Term
| Catecholamines are...? And what part of the N.S. are they released from? |
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Definition
| norepinephrine and epinephrine...and they are released from the sympathetic N.S. ganglion's |
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Term
| Parasympathetic post-ganglionic fibers release? |
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Definition
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Term
| What 2 substances inactivate the catecholamines? |
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Definition
| monoamine oxidase (MAO) and catechol-o-methyl transferase (COMT) |
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Term
| If you use a drug to inhibit MAO or COMT, what are you essentially doing? And what disorders are these drugs used for? |
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Definition
| Since MAO & COMT are used in the body to break down catecholamines, if you take a drug that inhibits these enzymes, you will have more epinephrine & norepinephrine...Depression & Parkinson's disease are 2 disorders treated with MAO & COMT inhibitors |
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Term
| Alpha 1 receptor stimulation causes: |
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Definition
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Term
| Stimulation of Dopaminergic receptors causes: |
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Definition
| Vasoconstriction (these receptors are predominantly located in the renal and coronary vessels) |
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Term
| Beta 2 receptors are located primarily where? And what does their stimulation cause? |
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Definition
| In the lungs...And it causes vasodilation & increased HR & contractility |
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Term
| What are the steps in the Enzymatic Synthesis of Catecholamines? |
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Definition
| Tyrosine > Dopa > Dopamine > Norepinephrine > Epinephrine |
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Term
| Name 2 alpha receptor agonists (stimulants): |
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Definition
| Used for vasoconstriction (hypotensive shock) or as a nasal decongestant (the vasocontriction helps to dry up the blood vessels in the nasal cavity): phenylephrine (Neo-Synephrine®), & norepinephrine or levarterenol (Levophed®) |
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Term
| Stimulation of ß-receptors leads to the activation of...? |
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Definition
| adenylcyclase and to an increase in the intracellular concentration of cyclic AMP |
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Term
| Name some clinical uses ß-agonists? |
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Definition
| Bronchodilation for asthma and COPD (ß2); Cardiac stimulant (ß1); Tocolytic (uterine relaxant) – classic off-label use (torbutaline) |
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Term
| Name the 4 main sympathetic N.S. receptors: |
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Definition
| Alpha 1, Dopaminergic, Beta 1, and Beta 2 |
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Term
| Name the 2 main parasympathetic N.S. receptors: |
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Definition
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Term
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Definition
| alpha blockers, and beta blockers |
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Term
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Definition
Cardiac arrhythmias,
Angina pectoris,
Hypertension,
Migraine headache prophylaxis,
Acute anxiety reaction,
Prevent recurrent M.I.,
Glaucoma (topically applied agents only),
Chronic (Congestive) heart failure;
Note: Not all Beta-blockers are approved for all these uses. The oldest, propranolol, is
approved for the first six of these indications |
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Term
| Side Effects of ß-blockers: |
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Definition
Prolongs hypoglycemia, Bradycardia
Mental dullness, fatigue, decreased HDL cholesterol, Bronchospasms...use with caution in persons with diabetes b/c some B-blockers cause an increase in blood glucose, Not for Asthmatics or people with COPD, Not for people with peripheral vascular disease |
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Term
| Uses of Cholinergic Agents: |
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Definition
| Neurological diseases such as Alzheimer's and myasthenia gravis; Glaucoma—due to miotic effect; Dry mouth associated with Sjögren’s syndrome; To stimulate GIT and GUT (urinary retention) |
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Term
| Side Effects of Cholinergic Agents (2): |
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Definition
| Abdominal cramping and diarrhea (contraindicated in ulcers), & secretions (perspiration, saliva, etc.) |
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Term
| Drugs that have anticholinergic effects are derived from natural sources such as the: |
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Definition
| Atropa belladonna or “Deadly Night Shade” |
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Term
| Uses of Anticholinergic Agents (8): |
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Definition
(1) Decreases glandular secretions, (2) “common cold” (to prevent rhinorrhea), (3) “drooling”
(in clients with cerebral palsy or other disabilities), (4) To dilate pupils for optical examinations, (5) Treatment of Parkinsonism, (6) To stimulate the heart for bradyarrhythmias, (7) To cause a bronchodilation effect in asthma and COPD, (8) To decrease gastrointestinal and genitourinary tract actions: (Diarrhea, Enuresis - involuntary urination, "Nervous Stomach" and "Spastic Colon", Overactive Bladder (OAB) and urinary incontinence) |
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Term
| Anticholinergics cause both mydriasis and cycloplegia, what does this mean? |
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Definition
Mydriasis is dilation of the pupil,
Cycloplegia is paralysis of the ability for “accommodation” or focusing mechanism in the eye (also blurring of eye) |
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Term
| “hot as a hare, blind as a bat, dry as a bone”...these side effects point to what type of drug usage? |
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Definition
| anticholinergic drugs...Other adverse reactions include tachycardia, constipation, confusion, and urinary retention, which is especially important in older male patients. |
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Term
| What are some of the Traditional Risk Factors for CVD? |
|
Definition
Increasing age (male ≥ 45, female ≥ 55);
Having parents with heart disease (family history of premature cardiac heart disease: male < 55, female < 65);
Smoking and second-hand smoke;
HDL < 40 mg/dL;
