Pharm

THESE AGENTS BIND TO ALPHA AND INTERFERE WITH CATECHOLAMINE OR OTHER SYMPATHOMIMETIC

• PRIMARY RESPONSE IS VASODILATION AND RELAXATION OF SMOOTH MUSCLE
• STOP EPI BLOCKING INSULIN RELEASE

• NONSELECTIVE
• PHENTOLAMINE (REGITINE)
• PHENOXYBENZAMINE

• SELECTIVE A 2
• YOHIMBINE

• SELECTIVE A2
• PRAZOSIN
• TERAZOSIN
• DOXAZOSIN
• TAMSULOSIN

• NONSELECTIVE COMP ALPHA
• REGITINE
• USE: LOW BP BLOCKS A2 SO UP NE TO UP HR AND CO
• TX; UP BP DT PHENCHROMCYTOMA (30-70 MCGS/KG)
• INFILTRATION OF DOPAMINE (2.5-5 MG)

• BLOCK A1 AND A2 1>2
• CARDIO; OTHRO BP WITH PT OF LOW VOL OR HTN. UP CO
• OTHER EFFECT: UP INSULIN, SEDATION, NASAL STIFFNESS
• C USE: PVD( RAYMAUDS), HEMO SHOCK, BP WITH PT OF PHEOCHROMOCYTOMA

• BLOCK PRESYNAPTIC A2
• INCREASE NE RELEASE
• TX; IDOPATHIC OTHRO BP, IMPOTENCE
• SE; CROSS BBB(TREMORS) HTN, RHIMORRHEA, PARESTHESIAS, DISSOCIATIVE STATES

• BLOCK PORTSYN A1
• TX HTN, CHF (DIUTETICS AND CARDIO GLYCOSIDES), BPH
• CARDIO; LOW SVR CAUSING REFLEX HI HR, LOW VENOUS RETURN AND CO, VASODIL OF VIENS AND ART
• SE; VERTIGO, FLUID RETENTION, O BP, DRY MOUTH, CONGESTION, UP URINE FREQ, SEX DYSFUNCTION.
• BLOCK NEOSYPHRINE

• BLOCK A1
• TX MILD TO MED HTN, BPH

• FLOMAX
• BLOCK A1C
• TX; BPH ONLY

• BLOCK BETA RECEPTORS
• EFFECT HEART AND SMOOTH MUSCLE OF THE LUNGS
• SHOULD BE CONTINUED THROUGH PERIOP PERIOD.
• PROPRANOLOL IS THE STANDARD TO WHICH OTHERS ARE COMPARED
• WATCH FOR LOW HR, UNCOM HF, MASKING OF LOW SUGAR
• CAUSE UPREGULATION WITH CHRONIC USE
• CAN BE REVERSED

• NONSELECTIVE
• PROPRANOLOL
• NADALOL
• TIMOLOL
• PINDOLOL

• SELECTIVE
• METOPROLOL
• ATENOLOL
• ACEBUTOLOL
• BETAXOLOL
• ESMOLOL

• PARTIAL BETA ANATGONIST
• LESS DIRECT BETTER FOR PT WITH POOR LVF

• B1 AND B2 ANGONIST
• CARDIO; LOW HR, CONTRACTILITY AND CO, UP PVR AND CORNARY VAS RES, LOW HEART O2 DEMAND
• PK; PROTIEN BOUND(90-95%) HIGH 1ST PASS, IV 0.5 MG VS 40-800 MG PO), META LIVER BUT DECREASE BLOOD FLOW AND ITS OWN META

CAUSE OPIOIDS TO HAVE 2-4X EFFECT

• BLOCK B1 AND B2
• HALF LIFE 20-40 HOURS
• NOT META EXCRETED IN URINE AND BILE

• BLOCK B1 B2
• TX GLAUCOMA
• IF LOW BP AND HR OCCUR THEN ATROPINE WITH NOT WORK
• SE; APENA

• NONSELECTIVE BETA
• CLASS III ANTIARRHYMIC
• UP QT INTERVAL, REFACTORY, ACTION POTENTIAL,
• TX; VT

• BLOCK B1
• CARDIO LOW HR CO CONTRACTILITY
• OK FOR PT WITH COPD
• INCREASE DOSE LOW SELECTIVITY OF B1

• MOST SELECTIVE B 1 BLOCKER
• PREOP ADMINISTRATION IN PT WITH CAD LOW POST OP MI BUT UP STROKE AND DEATH

• SE FATIGUE LOW HR BP
• EXCRETED VIA KIDNEYS LOOK AT FUNCTION

• BLOCK B1 BUT SOME B2
• TX; HTN, GLAUCOMA
• META; LIVER

• B1 BLOCKER (IV ONLY)
• DOSE;1ST 0.5 MG'KG OVER 1 MIN, FULL EFFECT 5 MINS LAST 10-30 MIN
• TX ADVERSE SYSTEMIC BP AND HR DURING ETT
• HALF TIME 9 MINS
• PROTIEN BOUND 55% LOW EXCRTION IN URINE
• SE; LOW BP, DIAPHORESIS, N/V, HA, CONFUSION, DIZZY,
• DECREASE PROPOFOL EFFECT

