Symapathetic agents

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shirljoa
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221198
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Symapathetic agents
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2013-05-26 16:49:28
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Sympathetic Agents
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Pharm
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  1. Norepinephrine (Levophed)
    • Potent  vasoconstrictor and inotropic agent
    • More a that B activity
    • glycogenolysis-inhibvition of insulin release and lipolysis
    • Reflex bradicardia
    • doesn't increase myocardial O2 consumption
    • decreases blood flow to abdominal organs and skeletal muscle, while coronary blood flow is increased indirectly due to alpha stimulation
  2. Epinephrine (adrenalin)
    • -used as a cardiac stimulant and bronchodilator
    • -Potent alpha and Beta agonist (non-selective adrenergic agonist)
    • -a1- arteriolar vasoconstriction
    • -a2- leads to decreased NE release from neurons
    • -B1- increased HR and contractililty
    • -B2- arteriolar vasodilation, bronchial smooth muscle relazation and increased glycogenolysis. also decreases mast cell histamine release
  3. Isoproterenol (Isoprel)
    • -potent bronchodilator and inotrop
    • -potent B agonist (non-selective)
    • -increases blood flow (vasodilation) and relaxes GI smooth muscles
    • -used for bronchospasms, bradycardia, and asthma
  4. Dobutamine HCL
    • -Inotrope
    • -selective B1 agonist (minor B2 or a effects)
    • -stimulates HR and contraction of heart, increasing CO
    • -increased coronary blood flow and myocardial O2 demand
    • -half life 2 min
    • -used in cardiac surgery,cardiogenic shock, and heart failure
  5. Dopamine HCL
    • -at low doses, dilates renal arterioles and increase renal blood flow and GFR
    • -at mod doses, stimulates B1 receptors, stimulating the heart (while maintaining vasodilation)
    • -at high doses, a receptors stimulated, increasing TPR
  6. Metaproterenol Sulfate
    • more B2 selective
    • -bronchodilator
    • -used for COPD, asthma and chronic bronchospasms
  7. Albuterol (ventolin)
    • Selective B2 agonist
    • -indications: bronchospasm in patients w obstructive airway disease, asthma
    • -adverse reaction: nervousness, tremor, tachycardia, palpitations
  8. Pirbuterol (maxair)
    • Selective B2 agonist
    • used for asthma and bronchospasms
  9. Salmeterol (Serevent)
    • B2 agonist
    • used for chronic tx of asthma
    • SE: tachycardia, palpitations hypersensitivity, tremor and H/A
  10. Terbutaline Sulfate
    • B2 agonist
    • used for bronchospasms and asthma, emphysema
    • SE: Tremor, nervousness, tachycardia, palpitations, N/V
  11. Clonidine (Catapres)
    • Selective A2 agonist
    • more CNS activity than peripheral
    • a2 stimulation in CNS leads to decreased sympathetic outflow, increased parasymp outflow
    • used for HTN
    • SE: dry mouth, skin irritation, sedation and xerostomia
  12. Phenylephrine
    • A agonist
    • used as vasoconstrictor to maintain blood press during surgery, decongestant, mydriatic
    • -contraindicated in narrow angle glaucoma, V-tach, aneurisms
    • SE: bradycardia, decreased CO, arrhythmias, angina, dizziness, CNS excitation
  13. Metaraminol Bitartrate
    • -potent vasoconstrictor (a1)
    • -used to prevent surgical (spinal anesthesia) hypotension and shock
    • -adverse reactions include anxiety, cardiac arrhythmias and HTN
  14. Methyldopa
    • -Form a-methyl NE- acts as a false transmitter
    • -used to treat HTN
    • -contraindicated in patients w hepatic disease
    • -SE: angina, CHF, orthostatic hypotension, bradycardia
  15. Cocaine
    • -inhibits amine re-uptake, thus cause increased stimulation
    • -LA
    • -potent vasoconstrictor
    • -SE: vaso constriction, mydriasis, nervousness, resp failure, cardiac arrest, general CNS stimulation
  16. Amphetamine (Adderal, Dexedrine)
    • -Indirect adrenergic agonist
    • -Triggers NE release
    • -used for narcolepsy, ADD and obesity
    • -contraindicated in any cardiac disease, HTN, and hyperthyroidisn
    • -Adverse reactions: palpitations, tachycardia, increase BP, psychoses, insomnia, H/A, tremor and general CNS stimuation
  17. Ephedrine
    • -Indirect adrenergic agonist
    • -stimulates both a and B receptos
    • -relaxation of smooth muscle
    • -cardiac stimulation
    • -increases systolic and diastolic BP
  18. Pseudoephedrine (sudafed)
    • -indirect adrenergic agonist
    • -potent sympathomimetic, possess a1, B1 and B2 activity in addition to triggering release of catecholamines
    • -used for asthma
    • Contraindicated in CV disease, HTN
    • SE: CNS excitation, tremors, insomnia, nervousness, palpitations, tachycardia, cardiac arrhythmias, H/A, sweating
  19. Tyramine
    • -indirect adrenergic agonists
    • -triggers release of neurotransmitter from neuron
