Lecture 6 Flashcards
Adrenergic Antagonists are also called: (3)
Adrenoreceptor antagonists
Sympatholytics
Adrenergic Blocking Agents
Adrenergic antagonists are usually ____ blockers and no ____.
Alpha 1 and Beta 1 blockers
No dopaminergic
What type of receptor is Phentolamine?
Competitive, non-selective alpha blocker
Duration of Regitine
Long acting about 4 hours
_____ is the short-term treatment of pheochromocytoma hypertension
Phentolamine (Regitine)
What is pheochromocytoma hypertension?
Rare tumor on the adrenal gland that causes too much secretion of epinephrine and norepinephrine.
Antagonist for Levophed in the case of infiltration or extravasation.
Regitine
Receptor actions of Phenoxybenzamine (Dibenzyline, Fenoxene)
Non-competeive alpha-1 selective blocker
Duration of Phenoxybenzamine (Dibenzyline, Fenoxene)
longer
Phentolamine (Regitine) is the ____ term treatment of pheochromocytoma hypertension.
Short
____ is the ideal treatment for long-term pheochromocytoma.
Phenoxybenzamine (Dibenzyline, Fenoxene)
Phentolamine causes ____ reversal.
What changes in VS would you expect to see?
Epinephrine
Decreased blood pressure
Side effects of poorly specific alpha blockers (4)
Orthostatic hypotension
Vertigo
Tachycardia
Sexual dysfunction
Phenoxybenzamine (Dibenzyline, Fenoxene) is the ideal ____-term treatment for pheochromocytoma.
Long
Phentolamine (Regitine) is the short term treatment of ______.
Pheochromocytoma hypertension
Why aren’t Phenoxybenzamine and Phentolamine not used for hypertension?
They decrease PVR = reflex tachycardia and reflex B1 stimulation (alpha 2 blocking effect) = norepi release and increase CO = ineffective HTN control
Phenoxybenzamine (Dibenzyline, Fenoxene) is the ideal long-term treatment of _____.
Pheochromocytoma
Alpha Adrenergic Blockers: (5)
Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura) Tamulosin (Flomax) Alfuzosin (Uroxatral)
Receptor effects of: Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura) Tamulosin (Flomax) Alfuzosin (Uroxatral)
Competeive and very alpha-1 selective blockers
Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura)
Are used extensively in the treatment of _____.
HTN
Tamulosin (Flomax)
Alfuzosin (Uroxatral)
have ____ muscle effect and are used for ____.
Less vascular smooth muscle
BPH
Alpha 2 adrenergic blockers (1)
Yohimbine
Why is Yohimbine contraindicated in CNS and CV conditions?
Because it is a stimulant
Most Beta Adrenergic Blockers end in “___”
olol
Beta Adrenergic Blockers are widely used in medicine and choose depends mostly on ____ and ____.
Side effects
Patient compliance and preference
Dosing of Beta-Adrenergic Blockers must be ____.
individualized
Which Alpha Adrenergic Blockers are used to treat HTN?
Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura)
What does beta 1 blockade cause?
Increase BP
What does partial Beta 2 activity cause?
Vasodiltion
All beta adrenergic blockers are ____, some also ____.
Antihypertensive
Block renin release from kidneys
Inotropic and chronotropic effects of beta adrenergic blockers:
Negative inotropic (decreases CO) Negative chronotropic (decreases HR)
Why are beta blockers a good treatment for SVT?
The negative chronotropic effect causes a decrease in SA and AV node conduction which lowers heart rate
Which Alpha Adrenergic Blockers are used to treat BPH?
Tamulosin (Flomax)
Alfuzosin (Uroxatral)
Beta blockers prevent ______.
Beta 2 mediated reflex vasodilation
What affect do beta blockers have on BP over time?
Causes decrease in SBP and DBP
Pulmonary effects of beta adrenergic blockers:
Bronchilar smooth muscle constriction particular in patients with COPD or asthma
Renal effects of beta adrenergic blockers:
Blocks production of renin contributing to decrease BP
Beta Adrenergic Blockers are used in the treatment of _____, but do not affect normotensive patients.
HTN
Beta blocker effects on lipids.
Inhibits lipolysis and causes increased VLDL (bad) and lowers HDL (good)
Beta blocker effects on glucose
Inhibits glycogenolysis and glucagon release which can over-synergize with insulin in Type 1 DM
1 organ beta blockers work on:
Heart
B1 antagonists block the ____ response.
Fight or flight
Decreased cardiac output caused by beta blocks cause reflex ____.
Vasoconstriction
Beta blockers ____ the size of evolving MI.
Decrease
Beta blockers are used to treat long-term management of _____.
Stable angina
Why are beta blockers used to treat HTN? (3)
Decrease CO
Decrease renal renin release
Decrease sympathetic outflow from CNS thus decreasing vascular tone
____ block the fight or flight response.
Beta 1 Antagonists
Beta blockers aid in the treatment of ______.
Migraine HA
Beta bockers ___ recovery time post MI.
Decrease
Beta blockers are used to treat ____-term management of stable angina.
Long
Beta blockers can be used to treat what type of thyroid problem? Why?
Hyperthyroidism
Thyroid Storm
B/C these result in massive sympathetic stimulation
Thyroid storm is very serious and can result in: (4)
Afib
Heart failure
Coma
Hyperthermia
6 Beta Blocker Side Effects
1) Difficulty breathing
2) Arrhythmias
3) Affect triglycerides (increase bad and lower good)
4) Mask signs of hypoglycemia
5) Trouble sleeping (decreases nocturnal production of melatonin)
6) Decrease sex drive
Beta blockers ____ the likelihood of a future MI.
Decrease
3 Nonspecific B1 and B2 Blockers drugs
Propanolol (Inderal)
Timolol (Betimol, Istaolol)
Nadolol (Corgard)
What are nonspecific B1 and B2 blockers used for?
Angina Arrhythmias Hyperthyroidism HTN Migraine HA
5 relatively specific B1 > B2 drugs
Esmolol (Brevibloc) Atenolol (Tenormin) Betaxolol (Kerlone) Nebivolol (Bystolic) Metoprolol (Lopressor, Toprol-XL)
Difference between non-specifics and relatively specific beta blockers?
Treat similar disease processes
Relatively specific SAFER to use in asthmatics
Fast acting use possibly needed with asthmatics
Brevibloc
4 Antagonists / Partial Agonists drugs
Acebutolol (B1) (Sectral)
Carteolol (Cartrol)
Penbutolol (Levatol)
Pindolol (Viskin)
Antagonists / Partial Agonists uses and characteristics
HTN with bradycardia Possess mild intrinsic sympathetic activity (ISA) Less cardiac depression Less lipid dyscrasias (disease) Not used for arrhythmias
2 Beta and Alpha 1 Antagonists Drugs
Labetolol (Trandate)
Carvedilol (Coreg)
Effects of Beta and Alpha 1 Antagonists
Peripheral dilation due to alpha 1 blockage
What groups of people can beta and alpha 1 antagonists be used in?
Pregnancy HTN
CHF in elderly
AA with poorly controlled BP
