Adrenergic Blockers

Question 1

phentolamine receptors

Answer 1

a1 and a2

Question 2

phentolamine effects

Answer 2

decreased BP
tachycardia, arrhythmia and MI; 
Hypotension
Gastric stimulation due to serotonin block and muscarinic and histamine stimulation
peptil ulcer and ab pain

Question 3

Use of phentolamine

Answer 3

HTN crisis (pheochromocytoma)
patients on MAOI that ingest tyramine
abrupt withdrawal from clonidine
prevent necrosis - when vasoconstrictor like NE is administered

Question 4

Pheochromocytoma tx

Answer 4

Phenoxybenzamine (1st)

Phentolamine

Question 5

-zosin`

Answer 5

alpha 1 selective blockers

Question 6

Prazosin dosage

Answer 6

duration: 7-10 hours 2x/daily
reduces reflex tachycardia
1st dose phenomenon!
(terazosin, doxazosin: better kinetics- 1/day dosing)

Question 7

Prazosin use

Answer 7

HTN
BPH!
GREAT FOR MEN W/ BOTH

Question 8

male w/ HTN and BPH

Answer 8

Prazosin

Question 9

SE of prazosin

Answer 9

first dose phenomenon
ortho hypotension (worse w/ viagra and nitrates!)
Dizziness
nasal stuffiness
inhibition of ejaculation and ED

Question 10

Drugs similar to prazosin

Answer 10

terazosin, doxasoin;

also decrease size of prostate; 1/day dosing

Question 11

Treatment for BPH that has little effect on BP

Answer 11

Tamsulosin & Alfuzosin (not as selective)

Question 12

Tamsulosin

Answer 12

selective for a1a and a1d (not a1b- in blood vessels); a1a in prostate; relaxes prostates makes urination easier; metabolized by P450

Question 13

SE of tamsulosin

Answer 13

ejaculation and hypotension

Question 14

SE of alfuzosin

Answer 14

dizziness

Question 15

Best DOC for BPH w/ hypotension problems

Answer 15

tamsulosin (or alfuzosin)

Question 16

Yohimbine

Answer 16

dangerous in men with HTN!!!
alpha2 antagonist- increases NE and sympathetic output
inc. HR and BP

Question 17

Contraindications of beta blockers

Answer 17

Epinephrine
Pheochromocytoma (unless alpha-blocker is also used)
asthma (bronchoconstriction- use CCB instead)
Type 1 diabetes (no glucagon response- can’t recover from hypoglycemia or see sx)

Question 18

used for glaucoma

Answer 18

timolol (betaxolol in asthmatics)

Question 19

SE of beta-blocker

Answer 19

beta3 block inhibits liplysis: less free fatty acids available- chronic use increases VLDL and decreases HDL (probably partial agonists or b1 selective antagonists)

Question 20

local anesthetic activity

Answer 20

labetalol, acebutolol, metoprolol, pindolol, propranolol (DON”T USE IN EYE)

Question 21

Non-selective beta-antagonists

Answer 21

Propranolol
Timolol
Nadolol
Sotalol

Question 22

Propranolol

Answer 22

slows heart, decrease contraction, decrease AV node

decrease renin release, decrease lipolysis and glycogenolysis

Question 23

Negative of propranolol

Answer 23

may mask hyperthyroidism and hypoglycemia (makes recovery more difficult)
long term: increase VLDL, dec. HDL

Question 24

Drugs that inhibit propranolol metabolism

Answer 24

cimetidine, chlorpromazine

Question 25

Drugs that increase propranolol metabolism

Answer 25

barbiturates, phenytoin, rifampin;

smoking

Question 26

CCB

Answer 26

additive with BB

Question 27

Timolol

Answer 27

eye for glaucoma

Question 28

Use for propranolol

Answer 28

hypertension (not first line)
decrease mortality in those who had MI
treat arrhthmias
improve survival in CHF
decrease HR and BP in hyperthroidism
prevent migrainee
reduce portal vein pressure
decrease bleeding in cirrhosis
decrease catecholamine induced tremor and stage fright