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120 Cards in this Set
- Front
- Back
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Tell me about alpha 2 NE receptors....
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-work on some end organs, adrenergic nerve endings, CNS
-negative feedback receptor |
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Tell me about beta 1 NE receptors
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-work on heart, kidney, brain
-cause tachycardia and increased contractility |
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Tell me about beta 2 NE receptors...
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-broncho dilation, relax blood vessels, relax uterus
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What is acetylcholinesterase?
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enzyme that breaks down ACH. It is a target and we can block in which expands life of ACH
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What is catecho-O-methyltransferase? (COMT)
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-metabolizes dopamine and blocking it can prolong dopamine in the brain.
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What is monoamine oxidase A?
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enzyme found in the gut
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What is monoamine oxidase B?
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-enzyme found in the brain, and is important in depression and Parkinson's disease.
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In general, what NS is in charge?
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-parasympathetic
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In general, parasympathetic and sympathetic NS work in ____________
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opposition
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Vascular smooth muscle is only innervated by what NS?
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-sympathetic (alpha 1 and beta 2)
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What drug would you use for a patient that can't contract their bladder?
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-bethanechol (Urecholine)
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What are some side-effects of bethanechol?
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-diarrhea
-salivation -constriction of eyes |
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Methacholine is used for what?
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to diagnos reactive airway disease
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What is pilocarpine used for?
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-eye drops for gloucoma
-in people with dry mouth |
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What kind of drugs are:
-bethanechol -methacholine -pilocarpine? |
Direct cholinergic agonists
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What kind of drugs are:
-edrophonium -pyridostigminc -physostigmine |
ACHase inhibitor
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What is edrophonium used for?
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-diagnostic tool for myestina gravis, short acting
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What is pyridostigmine used for?
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treat myestina gravis (orally for life)
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What is physostigmine used for?
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operating and recovery rooms to help wake patients up
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How do colinergic antagonists work?
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-block at the receptor
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Atropine is what kind of drug and used to treat what?
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-cholinergic antagonist
-increase heart rate when givin after EPI |
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What type of drug are benztropine and trihexyphenidyl?
Treatment for what? |
-cholinergic antagonist
-affects that brain, used for Parkinson's and used to balance dopamine and ACH |
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Dicyclomine:
Class Uses |
-cholinergic antagonist
-treat IBS by treating spasm of GI, and you can't spit on this drug |
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Oxybutynin, tolterodine
darifenacin, solifenacin, trospium all relax what muscle? |
bladder muscle
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Scopolamine:
Class Uses |
-cholinergic antagonist
-Patch used for motion sickness, supresses the vomiting center |
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Glycopyrrolate (Robinul)
class uses |
-cholinergic antagonist
-near time of surgery to clear up secretions |
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What is the MOA for neuromuscular blockers (NMBs)/skeletal muscle relaxants (SMRs)?
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-specific for motor-end plates, so ACH receptor on skeletal muscle is where they work
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Succinylocholine
class uses |
-NMBs/SMRs
-makes patient twitch and they parazlyzes them. (Depolarizing neuromuscular blocker) |
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What do you give after Succinylocholine to a surgery patient to make them breath?
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non-depolarizing neuromuscular blockers
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How does Botox work?
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-pralyzes local muscles at the injection site by blocking chloride fluxation and lasts for 6 months
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Dantrolene:
-class -uses |
-NMBs/SMRs
-antidote to succinylcholine that causes hyperthermia |
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Norepinephrine
-class -types of agonist |
-B1 and A1 agonist
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Epinephrine
-class -types of agonist |
-Direct adrenergic agonist
-B1, B2,A1 |
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Phenylephrine
-class -types of agonist |
Direct adrenergic agonist
-A1 |
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Clonidine
-class -types of agonist |
Direct adrenergic agonist
-A2 |
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Dubutamine:
-class -agonist |
Direct adrenergic agonist
-B1 and B2 |
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Beta-1
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increase heart rate
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Beta-2
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dilates lungs and lugn tissue and relaxes smooth muscle around blood vessels in skeletal muscle
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Alpha-1
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vasoconstrictor in organs and skin
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Alpha-2
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slows down sympathetic nervous system @ receptor b/c of negative feedback system
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Praxosin
class uses |
Direct adrenergic agonist
-alpha blocker, causes orthostatic hypotension and used for BPH on occasion |
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Terazosin
class uses |
Direct adrenergic agonist
-alpha blocker causes some orthostatic hypotension |
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Tamsulosin
class uses |
Direct adrenergic agonist
-binds to certain alpha-receptors found in urinary spincter doesn't cause orthostatic hypotension |
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What are some similarities among beta-blockers?
