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76 Cards in this Set
- Front
- Back
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norepinephrine - route
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oral ineffective
sq and im poorly absorbed, usually give iv |
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norepi receptors
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a1, a2, b1
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norepi effects
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b1 - stimulates heart - increase HR
a1 - increase tpr bradycardia may result as compensatory vagal reflex |
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norepi uses
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to inrease bp
in heart failure - increase heart contractility local hemmorage can be relieved by vasospasm |
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norepi side effects
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anxiety
arrythmias - increased automaticity of myocardium sc or im causes necrosis at site of infection |
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epinephrine receptors and route
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a1, a2, b1, b2
iv, im, sc, inhalation, NOT PO |
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effects of epi
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b1 - increased cardiac contractility, increased hr,
a1 - vasoconstriction of skin, mucosa, kidney b2 - increases splanchnic, cerebral blood flow, increases sm blood flow, relaxes bronchial, decreases GI motility, elevates blood glucose |
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epi uses
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vasoconstriction - topically, locally to prolong effects of local anesthetics, increase bp
cardiac stimulant, bronchodilator |
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epi side effects
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arrythmias, palpitations, angina, headache, cerebral hemorrage due to increase in bp
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epi contraindications
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pheochromocytoma, mao inhibitors, halothane anesthesia (sensitize myocardium to catecholamines, increasing risks)
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phenylephrine receptor and effects
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a1 stimulant - powerful vasoconstrictor
may have reflexive vagal response adminstered all routes except oral - long acting |
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phenylephrine uses
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nasal decongestant
increase bp mydriatic agent - mydriasis w/out cyclopegia glaucoma paroxysmal atrial tachy - due to vagal reflex > bradycardia |
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alpha methyl dopa
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a2 agonist - causes reduction in bp and hr - very common in pregnant women
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alpha methyl dopa side effects
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drowsiness, depression, some orthostatic hypotension, decreased ejaculation response
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Clonidine
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initially simulates peripheral a1 receptors - causes a rise in bp - then stimulates central a2, causes decrease
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clonidine side effects
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dry mouth - block salivation, occasional postural hypotension, overshoot hypertension when med is stopped
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Guanabenz
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similar to clonidine
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Phenoxybenzamine
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alpha antagonist - used in tx of peripheral vascular disease
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phenoxybenzamine side effects
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nasal congestion, miosis, reflex tachy, postural hypotension, impotency, depression, increased blood volume of socium retention, increased gi motility
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phentolamine
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short acting alpha antagonist
has stimulant action on gi tract and heart - cautious in pud or coronary arter disease |
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use of phentolamine
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pheochromocytoma
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side effects of phentolamine
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tachy - reflex response
orthostatic hypotension flushing - vasodilation |
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prazosin
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selective a1 antagonist - reduce arterial and venous tone - used in hypertension
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isoproterenol
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b1 and b2 agonist - causes a fall in bp with increase in hr - given parenterally or aerosol
b2 - hyperglycemia b1 lipolysis |
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isoproterenol uses
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bronchodilator
cardiac stimulant in heart blocks or cardiogenic shock |
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isoproterenol side effects
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palipitation, tachy, flushing, angina, tremor, cardiac arrest, arrythmia
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Dopamine
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da receptor, b1 - increased cardiac output and tissue perfusion
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dopamine actions
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decrease in tpr
increases renal blood flow, gfr, urine flow positive inotropic effect (b1) - cardiac output is increased |
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dobutamine
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b1 and b2 - mroe b1 - increases myocardial contractility and sv
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Metaproterenol, terbutaline, albuterol
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b2 agonist - relax bronchial smooth muscle, uterus and vascular supply to skeletal muscles
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metaproterenaol side effects
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nervousness, weakness, drowsiness, hypotension with tachy
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propranolol
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b1 and b2 blocker - used in tx of htn, arrythmia, angina, migraine
contraindicated in asthmatics and peripheral vascular disease, diabetes |
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pindolol
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beta antagonist with partial agonist activity - exacerbation of angina, increased mi, vetricular arrythmias less likely with abrubt withdrawl
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labetalol
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a1, b1, b2 antagonist - htn of pheochromocytoma and htn crisis
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carvedilol
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a1, b1, b2 antagonist - approved for chf
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metoprolol
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b1 antagonist - reduces plasma renin - can be useful in reducing htn in those individuals that have iddm, asthma,
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fenoldopam
