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Cardiology Drugs

Drugs for Cardiology

Drug (generic)ClassReceptorEffectUse
Norepinephirne natural catecholamine; direct acting B1 agonist, alpha agonist, no affinity for B2 increases cardiac contractility; arterial and vasoconstrictor; reduces renal perfusion; minor effect on splanchnic blood flow Temporary therapeutic use in severe hypotension that is non-responsive to other sympathomiemetics; give only via central venous catheter (tissue toxicity)
Dopamine natural catecholamine, mixed sympathomiemetic D1 receptor in periphery Low dose (D1): increase NE; more splanchnic and cerebral flow + coronary renal perfusion. Mid (beta adrenergic): more cardiac contractility) no/minor effect on BP + HR. High: alpha-1 receptors (increased BP, vasoconstriction of organs, tachycardia) Severe congestive heart failure, especially in patients with oliguria and low or normal peripheral vascular resistance
Isoproterenol Synthetic sympathomimetic amine; direct adrenergic agonist Non selective B agonist (B1>B2) Chronotropic effects (increases HR and AV conduction) and ionotropic (increases cardiac contractility and cardiac output); increases myocardial O2 demand; peripheral vasodilation and decreases diastolic pressure When myocardium poorly contractile and HR slow yet MAP high: after cardiac surgery or patients with prior Beta-blockade (or overdose); bronchodiolator; Avoid in cases of myocardial ischemia (increases O2 demand)
Dobutamine Selective beta adrenergic receptor B1>B2>>alpha (no dopaminergic effects) Increases cardiac contractility and HR; mild increase in vasodilation; no direct effects on renal or splanchnic blood flow; more prominent ionotropic than chronotropic effects, minimal effects on myocardial oxygen demand (Similar to isoproterenol, though ok for ischemic hearts) When myocardium poorly contractile and HR slow yet MAP high: after cardiac surgery or patients with prior Beta-blockade (or overdose); bronchodiolator
Terbutaline Selective B2 adrenergic receptor agonists B2 bronchodilators Short acting asthma and chronic obstructive pulmonary disease
Albuterol Selective B2 adrenergic receptor agonists B2 bronchodilators Short acting asthma and chronic obstructive pulmonary disease
Salmeterol Selective B2 adrenergic receptor agonists B2 bronchodilators Long acting asthma and chronic obstructive pulmonary disease
Formeterol B2
Arformoterol B2 bronchodilators
Ritodrine Tocolytic agent (B2 adrenergic receptor agonist for premature labor); phenethylamine derivative B2 adrenergic in myometrial cells in uterus Dreceases intensity and frequency of uterine contractions via adenyl cyclase-->increase cAMP-->enhances Ca++ efflux from SM cells--> prevents contractions Used to control premature labor; does not prevent pre-term labor
Phenylephrine alpha-1 adrenergic agonist alpha-1 receptors, but also activates B receptors at much higher concentrations Arterial vasoconstriction during IV infusion Nasal and opthalmic formulations used as mydriatics or decongestants
Naphozoline, phenylephirine Occular vasoconstrictor decongestant; alpha receptor agonist alpha-receptor reduces hyperemia in eye for eyes in people with allergies; can differentiate between ciliary and conjunctival infection (ciliary infection does not result in loss of redness when alpha agonist used)
Oxymetazoline Nasal vasoconstrictor-decongenstant (alpha-1 receptor adrenergic agonist) alpha 1 vasoconstriction + reduces blood flow and mucosa swelling Relieve nasal discomfort in colds, allergies, and hay fever; relieve sinus congestion and pressure. Prolonged use-->rebound phenomemon and mucosa necrosis
Modafinil, ardafinil alpha-1 adrenergic agonists with central effects alpha-1 adrenergic receptors in CNS psychostimulants; increases vigilance; decreases need for sleep; similar effects as indirect-acting sympathomimetics; hypothalamic histamine release in eldery: treat vigilance and attention disorders. Adverse effects: agitation, excitation, aggressiveness. Narcolepsy, shift work, sleep disorder, excessive daytime sleepiness
clonidine prototypic selective alpha-2 central adrenergic agonist alpha-2 receptor in vasomotor center (rostral ventrolateral medulla (RVLM)) alpha-2 receptors in RVLM inhibit sympathetic outflow + vasomotor tone; decreases norepinephrine release in prejunctional alpha-2 receptors Antihypertensive drug
alpha-methyldopa prototypic selective alpha-2 central adrenergic agonist alpha-2 receptor in vasomotor center (rostral ventrolateral medulla (RVLM)) alpha-2 receptors in RVLM inhibit sympathetic outflow + vasomotor tone; decreases norepinephrine release in prejunctional alpha-2 receptors Antihypertensive drug