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-slow heart rate
-redue mycardial contractility -block renin release -reduce sympathetic outflow -equally effective in reducing blood flow pressure at equipotent doses |
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What are some differences between beta-blockers?
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-pharmocokinetics
-receptor selectivity -potency |
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What are some benefits of beta-blockers for CHF?
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-slow resting heart rate
-decrease edema -increase exercise capacity |
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What are some potential drawbacks for the use of beta-blockers to treat CHF?
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-?usefulness
-relative or absolute contraindications |
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What are some benefits for the use of beta-blocker post MI?
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-decrease oxygen demand
-antiarrhythmic properties |
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What are some potential drawbacks for the use of beta-blockers post MI
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-many have absolute or relative contraindications (DM, COPD, heart block, etc)
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What are some benefits of combination therapy?
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-lower soes
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What are some drawback to using beta-blockers in combination therapy?
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-compliance
-side effects of new agent -increase cost |
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You should avoid the combination of a beta-blocker and what???
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beta-blocker and a central alpha antagonist
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If you combind a beta-blocker with a CCB, what CCB should you avoid?
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-verapamil
-diltiazem (slow HR) |
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What are some adverse effects of beta-blockers?
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-bradycardia
-hyptension -bronchospasm -imptence |
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Tenormin/Atenolol binds to what receptors?
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-B1-specific
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What are some benefits of using the beta-blocker Tenormin/Atenolol?
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-PO
-IV -once a day -after MI -preoperative |
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Lopressor/Toprol XL (Metoprolol) binds to what receptor?
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B1
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What are some benefits of usings Lopressor/Toprol XL (Metoprolol) as your beta-blocker?
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-PO
-IV -once or twice daily -after MI -CHF |
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Brevibloc/Esmolol binds to what receptors?
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-B1
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What are some benefits of using the beta-blocker Brevibloc/Esmolol?
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-treats superventicular tachycardia
-IV only |
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Inderal/Propanolol binds to what receptors?
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-B1 and B2 (non-specific)
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What are some benefits of using Inderal/Propanolol?
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-PO
-IV -migraine prophylaxis -after MI |
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Trandate, Normodyne (Labetalol) binds to what receptors?
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-B1
-B2 -A1 also vasodilator |
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What are some benefits of using Trandate, Normodyne (Labetalol) as your beta-blocker?
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-PO
-IV -twice daily -hypersensitive urgency |
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Coreg/Carvedilol binds to what receptors?
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-B1
-B2 |
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What are some benefits to using Coreg/Carvedilol as your beta-blocker?
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-PO
-Twice daily -CHF -HTN -can titrate |
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What are some RELATIVE contraindications for the use of beta-blockers?
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-diabetes
-sinus bradycardia -asthma/COPD -pregnancy |
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What are some ABSOLUTE contraindications for the use of beta-blockers?
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-heart block of any kind
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Can you use a beta-blocker in SVT, PVC, and tremor?
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YES
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WHat are the 4 stages of CHF?
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-A,B,C,D
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Tell me about stage A of CHF.
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ordinary physical activity does not cause symptoms, patient at risk without known structural abnormality
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Tell me about stage B of CHF.
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ordinary physical activity causes symptoms, patients at risk with known structural abnormality
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Tell me about stage C of CHF?
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current or proir symtoms of CHF
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Tell me about stage D of CHF.
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-inability to cary on any physical activity, end-stage disease (die w/in 1 year)
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What are the goals of treatment in CHF?
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-increase contractility
-decrease preload -decrease afterload |
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Dobutamin/Bobutrex is what kind of agonist?
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-B1
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Dobutamin/Bobutrex is used for what?
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-in hospital ofr decompinsated HF, improves rate of contraction and lowr BP slightly
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Tell me about dopamine...
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-B1 and A1
-2nd level drug -patients MUST be well hydrated |
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Tell me about the cardiac glycoside of digoxin/lanoxin
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-maintence medication (take at home)
-stabalizes pts cardiac output |
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Enlapril/Vasotec:
Class uses/benefits |
-ACE inhibitor
-PO,IV, once a day |
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Captopril/Capoten:
class uses/benefits |
-ACE inhibitor
-no real benefits (old and expensive) |
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Lisinopril(Zestril/Prinivil):
class uses/benefits |
-ACE inhibitor
-1 x day, easy to titrate, cheap |
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Fosinopril/Monopril:
class uses/benefits |
-ACE inhibitor
-associated w/less cough |
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Quinapril/Accupril:
class uses/benefits |
ACE inhibitor
-HOPE study, reduces HF symptoms |
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You can't use thiazide diuretics in people with what?