• THIS MEDS QUICKLY DISTRIBUTE TO LUNGS WHERE THEY ARE INACTIVE
• FENTANLY, ALFENTANIL, MEPERIDINE

• LOW META RATE OF MEDS
• ACUTE ETOH
• CIMETIDINE VALPRO ACID
• NEFAZODNE ERYTHROMYCIN
• AMIODARONE
• DILTIAZEM
• VERAPAMIL
• PROTEASE INHIBITORS

• MED THAT UP META OF OTHER MEDS
• CHRONIC ETOH, SMOKING, RIFAMPIN, PHENYTION, PHENOBARBITOL, CARBAMAZEPINE

• BREAK DOWN MED AT SITE WITH HYDROLYSIS
• SUCCS, MIVACURIUM

• MEDS THAT BIND TO PROTIEN
• WARFARIN, ASA, PHENYTOIN, PROPRANOLOL, DIAZEPAM

MED BREAK DOWN ON OWN WITH pH AND TEMP

ATRACURUIM, CISATRACURUIM

• (140-AGE)XTBW/ 72 X CREATININE
• O .85 FOR GIRLS
• IBW
• M 50+(2.3 X OVER 5FT)
• F 45.5+(2.3 X OVER 5FT)

• DRUG ELIMATION AT A CONSENT RATE OF TIME NOT BY AMOUNT.
• ASA, ETOH, PHENYTOIN

• BINDS TO B2 SOME B1
• C USE; ACUTE ASTHMA OR EXCERISE ASTHMA, COPD, PREMATURE LABOR
• ROUTE; PO, SC, IV, INHALE (PREFERRED)
• SE; TEMOR (B2), UP HR (DT VASODIL REFLEX), UP GLUCOSE K, LOW MAG, ALL LUNG OPEN EVEN WITH NOT ALL IS PERFUSED
• MEDS
• ALBUTEROL
• LEVOALBUTEROL
• BILOTEROL
• TERBUTALINE
• METAPROTERENOL

CONTROL MUSCLES (VOLUNTARY)

• B1 HEART
• B2 LUNGS
• A1 VASCULAR SYSTEM
• A2 NEG FEEDBACK LOOP

• VASOCONSTRICTION
• VASODILATION (SKELETAL MUSCLE)
• BRONCHDILATION
• UP HR CONTRACTILITY
• FREE FATTY ACID
• GLYCOGENOLYSIS
• CNS STIMULATION
• MODULATION OF INSULIN, RENIN, AND PIT HORMONES

• A +++
• B1++
• B2 0
• CO -
• HR -
• PVR +++
• RENAL ---
• MAP +++
• AIR RES NC
• CNS NO
• GTT 1-16 MCG/MIN

DIRECT

• A +
• B1 ++
• B2++
• CO++
• HR ++
• PVR +
• RENAL --
• MAP +
• AIR RES--
• CNS+
• BOLUS 2-8 MCG
• GTT 1-20 MCG/MIN
• DIRECT

• A ++
• B1++
• B2+
• CO +++
• HR+
• PVR +
• RENAL +++
• MAP +
• AIR RES NC
• CNS -
• GET 2- 20 MCG/KG/ MIN
• DIRECT

• A O
• B1 +++
• B2 +++
• CO +++
• HR +++
• PVR --
• RENAL -
• MAP +-
• AIR RES ---
• CNS +
• BOLUS 1-4 MCG
• GET 1-5 MCH/ MIN

• A ++
• B1 +
• B2 +
• CO ++
• HR++
• PVR+
• RENAL--
• MAP++
• AIR RES --
• CNS +
• BOLUS 10-25 MCG

• A+++
• B1 0
• B2 0
• CO -
• HR-
• PVR+++
• RENAL---
• MAP+++
• AIR RES NC
• CNS NO
• BOLUS 50-100MCG
• GTT 20-50 MCG/MIN
• DIRECT

• NO COMT
• ALL MAO
• SLOWER (THUS LONGER LASTING)

