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87 Cards in this Set
- Front
- Back
This receptor is located in vascular smooth muscle and causes vasoconstriction
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Alpha1
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This receptor is located in presynaptic adrenergic nerve terminals and vascular smooth muscle and causes inhibition of NE release and vasoconstriction
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Alpha2
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This receptor is located in heart and causes increase in heart rate, increase in contractility and increase in speed of AV node conduction
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Beta1 receptors
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This receptor is located in JG cells in kidney and causes renin release
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Beta1
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Activation of this receptor in presynaptic adrenergic nerve terminals causes increase in NE release
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Beta1
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Activation of this receptor in adipose tissue causes lipolysis
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Beta1
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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
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Beta2
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This receptor is located in renal blood vessels and causes vasodilation
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D1
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Sympathomimetic drugs are used for treatment of _
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Hypotension
Shock Acute heart failure |
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Sympatholytics are used for treatment of _
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Hypertension
Angina pectoris Cardiac arrhythmias CHF |
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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 |
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Which drugs increase effect of epinephrine
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Cocaine
TCA MAO inhibitors Thyroid hormones |
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This drug stimulates alpha1, alpha2, beta 1 receptors and has relatively little effect on beta 2 - only indicated for cardiac arrest and hypotensive states
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NE
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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)
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Isoproterenol
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D1 agonist used for severe hypertension
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Fenoldopam
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At low dose (less than 2 micrograms) dopamine binds which receptor and whats its action
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D1 receptor --> mesenteric and renal artery dilation (facilitates diuresis)
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At medium dose (2-10) micrograms dopamine binds what receptor and whats the action
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Beta 1 receptor --> inotropic effect, severe CHF
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At high dose (over 10 micrograms) dopamine binds what receptor and whats the action
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Alpha 1 receptor --> peripheral vasoconstriction, hypotensive state (shock)
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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
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IV dobutamine
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Dopamine and dobutamine are used for treatment of _
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Acute CHF
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Name 3 alpha 1 agonists
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Phenylephrine
Methoxamine Midodrine (prodrug) |
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Clinical use of phenylephrine and methoxamine
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Hypotensive emergencies - preserve cerebral and coronary flow, also used to maintain BP during anesthesia
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This alpha 1 agonist is used for posture hypotension
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Midodrine
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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
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Ephedrine
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Name 2 alpha 2 agonists
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Clonidine
Alpha methyldopa |
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Which drugs bind to receptors in CV control centers of CNS and decrease sympathetic outflow from the brain
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Alpha 2 agonists - clonidine, alpha methyldopa
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This drug is indicated for hypertension, it is very lipid soluble and also available as transdermal patch, alpha 2 agonist
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Clonidine
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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 |
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What are the major side effects of alpha 2 agonists
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Sedation in 50% of patients, sexual dysfunction in males, nausea, dizziness and sleep disturbances, dose related withdrawal
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What is the main precaution in clonidine
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DO NOT WITHDRAW SUDDENLY --> can cause rebound HTN
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Name alpha 1 selective blockers
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Prazosin
Doxazosin Terazosin |
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Name non-selective alpha blockers
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Phenoxybenzamine
Phentolamine |
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What is the main indication for use of alpha 1 blockers
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Hypertension - decrease sympathetic tone of arteries and veins - decrease TPR
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What are the adverse effects of alpha 1 blockers
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MILD TACHYCARDIA (reflex tachycardia)
1st dose hypotension Salt and water retention |
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Irreversible nonselective alpha blocker which is indicated for treatment of pheochromocytoma (pre op)
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Phenoxybenzamine
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Competitive reversible non selective alpha blocker, prevents hypotension during surgical excision of pheochromocytoma, also used for diagnostic purposes
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Phentolamine
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Name non selective beta blockers
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Propranolol
Timolol Pindolol |
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Prototype non selective beta blocker, highly lipid soluble, high 1st pass effect - used for HTN, angina, arrhytmias, MI, aortic dissection, hypertrophic cardiomyopathy
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Propranolol
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Name beta 1 selective blockers
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Atenolol
Metoprolol Esmolol |
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Multiple large studies indicate long term use of _ in patients who have had MI prolongs survival
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Propranolol
Timolol Metoprolol |
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Adverse effects of beta 1 blockade
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Bradycardia
Decreased CO AV block Can precipitate heart failure Arrhythmias Sodium water retention Rebound cardiac excitation if discontinued suddenly May worsen peripheral vascular disease |
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Adverse effects of beta 2 blockade
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Bronchoconstriction
Inhibition of glycogenolysis - detrimental for diabetics Masks tachycardia Vasoconstriction |
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Name two alpha/beta blockers
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Labetalol
Carvedilol |
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This drug depletes sympathetic neurons of NE, prevents NE from vesicular packaging - decreases HR, CO, vasodilation --> decreases BP
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Reserpine
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What is THE MOST SERIOUS side effect of reserpine that limits its use
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DEPRESSION (can lead to SUICIDE)
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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 |
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Ganglionic blocker that has rare use in treatment of essential hypertension in patients refractory to other antihypertensives
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Mecamylamine
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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 |
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3 classes of Ca channel blockers with examples
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Benzothiazepines - DILTIAZEM
Phenylalkylamines - VERAPAMIL Dihydropyridine - NIFEDIPINE |
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Name class of drug
First or second line drugs, selective inhibitors of L type Ca channel, work through natriuresis |
Ca channel blockers
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Side effects of Ca channels blockers
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Cardiac arrest
Bradycardia AV block Constipation Edema (peripheral) |
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MOA of Diltiazem
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Negative inotropic effect and decreased AV node conduction
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Ca channel blocker recommended in LVH, diastolic dysfunction and/or arrhythmias
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Diltiazem
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Diltiazem interacts with what other drug?