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-poor renal function
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What is the MOA for thiazide diuretics?
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-work in the nephron in the distal conveluted tubules and block the reabsorbtion of water and Na there
-lowers preload |
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Hydrochlorothiazide/HydroDiuril:
Class uses/benefits |
-Thiazide diuretics
-is mild and only works well in patients w/good renal function |
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Metolazone/Zaroxolyn:
Class benefits |
-Thiazide diuretic
-when given with a loop diuretic, it makes loop work better |
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What is the MAO for loop diuretics?
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-work in the asending arm of the loop of Henley, and it limits the reabsorbtion of Na and water
-works regardless of renal function |
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Furosemide/Laxix:
Class Uses/benefits |
-Loop diuretic
-most common, but short acting |
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Too much of a loop diuretic could cause what?
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-dehydration
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Bumetanide/Bumex
Torsemide/Demadex are both what kind of drug? |
-Loop diuretic
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For diuretics, what do you have to monitor?
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-serum K and Na
-fluid balance -serum creatinine -BP |
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Spironolactone/Aldactone and
Eplerenone/Inspra are what type of antagonist? |
-aldosterone antagonist
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Tell me about Spironolactone/Aldactone..
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-aldosterone antagonist
-slow drug (2 weeks to work) -don't start unless on another drug |
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Tell me about Eplerenone/Inspra?
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-aldosterone antagonist
-monitor K closely -don't give to someone in renal failure |
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Hydralazine/Apresoline and long-acting nitrates are what kind of drug?
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vasodilator
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Hydralazine/Apresoline dilates what?
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-arterioles
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Long-acting nitrates depress what?
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-depresses the venous system
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Losartan and valsartan are what kind of drugs?
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-Angiotensin II antagonists
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Tell me about angiotensin II antagonists...
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-alternate to ACE inhibitors
-can help reduce mortality in HR -not known to enter kidneys |
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Amlodipine/Norvasc is what type of drug?
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-CCB
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Tell me about CCBs in HF
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-not harmful to those in HF
-vasodilator |
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Tell me about beta-blockers for HF
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-slow HR
-small doses should be used -improves filling pressure and cardiac output -improves exercise tolerance |
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Tell me about Nesiritide/Natrecor for HF...
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-synthetic analog of grain naturetic peptide
-good vasodilator -monitor for hypotension -last line drug |
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Name some short acting nitrates.
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-sublingual nitro
-IV nitro -nitro spray |
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-Nitro patch
-nitro ointment -isosorbide dinitrate -isosorbide mononitrate -oral Nitro Are all what??? |
-long acting nitrates
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Isosorbide dinitrate/Isordil:
-class -uses/about |
-long acting nitrate
-1 x day -can cause headache |
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isosorbide mononitrate/Imdur:
-class -uses/about |
-long acting nitrate
-2-3 times a day -does titration is hard |
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How does a beta-blocker help with angina?
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-decreases HR by reducing O2 demand.
-keeps resting and max HR lower |
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How do CCB help in the treatment of angina?
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-vasodilate receptors in the heart, so lower HR
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What are some side-effects of Diltiazem/Verapamil?
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-dizziness
-edema -headache -constipation -bradycardia |
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What are some side-effects of dihydropyridines?
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-dizziness
-headache -peripheral edema -flushing -tachycardia -rash |
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Why should us avoid using verapamil and a beta-blocker together?
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-can cause excessive bradycardia
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CCB + Thiazide = ?
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useful
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CCB + ACE inhibitor = ?
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useful, particularly in resistant HTN
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CCB + methyldopa = ?
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useful
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What things can interact with CCBs?
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-grape fruit
-digoxin -beta-blockers (some) -Ca salts |
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What are some benefits of CCbs?
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-don't affect lipids
-useful for more than one condition -LVH regression -don't contribute to worsening of renal function -1 or 2 times a day -well tolerated |
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Tell me about glycoprotein IIb/IIIa inhibitors.
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-anti-platlet drug used @ time of procedure
-inhibit the last step of platlet agglugation |