• INACTIVATED BY
• MONOAMNINE OXIDASE
• CATECHOL-O-MEHTYLTRANSFERASE
• IN LIVER, GI, RENAL
• MAO RECYCLE OR UPTAKE IN POSTGANG ENDINGS

• B1 B2 AGONIST
• C USE; LOW SYSTEM ABSORBATION OF LOCAL ANEST, ALLERGIC RX, CPR, UP MYOCONTRACTILITY
• CARDIO; 1-2 MCG/MIN VASODIL, BETA2 AT 4 MCG, 10-20 MCG A AND B WITH A PREDOMINATION (VASOCONSTRICTION, LOW DP, NC WITH MAP, UP HR CO, LOW BLOOD FLOW TO SKIN, MUCOSA, RENAL, LIVER AND DILATION OF MUSCLE, UP RENIN RELAX OF LUNG S. MUSCLE
• OTHER EFFECTS; UP GLUCOSE, LOW INSULIN K, MYDRIASIS, UP COAGULATION, RELAX GI S. MUSCLE

• ENDOGENOUS NT A, B1 AND LITTLE B2
• CARDIO' 4-16 MCG/MIN UP SBP DBP MAP, LOW HR BLOOD FLOW TO RENAL SKIN LIVER, LOW VENOUS RETURN TO LOW CO, LOW PERFUSION =M ACIDOSIS

• D1 D2 (D2 N/V) D1 VASOCON
• C USE' 0.5-3 D1 UP RENAL PERFUSION, 3-10 BETA2 UP HR, 10 AND UP PERIPHERAL VASOCON UP HR CONTRACTILITY, URINARY OUT, UP NA EXCRETION

• CARDIO; UP HR SBP SVR
• OTHER EFFECTS; SOME NE RELEASE, WORKS WELL WITH DOUTAMINE.
• INTERFERS WITH ART HYPOXIA RESPONES THUS LOW ABG, HYPERGLYCEMIA

• B1 GTT 2-10
• C USE; UP CO
• CARDIO; DOSE DEPENDANT UP CO WITH ATRIAL FILLING, SMALL UP HR UP RENAL DT UP CO. HIGH DOSE WILL UP HR AND DYSRHTHEMA

• B1 B2 NO A NEED GTT
• C USE; BRONCHODIL, UP HR 1-5 FOR HEART BLOCK, TX PUL HTN
• CARDIO; 1-5 UP HR CONTRACTILITY AUTMATICITY CO SBP. LOW MAP SVR DBP CORNARY BLOOD 02= UP ISCHEMIA

• INDIRECT A AND B RELEASE OF NE
• C USE LONGER EFFECT 10-25 MG IV FOR JUP HR CO SBP DBP FLOW TO HEART AND MUSCLE CONTRACTILITY. LOW RENAL AND SPLENCHIC FLOW, PO FOR BRONCHIAL ASTHMA, DECONGESTION, 0.5 MG FOR NV. OK FOR PREGO USE NO CHANGE IN UTERIN BLOOD FLOW.
• 2ND DOSE NOT AS EFFECTIVE

• MOST A1 AGONIST SOME B
• C USE. 50-200 FOR BP LOW HR CO BUT INCREASE HEART PERFUSION DECONGESTION, PROLONG SPINAL

CARDIO UP BE BUT LOW CO DT LOW HR FROM BARO REFLEX. INCREASE ACTION WHEN CLONIDINE IS TAKEN, LOW BLOOD FLOW TO LIVER, RENAL, SKIN, SPLANHIC, UP PUL ART PRESSURE

• DEPEND ON ISA
• LOW HR, CO, BP CONTRACT
• ALTER AIRWAY RESISTANCE, CARB AND LIPID META
• LETHARGY AND VIVID DREAMS. MEMORY LOSS, CROSS PLACENTA
• UPREGULATE

• CONTRAN
• SB, H BLOCK UNCOM CHF, CARDIO SHOCK, HYPERSEN TO BETA BLOCKER

• WARNINGS
• HYPER ACTIVE AIRWAY, DM, HYPOCLUYCEMIA, ESRD

• ATROPINE 7 MCG/KG
• ISOPRTERENOL 2-25 MCG/KG
• PURE B1 TRY DOUBTAMINE
• GLUCAGON 1-10 MG THEN 5 MG/HR GTT
• CA CL 250-1000 MG IV

HTN, ANGINA, POST MI, PREOP HYPOTHYROIDISM, CARDIO DYSRHYTHMIAS, HF

• BLOCK A1 B1 B2
• MORE BETA POTENT THAN ALPHA
• CARDIO; LOW BP SVR, NO CHANGE TO CO
• TX; HTN, EPI OD, ANGINA,
• SE O BP, BRONCHOSPASMS, HEARTBLOCK, FLUID RETENTION