guanfacine prototypic selective alpha-2 central adrenergic agonist alpha-2 receptor in vasomotor center (rostral ventrolateral medulla (RVLM)) alpha-2 receptors in RVLM inhibit sympathetic outflow + vasomotor tone; decreases norepinephrine release in prejunctional alpha-2 receptors Antihypertensive drug
Guanabenz prototypic selective alpha-2 central adrenergic agonist alpha-2 receptor in vasomotor center (rostral ventrolateral medulla (RVLM)) alpha-2 receptors in RVLM inhibit sympathetic outflow + vasomotor tone; decreases norepinephrine release in prejunctional alpha-2 receptors Antihypertensive drug
Amphetamine (and dextro-amphetamine) Indirectly-acting sympathomimetic None--increases monoamine release (NE, DA, 5HT), which bind to their receptors Powerful CNS stimulant (dextro amphetamine is more potent) ADHD, narcolepsy, and suppression of appetite
Metamphetamine (and methamphetamine hydrochloride) Indirect acting sympathomimetics; manufactured from pseudoephedrine None--increases monoamine release (NE, DA, 5HT), which bind to their receptors Mainly central effects; stimulant; similar to cocaine Side effects: tachycardia, hypertension, hyperthermia, cerebrovascular incidents, and myocardial infarction; may induce sympathomimetic toxicity
Ephedrine alkaloid; mixed-acting sympathomimetic agonist for both alpha and beta receptor; also enhances NE release mixed acting sympathomimetic drug (pan receptor agonist) enhances weight loss, but causes cardiovascular toxicity and mortality
Methylphenidate (ritalin) indirect acting sympathomimetic None (?); inhibits the reuptake of NE and DA and stimulates cerebral cortex similar to amphetamines blocks reuptake of NE and DA in CNS ADHD
Dexamphetamine (Dexedrin) indirect acting sympathomimetic None (?); inhibits the reuptake of NE and DA and stimulates cerebral cortex similar to amphetamines Completely inhibits catecholamine reuptake by presynaptic nerve terminal ADHD
Bupoprion (wellbutrin) indirect acting sympathomimetic None (?); inhibits the reuptake of NE and DA and stimulates cerebral cortex similar to amphetamines inhibits neuronal NE and DA reuptake by presynaptic nerve terminal ADHD
Atomoxetine indirect acting sympathomimetic None (?); inhibits the reuptake of NE and DA and stimulates cerebral cortex similar to amphetamines selectively inhibits neuronal NE (not DA?) reuptake by presynaptic terminal ADHD
Prazosin, doxazosin, terazosin alpha-1 selective adrenergic antagonists alpha1A, 1B, 1D Inhibits vasoconstriction-->vasodilation in resistant arteriolar vessels and veins --> fall in blood pressure due to less MAP and reduced venous return; effect depends on activity of sympathetic nervous system Used against hypertension
Alfuzosin, tamsulosin, silodosin alpha-1 selective adrenergic antagonists alpha 1A (1D) > 1B Inhibits vasoconstriction-->vasodilation in resistant arteriolar vessels and veins --> fall in blood pressure due to less MAP and reduced venous return; effect depends on activity of sympathetic nervous system Used in benign prostatic hyperplasia (BPH) due to higher number of alpha-1A receptors; alpha-1B, D receptors still activated, but effects not seen as much
Yohimbe selective alpha-2 adrenergic antagonist alpha-2 (mainly in CNS) increases blood pressure via central mechanism (opposite of clonidine) by inhibiting alpha-2 receptors in CNS-->increased sympathetic outflow only used in veterinarian medicine
Phenoxibenzamine, phentolamine old, classical non-selective alpha-adrenergic antagonists alpha-receptor antagonists antihypertensives; Phenoxibenzamine is irreversible antagonist; phentolamine is competitive antagonist limited clinical use: preoperative pheochromocytoma, adrenergic crisis, frost bite, prevention of dermal necrosis, sympathomimetic extravasation
Ergotamine, ergonovin, bromocriptin Ergot alkaloids Many alpha-receptor agonists, weak dopamine receptor agonist, or serotonin receptor antagonist/partial agonist various (depends if antagonist or agonist) Ergotamine: migraine; ergonovin: prevents postpartum hemorrhage. Bromocriptin (DA agonist): parkinsonism and control prolactin
Epinephrine natural catecholamine, direct acting agonist alpha and beta adrenergic receptors; at low dose, D1; at mid dose, beta adrenergic; at high dose, alpha-1 adrenergic Direct agonist of receptor; response depends on relative ratio of receptors, penetration, concentration at site of action, sensitivity of adrenergic receptors, and level of activation Cardiac arrest (increases systemic vascular rsistance, diastolic blood pressure, decreases non-vital organ perfusion. CPR, anaphylactic shock, asthma, glaucoma, local anesthetics (prolongs effects)
Created by: karkis77
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