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Pharm - Autonomics 2
Autonomic Drugs (Part 2) from First Aid 2013
| Question | Answer |
|---|---|
| Epinephrine: receptor binding, uses | All adrenergic receptors (a1,2, b1,2). Treats anaphylaxis, glaucoma, asthma, and hypertension. |
| Norepinephrine: binding, uses | Alpha-1 and alpha-2 receptors. Treats hypotension (but still decreases renal perfusion). |
| Isoproterenol: binding, uses | Beta-1 and beta-2 receptors. Treats Torsades (inc HR decreases QT) and bradyarrhythmias. |
| Norepinephrine vs. Isoproterenol | Norepi: inc BP via vasoconstriction, leading to bradycardia. Isopro: dec BP via vasodilation, leading to tachycardia. |
| Dopamine: binding, uses | Low dose -> D1 receptors Med dose -> beta-1 & 2 Hi dose -> alpha-1 & 2 Treats shock (inc renal perfusion), HF (inotropic, chronotropic) |
| Dobutamine: binding, uses | Beta-1 receptors. For HF and cardiac stress testing. |
| Phenylephrine: binding, uses | Alpha-1,2 receptors. For hypoTN (vasoconstrictor), ocular procedures (mydriatic), and rhinitis (decongestant). |
| Albuterol, salmeterol, terbutaline: binding, uses | Beta-2 > beta-1. Albuterol - acute asthma Salmeterol - long-term asthma, COPD Terbutaline- reduce uterine contractions |
| Indirect sympathomimetics | Amphetamines (releases stores) Ephedrine (releases stores) Cocaine (re-uptake inhibitor) |
| Ephedrine uses | Treats nasal congestion, urinary incontinence, hypotension |
| Cocaine uses, warnings | Causes vasoconstriction and local anesthesia. Never give beta-blockers if cocaine use is expected. -> unopposed a1-activation -> HTN |
| Clonidine, methyldopa: MOA, Use | Act as alpha-2 agonists, which actually decrease sympathetic outflow by negative feedback. AKA "sympathoplegics," they are used in pregnant HTN or in HTN with renal disease (preserve blood flow). |
| Nonselective alpha-blockers | Phenoxybenzamine - use before removing a pheochromocytoma Phentolamine - give with local Epi injection to prevent local vasocronstriction, necrosis Also an antidote for MAO-I patients who ingest tyramine. |
| Alpha-1 selective alpha-blockers: naming, Use, Tox | End in "-osin". Use: HTN or urinary retention in BPH Tox: orthostatic hypoTN, dizziness |
| Alpha-2 selective alpha-blocker: naming, Use, Tox | Mirtazapine Use: Depression Tox: Sedation, inc. cholesterol and appetite |
| Beta blockers: naming, Uses | Naming: end in -"lol" Angina: dec HR/cont, decreasing O2 need MI: dec mortality SVT: dec AV conduction (Class II AA) HTN: dec CO, dec renin (b1 blockade on JGA) CHF: slows progression Glaucoma: dec secretion of aq humor |
| Beta blockers: toxicities | Impotence, asthma, CV adverse effects, CNS effects (seizures, sedation, sleep alterations), use cautiously with diabetics |
| Beta-1 selective beta-blockers | A BEAM of blockers: Acebutolol Betaxolol Esmolol - Class II AA / SVT Atenolol Metoprolol - Class II AA / SVT Use in patients with lung disease. |
| Non-selective beta blockers (beta-1,2 only) | Please Try Not Being Picky: Propanolol Timolol Nadolol Pindolol |
| Non-selective beta blockers (with anti-alpha vasodilatory effects, too) | Carvedilol, labetalol |
| Partial beta agonists | PAPA: Partial Agonists: Pindolol Acebutolol |
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