Week 12 - Combined Alpha and Beta-Adrenergic Agonists and Antagonists

Question 1

Carvedilol: indications

Answer 1

• HTN
• HF w/ reduced ejection fraction
• Left ventricular dysfunction following MI

Question 2

Carvedilol: MOA

Answer 2

Nonselective beta receptor blockade and alpha-1 receptor blockade –> decrease BP and peripheral resistance

Combined effects decrease myocardial oxygen demand and lower cardiac workload

Question 3

Carvedilol: caution and contraindications

Answer 3

• Do not abruptly withdraw
• Avoid in patients with bronchospasms
• Avoid in severe hepatic impairment
• Avoid in patients w/ 2nd or 3rd degree AV block
• Avoid in patients with NYHA class IV HF
• Caution in peripheral vascular disease
• Caution in diabetic patients
• Caution in hyperlipidemia

Initiated by cardiologists in pediatrics

Question 4

Carvedilol: ADR

Answer 4

Hypotension (including orthostatic), dizziness, fatigue, weight gain, hyperglycemia, HA, N/V, impotence

Rare: anaphylactic reactions

Question 5

Labetalol: indications

Answer 5

HTN including severe acute

Question 6

Labetalol: MOA

Answer 6

Nonselective beta receptor blockade and alpha-1 receptor blockade –> decrease BP and peripheral resistance

Combined effects decrease myocardial oxygen demand and lower cardiac workload

Question 7

Labetalol: caution and contraindications

Answer 7

• Do not abruptly withdraw
• Avoid in patients w/ bronchospasms
• Avoid in severe liver impairment
• Avoid in patients w/ 2nd or 3rd degree AV block
• Avoid in patients w/ NYHA class IV HF
• Caution in peripheral vascular disease
• Caution in diabetic patients
• Caution in hyperlipidemia
• Compatible in pregnancy after first trimester

Question 8

Epinephrine: indications

Answer 8

Emergency treatment of type 1 allergic reaction (including anaphylaxis)

Question 9

Epinephrine: MOA

Answer 9

Decreases vasodilation and vascular permeability that occurs during anaphylaxis

Relaxes smooth muscles

Relieves bronchospasm, wheezing, dyspnea, pruritus, angioedema, urticaria

Question 10

Epinephrine: caution and contraindications

Answer 10

• Caution in cardiac disease
• Compatible in pregnancy and lactation
• Approved in pediatrics

Question 11

Epinephrine: ADR

Answer 11

Apprehensiveness, tremor, anxiety, weakness, HA, palpitations, angina, alterations in blood sugar, disorientation, HTN