Vasodilators and Sympatholytics DSA II Flashcards
beta3 agonist
nebivolol
propranolol
non-selective beta blocker
-decreased BP and CO
beta1 in kidney
blockade inhibits renin release
esmolol
not available oral
lipophilic sympathplegics
propranolol and penbutolol
asthma/COPD
adverse effects of beta-2 blockade with sympatholytics
diabetes
glycogenolysis blocked after beta-2 blockade
-use sympatholytics w/ caution
cardiac arrhythmias
caution sympatholytic use
-cardiac decompensation
side effect of sympatholytics
fatigue, bradycardia, sexual dysfunction, depression
chronic sympatholytic use
high lipid plasma leels
sudden sympatholytic withdrawal
rebound hypertension, angina, possible MI
drug-drug interactions sympatholytics
with CCBs - verapamil and diltiazem
-heart block
HTN Tx
metoprolol and atenolol
-beta-1 selective antagonist
carvedilol and labetalol
non-selective beta blockers
alpha 1 blockers
heart failure Tx
carvedilol, bisopril, metoprolol
-reduce mortality
-may worse CHF - careful long term use
bisoprolol
beta1 selective antagonist
ISA
intrinsic sympathomimetic activity
-labetolol, acebutolol, nevibutolol
non-ISA
no intrinsic sympathomimetic activity
-propranolol, carvedilol, metoprolol, atenolol
ischemic heart disease Tx
beta blockers - reduce angina episodes
- increased exercise tolerance
- timolol, metoprolol, propranolol - prolong survival after MI
cardiac arrhythmia Tx
beta blockers - supraventricular and ventricular arrhythmias
glaucoma Tx
topical timolol, btaxolol, carteolol
prazosin
alpha1 antagonist
- prevent constriction of arteries and veins
- BP reduced - decreased TPR
- relaxes prostate smooth m
- without diuretic - Na and water retention
does not effect alpha-2 receptor inhibition of NE release (decreased reflex tachycardia)
men with HTN and BPH
prazosin
central acting alpha-2 agonists
clonidine and methyldopa
-reduce sympathetic outflow from vasomotor centers of brainstem
rarely used today
pregnancy HTN
methyldopa
clonidine
decreases BP - via decreased CO and TPR
-sedation, dry month, depression, sexual dysfunction
methyldopa
lower BP by reducing TPR
- analog of L-dopa
- converted to alpha-methylnorepinephrine
-sedation dry mouth, lack of concentration, sexual dysfunction
HTN in pregnancy
stroke risk - SBP > 160 and DBP > 110
consider mother and fetus
drugs for HTN in pregnancy
acute - labetalol, hydralazine, CCB, nitro
chronic - methyldopa, labetalol, nifedipine, hydralazine
contraindicated for HTN in pregnancy
ACE (-), ARBs, direct renin inhibitors - fetal abnormalities
nitroprusside - CN poisoning
hypertensive emergency
> 180/120 with acute end organ damage
goal - gradual reduction of BP without excessive hypotension
most effective for hypertensive emergency
sodium nitroprusside
-long term - possible CN poisoning
cardiac ischemia or after coronary bypass surgery with hypertensive emergency
nitroglycerin
hypertensive emergency meds
nicardipine, clevidipine - DHP-CCB
fenoldopam - dilates renal arteries - good choice for pt with renal dysfunction
hydralazine - pregnancy related to eclampsia
phentolamine
alpha-blocker
- treat pts with HTN due to elevated catecholamines
- cocaine intox, pheochromocytoma
esmolol
rapid, short acting beta1 blocker
-treat aortic dissection or post-op HTN
labetolol
alpha and beta blocker
-safe for patients with active coronary disease
initial monotherapy in essential HTN
thiazide ACE (-) ARB CCB **beta blockers NOT used unless specific indication
black pt with essential HTN
better to thiazide diuretics and CCBS
-worse to ACE (-) and beta-blockers
monotherapy vs. polytherapy in HTN
mono - pt compliance, decreased cost, less adverse effects
poly - each drug acts on one of set of interacting mutually compensatory mechanisms
-decreased toxicity (2-3 drugs at low dose as opposed to one at higher dose)
example HTN combo drugs
ACE (-) and CCB
-trandolapril/verapamil
ACE (-) and diuretic
-benazepril/HCTZ
ARB and diuretic
-valsartan/HCTZ
beta-blocker and diuretic
-propranolol/HCTZ
central agent and diuretic
-reserpine/chlorothiazide
diuretic and diuretic
-spironolactone/HCTZ
triple drug regimens
thiazide diuretic, DHP-CCB, and
-ACE (-), ARB, or renin (-)
