Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology II > Beta Blockers, Alpha Blockers, Alpha Stimulants, Emergencies, & Urgencies > Flashcards

Beta Blockers, Alpha Blockers, Alpha Stimulants, Emergencies, & Urgencies Flashcards

1
Q

What are the sympathetic effects on alpha 1 receptors?

A

Vasoconstriction
Increased peripheral resistance
Mydriasis
Increased closure of internal sphincter of the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the big differences in the beta blockers?

A

Selectivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do non-selective beta-blockers work?

A

Block both beta-1 and beta-2 receptor sites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do selective beta-blockers work?

A

Specifically block beta-1 receptors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an example of a non-selective beta blocker?

A

Propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an example of a selective beta-blocker?

A

metroprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do beta-blockers with peripheral vasodilatory effects work?

A

Adds in an alpha-1 blockade effect.

Affects nitric oxide levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is an example of a beta-blocker which adds an alpha-1 blockade effect?

A

Labetolol

Carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is an example of a beta-blocker that affect nitric oxide levels?

A

nebivolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the sympathetic effects of alpha-2 adrenoreceptors?

A

Inhibition of norepinephrine release
Inhibition of acetylcholine release
Inhibition of insulin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the sympathetic effects of beta-1 adrenoreceptors?

A

Tachycardia
Increased lipolysis
Increased myocardial contractility
Increased release of renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the sympathetic effects of beta-2 adrenoreceptors?

A 
Vasodilation
Slightly decreased peripheral resistance
Bronchodilation
Increased muscle and liver glycogenolysis
Increased release of glucagon
Relaxed uterine smooth muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do people use metroprolol, labetolol, and carvedilol?

A

Decreased mortality found in clinical studies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can we affect blood pressure within the sympathetic nervous system?

A

Blocking the beta-1 receptors.
Blocking peripheral alpha-1 receptors.
Trigger central alpha-2 receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does blockade of the beta-1 receptors reduce blood pressure?

A

Reduce heart rate

Reduce renin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does blockade of the alpha-1 receptors reduce blood pressure?

A

Vasodilation

Decreased peripheral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does triggering central alpha-2 receptors affect blood pressure?

A

Reduces sympathetic outflow to the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do beta blockers work?

A

Activation of beta-1 adrenoreceptors on the heart
Decreased cardiac output
Decreased Renin > Decreased angiotensin II > Decreased peripheral resistance
Decreased aldosterone > Decreased sodium and water retention> decreased blood volume
*Decrease in blood pressure!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an example of a non-selective beta blocker?

A

Carvedilol
Labetalol
Propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an example of a selective beta blocker?

A

Metroprolol

Nebivolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Who are the candidates for use of beta blockers?

A

Younger patients!

Higher cardiac output and cardiovascular system efficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the effectiveness of beta blockers?

A

No evidence for primary prevention of hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the preferred HTN agents for patients with cardiovascular disease?

A

beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

At what creatinine clearance do beta-blockers eliminated renally need dose adjustments?

A

35 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a beta blocker which is eliminated renally?

A

Atenolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the half life of atenolol?

A

6-8 hours

Therefore dosed twice per day for clinical effectiveness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What adjustments need to be made for beta blockers metabolized hepatically?

A

No renal dose adjustment but first pass effect issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a beta blocker affected by hepatic metabolism?

A

Metoprolol

Carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the indications for Atenolol?

A

Treatment of HTN alone or in combination with other agents.
Management of angina pectoris.
Secondary prevention postmyocardial infarction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the indications for Carvedilol?

A

Management of HTN.
Mild-to-Severe heart failure of ischemic or cardiomyopathic origin.
Left ventricular dysfunction following myocardial infarction (clinically stable with LVEF < or = to 40%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you adjust the dose of Atenolol for renal impairment?

A

Dose once per day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the indications for metroprolol succinate?

A

Treatment of hypertension.
Treatment of angina pectoris.
To reduce mortality/hospitalization in patients with heart failure (stable NYHA Class I or III) already receiving ACE inhibitors, diuretics, and/or digoxin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the brand name for Carvedilol?

