module 7 beta blockers

Question 1

B1 selective

Answer 1

affects B1

dec. HR and BP
- Atenolol (tenormin)
- Bisoprolol (zebeta)
- Metoprolol (lopressor, Toprol)
- Nebivolol (bystolic)

Question 2

Non selective BB

Answer 2

B1: heart -> dec. HR and BP
B2: lungs -> bronchoconstriction
- Carvedilol (coreg)
- Propranolol (inderal)

Question 3

BB mechanism of action

Answer 3

Fits into receptor sites, blocking epi and norepi released from nerve endings

• heart: dec. CO -> dec. BP
• kidney: dec. activation of B1 -> dec. renin -> dec. angiotensin –> dec. Na and H2O retention -> dec. Blood volume -> dec. CO -> dec. BP

Question 4

Benefits of beta blockade

Answer 4

dec. myocardial O2 demand
inc. ventricular filling (dec. HR)
antianginal
antiarrhythmic

Question 5

selective BB adverse effects

Answer 5

hypoTN
bradycardia 
heart block, heart failure 
fatigue 
dizzy

Question 6

BB black box warning

Answer 6

abrupt cessation with CAD -> exacerbation of angina, MI, and ventricular arrhythmias

Question 7

Mixed alpha-beta blockers

Answer 7

labetalol

carvedilol

Question 8

labetolol mechanism of action and use

Answer 8

stronger alpha blockage than beta blockade (3:1)

- tx HTN and HTN urgency

Question 9

carvedilol mechanism of action and use

Answer 9

nonselective beta blockade + a blockade

- tx: heart failure

Question 10

nonselective BB adverse effects

Answer 10

hyper/hypoglycemia 
hypoTN
bradycardia
hyperkalemia
hyperlipidemia

Question 11

a1 blockers

Answer 11

doxazosin
prazosin
terazosin
labetalol (stronger A antagonist than B)

Question 12

a1 blocker indications

Answer 12

HTN

BPH

Question 13

a1 Blocker adverse effects

Answer 13

• first dose effect: lack of vasoconstrivtive mechanism -> postural hypoTN
• dizziness/lightheaded
• palpitations
• hypoTN
• fluid and Na retention
  Contraindicated in: CV disease

Question 14

a1 blocker (a1 adrenergic receptor antagonist) mechanism of action

Answer 14

causes peripheral arterial and venous vasodilation by blocking effects of catecholamines on alpha receptors of the peripheral vascular

Question 15

central acting a2 receptor agonists

Answer 15

clonidine
methyldopa
guanfacine

Question 16

central acting a2 agonist indication

Answer 16

HTN

Question 17

central acting a2 agonists mechanism of action (methyldopa and clonidine)

Answer 17

reduces sympathetic outflow from vasopressor centers in brain stem and enhance PSNS activity -> dec. HR, CO, and total PVR

Question 18

central acting a2 agonist adverse effects (methyldopa, clonidine)

Answer 18

sedation
impaired concentration 
nightmares
depression
vertigo
extrapyramidal s/s
lactation in men 
ortho hypoTN
dizzy
dry mouth
Na and H2O retention

Question 19

methyldopa mechanism of action

Answer 19

converted to alpha-methydopamine and alpha-methylnorephinephrine in CNS
- stimulates central a2 -> dec. activity of vasomotor center
Renal blood flow maintain, good for renal disease

Question 20

clonidine site of action

Answer 20

CNS non-adrenergic binding sites

- agonizes a2 receptors

Question 21

clonidine route of admin

Answer 21

oral

transdermal: change every 7 days

Question 22

clonidine indication

Answer 22

HTN
induce sleep
minimize s/s of withdrawal from opiates or benzos

Question 23

clonidine contraindication

Answer 23

tricyclic antidepressant use

- inhibit norepi reuptake and block the effects of clonidine