    • -taken up into nerve terminal and converted to false transmitter leading to decreased symp tone
  20. Phenoxybenzamine (Dibenzyline)
    • -a1 and a2 antagonist
    • -most effective at smooth muscle and exocrine glands
    • -used for preop tx of pheochromocytoma to block hypertensive crisis during surgery, vasospastic disorders and frostbite therapy
    • SE: dizziness, decreased ejaculation ability, fatigue, miosis, orthostatic hypotension, tachycardia
  21. Phentolamine (Regitine)
    • -a1 and a2 competitive antagonist
    • -used for pheochromocytoma dx, pheochromocytomectomy, MAO induced hypertensice crisis, impotence
    • SE: dizziness, decreased ejaculation ability, flushing, hypotension, ST
  22. Prazosin (minipress)
    • Selective a1 antagonist
    • used for treating HTN
    • SE: dizziness, H/A, drowsiness, palpitations, tachycardia, orthostatic hypotension and fluid retention
  23. Terazosin (Hytrin)
    • Selective a1 antagonist
    • used to treat HTN and BPH (benign prostatic hypertrophy)
  24. Doxazosin (Cardura)
    • -selective a1 antagonist
    • -used to treat HTN and BPH
  25. Alfuzosin (Uroxatral)
    • -selective a1 antagonist
    • used to treat BPH-relaxes smooth muscle in bladder neck and prostate
  26. Tamsulosin (Flomax)
    • -selective a1 antagonist
    • -treats BPH
  27. Yohimbine
    • -selective competitive a2 antagonist
    • -blocks central a2 receptors leading to increased BP and HR, poss. aphrodiasiac prop
    • SE: antidiuretic effects, CNS excitation, HTN, tachycardia, increased motor activity, nervousness, irritability, N/V
  28. Propanolol (Inderal)
    • -B blocker
    • -nonselective B1 and B2 antagonist
    • -used for HTN, angina, arrythmias, migranes, pheochromocytoma
    • -contraindicated in shock, baradycardia, asthma and CHF
    • -SE: bradycardia, CHF, hypotension, heart block, insomnia, hallucinations and bronchospasms
  29. Nadolod (Corgard)
    • non-selective B antagonist
    • -used for treating angina, HTN
    • -contraindicated in bradycardia, bronchial asthma, shock, heart block, MI
    • SE: bradycardia, cardiac failure, conduction disturbances, arrythmias, dizziness, bronchospasm, diarrhea, impotence, decreased libido, blurred vision
  30. Timolol ( Timoptic)
    • -non-selective B antagonist
    • -used for treating  HTN, ocular HTN (wide angle glaucoma)
    • -contraindications: asthma, COPD, bradycardia, heart failure
    • SE: fatigue, bradycardia, dizziness, cold hands and feet
  31. Pindolol
    • -non-selective B antagonist w some symp agonist activity
    • -vasodilatory B blocker (d/t strong B2 agonist activity)
    • -used to treat HTN
    • -contraindications: bradycardia, COPD, heart failure
    • SE: fatigue, dizziness, diarrhea, cardiac failure
  32. Labetalol HCL
    • -a1, B1 and B2 antagonist (non-selective)
    • -partial agonist at some B2 receptors
    • -used for treating HTN
    • -Contraindications: asthma, cardiac failure, severe bradycardia
    • SE: postural hypotension, sweating, dizziness, N/V, nasal stuffiness, bradycardia, impotence
  33. Carvedilol (Coreg)
    • -a1, B1, and B2 antagonist
    • -indications: angina, heart failure, HTN
    • -Contraindications: bronchospasm, emphysema, bradycardia, DM, heart failure, liver disease, pheochromocytoma
    • Adverse effects: bronchospasm, diarrhea, dyspnea, fatigue, H/A, hypotension, peripheral edema, bradycardia, syncope
  34. Metoprolol (Lopressor)
    • B1 antagonist
    • -used to treat HTN and angina pectoris
    • -contraindications: bradycardia, heartblock, shock, MI
    • -SE: dizziness, bradycardia, nightmares, CHF, peripheral edema, brochospasms, nausea, diarrhea
  35. Acebutelol (Sectral)
    • Mostly B1 blockade, but also partial sympathetic agonist (non-selective)
    • -used for HTN and to control ventricular arrhythmias
    • SE:alopecia, dizziness, angina, fatigue, heart failure
  36. Atenolol (Tenormin)
    • Blocks B1 mostly
    • -used to treat HTN, acute MI, angina pectoris
    • -Contraindicated: bradycardia, heart block, shock, cardiac failure
    • Adverse reactions: bradycardia, dizziness, fatigue
  37. Esmolol (Brevibloc)
    • B1 antagonist
    • used for a-fib/flutter, paroxysmal SVT
    • contraindications: bronchospasms, bradycardia, shock
    • SE: AV block, cardiac arrest, hypotension, bradycardia
  38. Metyrosine (Demser)
    • used for pheochromocytoma
    • contraindicated in hepatic disease, Parkinsons's disease
    • Adverse reaction: anxiety, confusion, crystalluria, depression, Parkinsonism, salivation
  39. Bretylium Tosylate
    • blocks catecholamine release from nerve terminal
    • used for v-tach, prophylaxis v-fib
    • adverse reactions: hypotension, bradycardia
  40. Reserpine (serpalan)
    • inhibits storage of catecholamines leading to depletion
    • -used for HTN, schizophrenia
    • -contraindications: mental depression, peptic ulcer, ulcerative colitis
    • SE: vomiting, diarrhea, dry mouth, syncope, angina
  41. Digoxin (Lanoxin)
    used to treat heart failure
  42. PDE inhibitor

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