Chapter 10: Adrenoceptor Blockers

Question 1

Hypotension that is most marked in the upright position; caused by venous pooling (typical of α blockade) or inadequate blood volume (caused by blood loss or excessive diuresis)

Answer 1

Orthostatic hypotension

Question 2

A tumor consisting of cells that release varying amounts of norepinephrine and epinephrine into the circulation

Answer 2

Pheochromocytoma

Question 3

The best-documented application of these adrenoceptor blockers is in the presurgical management of pheochromocytoma

Answer 3

Nonselective alpha blockers

Question 4

Adrenergic antagonist (alpha-nonselective) which irreversibly blocks alpha adrenergic receptors (a1>a2) by forming a covalent bond with the receptors, used for pheochromocytoma

Answer 4

Phenoxybenzamine

Question 5

Adrenergic antagonist (alpha-nonselective), which reversibly blocks alpha adrenergic receptors (a1=a2), used for pheochromocytoma (pre-surgical) and rebound hypertension

Answer 5

Phentolamine, Tolazoline

Question 6

Adrenergic antagonist (alpha1-selective) used for BPH

Answer 6

Prazosin, Doxazosin, Terazosin, Tamsulosin, Silodosin, Alfuzosin

TAMSULOSIN - most selective for prostatic smooth muscle

Question 7

What is the pharmacologic advantage of a1 selectivity?

Answer 7

Reflex Tachycardia is LESS common and less severe

Question 8

Selective a2 antagonist used for orthostatic hypotension and male erectile dysfunction

Answer 8

Yohimbine

Question 9

A beta blocker that lacks local anesthetic action and has marked class III antiarrhythmic effects

Answer 9

Sotalol

Question 10

Effects of beta blockers in DM patients

Answer 10

1. Beta blockers can mask premonitory symptoms of hypoglycemia from insulin overdosage (tachycardia, tremor, anxiety)
2. Impaired hepatic mobilization of glucose

Question 11

Beta blockers that prolongs survival in patients with

myocardial infarction

Answer 11

1. Timolol (non-selective)
2. Propranolol (non-selective)
3. Metoprolol (b1 selective)

Question 12

Beta blockers which are effective in reducing mortality in selected patients with chronic heart failure

Answer 12

1. Metoprolol (b1 selective)
2. Bisoprolol (b1 selective)
3. Carvedilol (a/b antagonist)

Question 13

Beta blockers without local anesthetic activity

Answer 13

1. Timolol
2. Betaxolol

(useful in glaucoma)

Question 14

Beta blocker with the longest half-life

Answer 14

Nadolol

Question 15

Beta blocker with the shortest half-life

Answer 15

Esmolol

Question 16

Selective Beta-1 blockers

Answer 16

1. Atenolol
2. Betaxolol
3. Esmolol
4. Acebutolol
5. Metoprolol
6. Alprenolol
7. Bisoprolol
8. Celiprolol

(A-M are cardioselective)

Question 17

Drug class of glaucoma drugs which decrease the production of aqueous humor from ciliary epithelium

Answer 17

mnemonic: ABCOs

1. Alpha 2 antagonists
   - Brimonidine
   - Apraclonidine
2. Beta antagonists
   - Timolol
   - Levobunolol
   - Carteolol
   - Metipranolol
   - Betaxolol
3. Carbonic anhydrase inhibitors
   - Acetazolamide
   - Dorzolamide
4. Osmotic agents
   - Mannitol

Question 18

Drug class of glaucoma drugs which increase the outflow of aqueous humor

Answer 18

Increase outflow

1. Cholinomimetics
   - Pilocarpine
   - Physostigmine & Echothiopate
2. Prostaglandin analogue (through canal of Schlemm)
   - Latanoprost
   - Brimatoprost
3. Non selective alpha agonists (via uveoscleral veins)
   - Epinephrine