Pharm 6 Lecture

Question 1

What do we use phentolamine to treat?

Answer 1

Pheochromocytoma hypertension

Question 2

What is the “old school” use for phentolamine?

Answer 2

Give with levophed if you give the levo through peripheral line

given as local flood post levophed

Question 3

Phenoxybenzamine

Answer 3

Noncompetitive, somewhat alpha 1 selective blocker; long duration of action therefore ideal for long-term pheochromocytoma treatment

Question 4

Phenoxybenzamine trade names

Answer 4

dibenzyline, fenoxene

Question 5

Why aren’t phenoxybenzamine or phentolamine used for hypertension?

Answer 5

Decrease PVR = reflex tachycardia and reflex B1 stimulation (an A2 blocking effect)= NE release and increase CO

Question 6

Poorly specific alpha blocker side effects

Answer 6

Orthostatic hypotension
Vertigo
Tachycardia
Sexual dysfunction

Question 7

What are some alpha 1 (competitive) adrenergic blockers?

Answer 7

Prazosin (minipress)
Terazosin (Hytrin)
Doxazosin (Cardura)
Tamulosin (Flomax)
Alfuzosin (Uroxatral)

Question 8

What A1 adrenergic blockers are used extensively for the treatment of HTN?

Answer 8

Prazosin
Terazosin
Doxazosin

Question 9

What A1 adrenergic blockers are used for treatment of BPH?

Answer 9

Tamulosin
Alfuzosin
(Less vascular smooth muscle effect)

Question 10

What is the supplement that is A2 adrenergic blocker?

Answer 10

Yohimbine, stimulant contraindicated in CV conditions

Question 11

B Adrenergic Blockers end with….

Answer 11

“olol”

Question 12

B Blocker choice depends on….

Answer 12

Side effects

patient compliance and preference

Question 13

B Blocker: Cardiovascular Effects

Answer 13

1. Tx HTN (wont affect normotensive)
2. Negative inotropic
3. Negative chronotropic
4. Tx SVT (AV node conduction)
5. Prevent (B2 dilation)

Question 14

What do B blockers cause over time?

Answer 14

Reduction in SBP and DBP

Question 15

B Blocker: Pulmonary Effects

Answer 15

Bronchoconstriction (COPD/ashtma)

Question 16

How do B blockers affect the kidney?

Answer 16

Reduced renin –> lower bp

Question 17

How do B blockers affect the eyes?

Answer 17

Decreases aqueous humor; lowers intraocular pressure

Question 18

How do B blockers affect lipolysis?

Answer 18

Inhibits lipolysis

Increase in VLDL and decrease HDL (more bad)

Question 19

How do B blockers affect glyconolysis?

Answer 19

Inhibits glycogenolysis

inhibits glucagon release (over synergize w. insulin in Type I DM)

Question 20

What happens when you have a heart attack?

Answer 20

Body dumps catecholamines
Positive inotrope
Positive chronotrope

Question 21

How does B blocker treat HTN?

Answer 21

Decrease CO
Decrease renin
Decrease sympathetic outflow form CNS
decresaed vascular tone

Question 22

What else do B blockers treat?

Answer 22

Headaches

Hyperthyroidism and thyroid storm

Question 23

B Blocker Side effects

Answer 23

Bronchoconstriction
Arrythmias
Increase bad cholesterols
hypoglycemia
fatigue
sexual dysfunction

Question 24

Nonspecific B Blockers (B1 ~ B2)

Answer 24

Propanolol (Inderal)
Timolol (Betimol, Istaolol)
Nadolol (Corgad)

Question 25

What do nonspecific B blockers treat?

Answer 25

Angina
Arrythmias
Hyperthyroidism
HTN
Migraine Headaches

Question 26

Relatively Specific B Blockers (B1 > B2)

Answer 26

Esmolol (Brevibloc)
Atenolol (Tenormin)
Betaxolol (kerlone)
Nebivolol (Bystolic)
Metoprolol (Lopressor, Toprol-XL)

Question 27

What advantage do relatively specific B blockers have?

Answer 27

Safer to use in asthmatics

Question 28

Antagonists/Partial Agonist B Blockers

Answer 28

Acebutolol (B1) (Sectral)
Carteolol (Cartol)
Penbutolol (Levatol)
Pindolol (Viskin)

Question 29

B AND A1 Antagonists

Answer 29

Labetolol (Trandate)

Carvedilol (Coreg)

Question 30

What are B and A1 Antagonists useful for treating?

Answer 30

Peripheral vasodilation (A1) makes them useful for pregnancy HTN and CHF in elderly or black whose pressure is poorly controlled