ANS pharmacology & pathophysiology 3

Question 1

A common side effect of prazosin is:
a. diuresis
b. severe bradycardia
c. orthostatic hypotension
d. excessive energy

Answer 1

c. orthostatic hypotension

Question 2

Alpha 1 adrenoreceptor antagonists

Answer 2

reduce arterial BP but can also trigger reflex tachycardia and orthostatic hypotension

Question 3

Examples of nonselective alpha antagonists are

Answer 3

phenoxybenzamine and phentolamine

Question 4

Examples of selective alpha antagonists are

Answer 4

prazosin
tamsulosin
yohimbine

Question 5

Beta-blockers are used to manage

Answer 5

hypertension
CAD
MI
heart failure

Question 6

The prototypical B-adrenoreceptor antagonist nonselective is

Answer 6

propranolol

Question 7

The alpha receptor antagonist are used to treat

Answer 7

HTN
HF
BPH
pheochromocytoma

Question 8

Phenoxybenzamine is a (moa

Answer 8

noncompetitive a antagonist
blocks the alpha mediated activity of NE and EPI resulting lower peripheral vascular resistance and BP

Question 9

What is used exclusively in the preoperative management of pheochromocytoma to normalize BP and prevent episodic hypertension?

Answer 9

phenoxybenzamine

Question 10

Phenoxybenzamine produces an irreversible block rendering ______________ ineffective in treating phenoxybenzamine-induced severe hypotension

Answer 10

norepinephrine and phenylephrine

Question 11

The best treatment for phenoxybenzamine-induced severe hypotension is

Answer 11

vasopressin and fluids

Question 12

What is the MOA of phentolamine?

Answer 12

competitive nonselective alpha receptor antagonist

Question 13

Unlike phenoxybenzamine, the receptor interaction with phentolamine can be overcome by

Answer 13

using an alpha receptor agonist such as phenylephrine or norepinephrine

Question 14

Phentolamine should be used with extreme caution in patients with

Answer 14

flow-limited coronary artery disease b/c it causes baroreceptor mediated reflex tachycardia

Question 15

What is the half-life of phentolamine?

Answer 15

<10 minutes

Question 16

Phentolamine may have a benefit in treating otherwise

Answer 16

refractory HTN that may be seen with abrupt clonidine discontinuation

Question 17

_________ can be used as a local infiltration injection after IV extravasation of a vasoconstrictor to prevent tissue necrosis.

Answer 17

Phentolamine

Question 18

What is the MOA of prazosin?

Answer 18

highly selective alpha 1 receptor antagonist

Question 19

Is there a change in HR with prazosin?

Answer 19

No

Question 20

Side effects of prazosin include

Answer 20

postural/orthostatic hypotension

Question 21

The following three drugs are analogs of prazosin:

Answer 21

terazosin
doxazosin
tamsulosin

Question 22

The main uses of terazosin, doxazosin, and tamsulosin are to treat

Answer 22

BPH

Question 23

Terazosin, doxazosin, and tamsulosin anesthetic complications:

Answer 23

these drugs can exacerbate anesthetic-induced hypotension

Question 24

Yohimbe (MOA)

Answer 24

selective alpha 2 adrenergic antagonist

Question 25

What is yohimbe used for?

Answer 25

erectile dysfunction athletic performance weight loss hypertension diabetic neuropathy

Question 26

Yohimbe can diminish the

Answer 26

antihypertensive effect of other antihypertensive medications

Question 27

Indications for a beta-blocker include

Answer 27

hypertension supraventricular tachycardia afib blunting an acute hemodynamic response, CHF, and conditions of ischemic heart disease reducing myocardial O2 consumption and improving perfusion

Question 28

Concerns with beta blockers include

Answer 28

bradyarrhythmias obtunding the CV response to hypovolemia progressive heart block heart failure bronchoconstriction

Question 29

Abrupt discontinuation of long-term use of beta blockers can result in

Answer 29

rebound tachycardia and hypertension

Question 30

Some beta blockers (propranolol and acebutolol) have

Answer 30

membrane stabilizing activity--> act as antiarrhythmics

Question 31

Some beta blockers (pindolol, labetalol, & acebutolol) possess _________

Answer 31

intrinsic sympathomimetic activity (has a partial stimulating action while also blocking endogenous catecholamines)

Question 32

Antagonism of B2 receptors can produce

Answer 32

bronchoconstriction hypoglycemia peripheral vascular constriction (can aggravate Raynauds or PVD)

Question 33

_________ has a very long half-life

Answer 33

Nadolol

Question 34

___________ has some weak beta agonist effects and is associated with less slowing of HR and less of an impact on BP

Answer 34

Pindolol

Question 35

Examples of nonselective B-adrenergic antagonists include

Answer 35

carvedilol nadolol pindolol sotalol timolol propranolol

Question 36

Beta 1 blockers include

Answer 36

metoprolol atenolol esmolol bisoprolol acebutolol

Question 37

_________has some weak beta agonist effects and is associated with less slowing of HR and less of an impact on BP

Answer 37

acebutolol

Question 38

What is the MOA of metoprolol?

Answer 38

competitive, cardioselective B1 receptor antagonist

Question 39

What is the dose of metoprolol?

Answer 39

administered IV 2.5-5 mg increments to a max dose of 15 mg

Question 40

What is the first-line drug for rapid perioperative control of HR & BP?

Answer 40

esmolol swift onset & brief duration of action (<15 minutes)

Question 41

Esmolol is metabolized by

Answer 41

nonspecific esterases found in the RBC

Question 42

What is the dose of esmolol?

Answer 42

bolus: 10-80 mg or an infusion (50-300 mcg/kg/min.)

Question 43

What is the MOA of labetalol?

Answer 43

adrenergic antagonist with alpha 1 and nonselective beta adrenergic antagonist effects

Question 44

The primary indication of labetalol is

Answer 44

acute hypertension

Question 45

The B2 antagonism of labetalol can produce

Answer 45

bronchospasm in patients with asthma or COPD

Question 46

Carvedilol MOA:

Answer 46

antagonist at alpha 1 and B1 & B2 adrenergic receptors

Question 47

Which beta-blocker has intrinsic sympathetic activity (ISA)?

Answer 47

labetalol

Question 48

Which beta receptor antagonist undergoes renal metabolism?

Answer 48

atenolol