A

Coreg

Coreg CR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the brand name for Metroprolol succinate?

A

Toprol XL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the brand name for Nebivolol?

A

Bystolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the indications for nebivolol?

A

Treatment of hypertension alone or in combination with other agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the adverse effects of beta blockers?

A

Many side effects on cardiac tissue:

  • Bradycardia
  • Hypotension
  • Atrioventricular nodal conduction block

Bronchoconstriction
Hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Are beta blockers contraindicated in controlled asthma or controlled COPD?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Metroprolol Ext. Rel

A

100 mg

One tablet daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Carvedilol

A

12.5 mg

One tablet twice a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why should you watch a diabetic on a beta blocker?

A

Beta blockers can mask the symptoms of diabetes.

Decrease heart rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Bystolic

A

20 mg

One tablet daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the beta blockers to use?

A

Metroprolol
Carvedilol
Bystolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the extended release of Metroprolol?

A

Metroprolol succinate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What does the lipid and water solubility of beta bockers determine?

A

the degree of penetration of the blood-brain barrier.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the max dosing of metroprolol extended release?

A

400 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Theoretically, what effects can beta blockers have on the central nervous system?

A

Lethargy
Nightmares
Confusion
Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the characteristics of water soluble beta blockers?

A

Less tissue penetration

Longer biological half-lives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Coreg CR

A

25 mg

One tablet per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the mechanism of action for alpha blockers?

A

Block peripheral post synaptic adrenergic receptors resulting in arterial/venous vasodilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How long do you continue beta-blocker therapy before determining the effectiveness of therapy?

A

4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the adverse drug reactions of alpha blockers?

A

first dose syncope

peripheral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How do alpha blockers work?

A

Affect both arteriolar and venous resistance of vessels.

Dependent on the magnitude on sympathetic system activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What can be the body’s blood pressure response to alpha-1 blockade?

A

Increase in heart rate
Increase in cardiac output
Increased fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which alpha blocker has the longest half life of the hypertension agents?

A

Doxazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the three alpha blockers?

A

Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the indications for Prozasin?

A

Treatment of hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the indications for Terazosin?

A

Management of mild-to-moderate hypertension alone or in combination with other agents such as diuretics or beta-blockers.
Benign prostate hyperplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the indications for doxazosin?

A

Treatment of hypertension as monotherapy or in conjunction with diuretics, ACEI, beta-blockers, or calcium antagonists.

Treatment of urinary outflow obstruction and/or obstructive or irritative symptoms associated with benign prostate hyperplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Commercial name for Prozasin

A

Minipress

61
Q

Commercial name for Terazosin

A

Hytrin

62
Q

Commercial name for Doxazosin

A

Cardura

63
Q

What are the adverse drug reactions of alpha blockers?

A

Orthostatic hypertension - increased fall risk. Easing into therapy or dose changes.

Aggravators - nasal congestion, headache, reflex tachycardia, peripheral edema.

Non-selective alpha blockade - smooth muscle of the base of the urinary bladder

64
Q

Doxazosin

A

8 mg

One capsule daily

65
Q

What is an example of an alpha blocker to remember?

A

Doxazosin

66
Q

Do alpha blockers have a favorable effect on lipid profile?

A

Diminish risk of atherosclerosis by this mechanism and reduction of effect of cathecholamines in stimulation of vascular smooth muscle hypertrophy

67
Q

What is the maximum dose for doxazosin?

A

> 16 mg per day

68
Q

Where do alpha stimulants work?

A

The brain

69
Q

How do alpha stimulants work?

A

Block signals out of the central nervous system.

70
Q

What are the alpha stimulants?

A

Methyldopa
Clonidine
Guanfacine
Guanabenz

71
Q

What are the indications for Methyldopa?

A

Management of moderate-to-severe hypertension.

72
Q

What are the indications for Clonidine?

A

Management of hypertension (monotherapy or as adjunctive therapy).
Tablets or patch

73
Q

What are the indications for Guanfacine?

A

Management of hypertension.

