonidine prevent diarrhea

Back 69

increase Na and H2O absorption

Front 70

hot flashes due to ----

Back 70

vasodilation

clonidine has acute pressor effects

Front 71

apraclonidine is --- agonist

Back 71

alpha2

Front 72

t/f

apraclonidine crosses bbb

Back 72

f

doesn't cross bbb

Front 73

decrease------- mediated aqueous humor production

Back 73

a2

decreased a2 leads to an increase in aq humor

Front 74

t/f

apraclonidine is doc for glaucoma

Back 74

f

Front 75

apraclonidine is used after --- sx

Back 75

laser

Front 76

t/f

apraclonidine is monotx only

Back 76

f

used w/ other agents when pressure not controlled

Front 77

brimonidine ----- aq humor outlfow

Back 77

increase

Front 78

which crosses bbb:

apraclonidine

or brimonidine

Back 78

brimonidine

Front 79

se of briminodine include ---tension and sedation

Back 79

hypotension

Front 80

why does briminodine cause sedation

Back 80

cuz it crosses bbb

central effects

Front 81

apraclonidine is a ---- of the clonidine structure

Back 81

modification

Front 82

guanabenz has less --- and --- -----

Back 82

na and water retention

Front 83

t/f

guanabenz is less selective for alpha 2 than clonidine

Back 83

f

more selective

Front 84

se of guanabenz

Back 84

sedation

dry mouth

Front 85

which has less imdazoline activity

Back 85

guanabenz

Front 86

which is more potent guanfacin or clonidine

Back 86

clonidine

Front 87

which has occasional withdrawal symptoms guanabenz or guanfacine

Back 87

guanfacine

Front 88

which is guanafacine more selective for alpha 1 or 2

Back 88

alpha 2

Front 89

which has more sedation guanfacine or guanabenz

Back 89

guanabenz

Front 90

receptor for rilmenidine

Back 90

I1

Front 91

I1 receptors are in the --- and ---

Back 91

RVLM

NTS

Front 92

why is rilmenidine better than clonidine

Back 92

fewer classical a2-adrenergic effects

same advantage to lowering bp, but decreased SE

Front 93

few classical alpha 2 effects of rilmenidine

Back 93

less dry mouth

minor sedation

little na and H2O retention

no withdrawal syndrome

no orthostatic hypotension

Front 94

t/f

rilmenidine is a new drug approved in the us in 2007

Back 94

f

only in europe

Front 95

--- blocks transport into vesicles

Back 95

reserpine

Front 96

---- blocks new synthesis of vesicles

Back 96

reserpine

Front 97

reserpine blocks --- into vesicles and new ---- of vesicles

Back 97

transport

synthesis

Front 98

reserpine depletes --- stores

Back 98

NE

Front 99

t/f

reserpine has peripheral effects only

Back 99

f

both central and peripheral

Front 100

what does reserpine decrease

Back 100

CO

TPR

HR

RENIN

Front 101

who's reserpine effective in

Back 101

in the elderly w/ diuretic

Front 102

why use a diuretic w/ reserpine

Back 102

cuz of Na H2O retention

Front 103

se of reserpine

Back 103

sedation

drowsiness

fatigue

dysrhythmias

depression

suicide

Front 104

what did reserpine lead to the discovery of

Back 104

tricyclic antidepressants

Front 105

to prevent depression what should you do

Back 105

slow withdrawal drug

Front 106

which drug can cause dysrhythmias

Back 106

reserpine

Front 107

which drug can tx dysmenorrhea

Back 107

clonidine

Front 108

which drugs will cause sedation and dry mouth

Back 108

guanabenz

rilmenidine (less)

clonidine

guanfacine (less sedation only)

reserpine (sedation only)

Front 109

which drug will cause allergic skin rxn

Back 109

alpha methyldopa

Front 110

which drug will cause hemolytic anemia

Back 110

alpha methyldopa

Front 111

hepatotoxic drug

Back 111

alpha methyldopa

Front 112

which is used during pregnancy

Back 112

alpha methyldopa

Front 113

there's a + comb's test in ----% , only ---% gave true autoimmune respone

Back 113

20%

5%

Front 114

what does comb measure

Back 114

antibodies that attack Rh factor on RBC

Front 115

which drug causes a false comb's test

Back 115

alpha methyldopa

for up to 1 yr