Hypertension - Lecture 2 ( A1 blocker, A2 agonist, Beta Blockers)

Question 1

a1 stimulation results in….

Answer 1

vasoconstriction (reflex bradycardia)
Bladder sphincter contraction
Reduced Lipolysis

Question 2

a2 stimulation results in….

Answer 2

decreased pre-synaptic NE release (reduced sympathetic outflow)

Question 3

A1 blockers MOA

Answer 3

selectively block a1 receptors on smooth muscle cells of peripheral vasculature

Lowers BP via vasodilation, decrease PVR

Question 4

Doxazosin (Cardura) Dose and Frequency

Answer 4

1-8mg, daily

Question 5

Orthostasis…

Answer 5

when stand up BP drops but doesn’t go back up = dizziness

Question 6

A1 Blockers Clinical considerations

Answer 6

No benefit in prevention of MI or CHD

“Last line”

Question 7

A1 Blocker special considerations

Answer 7

2nd line agent in men with BPH

improves urine flow and decrease frequency with some drop in BP

Question 8

ADE of A1 blocker

Answer 8

Orthostatic hypotension
1st dose syncope
Dizziness
Reflex tachycardia
Peripheral Edema
Sexual Dysfunction

Question 9

a2 agonist MOA

Answer 9

stimulate a2 presynaptic receptors in the brain

increase inhibitory neuron acitivty decrease sympathetic outflow

Lower BP primarily via decrease PVR

Question 10

Clonidine (Catapress) Dose and Frequency

Answer 10

0.1-0.8 mg, BID

Question 11

Clonidine (Catapress - TTS) Dose and Frequency

Answer 11

0.1-0.3 mg, Weekly

Question 12

Benefits of TTS

Answer 12

decreased rebound HTP with abrupt withdrawal

reduces side effects

Question 13

A2 agonist Clinical considerations

Answer 13

Not 1st line

Avoid in pt with HF

Question 14

A2 agonist possible indications

Answer 14

Resistant HTN (Clonidine)
Pregnancy (Methyldopa)

Question 15

ADE of A2 agonist

Answer 15

Significant CNS ADE
Orthostatic Hypertension
Dry mouth
Depression
Rebound HTN w/ abrupt stop

Question 16

B1 Location

Answer 16

Heart

Question 17

B2 Location

Answer 17

Lungs and Periphery

Question 18

B1 receptor stimulation….

Answer 18

increase HR

increase Renin Secretion

Question 19

B2 receptor stimulation…..

Answer 19

Smooth muscle relaxation
peripheral vasodilation
Skeletal muscle stimulation
Glycogenolysis & gluconeogenesis

Question 20

Beta Blocker MOA

Answer 20

Competitively inhibit catecholamine NT at B1 and B2 receptor

reduce CO leading to decrease BP

Question 21

Non-selective Beta blockers

Answer 21

B1 and B2 activty

Question 22

Cardioselective Beta Blockers

Answer 22

B1 activity only

Question 23

Non-selective Beta Blockers MOA

Answer 23

antagonist at B1/B2 receptors

Question 24

Propranolol (Inderal) Dose and Frequency

Answer 24

160-480mg, BID

Question 25

Propranolol long-acting (Inderal LA) Dose and Frequency

Answer 25

80-320 mg, Daily

Question 26

Non-selective Beta Blockers Clinical Considerations

Answer 26

Avoid pt with reactive airway disease

Question 27

Non-selective Beta Blockers Clinical uses...

Answer 27

``` Angina Post MI CV event prevention Atrial fibrillation/flutter supraventriclar arrhythmias migraine prophylaxis Tremors ```

Question 28

Atenolol (Tenormin) Dose and Frequency

Answer 28

25-100, Daily

Question 29

Which Beta blocker should someone with asthma take?

Answer 29

B1 blocker

Question 30

Metoprolol Succinate (Toprol XL) Dose and Frequency

Answer 30

50-400mg, Daily or BID

Question 31

Metoprolol Tartrate (Lopressor) Dose and Frequency

Answer 31

50-200mg, BID

Question 32

B1 Selective Blockers Clinical indications

Answer 32

``` Angina Post MI CV event prevention Atrial fibrillation/flutter HF migraine prophylaxis ```

Question 33

Carvedilol (Coreg) Dose and Frequency

Answer 33

6.25-50mg, BID

Question 34

Carvediolol (Coreg CR) Dose and Frequency

Answer 34

20-80mg, Daily

Question 35

Labetalol (Normodyne) Dose and Frequnecy

Answer 35

200-800mg,BID

Question 36

Mixed A1/Beta Blockers

Answer 36

Carvediolol | Labetalol

Question 37

Mixed A1/Beta Blockers Clinical Considerations

Answer 37

Carvedilol = mortality benefit in HF after stabilized Labetalol = increased safety data in pregnancy, hypertensive emergency (IV)

Question 38

Are Beta Blockers 1st line for uncomplicated HTN?

Answer 38

no

Question 39

Who should use Beta Blockers?

Answer 39

pt with HTN plus compelling co-existing condition (HF, Post-MI, Angina)

Question 40

B1 selective blockers

Answer 40

Atenolol | Metoprolol

Question 41

Non-selective Beta Blockers

Answer 41

Propranolol

Question 42

Beta Blocker Clinical Considerations

Answer 42

abrupt discontinuation can cause rebound HTN Can cause fatigue ppl with Asthma should avoid (use cardioselective if have to) caution use with COPD

Question 43

ADE Beta Blockers

Answer 43

Bronchspasm, worsen asthma Cold hands, feet Bradycardia Fatigue masked signs and symptoms of hypoglycemia except sweating insomnia, sex dysfunction

Question 44

Beta Blocker contraindications

Answer 44

SA or AV node dysfunction Decompensated HF Severe bronchospastic disease

Question 45

Beta Blocker Drug interactions

Answer 45

Non-DHP CCBs

Question 46

what to monitor when on Beta Blockers

Answer 46

BP HR BG if have diabetes Signs and symptoms of asthma/COPD

Question 47

What drug is Alpha-1 blocker?

Answer 47

Doxazosin

Question 48

What drug is Alpha-2 Agonist?

Answer 48

Clonidine