test 5 part 2

Question 1

Adrenergic Antagonists

Answer 1

▪ Smypatholytics
▪ Adrenoreceptor antagonists
▪ Adrenergic blocking agents
▪ These drugs block “fight or flight” response
–α Blockers
–β Blockers

Question 2

α Blockers

Answer 2

• profoundly affect BP
• blocks the binding of the ligand to the receptor
• end up with vessel dilation
• causes reflex tachycardia
• baroreceptors respond to decrease in BP so parasympathetic output decreases and sympathetic outflow increases

Question 3

types of α Blockers

Answer 3

▪ Non Selective α Blockers
▪ Selective α1 Blockers
▪ Selective α2 Blockers

Question 4

what does α1 do

Answer 4

– Increased vascular tone

Question 5

what does α2 do

Answer 5

– Control release of norepinephrine

– Inhibitory autoreceptors

Question 6

Phenoxybenzamine (Dibenzyline) uses

Answer 6

• Pheochromocytoma which is a tumor in the adrenal gland which causes too much catecholomine release (body has higher levels of epi and NE => sympathetic stimulation
• phenoxybenzamine blocks all of the receptors that the catecholomines are acting at

Question 7

Phentolamine (Regitine) uses

Answer 7

– Short term treatment of pheochromocytoma
– Locally to prevent dermal necrosis when NE given peripherally
– Given locally post NE extravasation
– Epinephrine reversal

Question 8

Nonspecific α Blocker Side Effects

Answer 8

• Orthostatic hypotension (lying down you feel fine then when you stand up and get really light headed)
• Dizziness and headache
• Tachycardia
• Sexual dysfunction

Question 9

Selective α1 Blockers

Answer 9

▪ Competitive
▪ Decrease PVR and lower BP
▪ Minimal changes in cardiac output
▪ First dose may produce orthostatic hypotension

Question 10

β Adrenergic Blockers “-olol”

Answer 10

▪ Competitive antagonists 
▪ Vary in
        – Selectivity
        – Intrinsic sympathomimetic activity
        – CNS effects
        – Vasodilatory effects
        – Pharmacokinetics

Question 11

β Adrenergic Blockers dosing

Answer 11

▪ Choice depends on side effects, patient compliance and preference
▪ Dosing must be individualized due to differences in base catecholamine levels, receptor density and variable cellular responses

Question 12

β Adrenergic Blockers used to treat

Answer 12

▪ Hypertension
▪ Angina
▪ Cardiac arrhythmias
▪ Myocardial infarction
▪ Heart failure
▪ Hyperthyroidism
▪ Glaucoma
▪ Migraine prophylaxis

Question 13

Blockade of the β1 Receptors

Answer 13

• Decreases force of heart
• decreases HR
• Decreases renin secretion

Question 14

Blockade of the β2 Receptors

Answer 14

• Increase airway resistance

- Increase vascular resistance

Question 15

β Adrenergic Blockers types

Answer 15

▪ Nonselective β blockers
▪ Selective β blockers
▪ Antagonists and partial agonists
▪ β and α blockers

Question 16

Propranolol Cardiac Effects

Answer 16

▪ Negative inotrope
▪ Negative chronotrope
▪ Reduces cardiac output, workload, and oxygen consumption

Question 17

Propranolol Vascular Effects

Answer 17

▪ Prevents β2 mediated vasodilation in skeletal muscles
▪ PVR increases
▪ CO reduction triggers reflex peripheral vasoconstriction
▪ PVR returns to normal or decreases with long term use

Question 18

Propranolol Bronchial Effects

Answer 18

▪ Blockade of β2
receptors causes constriction of bronchial smooth muscle
▪ Contraindicated in patients with asthma or COPD!

Question 19

Propranolol Glucose effects

Answer 19

▪ Decreased glycogenolysis
▪ Decreased glucagon secretion
▪ Hypoglycemia

Question 20

Propranolol Drug Interactions with Isoproterenol (nonselective β1 and β2 agonist)

Answer 20

▪ Blocks the action of Isoproterenol
– No cardiac stimulation (β1)
– No reductions in MAP and diastolic BP (β2)

Question 21

Propranolol Drug Interactions with epinephrine

Answer 21

▪ Blocks some actions of Epinephrine
– No cardiac stimulation (β1)
– No reductions in MAP and diastolic BP (β2)
– Still get vasoconstriction (α1)

Question 22

Propranolol Therapeutic Uses for hypertention

Answer 22

– Decreased cardiac output
– Inhibition of renin release (don’t have angiotensin)
– Decrease in total PVR with long term use
– Decreased sympathetic outflow from CNS

Question 23

Propranolol Therapeutic Uses for long term angina

Answer 23

– Decreases oxygen requirement of the heart muscle

Question 24

Propranolol Therapeutic Uses for Myocardial infarction

Answer 24

– Protective effect for future MI
– Reduces infarct size and hastens recovery
– Reduces sudden death post MI

Question 25

Propranolol Therapeutic Uses for migraine

Answer 25

– Prophylactically

– Enters CNS

Question 26

Propranolol Therapeutic Uses for hyperthyroidism

Answer 26

– Blunts the widespread sympathetic stimulation

Question 27

Propranolol Adverse Effects

Answer 27

▪ Bronchoconstriction
▪ Arrhythmias
▪ Sexual impairment
▪ Metabolic disturbances
▪ CNS effects

Question 28

Propranolol Adverse Effects: Bronchoconstriction

Answer 28

• blocks β2 receptors not allowing them to bronchodilate

- don’t use with asthma or COPD

Question 29

Propranolol Adverse Effects: Arrhythmias

Answer 29

– Long term use leads to receptor up-regulation
– Abrupt discontinuation can lead to severe arrhythmias and worsen angina or hypertension
- NEVER STOP ABRUPTLY

Question 30

Propranolol Adverse Effects: Metabolic disturbances

Answer 30

– Hypoglycemia β2
– Increased LDL
– Increased triglycerides β3 in the fats so it is not breaking down
– Decreased HDL

Question 31

Propranolol Adverse Effects: CNS effects

Answer 31

– Depression 
-Dizziness 
-Lethargy 
-Weakness
– Visual disturbances 
-Hallucinations 
-Vivid dreams 
-Short term memory loss

Question 32

Selective β1 Blockers

Answer 32

▪ Minimize the unwanted bronchoconstriction

▪ Cardioselectivity lost at high doses and start to block the β2 receptor

Question 33

Selective β1 Blockers

Therapeutic Uses

Answer 33

▪ Lower blood pressure in hypertension
▪ Increase exercise tolerance in angina
▪ Chronic stable angina therapy
▪ Chronic heart failure management

Question 34

Acebutolol (Sectral) therapeutic uses

Answer 34

– Hypertension with bradycardia

▪ Further decrease in heart rate is less pronounced

Question 35

Nonselective β Blockers with α1 Blocking Actions

Answer 35

▪ Produce peripheral vasodilation (block α1)
– Other β blockers produce an initial increase in PVR
▪ Reduce blood pressure

Question 36

Nonselective β Blockers with α1 Blocking Actions Therapeutic Uses

Answer 36

▪ Pregnancy induced hypertension

▪ Hypertensive emergencies (IV)