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Cyclosporine
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Ca channel blocker of choice in CHF
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Nifedipine
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This Ca channel blocker is smooth muscle selective, adjunctive to beta blocker or ACE inhibitor
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Nifedipine
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Nifedipine interacts with _
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Grapefruit juice
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Adverse effect of nifedipine
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Acute MI
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Verapamil is contraindicated in _
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Heart block and CHF
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Adverse effect of Verapamil
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Constipation
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This direct vasodilator is indicated in pregnancy related HTN and HF with ACE inhibitors intolerance, severe HTN
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Hydralazine
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Side effects of hydralazine
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Headache
Nausea Anorexia Palpitation Sweating Flushing Lupus like fever |
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This direct vasodilator opens K channels in smooth muscle membrane and is indicated in case of refractory HTN
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Minoxidil
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Side effect of Minoxidil
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Hirsutism in women
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MOA of sodium nitroprusside
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Direct and indirect stimulation of guanylyl cyclase
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Side effects of sodium nitroprusside
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Decreased BP
Cyanide accumulation Metabolic acidosis Arrhythmia |
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Indications for sodium nitroprusside
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Pheochromocytoma (in operation)
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This direct vasodilator increases K conductance in smooth muscle - indicated occasionaly in hypertensive emergencies and hypoglycemia
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Diazoxide
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Adverse effects of diazoxide
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Excessive hypertension
Renal salt and water retention |
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D1 agonist that is indicated for post op HTN and HTN emergencies
What is the contraindication? |
Glaucoma
Fenoldopam |
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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 |
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Contraindication for alpha methyldopa
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Depression
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Side effects alpha methyldopa
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Sedation
Nightmares Depression Vertigo Lactation |
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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 |
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Which anti HTN drug causes delayed or retrograde ejaculation
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Guanethidine
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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 |
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This class of drugs is indicated in concomitant heart failure and angina and high renin hypertension - decrease CO and inhibit renin production
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Beta blockers
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2 contraindications for beta blockers
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Concomitant asthma + insulin dependent diabetes
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Side effects of beta blockers
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Bradycardia
Asthma Increase triglycerides Depression |
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Patient has concomitant asthma, ischemic heart disease and cardiac arrhythmias - which anti HTN would you give
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Metoprolol (atenolol, esmolol) - cardioselective beta blockers
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Side effects of beta 1 blockers
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Bradycardia
Heart block Asthmatic symptoms at high doses |
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Patient has HTN, concomitant migraines, esential tremors and reflex tachycardia - which HTN drug would you give
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Propranolol (timolol, pindolol, carteolol, nadolol, penbutolol)
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What are the contraindications non selective beta blockers
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Bronchospasic pulmonary disease
Insulin dependent diabetes |
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Side effects of non selective beta blockers
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Bronchospasm
Heart block |
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Name class of drugs which decrease TPR, no reflex sympathetic activation and save in ischemic heart disease
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ACE inhibitors - enalapril, captopril, fosinopril
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Patient has HTN and concomitant heart failure, KIDNEY DISEASE and diabetes, also resistant HTN - which anti HTN drug would you give
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ACE inhibitor
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ACE inhibitors are contraindicated in ?
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2nd and 3d trimester of pregnancy
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