High blood pressure - For every increase of 20/10 mmHg in blood pressure, there is a doubling in the risk of death from cardiovascular disease;
Lack of physical activity and/or being overweight;
Diabetes (insulin resistance) |
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Term
| In a patient without renal insufficiency, what is the type of diuretic of choice? |
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Definition
| Thiazide b/c it also has vasodilator action |
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Term
| What is a normal range for C-reactive protein (indicative of inflammation)? And when this is high it is an indicator for what? |
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Definition
| 1-3 mg/L is normal...If this is high it indicates CVD |
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Term
| C-reactive protein can be lowered by: |
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Definition
| Diet, Exercise, Statins, Aspirin, Alcohol |
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Term
| Hypertension is defined as an elevation of: |
|
Definition
| either the systolic blood pressure or the diastolic blood pressure or both |
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Term
| The _____ pressure is the most important in people over age 50 |
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Definition
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Term
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Definition
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Term
|
Definition
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Term
| The mainstay of hypertension therapy is: |
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Definition
| lifestyle interventions initiated prior to or in conjunction with pharmacologic therapy: smoking cessation, weight reduction, dietary sodium restriction to < 2.3 grams/day and low-saturated-fat diet, discontinuance (if appropriate) of caffeine and drugs that increase blood pressure: e.g., oral contraceptives, corticosteroids, sodium-containing antacids, NSAIDs, supplemental potassium, calcium and magnesium, regular aerobic activity |
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Term
| What should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes? |
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Definition
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|
Term
| The ALLHAT Study showed what? |
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Definition
| The study concluded that thiazide diuretics, specifically chlorthalidone, should be the initial drug of choice for the treatment of hypertension |
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Term
| ____ are no longer recommended for initial treatment of uncomplicated hypertension? |
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Definition
|
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Term
| Aim for a BP less than _____ for most patients and less than _____ for those with coronary artery disease, diabetes, or kidney disease. |
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Definition
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Term
| The ACCOMPLISH study found that: |
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Definition
| It shows that some patients do better on an ACE inhibitor plus calcium channel blocker, than on an ACE inhibitor plus thiazide |
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Term
| Thiazide-Type Diuretics are taken ____ daily, and preferably in the _____? |
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Definition
| once daily...in the morning |
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Term
| Side effects of thiazide treatment: |
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Definition
| hypokalemia, their efficacy is diminished in patients with renal insufficiency, Use with caution in severe renal disease and severe hepatic disturbances |
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Term
| A creatinine clearance of less than < 30 to 50 ml/min shows what? And in this case what kind of diuretic should you use if needed? |
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Definition
| It shows impaired renal function, and in this case it would be better to use a loop diuretic |
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Term
| Side Effects of Thiazides: |
|
Definition
Hypokalemia,
Hyperuricemia (can precipitate gout),
Hyperglycemia,
Hyperlipidemia, and hypercholesterolemia |
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Term
| Loop diuretics have basically the same side effects as thiazides plus the possibility of ______ from intravenous furosemide |
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Definition
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Term
| Replacement of ____ is essential in patients taking either thiazide or loop diuretics. This is especially important in patients on Digoxin b/c _____ increases the potential for digoxin toxicity. |
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Definition
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Term
| Potassium Supplements are notoriously...? |
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Definition
| irritating to the GI tract and also have a “bad” taste |
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Term
| Spironolactone is an _____ receptor antagonist. Its side effects include: |
|
Definition
| aldosterone...Side effects: mastodynia, gynecomastia and menstrual abnormalities...It is also used for acne due to its anti-androgen (estrogenic) effects |
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Term
| Name which drug is a Selective Aldosterone Receptor Antagonists (SARA)— for the treatment of high blood pressure? |
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Definition
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Term
| B-blocker agents reduce blood pressure not only by reducing adrenergic stimulation to the B-receptors, but also by...? |
|
Definition
| decreasing renin release from the kidney |
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Term
| Patients who develop symptomatic bradycardia with other ß-blockers may want to switch to a B-blocker with what intrinic activity? |
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Definition
| A B-blocker with intrinsic sympathomimetic activity (ISA), which does not cause a decrease in heart rate at rest |
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Term
| B-blockers with ISA should not be used for...? (3) |
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Definition
| angina pectoris, for cardiac protection during surgery, or after a MI |
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Term
| Which B-blocker is better for diabetic patients since it doesn't increase blood glucose? |
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Definition
|
|
Term
| Taking a Central Alpha-Adrenergic Agonist causes what result? |
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Definition
| Results in a peripheral drop in blood pressure |
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