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d1 agonist - activates adynylyl cyclase, vascular smooth muscle relaxation
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bromocriptine
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d2 agonist, - restores dopamine action in CNS - used for parkinsons disease
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yohimbine
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a2 antagonist - increases epi and norepi release - raises bp, male erectile dys
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metyrosine
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blocks tyrosine hydroxylase (rate limiting step L-tyrosine to l dopa) - reduces bp`
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bethanechol
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direct acting muscarinic agonist - used to treat gi atony, urine retention
gi - improve tone, persistalsis, sphincter relaxation |
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pilocarpine
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direct acting muscarinic agonist - used topically to tx glaucoma
miosis |
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physostigmine
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m indirect acting agonist
anticholinesterase |
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atropine
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muscarinic antagonist - reversible blockade of cholinomimetic action, m1, m2, m3
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atropine uses
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widen pupil, fix lens
dry airway in anesthesia reverse bradycardia bronchodilation motion sickness cholinergic toxicity |
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atropine toxicity
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Hot as a pistol - hyperthermia - decreased sweating
red as a beet - vasodilation dry as a bone - decreased secretions blind as a bat - pupil dilations mad as a hatter - sedation, hallucinations constipation |
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Nicotinic receptor locations
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SANS/PANS post ganglionic neurons, adrenal medulla - epi release
NMJ |
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CNs nicotinic uses
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regulate nt - glutamate, serotonin, gaba, ne, da
autonomic ganglia are sites of action |
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mecamylamine
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ganglionic blocker - at nicotinic site - decreases sans control of tpr
side effects - CNS - sedation cyclopegia with mydriasis cv - blocking reflexive control of bp gi/gu - decreased gi motility |
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ordinary tone of body
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eye - PNS - miosis/accomadation
cv PANS HR, SANS positive inotrope vascular - SANS vasoconstriction GI/GU PANS - tone motility salivary PANS sweat PANS |
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anticholinesterase blocker and nicotinc agonist
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neostigmine, pyridostigmine, edrophonium
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only acetylcholinesterase blocker
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physostigmine
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carbidopa
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inhibitor of peripheral aaad - so in tx of parkinsons dont' get adverse side effects
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amphetamines
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release NE - used in narcolepsy, obesity, ADHD
increased doses result in decreasing effectiveness |
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tyramine
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displaces stored ne
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reserpine
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irreversibly binds to ca storage vesicles - major side effects sedation, gi hyperactivity, ulcer, occassional depression
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guanethidine
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does not cross bbb
enters into neuron by the ne reuptake and competes for ne storage if block reuptake process - effects |
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cocaine
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blocks neuronal reuptake of ne, da and serotonin
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tricyclic antidepressants
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imipramine, desipramine - inhibit reuptake process
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phenelzine
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irreversibly blcoks mao-a and mao-b
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nylcypromine
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reversibly binds mao a and mao b
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selegiline
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selective maob inhibitor used for parkinson disease
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2 classes of neuromuscular blockers
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non depolarizing - competitive antagonist
depolarizing |
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tubocurarine curare
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long acting
invokes histamine some ganglionic block |
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mivacurium
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short duration - 10-15 minutes
7x more potent rapid elimination |
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atracurium
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2.5 times more potent
intermidiate action 20-30 minutes ability to cross bbb can cuase seizures |
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cisatracurium
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less dep on hepatic metabolism
replaced atracurium in practice |
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pancuronium
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5x more potent
not much histamine blocks m2 receptors increase hr |
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vecuronium
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10 more potent
shorter duration no histamine no ganglionic block |
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rocuronium
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most rapid onset
an alternate to succinylcholine |
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succinylcholine
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rapid onset - .5 minute
short duration anticholinesterases will block effects |
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issues with succinylcholine
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release histamine
stimulate sans pans release intracellular k malignant hyperthermia |
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tetroxotoxin
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puffer fish
sodium channel blockade, respiratory failure |
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saxitoxin
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sodium channel blocker
shellfish skeletal muscle weakness, sob - support most will live |
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batrachotoxin
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sodium influx - persistant depolarization
tree frog acts like succinylcholine - later fatigue paralysis |
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latrotoxin
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black widow spider, ach flood
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