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peripheral vasodilators2 > beta blockers 2 > Flashcards

beta blockers 2 Flashcards

1
Q

preganglionic fibers are

A

myelinated, rapid

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2
Q

post ganglionic

A

un-myelinated, slower

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3
Q

sns arise from

A

thoracolumbar outflow

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4
Q

adrenal medulla releases

A

epinephrine

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5
Q

pns arise from

A

craniosacral outflow

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6
Q

2 types pns receptors

A

nicotinic, muscarinic

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7
Q

what breaks down acetylcholine

A

acetylcholinesterase to choline and acetic acid

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8
Q

norepinephrine is broken down by what in the nerve synapse

A

MAO or sequestered in storage vesicles for release

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9
Q

norepi that diffuses away from synapse is inactivated by

A

COMT

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10
Q

beta 1 effects with agoinism

A 
increased HR
increased conduction
increased contractility
increased renin releast
(ALL EFFECTS ON HEART)
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11
Q

beta 2 effects with agonism

A 
skeletal muscle relaxation
bronchodilation
gluconeogenesis
glycogenolysis
vasodilation (some)
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12
Q

alpha1 actions with agonsm

A

works on arterial blood vessels
increases constriction
increases BP
can cause reflex bradycardia secondary to baroreceptor mediated reflex

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13
Q

alpha2 actions with agonism

A

negative feedback, when receptor is activated there is a decrease in norepi release, when blocked NE release increases

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14
Q

s/e alpha block

A

orththostatic hypertension, baroreceptor med. tachycardia

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15
Q

which alpha blocker causes covalent binding

A

phenoxybenzamine

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16
Q

which alpha blockers are reversible

A

prazosin, yohimbe, phentolamine

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17
Q

phenolamine

A

nonselective alpha blocker. tx htn emergency, hyperreflexia, pheochromo, reversible binding

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18
Q

effects of phentolamine

A

decreased bp due to vasodilation (peripheral), hr increased, co increased

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19
Q

phenoxybenzamine

A

nonselective alpha blocker

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20
Q

uses phenoxybenzamine

A

excesive vasoconstriction secondary to shock but only after volume rescucitation

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21
Q

effects phenoxybenzamine

A

vasodilation, decreased bp

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22
Q

what cannot happen with phenoxybenzamine

A

compensatory vasoconstriction, get large drops in bp

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23
Q

1/2 life phenoxybenzamine

A

24 hours

24
Q

onset phenoxybenzamine

A

60 minutes

25
Q

onset phentolamine

A

2 min, duration 10-15

26
Q

prazosin

A

selective alpha 1, less liekely to cause tachycardia. dilates arteries and veins

27
Q

yohimbe

A

selective alpha 2, increased release norepinephrine used to treat idiopathic orthostatic htn

28
Q

gold standard beta blocker

A

propanolol

29
Q

do b blockers cros bbb

A

yes and placenta can cause hypoglycemia, bradycardia and hypotension in fetus

30
Q

what are all beta antagonists derived from

A

isoproterenol

31
Q

partial antagonist

A

presece of intrinsic sympathomim activity

32
Q

pure antagonist

A

absence of intrinsic sympatho activity

33
Q

beta blockers with intrinsic activity

A

timolol, pindolol, acebutalol

34
Q

selective beta blockers beta 1

A

metoprolol, esmolol, atenolol

35
Q

metoprolol effects

A

negative inotrope and chronotrope. 10% protein binding, 1/2 time 3-4 hours

36
Q

atenolol

A

renal excretion 1/2 time 6-7 hours

no insulin induce hypoglycemia, may be used in diabetics

37
Q

esmolol

A

5 min onset, 10-30 min duration
1/2 life 9 minutes.
rapid ester hydrolysis

38
Q

propanolol

A

pure antagonist, decreases hr and cardiac output,decreases peripheral vascular return, increase myocardial o2, but with decrease hr and contractility decreases myocardial o2

39
Q

propanolol metabolism

A

hepatic, 70% on first pass, 90-95% protein bound 1/2 time 2-3 hours

40
Q

nadolol

A

no metabolism, excreted unchanged in urine, 1/2 time 20-40 hours

41
Q

pindolol

A

partial antagonist, minimal resting bradycardia 40-60% protein bound, 1/2 time is 3-4 hours

42
Q

timolol

A

elimination 1/2 time 4 hours, tx glaucoma

43
Q

contraindications to beta blockers

A

prexist av block or heart failure not caused by tachycardia, diabetics secondary to hypoglycemia masking

44
Q

if give beta blocker to hypovolemic pt with compensatory tachy what happens

A

profound drops in bp

45
Q

effects on heart represent

A

removal sns innervation

46
Q

weak left ventricle after beta blocker may

A

go into heart failure

47
Q

what happens with epi and beta blockers

A

may enhance vasodilatory effect

48
Q

pvd and beta blockers

A

may have cold hands/feet

49
Q

s/s excess myocardial depression

A

decreased hr, decreased co, hypotension, cardiogenic shock, bronchospasm, vent depression, seizures, prolonged intravent contraction

50
Q

tx myocardial depress

A

atropine 7mcg/kg then beta agonist isoproterenol or pure agonist
glucadon which stimulates adenylate cyclase and intracellular cmp, pacer or HD

51
Q

potassium and beta blockers

A

when beta blocked stops facilitation of k intracellularlly and can increase k level

52
Q

s/e labetalol

A

orthostatic hypotension, heart block, chf

53
Q

labetalol is

A

alpha1 selective, beta1 and beta2 nonselective

54
Q

1/2 time labetalol

A

5-8 hours, prolonged with liver disease onset 5-10 minutes

55
Q

actions labetalol

A

decrease bp and svr, stops reflex tachycardia, co unchanged

56
Q

dose of labetalol

A

0.1-0.5mg/kg

peripheral vasodilators2 (10 decks)

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