E1- Adrenergic Blocking Agents Flashcards by Catherine sendek

What are possible effects of alpha blockers?

Decrease BP
Reflex tachycardia
Miosis
Make it easier to urinate
Inhibit ejaculation
EPI reversal

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What are possible effects of beta blockers?

Decrease rate and force of contraction in the heart
Decrease O2 demand of heart
Decrease renin secretion
Cause bronchoconstriction
Decrease glycogenolysis and lipolysis
Inhibit insulin secretion
Decrease intraocular pressure

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Why should beta blockers and EPI never be given to someone with pheochromocytoma without concomitant administration of an alpha blockers?

Beta blockers will inhibit the vasodilation caused by B2 receptors, increasing the pressor effect of EPI

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What should not be used in they eye because they will anesthetize the cornea?

Beta blockers

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What is the only noncompetitive irreversible alpha blocker?

Phenoxybenzamine

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What type of antagonist shifts the dose-response curve to the right, but the maximum effect is the same?

Competitive

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What type of antagonist shifts the dose-response curve to the right, and the maximum effect is diminished?

Non-competitive

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What are the two drugs classified as non-selective alpha receptor blockers?

Phentolamine

Phenoxybenzamine

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What is Phentolamine used for?

Rarely used for short-term tx of HTN crisis
-Pheochromocytoma
-Pts on MAOIs who ingest tyramine
-After abrupt withdrawal from clonidine
To prevent necrosis if vasoconstrictor like NE is accidentally injected into tissues

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What are contraindications of Phentolamine?

Caution in pts with CAD

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What are side effects of Phentolamine?

Hypotension
Tachycardia
Arrhythmias
MI

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What is Phenoxybenzamine used for?

DOC for prevention of severe hypertension in pheochromocytoma before surgery

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What are side effects of Phenoxybenzamine?

Orthostatic hypotension
Tachycardia
Inhibit ejaculation

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What are the two drugs classified as selective alpha 1 receptor blockers?

Prazosin

Tamsulosin

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What is Prazosin used for?

1st choice for men with BPH and HTN

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What are contraindications for Prazosin?

Combination with ED drugs and nitrates can lead to severe HTN

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What are side effects of Prazosin?

Orthostatic hypotension
- Dizziness
- “First dose phenomenon”
Tachycardia

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What are the two drugs classified as non-selective beta receptor blockers?

Propranolol

Timolol

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What is propranolol metabolized by?

P450s

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What is propranolol used for?

Post MI
Increase exercise tolerance in angina pts
Arrhythmias
Heart failure (early stages only)
Control hyperthyroidism sxs
Migraine prevention
Decrease catecholamine-induced tremor and stage fright
HTN (chronic use)

What are contraindications of propranolol?

Acute HF, asthma, AV block, bradycardia, cardiogenic shock, pheochromocytoma

In which pts should you caution propranolol use?

COPD

Diabetics

What are side effects of propranolol?

Bronchoconstriction in asthma and COPD
Exacerbate HF in late stages 
Bradycardia
Sedation/fatigue
Recovery from hypoglycemia more difficult/masks sxs

What is Timolol used for?

Glaucoma

In which pts should you caution Timolol use?

Athmatics

What are the four drugs cardio-specific beta 1 receptor blockers?

Metoprolol Betaxolol Esmolol Nebivolol

What is the most selective beta 1 blocker/antagonist?

Nebivolol

What is Metoprolol used for?

``` Decrease rate and force of contraction of heart HTN Post-MI Angina Heart failure Migraine prophylaxis ```

What are contraindications of Metoprolol?

Acute HF, AV block, bradycardia, cardiogenic shock, pheochromocytoma

What medication is similar to Propranolol but has better exercise tolerance in angina and is safer in diabetics and asthmatics?

Metoprolol

What are side effects of Metoprolol?

Dizziness, bradycardia, hypotension

What is Betaxolol used for?

Glaucoma

In which pts should you caution Betaxolol use?

Asthmatics

What is Esmolol used for?

Used in critically ill pts where you don’t want the risk of lasting Beta blocker effects Emergency situation where rapid effect is needed

What is Nebivolol used for?

Direct vasodilation (release NO from endothelial cells)

What are the two drugs classified as combined alpha 1 and beta blockers?

Carvedilol | Labetalol

What is Carvedilol used for?

Vasodilation w/o reflex tachycardia HTN Heart failure (especially after MI)

What are side effects of Carvedilol?

Orthostatic hypotension | Bronchoconstriction (don’t use in asthmatics)

What is Labetalol used for?

Vasodilation w/o reflex tachycardia Lower BP in HTN emergency HTN in pregnancy

What are side effects of Labetalol?

Orthostatic hypotension Bronchoconstriction (don’t use in asthmatics) Hepatotoxicity

What is the order of glaucoma tx?

1. Prostaglandin analogues – initial DOC 2. Beta blockers •Timolol •Betaxolol 3. Selective alpha 2 agonist 4. Carbonic anhydrase inhibitors 5. Cholinergic agonist •Pilocarpine (last choice b/c blurs vision)

What are the main 4 responses to alpha blockade?

- Decreased vasoconstriction - Reflex tachycardia - Orthostatic hypotension - Epinephrine reversal

What is the DOC is pheochromocytoma?

Phenoxybenzamine

What is the first dose phenomenon and what drug is it associated with?

- Bad orthostatic hypotension and syncope 30-90 minutes after first dose - Associated with Prazosin

What are the cardiovascular effects of B blockade?

- Decreased chronotropy, inotropy, and dromotrpy - decreased renin - decreased O2 demand - Decreeased CO2 - Decreaed BP when used chronically

How does beta blockade affect the endocrine system?

- inhibits glycogenolysis - inhibits insulin secretion - May cause hyperglycemia

What are the CYP50 inactivating drugs that you shouldn’t give with propranolol?

Cimetidine and chlorpromazine

What are the CYP450 inducers that you shouldn’t give with propranolol?

Barbiturates, phenytoin, and rifampin