74
Q

What are the indications for Guanabenz?

A

Used alone or in combination with other classes of antihypertensive agents in the management of hypertension.

75
Q

Commercial name for Methyldopa

A

Aldomet

76
Q

Commercial name for Clonidine

A

Catapres

77
Q

Commercial name for Guanfacine

A

Tenex

78
Q

What are the adverse drug reactions for alpha stimulants?

A

dry mouth
bradycardia
orthostatic hypotension
sedation

79
Q

What are alpha stimulants also used for?

A

Addiction treatment

Clonidine: Psychosis, Restless Leg Syndrome, Ulcerative colitis

80
Q

What can occur with abrupt withdrawal of an alpha stimulant?

A

Life-threatening hypertensive crisis

81
Q

Do alpha stimulants have metabolic effects of beta blockers and thiazides?

A

No!

82
Q

Clonidine

A

200 mcg

one tablet twice a day

83
Q

What are the alpha stimulants to remember?

A

Clonidine
Catapres TTS
Methyldopa

84
Q

Catapres TTS

A

0.2 mg/ 24 hours

apply one patch once every 7 days

85
Q

Methyldopa

A

500 mg

one tablet twice per day

86
Q

Minoxidil

A

5 mg

one tablet daily

87
Q

What is an example of a direct vasodilator?

A

Minoxidil

Hydralazine

88
Q

How does Minoxidil work?

A

Increase in nitric oxide levels.

Increaed nitric oxide = increased vasodilation = decreased blood pressure

89
Q

What are the adverse drug reactions of Minoxidil?

A

Standard side effects for an antihypertensive

Pericarditis and pericardial effusion that could progress to tamponade.

Increase oxygen deman and exacerbation of angina.

Some sodium and water retention.

90
Q

Anti-hypertensive agent used in pregnancy

A

Methyldopa

or

beta blocker

91
Q

How does Hydralazine work?

A

Opening up potassium channels in vascular smooth muscle.

Increased nitric oxide levels.

92
Q

When can you write for Minoxidil?

A

After you’ve used 3 antihypertensive agents and still have not met goal of therapy.

93
Q

What is Minoxidil also known as?

A

Rogaine

94
Q

Hydralazine

A

50 mg
one tablet twice a day

Initially 4 times per day until maintenance is achieved.

95
Q

Why must you give a beta blocker to blunt the effect of Hydralazine?

A

blood pressure drops significantly enough to cause reflex tachycardia.

96
Q

What are the adverse drug reactions of hydralazine?

A

Headache

Lupus-like syndrome

97
Q

What is the half life of hydralazine?

A

Short!!

Frequent daily doses.

No extended release form.

98
Q

hypertensive emergencies

A

severe elevations in blood pressure

often higher than 220/140 mmHg

99
Q

What does a hypertensive emergency require?

A

requires immediate attention and blood pressure reduction

100
Q

hypertensive emergency

A

marked elevation in blood pressure

usually higher than 180/110 mmHg

101
Q

What are the signs and symptoms of hypertensive urgency?

A

headache
SOB
pedal edema

102
Q

How is a hypertensive urgency handled?

A

oral agents

103
Q

What oral drugs are appropriate for hypertensive emergency?

A

Captopril
Clonidine*
Labetalol
Amlodipine

104
Q

What injectable drugs are appropriate for hypertensive emergency?

A 
sodium nitroprusside
nitroglycerin
nicardipine
hydralazine
enalaprilat
labetalol
esmolol
105
Q

sodium nitroprusside

A

0.25-10 mcg/kg/min IV infusion

106
Q

onset/duration of sodium nitroprusside

A

Immediate/ 2-3 min after infusion stop

107
Q

ADR of sodium nitroprusside

A

nausea
vomiting
cyanide poisoning

108
Q

nitroglycerin

A

5-100 mcg IV infusion

109
Q

onset/duration of sodium nitroprusside

A

2-5 min/ 5-10 min after infusion stop

110
Q

ADR of nitroglycerin

A

headache

tachycardia

111
Q

What is sodium nitroprusside?

