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P&T Block 1 > L8 > Flashcards

L8 Flashcards

1
Q

4 A1 blocker effects

A
  1. ↓BP
  2. Dilate eye
  3. Relax GU smooth muscle
  4. ↓Viscous salivation
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2
Q

3 A2 blocker effects

A

Blocks A2 autoreceptor that normally stops NE release

  1. ↑NE - sympathetic effects (↑HR)
  2. ↑Insulin
  3. ↑GI motility
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3
Q

What are the effects of non-selective A1 & A2 block?

A

A1 block effects
+
B effects - ↑NE release (tachycardia, etc)

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4
Q

What kind of drugs are ergot alkaloids? Name 2.

A

Partial A1 and serotonin agonists
From infected grains
1. Ergotamine
2. Ergonovine

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5
Q

Use ergotamine

A

Vasoconstrict to abort migraine headaches

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6
Q

Use ergonovine

A

W/ oxytocin

Vasoconstrict POST-partum uterus -> prevent hemorrhage

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7
Q

What is ergotism?

A

Too much ergot in system

Vasospasm -> painful limbs -> peripheral gangrene

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8
Q

What are the 2 A1 & 2 non-selective blockers? What are the differences between them?

A
  1. Phenoxybenzamine
    - Irreversible
    - Long acting
  2. Phentolamine
    - Competitve
    - Short acting
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9
Q

Major use of A1 & 2 non-selective blockers

A

Before/during surgical resection of catecholamine secreting tumors
(1st alpha block, 2nd beta)

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10
Q

Do you use A1/2 non selective blockers to manage 1ary HTN?

A

NO

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11
Q

3 uses of prazosin and terazosin

A

A1 blockers

  1. 1ary HTN but not 1st line
  2. Vasodilate for peripheral vasc diseases
  3. Relax urinary smooth muscle
    - Pee out kidney stones
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12
Q

How does tamsulosin act differently than other A1 blockers?

A

A1a specific - in vascular smooth muscle most A receptor are b type
- Doesn’t change BP as much
Selectively relaxes urinary tract smooth muscle

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13
Q

Pathophys of benign prostatic hyperplasia - what can you use to treat it

A

Causes constriction of upper urethra –> incomplete bladder emptying –> ↑urinary freq
Use any of the A1 blockers

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14
Q

7 adverse effects of A1 blockers

A
  1. Postural hypotension - try to take meds at bedtime
  2. Nasal congestion since dilating
  3. Intraop floppy iris syndrome since relaxing smooth muscle of iris, avoid these drugs pre-cataract surg
  4. Retrograde ejaculation
  5. Delayed ejaculation
  6. Priapism = sustained, painful erection
  7. Dry mouth
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15
Q

Explain sympa activity vs A blocker activity at erectile tissue

A

Sympa = bind A receptor - contract vascular & trabecular smooth muscle –> faccid
A blocker = dilate smooth muscle –> ↑blood flow & collapse veins - erection

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16
Q

What are the expected cardiac outcomes of B blockers?

A

↓HR, CO
↓O2 demand
↓AV conduction velocity

17
Q

Effects of B blockers on electrolytes

A

Hypoglycemia

Hyperkalemia

18
Q

Other effects of B blockers

A 
↓Renin
Vasoconstriction
Bronchoconstriction
↓Tremors since ↑K uptake into muscle = muscle weakness
↑Mast cell degranulation
19
Q

5 CV indications to use B blockers

A 
Angina of effort
Post-infarction
Arrhythmias
Systolic HF
1ary HTN
20
Q

Which thyroid condition means you can use B blockers

A

Hyperthyroidism - short term management

21
Q

Why use B blockers for glaucoma?

A

↓Aqueous inflow –> ↓IOP

Use topically

22
Q

How would you take B blockers for migraines?

A

Prophylactic

23
Q

Adverse CV effects of B blockers

A

↓Exercise capacity
Bradycardia
AV conduction block
Exacerbate HR
Peripheral vasoconstriciton = cold extremities
Withdraw B super sensitivity - ↑ed risk for CAD pts

24
Q

Non-CV adverse effects of B block

A
  1. Asthma/COPD bronchoconstriction
  2. Mast cell destablize via B2 receptors - don’t use E to manage anaphylaxis
  3. Blunted signs or delayed recovery of hypoglycemia - don’t get the responsive sympo-adrenal discharge
  4. Exercise induced hyperkalemia as B2 ↑s K uptake in skeletal muscle –> weakness
25
Q

What do you need to worry about with topical B blocker application?

A

Getting into systemic circulation

26
Q

If a pt has a condition of adrenergic excess, what can result from use of B blockers?

A

Hypertensive emergency

27
Q

What is the difference between high and low lipid soluble beta blockers?

  • How excreted
  • Membrane crossing
A 
High = eliminated by liver metabolism, crosses BBB & placenta
Low = renal excretion
28
Q

Which pts would greatly benefit from use of partial B agonists?

A

Bradycardia

Partial conduction block

29
Q

What is the major advantage of using a B1 selective blocker?

A

Leave B2 alone = less risk non-CV adverse events

As you increase B1 selective blocker dose, this benefit decreases

30
Q

Which B blocker is used in eye drops?

A

Timolol = noselective blocker

31
Q

What are 2 B1 selective blockers?

A

Atenolol

Metoprolol

32
Q

What are 2 non-selective B blockers with additional vasodilator actions?

A

Carvedilol

Labetalol - alpha1 and B blocker

33
Q

What is the body’s response to BB given IV in an acute setting?

A

↓↓CO
↑TPR
- Not due to B2 block, due to reflex vasocontriction post ↓CO
No change BP

34
Q

What is the body’s response to BB given PO over a longer period of time?

A

↓TPR –> ↓BP

  • Not secondary to ↓CO - independent
  • Doesn’t bring you back to baseline, residual vasoconstriction means pts will complain of cold extremities
35
Q

Which BB is used in heart failure to prevent myocyte cell death? Mechanism?

A

Carevdilol

Signals through B arretins -> inhibits apoptosis -> ↑cardiomyocyte survival

36
Q

2 uses of B2 blockers

A

Chronic glaucoma - ↓aqueous inflow

↓tremors

P&T Block 1 (43 decks)

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