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Sympathomimetic agents/ Adrenergic agonists
- Catacholamines
- Alpha adrenergic agents
- Mixed; direct/indirect/ CNS
- Indirect
- Beta adrenergic agent
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Catecholamine drugs
- Epinephrine
- Norepinephrine
- Isoproterenol
- Dopamine
- Fenolodopam
- Dobutamine
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Alpha adrenergic agents
- Phenylephrine (prototype)
- Oxymetazoline
- Pseudoephedrine
- Clonidine
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Mixed sympathomimetic agents
- Ephedrine
- Amphetamines
- Phenylpropanolamine
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Indirect acting sympathomimetics
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Beta adrenergic agents
- Metaproterenol
- Albuterol
- Terbutaline
- Dobutamine
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Non selective alpha blockers
- Phentolamine
- Phenoxybenzamine
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Selective alpha 1 receptor blockers
- Prazosin (prototype)
- Tamsulosin (BPH)
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Selective alpha 2 receptor blockers
Yohimbine
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Non selective beta blockers
- Propranolol (prototype)
- Timolol
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Selective beta 1 receptor blockers
- Metoprolol (prototype)
- Atenolol
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Beta blockers with Intrinsic Sympathomimetic Activity (ISA)
- Pindolol (non selective beta 1 and 2)
- Acebutolol (beta 1 selective)
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Thiazide Diuretics
Hydrocholorothiazide
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High ceiling (loop) diuretics
Furosemide
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Potassium Sparing Diuretics
Spironolactone
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Centrally acting sympatholytics
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Sympatholytics acting on adrenergic neurons
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Ganglionic blocking agents
Mecamylamine (only one available)
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Vasodilators for hypertensive emergency
- Nitroprusside
- Diazoxide
- Fenoldopam
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Cardioactive calcium channel blockers (CCB)
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Vasoactive calcium channel blockers (CCB)
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Angiotensin-Converting Enzyme Inhibitors (ACE I)
- Captopril (prototype)
- Enalapril
- Lisinopril
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Angiotensin II Receptor Blockers (ARBs)
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Renin Inhibitors
Aliskiren (only one)
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Aldosterone antagonists
- Spironolactone
- Eplerenone (preferred due to fewer AE on sex hormones)
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Uses of epinephrine
- allergic reactions
- COPD
- asthma
- mydriasis
- reduce intraocular pressure
- cardiac arrest
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adverse effects of epinephrine
- hypertension
- tachycardia
- ventricular arrythmia
- tissue damage/ necrosis at injection site
- CNS effects
- hyperglycemia
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uses for norepinepherine
acute hypotensive emergencies
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uses for isoproterenol
- bronchodilator
- cardiac stimulant (shock MI)
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A/E for Isoproterenol
- tachycardia
- hypotension
- palpatations, anxiety, H/A, angina
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uses for dopamine
- shock
- heart failure
- acute renal failure
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A/E for dopamine
- tachycardia, arrythmias
- hypertension
- N/V
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uses for alpha-1 selective agents
- acute hypotensive conditions
- reduction of regional blood flow
- ophthalmic uses, mydriasis, glaucoma, allergic hyperemia
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uses for alpha-2 selective agent
- antihypertensive (CNS)
- reduce symptoms of withdrawl
- analgesia
- reduce intraocular pressure
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use for indirect sympathomimetic drugs
- bronchodilator
- cardiovascular uses
- mydriasis
- decongestant
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use of beta-2 selective agents
- bronchodilator
- delay delivery of premature labor
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uses of beta-1 selective agents
cardiac stimulation
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uses for non-selective alpha blockers
- prevent ischemic necrosis
- limited use to lower BP
- Dx and Tx of pheochromocytoma
- peripheral vascular diseases
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uses for selective alpha-1 inhibitors
- management of essential hypertension
- prevention of urinary retention in BPH
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A/E for alpha blockers
- postural hypotension
- reflex tachycardia
- nasal congestion
- miosis
- N/V, GI pain
- Priapism
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uses of beta receptor blockers
- Tx of cardiac arrhythmias
- Tx of coronary insufficiency and angina pectoris
- Tx of thyrotoxicosis
- managment of hypertension
- CNS indications
- Tx of glaucoma
- Tx of CHF
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A/E of beta receptor blockers
- caution with function compromised
- bronchospasm
- intensify hypoglycemia
- masks tachycardia
- CNS effects
- intensify symptoms of PVD
- decline in HDL/LDL ratio
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abrupt discontinuation of beta blockers leads to what
- rebound HTN
- increased risk of IHD
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what are the sites of BP regulation
- arterioles (resistance)
- venules (capacitance)
- heart (pump output)
- kidneys (volume control)
- and ultimately the brain
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three basic processes of the nephron
- glomerular ultrafiltration
- tubular reabsorption
- active tubular secretion
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carbonic anhydrase inhibitors
acetazolamide
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uses of the carbonic anhydrase inhibitors
- Glaucoma
- high altitude sickness
- alkalinization
- metabolic alkalosis
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what are the 3 compensatory mechanisms for hydralazine (is poster child)
- reflex tachycardia
- increased renin
- na and water retention
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what are the classes of diuretics used in hypertension
- thiazides
- loop (high ceiling)
- potassium sparing
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sites of action for sympatholytics
- brain
- adrenergic receptors
- adrenergic receptors
- autonomic ganglia
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