A

a powerful intravenous vasodilator.

112
Q

What does sodium nitroprusside dilate?

A

arterial and venous vessels

113
Q

sodium nitroprusside toxicity causes…

A

hypotension
metabolic acidosis
arrhythmias
death

114
Q

What limits the extent of your ability to prescribe injectable vasoactive products?

A

state laws and regulations

115
Q

True or False: You are limited by state laws, regulations, etc as to the extent of your ability to prescribe oral vasoactive agents.

A

False!

116
Q

hypertensive emergencies caused by acute coronary syndrome are treated with…

A

Nitroglycerin
Nitroprusside
Nicardipine

117
Q

hypertensive emergencies caused by heart failure are treated with…

A

Nitroprusside
Nitroglycerin
IV loop diuretic

118
Q

What is the goal of therapy in a hypertensive emergency?

A

20-25% reduction from starting pressure in 1-3 hours

119
Q

hypertensive emergencies caused by acute or chronic renal failure are treated with…

A

Nitroprusside
Labetalol
Nicardipine

120
Q

hypertensive emergencies caused by ischemic stroke are treated with…

A

Nitroprusside
Nicardipine
Labetalol

121
Q

oral agents used to treat hypertensive emergencies include

A

Captopril
Clonidine
Labetalol
Amlodipine

122
Q

Captopril

A

25 mg PO, repeat as needed

SL - 25 mg

123
Q

onset/duration of Captopril

A

PO: 15 - 30 minutes / 6-8 hours
SL: 10-20 min / 2-6 hours

124
Q

ADRs of Captopril

A

hypotension
renal failure
bilateral renal stenosis

125
Q

Clonidine

A

0.1 - 0.2 mg PO

repeat hourly as required to total dosage of 0.6 mg

126
Q

onset/duration of Clonidine

A

30-60 minut / 8-16 hours

127
Q

ADRs of Clonidine

A

hypotension
drowsiness
dry mouth

128
Q

Labetalol

A

200 - 400 mg PO

repeat every 2-3 hours

129
Q

onset/duration of Labetalol

A

1-2 hours/ 2-12 hours

130
Q

ADRs of Labetalol

A

bronchoconstriction
heart block
orthostatic hypotension

131
Q

Amlodipine

A

2.5 - 5 mg PO

132
Q

onset/duration of Amlodipine

A

1-2 hours / 12-18 hours

133
Q

ADRs of Amlodipine

A

tachycardia

hypotension

134
Q

injectable agents for hypertensive emergencies

A 
Nicardipine
Hydralazine
Enalaprilat
Labetalol
Esmolol
135
Q

Nicardipine

A

5-15 mg/hr IV infusion

136
Q

onset/duration of Nicardipine

A

1-5 min / 15 - 30 min

137
Q

ADRs of Nicardipine

A

tachycardia
nausea
increased intracranial pressure

138
Q

Hydralazine

A

5-20 mg IV bolus;
10 - 40 mg IM
repeat every 4-6 hours

139
Q

onset/duration of Hydralazine

A

10 min/ 1 hr IV 20-30 min / 4-6 hr IM

140
Q

ADRs of Hydralazine

A

tachycardia
headache
aggravation of angina

141
Q

Enalaprilat

A

0.625-1.25 mg every 6 hr IV

142
Q

onset/duration Enalaprilat

A

within 30 min / 12-24 hours

143
Q

ADRs of Enalprilat

A

renal failure in bilateral renal stenosis

144
Q

Labetalol

A

20 - 40 mg IV bolus every 10 min; up to 2 mg/min IV infusion

145
Q

onset/duration Labetalol

A

5-10 min / 2-6 hours

146
Q

ADRs of Labetalol

A

bronchoconstriction
heart block
bradycardia

147
Q

Esmolol

A

500 mcg/kg IV bolus; 50-100 mcg/kg/min IV infusion

148
Q

onset/duration Esmolol

A

1-5 min/ 15-30 min

149
Q

ADRs of Esmolol

A

first-degree heart block
heart failure
worsen asthma symptoms

Pharmacology II (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions