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Pharm 2 Exam > Ch 16 > Flashcards

Ch 16 Flashcards

1
Q

Therapeutic applications fo A1 antagonist

A

Essential HTN (causes vasodilation)

reversal of tox from a1 agonist (EPI) - cause HTN reverse with a1 antagonist

BPH

Raynaud disease

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2
Q

symptoms of BPH

A 
dysuria
increased frequency of daytime urination
nocturia
urinary hesitancy
urinary urgency
sensation of incomplete voiding
reduction in size and force of the urinary stream
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3
Q

peripheral vascular disorder characterized by vasospasm in toes and fingers. local sensations of pain and cold

A

Raynaud disease

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4
Q

Adverse effects of A blockade when using adrenergic antagonist

A

orthostatic hypotension (reduces musle tone in venous wall - blood pool sin veins and when pt stands, return of blood to heart is reduced -> decrease cardiac output and drops BP

Reflex tachycardia (baroreceptor reflex)

nasal congestion (dilates blood vessels of nasal mucosa)

inhibition of ejaculation

sodium retention and increased blood volume ( bp drops -> a1 blockers decrease renal blood flow ->kidney excretes less na and h20 -> bp is elevated

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5
Q

to prevent the kidney from neutralizing hypotensive actions of A blocking agents what can you give

A

combine with diuretic in pt with htn

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6
Q

A2 blockade and reflex tachycardia

A

A2 is blocked so norepinephrine are increased which stimulates heart rate to increase

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7
Q

A1 blockade and reflex tachycardia

A

Baroreceptor reflex

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8
Q

phentolamine and reflex tachycardia

A

blocks A1 and A2 so greater reflex tachycardia

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9
Q

Alpha blockers and children

A

not approved except for

OraVerse - reversal of local anesthesia following dental surgery

Phentolamine - post extravasation

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10
Q

Pregnant women and alpha blockers

A

no

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11
Q

Breastfeeding women and alpha blockers

A

no

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12
Q

older adults and Alpha blockers

A

esp vulnerable to first dose effects

with worsening of urinary incontinency in women and increase syncope in both genders

BEERS criteria identifies doxazosin, prazosin, terazosin not appropriate

diuretics and CNS depressants can cause additive adverse effects when given with alpha blockers

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13
Q

Prazosin (Minipress)

A

selective blockade of A1 adrenergic receptors

approved only for HTN
benefits men with BPH

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14
Q

Adverse effects of Prazosin (Minipress)

A

orthostatic hypotension - “first-dose” effect
reflex tachycardia
nasal congestion

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15
Q

Pt education on first pass effect on Prazosin (Minipress)

A

About 1% of pt lose consciousness 30-60 min after their first dose. Avoid driving and other hazardous activities for 12-24 hours

Take first dose right before going to bed to eliminate risk for this

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16
Q

How to minimize first dose effect (Prazosin)

A

the initial dose should be small (no more than 1mg) and doses gradually increased

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17
Q

pt ed on orthostatic hypotension

A

sit or lie down if become dizzy. change positions slowly when changing from a supine or sitting to an upright position

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18
Q

Terazosin uses

A

HTN
BPH

selective antagonist at A1 adrenergic

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19
Q

Tarazosin adverse effects

A 
orthostatic HTN
Reflex Tachycardia
nasal congestion
headache
first dose effect
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20
Q

Doxazosin (Cardura, Cardura XL) uses

A

HTN
BPH

Cardura XL - only approved for BPH

selective inhibitor of A1 adrenergic

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21
Q

Doxazosin (Cardura, Cardura XL) adverse effects

A

orthostatic hypotension
reflex tachycardia
nasal congestion
first- dose effect

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22
Q

Tamsulosin (Flomax) approved for

A

BPH

A1 adrenergic antagonist

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23
Q

Tamsulosin (Flomax) adverse effects

A

headache
dizziness
abnormal ejaculation
increased incidence of rhinitis

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24
Q

Tamsulosin (Flomax) max benefits develop within

A

2 weeks

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25
Q

Tamsulosin (Flomax) drug interactions

A

combined with cimetidine - increases flomax drug levels can cause tox

combined with hypotensive drugs to include PDE-5 drugs such as viagra may cause a drop in BP

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26
Q

Alfuzosin (Uroxatral) approved for

A

BPH

A1 blocker

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27
Q

Alfuzosin (Uroxatral) adverse effects

A

dizziness

syncope and clinically sig hypotension is rare

doses 4 times recommended can prolong QT which can be a problem in pt with mod to severe hepatic impairment - do not give to these pts

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28
Q

Alfuzosin (Uroxatral) drug interactions

A

CYP3A4 - erythromycin, clarithromycin, itraconazole, ketoconazole, nefazodone, HIV protease inhibitors such as ritonavir. - do not give

combining with hypotensive agents could dramatically reduce BP. Avoid combos such as organic nitrates, antihypertensive agents, PDE 5 inhibitors such as viagra

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29
Q

Silodosin (Rapaflo) use

A

A1 adrenergic antagonist

BPH

30
Q

Silodosin (Rapaflo) adverse effect

A

greatly reduce or eliminate release of semen during orgasm
dizziness
lightheadedness
nasal congestion

31
Q

Phentolamine (OraVerse) use

A

diagnose and treatment of pheochromocytoma

prevention of tissue necrosis after extravasion of IV vasopressors

reversal of soft tissue anesthesia

32
Q

Phentolamine (OraVerse) adverse effects

A

orthostatic Hypotension
reflex tachycardia !!!
nasal congestion
inhibition of ejaculation

33
Q

if reflex tachycardia is esp severe with phentolamine, the HR can be reduced with

A

B Blocker

34
Q

what pt population is phentolamine contraindicated

A

angina pectoris and myocardial infarction

35
Q

Overdose of phentolamine can produce ____ and what should you give?

A

profound hypotension
give norepinephrine

Epi could activate B2 which could cause vasodilation and worsen hypotension

36
Q

which 2 drugs block a1 and a2 receptors

A

Phentolamine

Phenoxybenzamine -irreversible and only for pheochromocytoma

37
Q

Pt ed on A1 adrenergic antagonist for self monitoring

A

monitor HR and BP

hold the drug and notify provider for sustained bradycardia or hypotension develops

38
Q

A1 adrenergic Antagonists for HTN

A

Doxazosin
prazosin
terazosin

on the BEERS list

39
Q

A1 adrenergic antagonists for BPH

A 
Doxazosin
terazosin
alfuzosin
silodosin
tamsulosin
40
Q

B blockade used to

A

reduce HR
reduce contractility
reduce velocity of impulse conduction through AV node

41
Q

3 B blockers approved for Heart failure

A

Carvedilol
bisoprolol
metoprolol

42
Q

in heart failure when would you not initiate or increase dose of a b blocker

A

during a exacerbation

43
Q

long term use of a B blocker can sensitize the heart to catecholamines, if withdrawn abruptly

A

anginal pain or ventricular dysrhythmias may develop (referred to as rebound excitation)

44
Q

B blocker approved for asthmatics

A

B1 selective blocker such as metoprolol

45
Q

B2 blockade in diabetics

A

at risk for hypoglycemia

46
Q

Neonates born to a mother on B blockers esp Betaxolol

A

3-5 days after birth closely monitor for
Bradycardia (B1 blockade)
Resp distress (B2 blockade)
Hypoglycemia (B2 blockade)

47
Q

Propanolol category

A

B Blocker
First gen
nonselective B Blockade

48
Q

Pharm effect Propanolol

A

B1
decrease HR
decrease contractility
suppress impulse conduction AV node

all equals reduction in cardiac output

B2
bronchoconstriction
vasoconstriction
reduced glycogenolysis

49
Q

therapeutic uses Propanolol

A

HTN
angina
cardiac dysrhythmias
MI

50
Q

Contraindications for Propanolol

A

pt with preexisting AV block greater than first degree

Sinus Brady

preexisting heart failure

asthma

COPD

Diabetics - use caution

with history of depression

pregnancy

history of anaphylaxis

51
Q

CNS side effects Propanolol

A 
depression
insomnia
nightmares
hallucinations
depression
52
Q

B blocker approved for pregnancy

A

labetalol

other
methyldopa
nifedipine

53
Q

Metoprolol (Lopressor) class

A

B Blocker
second gen
selective B1

54
Q

preferred B blocker for asthmatics or diabetics or history of anaphylaxis

A

Second gen B1 selective

Metoprolol (Lopressor)

side note - still dm will not have tachycardia to warn of hypoglycemia

55
Q

Metoprolol (Lopressor) uses

A

HTN
angina
Heart failure
MI

56
Q

Metoprolol (Lopressor) adverse effects

A

bradycardia
reduced cardiac output
AV heart block
rebound excitation with abrupt withdrawal

57
Q

which 2 B Blockers block alpha adrenergic receptors in addition to B receptors

A

labetalol

carvedilol

58
Q

Which b blockers have high lipid solubility meaning they penetrate BBB and eliminated primarily by hepatic metabolism

A

propanolol
metoprolol
Nebivolol

59
Q 
Nadolol
pindolol
propanolol
sotalol
timolol
A

first gen non selective b blocker

60
Q 
Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
A

Second Gen B Blocker Cardioselective

Maebba - pneumonic

61
Q

Carvedilol
Lebetalol
Nebivolol

A

3rd Gen
B Blocker
Vasodilating action

62
Q

Children and B Blockers

A

yes

63
Q

Pregnancy and B Blockers

A

Labetalol drug of choice

acebutolol
pindolol
sotalol
are considered alternative safest

64
Q

Breastfeeding and B blockers

A

no and Betaxolol is worst

65
Q

older adults and B Blockers

A

commonly prescribed

if hepatic and renal impairment, pay attention to which you prescribe

66
Q

Black box warning sotalol (Betapace)

A

When starting or restarting Sotalol - pt should be inpatient on continuous EKG for min of 3 days

Creatinine clearance should be established prior

Betapace cannot be subbed for Betapace AF when treating A fib

67
Q

How is Esmolol and sotalol differ from other b blockers

A

very short half life and not used for HTN

esmolol - IV therapy for SVT
Sotalol - treat ventricular dysthythmias (A-fib or A-flutter)

68
Q

Because of their ability to block a adrenergic receptors, carvedilol and labetalol can cause

A

postural hypotension

69
Q

what b blocker protects from resting heart rate from dropping too low and why

A

Pindolol - partial agonist a b adrenergic receptor (p 116)

It is a intrinsic sympathomimetic activity (IMA) partial agonist

70
Q

what pt population cannot have pindolol

A

history of MI

71
Q

which B Blockers carry the black box for abrupt discontinuation may cause exacerbation of angina and increase risk for MI

A

Atenolol
metoprolol
nadolol
timolol

72
Q

other signs diabetics need to key into for signs of hypoglycemia

A

hunger
fatigue
poor concentration

Pharm 2 Exam (18 decks)

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