HTN: A/B Blockers Flashcards
1
Q
What are the long-acting (QD) alpha blockers? Short acting?
A
- Long acting: terazosin, doxazosin**
- Short acting: prazosin
2
Q
Alpha-blocker MOA
A
- a1 selective–> decrease arterial psi by dilating resistance and capacitance vessels
- Greatest BP reduction when upright
- Fluid retention common when not pair with diuretic**
3
Q
Alpha-blocker indications
A
- BPH–> less use now with Tammy
- Expulsive therapy for ureteral stones
- HTN–> less use given poor data
- Prazosin used in combat vets with PTSD but poor data
4
Q
Alpha-blocker Pearls
A
- Less tachy but more postural hypoTN (esp in first few doses)**
- AVOID vasodilators (nitrates, PDE5) and decongestants (increase bladder neck tone and urinary retention)
5
Q
Alpha-blocker ADR
A
- Postural hypoTN/dizziness VERY common in 1st few doses** (take at bedtime)
- Drowsiness/fatigue
- Nasal congestion/rhinitis**
- Retro ejac
- Floppy iris syndrome
6
Q
What are the non-selective B-blockers?
A
- Propranolol**
- Nadolol
- Timolol
- Ass with bronchospasm
7
Q
What are the selective B-blockers?
A
- Metoprolol Tartrate (IR) & Metoprolol Succinate (ER, used in HF)**
- Atenolol
- Esmolol
- Betaxolol
- Bisoprolol
- Less likely to cause bronchospasm
-Best for post-AMI, HF, AF, etc
8
Q
B-blockers with vasodilation?
A
- Used for CHF > HTN
- Carvedilol**
- Labetalol
- Nebivolol
9
Q
B-Blocker MOA
A
-Competitive inhibitors of catecholamines at B-receptors
- B1 (heart): increase HR, contractility, AV conduction
- B2 (Bronchial/peripheral SM > heart): vasodilation and bronchodilation
10
Q
B-Blocker Cardiac Indications
A
- HTN
- Stable/unstable angina (for sx and exercise tolerance)
- Post-AMI (at least 2-3 yrs)
- Systolic HF/HFrEF (indefinitely)
- Certain arrhythmias (AF)
- Periop CV risk
11
Q
B-Blocker non-cardiac Indications**
A
- Propranolol for proliferating infantile hemangioma
- Migraine
- Essential tremor
- Sx mgmt of pheochromocytoma/hyperthyroid
12
Q
B-Blocker Pearls
A
- Monotherapy less sensitive in blacks**
- Taper 1-3 wks–> accelerated angina, AMI, death if abrupt stop (pts w ischemic HD)**
- Don’t give to pts on cocaine
- Generally less effective in preventing CV events (esp CVA) compared to ACE, ARB, CCB**
13
Q
B-blockers and HF
A
- Carvedilol
- Metoprolol succinate if symptomatic hypoTN or ventricular arrhythmia
- Long term use= reduced hospitalizations, improves sx, QOL and survival
- STABLE patients with EF 40% or less
14
Q
B-Blockers Precautions/CI
A
- Asthma/COPD (non-selective)
- 2nd or 3rd degree AV block
- Sick Sinus Syndrome (unless used with pacer)
- Brady <50 bpm
15
Q
B-Blocker Drug interactions
A
- Propranolol, metoprolol, carvedilol 2D6 subs
- Careful with CCB and antiarrhythmics
- Anti-HTN and vasodilators
- Blunts effects of Epi (EpiPen)**