• A1 B1 B2
• FOR CHF LOW BP MED TO SERVER
• ADD ON TX
• FOR HF START 3.125 MG BID TO 50
• FOR BP 6.25 BID TO 50

• CARDIO GLYCOSIDES
• DIG, DIGITOXIN, OUABAIN

• NONGLYCOSIDES
• PDE INHIBITOR (MIDRINONE, INAMRINONE)
• CA
• GLUCAGON

• MECH; 1. BLOCK NA/K ATP PUMP THUS UP NA THUS UP INTRACELL CA IONS 2. ENHANCE PSN ACTIVITY THAN LOW SA NODE(VAGAL TONE)
• C USE; TX HF AND SLOW VENT RATE, IMPROVE S/S OF HR, CONTROL RATE OF HR WITH SUPERVENT ARRHYTHMIAS, LOW DEATH IN HR BUT UP IN CARDIAC DEATH
• CARDIO; UP CONTRACTILITY STROKE VOL, LOW HEART SIZE LVDEP. UP CO AND PERFUSION TO KIDNEYS TO EXCRETE EXCESS FLUID
• PROLING P-R INTERVAL, SHORTEN Q-T, LOW STAGE 3 DEPOL DIM T WAVE

• ABSORD 75% PO
• RAPID THERAPY INDEX VIA IV
• NONO TO IM
• 35% EXCRETED BY URINE DAILY
• T.5 31-35 HOURS, 4.4 DAY IN ESRD
• CLCR 10-50 (25-75%) LESS THAN 10 (10-25% OF DOSE)
• 15-30 TIME HIGH CONCENTRATION IN HEART AND HALF THAT IN MUSCLE
• 25% PROTEIN

• CHF .2-.8
• ARRHYTHMIAS 1.5-2.5
• TOXIC OAVE 2.5
• TACH COMMON OVER 2
• MEASURE THROUGH (8 HOURS)

• CON
• AV BLOCK
• CONSTRICTIVE PERICARDITIS
• IDIOPATHIC HYPERTHRPOPHIC SUBAORTIC STENOSIS\

WARNINGS

• HYPOXIA WPW
• MYXEDMA SSS
• INCOMPLETE AV BLOCK ESRD
• ACUTE MI ELDERLY
• SERVERE PUL DISEASE

• ENEZYM INDUCTORS AND INHIBITORS
• INCREASE SERUM K
• INCREASE ARRHYTHMIAS WITH UP CA LOW K AND MAG

DT ELECTROLYTES, RENAL FUNCTION, HYPOXEMIA,

• LEVELS .5-2.5
• KIDS MORE TOLERANT

S/S NV ANOREXIA, VISUAL DISTERBANCE AND PAIN FOR NEURALGIA, V FIB ATRIAL TACHY WITH BLOCK

BASED ON CONTRACTION

CONDUCTION OF AV NODE

CHANGE OF HR

• ONE TIME USE OF DIGOXIN IMMUNE FAB (DIGIBIND)
• BIND WITH KIDNEYS EXCRETED
• COST $$$ GIVE FOR 1 DIG ARRHYTHMIAS, ACUTE OD 10 MG OR MORE, K OF 5 OR HIGHER
• NOTE SURE REPLACE K BUT BE CAREFUL
• TEST IF ARRHYTHMIAS UNREPSONIVE TO K THEN TRY PHENYTOIN OR LIDIOCAINE
• AVOID EPI, DOBUTAMINE, DOP

DIGITOXIN LONG TERM DIG, HALF LIFE 5-7 DAYS

OUABAIN SHORT ACTING IV ONLY NO ADVANTAGE OVER DIG IV

• INHIBIT ISOENXYME FRACTION PDEIII UP CO AND VASODIL
• SLOW HYDROLYSIS OF cAMP THUS UP INTRA CELL THUS UP CA IN CELL= INOTROPIC
• LONG ACTING DOBUTAMINE
• BYPASS BETA BLOCKERS
• CAN USE WITH CATECHOLAMINE, DIG (WITHOUT UP CHANCE OF TOXICITY)
• USE FOR PT WITH ACUTE HR (MI) OD ON BETA BLOCKERS

• PDE III
• POSTIVIE INOTRPIC AND VASODIL
• LOW LVEDP, BP
• UP HR UP CO
• LOW CHANCE OF ARR
• SE LOW BP, THROMBOCYTOPENIA,
• DOSE HIGH THERE WINDOW
• .75 MGKG OVER 2-3 MINS THEN 5-10 MCG GTT MAY REPENT BOLUS IN 30 MINS
• LOOK FOR KIDNEYS (75% DOSE)

• PDE III
• POSTIVE INOTROPIC VASODIL
• FOR ACUTE L VENT DYSFUNCTIONS
• T.5 2.7 HOURS WITH EXCRETED URINE UNCHANGED
• DOSE 50 MCGKG BOLUS WITH .5 MCG KGMIN GTT
• LOOK FOR KIDNEY
• SE VENT ARR, ANGINA, LOW BP, HA

• NONPHOSHPDIESTERASE INHIITOR
• TX BRONCHSPASMS (NOW ITH B2 ANGONIST AND STEROIDS DON'T WORK
• REVERSE STRESS TEST WITH ADENOSINE
• NEONATE FOR APENA
• NARROW WINDOW 6-8 OVER ARR

• INCREASE FLEXIBLITY OF ERTHROCYTES AND LOW VISCOSITY OF BLOOD, IMPROVING BLOOD FLOW
• USED IN CLAUDICATION DT OCCLUSIVE DISEAASE OF LIMBS
• SE LOW BP, ANGINA, ARR
• INCREASE BLEEDING

• IV LAST 10-20 MINS INCREASE STROKE VOL, AND LVEDP
• LOW SVR HR
• STABLIZE CELL MEMBRANE FOR HYPER K
• 5-10 MG KG IVE BOLUS
• LOOK FOR LOW CA WITH
• CARDIOPASS SOLUTION
• WHOLE BLOOD TRANSFUSION
• META ACIDOSIS WITH BICARB

• HORMONE IV, SQ OR IM
• ENHANCE PRODUCTION OF cAMP NO BETA RELEASE CATECHOLAMINES
• INCREASE HEART CONTRACTIY
• IV 1-5 MG THEN 20 MGHR GG
• CAN GET UP HR MAP NONE SVR
• SHORT TERM
• SE NV HYPER SUGAR, HYPO K, CAN CAUSE HTN

• binds to the intracelluar portion of the ltype channel
• Verapamil
• block Ca channels to the av node
• class 4 antiarrythmics

• med nifedipine, amiodipine, felodipine, isradapine, nicardipine, nimodipine, celvidipine
• for angina and htn

• low heart contract, HR, SA NODE CONDUCT, RELAX VASCO SMOOTH MUSCLE THUS LOW BP
• RISK OF CHRONIC TX GI BLEEDING, CANCER

• PHENYLALKYLAMINE
• TX SUPRAVENT TACH(AT AV NODE), ANGINA, HTN, PREMATURE LABOR, MAY LOWER UTERINE FLOW
• PK; COMPLETELY ABSORBED PO, HIGH FIRST PASS, T.5 6-12 HOURS, WACTH KIDNEY FX
• SE DEPRESS AV NODE, NEG CHRONOTROPIC, INOTROPC EFFECTS,

• BENZOTHIAZEPINES
• BLOCK CA AT AV NODE (1ST LINE AGENT FOR SUPRAVENT TACHYARR
• TX AFIB/FLUTTER, ANGINA, HTN

• DIHYDROPYRIDINE
• DIL CORNARIES AND PERPHERAL BETTER THAN VERAPAMIL
• LITTLE TO NO DEPRESSION OF SA AV NODE
• DCREASE IN BP MAY LEAD TO REFLEX TACHYCARDIA
• DOSE 10-20 PO 3X DAY
• SE LEAD TO CEREBROVASCULAR EDEMA, MI, LOW BP

• DIHYROPYRIDINE
• LACK SA AND AV EFFECTS
• GREASTEST VASODIL OF ALL CCB,
• PO OR IV
• SIMILAR TO NIFEDIPINE

• DIHYDROPYRIDINE
• INJECTABLE
• NOT AVAILABLE NOW
• TX HTN
• ONSET 2-4 MIN
• DURATION IV 5-15 MIN
• DISTRIBUTION 0.17 L/KG
• 99.5% PROTEIN BOUND
• META BY ESTERASES
• T.5 1 MIN AND TOTAL OUT 15 MIN
• WARNINGS HYPO BP, REBOUND HTN, REFLEX TACHYCARDIA
• MAX DOSE 16 MG/HR
• INTIAL DOSE 1-2 MG/HR
• DOUBLE DOSE TILL WANTED BP IS REACHED

• DIHYDROPYRIDINE
• HIGHLY LIPID-SOLUBLE, GOES IN TO CNS
• FOR CEREBRAL VASOSPASMS
• DOES .7 MG/KG INITIALLY THEN .35 MG/KG Q 4 HOURS FOR 21 DAYS
• INTERACTIONS; ANESTHETIC DRUGS, VERAPAMIL