Pharm 6 Lecture Flashcards
What do we use phentolamine to treat?
Pheochromocytoma hypertension
What is the “old school” use for phentolamine?
Give with levophed if you give the levo through peripheral line
given as local flood post levophed
Phenoxybenzamine
Noncompetitive, somewhat alpha 1 selective blocker; long duration of action therefore ideal for long-term pheochromocytoma treatment
Phenoxybenzamine trade names
dibenzyline, fenoxene
Why aren’t phenoxybenzamine or phentolamine used for hypertension?
Decrease PVR = reflex tachycardia and reflex B1 stimulation (an A2 blocking effect)= NE release and increase CO
Poorly specific alpha blocker side effects
Orthostatic hypotension
Vertigo
Tachycardia
Sexual dysfunction
What are some alpha 1 (competitive) adrenergic blockers?
Prazosin (minipress) Terazosin (Hytrin) Doxazosin (Cardura) Tamulosin (Flomax) Alfuzosin (Uroxatral)
What A1 adrenergic blockers are used extensively for the treatment of HTN?
Prazosin
Terazosin
Doxazosin
What A1 adrenergic blockers are used for treatment of BPH?
Tamulosin
Alfuzosin
(Less vascular smooth muscle effect)
What is the supplement that is A2 adrenergic blocker?
Yohimbine, stimulant contraindicated in CV conditions
B Adrenergic Blockers end with….
“olol”
B Blocker choice depends on….
Side effects
patient compliance and preference
B Blocker: Cardiovascular Effects
- Tx HTN (wont affect normotensive)
- Negative inotropic
- Negative chronotropic
- Tx SVT (AV node conduction)
- Prevent (B2 dilation)
What do B blockers cause over time?
Reduction in SBP and DBP
B Blocker: Pulmonary Effects
Bronchoconstriction (COPD/ashtma)
How do B blockers affect the kidney?
Reduced renin –> lower bp
How do B blockers affect the eyes?
Decreases aqueous humor; lowers intraocular pressure
How do B blockers affect lipolysis?
Inhibits lipolysis
Increase in VLDL and decrease HDL (more bad)
How do B blockers affect glyconolysis?
Inhibits glycogenolysis
inhibits glucagon release (over synergize w. insulin in Type I DM)
What happens when you have a heart attack?
Body dumps catecholamines
Positive inotrope
Positive chronotrope
How does B blocker treat HTN?
Decrease CO
Decrease renin
Decrease sympathetic outflow form CNS
decresaed vascular tone
What else do B blockers treat?
Headaches
Hyperthyroidism and thyroid storm
B Blocker Side effects
Bronchoconstriction Arrythmias Increase bad cholesterols hypoglycemia fatigue sexual dysfunction
Nonspecific B Blockers (B1 ~ B2)
Propanolol (Inderal)
Timolol (Betimol, Istaolol)
Nadolol (Corgad)
What do nonspecific B blockers treat?
Angina Arrythmias Hyperthyroidism HTN Migraine Headaches
Relatively Specific B Blockers (B1 > B2)
Esmolol (Brevibloc) Atenolol (Tenormin) Betaxolol (kerlone) Nebivolol (Bystolic) Metoprolol (Lopressor, Toprol-XL)
What advantage do relatively specific B blockers have?
Safer to use in asthmatics
Antagonists/Partial Agonist B Blockers
Acebutolol (B1) (Sectral)
Carteolol (Cartol)
Penbutolol (Levatol)
Pindolol (Viskin)
B AND A1 Antagonists
Labetolol (Trandate)
Carvedilol (Coreg)
What are B and A1 Antagonists useful for treating?
Peripheral vasodilation (A1) makes them useful for pregnancy HTN and CHF in elderly or black whose pressure is poorly controlled
