Adrenergic Blocking Agents Flashcards by Lauren F

Which drug is used to treat stage fright

Propranolol

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What happens to the heart when you block B receptors

Decreased HR

Decreased contractility

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What happens if you take a calcium channel blocker with propranolol?

The effects are additive- you get an AV block

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Will alpha blockers help you ejaculate or make it harder?

Inhibits ejacyulation

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B3 receptor stimulation will have this effect

Lipolysis

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What does Metyrosine (Demser) do?

It is a tyrosin analogue that blocks the rate limiting step in the synthesis of dopamine, so you can’t make NE and Epinephrine

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What happens to peopel with asthma when you give them beta blockers?

They die - bronchoconstriction

A B1 selective blocker may be tolerated

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What receptors are blocked by phentolamine

a1 and a2

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What happens to peripheral resistance in the short term when you first start B-blockers?

Peripheral resistance increases

CO will be reduced, which will stimulate SNS activity, and skeletal muscle vasculataure will dilate due to B2 block

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What happens if you abruptly stop B blockers?

Arrhythmia- your B-receptors get upregulated while you’re on the drug

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B-blockers are great for reducing intraocular pressure in ppl with glaucoma, but some shouldn’t be used. Why?

Do not use the ones that cause local anesthesia in the eye- may accidentally scratch cornea and not know it

(Acebutolol, labetalol, metoprolol, pindolol, propranolol)

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What are the 2 non-selective B-blockers with ISA?

Pindolol (Visken)

Carteolol (Cartol)

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Do we use Guanethidine today?

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If a receptors are blocked, _____ receptors may become dominant

(Especially if a drug blocks a1 and a2 since stimulation of a2 receptors normally INHIBITS NE release.) Removing this modulation will ENAHNCE the release of NE and B receptor stimulation will be more pronounced

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Will you get more or less nasal congestion if you give an alpha blocker?

Increased nasal stuffiness due to vasodilation in the nasal mucosa

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Metoprolol, Atenolol, and Bisoprolol will affect which receptor?

B1 only!

Decreased HR

Decreased Contractility

Decreased Renin

Decreased AV node conduction

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What kind of B blocker should you take if you are an insulin dependent diabetic

B1 specific- will have less effect on glycogenolysis

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What is special about esmolol (Breviblock)

VERY short acting B1 blocker

IV only

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What is meant by an epinephrine reversal?

Blocking of the a receptors exposes effects of B stimulation, so you get decreased BP and increased HR

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Phentolamine, prazosin, doxazosin and terazosin are (reversible/irreversible) antagonists

Reversible

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What is the only B1 selective blocker that has ISA?

Acebutolol (Sectral)

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If you give epinephrine and your patient is on propranolol, what will happen to their HR and Contractility?

Nothing will happen

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Alpha blockers have what effect on peripheral vascular resistance

Lowers- decreases blood pressure

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What is a good beta-blocker to put diurectly in your eye for glaucoma treatment and will be safer for asthmatics?

Betaxolol (Betoptic)

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The effect of an adrenergic blocker depends on the _________ of the tissue and the _______ of the drug

Prevailing adrenergic tone Selectivity for α and β receptors

What drugs are used for pheochromocytoma?

Phenoxybenzamine (long term blocking of epinephrine) Phentolamine- hypertensive crisis

Phenoxybenzamine is (long/short) acting

Very long- it’s an irreversible alpha blockade

A competitive antagonist will shift the dose response curve to the _________ and the maximum effect (stays the same/decrease)

Right, Stays the same

Stimulation of a2 receptors will cause:

Decreased NE Decreased insulin (So what would happen if you blocked these receptors?)

If your patient is on phentolamine, what happens to the HR and BP if you give them Epinephrine?

The a-blocker allows the B2 vasodilation effect of epinephrine to be dominant, so that BP is decreased, rather than increased. Effects of epinephrine now resemble isoproterenol

Phenoxybenzamine is the only (reversible/irreversible) alpha antagonist

Irreversible

Which 2 drugs will block B1, B2, and a1 receptors?

Carvedilol (Coreg) Labetalol (Normodyne)

Postural hypotension May occur if you block this receptor: ________

a1 If its blocked in venous smooth muscle, and the pt stands up the BP will drop too much

Which B-blockers can be used as local anesthetics?

Acebutolol Labetalol Metoprolol Pindolol Propranolol

What do we use Tamsulosin for?

BPH. Easy to peeeee

An irreversible/non competitive antagonist will cause the dose-response curve to shift the the _______ and the max response will (decrease/stay the same)

Right Decrease

What does yohimbine do to your body?

Blocks a2 receptors, so it will increase NE release. BP and HR go up (Sold as an herbal viagra)

B2 receptor stimulation has these effects:

Relax the bronchioles Dilate blood vessels to skeletal muscle Dilate coronary and cerebral arteries Increase glycogenolysis

What do you need to tell your patient to do when they are starting an alpha blocker?

Take first dose at bedtime becasue it causes a HUGE drop in BP and postural hypotension for 30-90 minutes after the first dose

What is the main side effect of tamsulosin?

Ejaculation dificulty | Remember it targets the a1A subtype on the prostate

If you injected epinephrine right into the tip of your patients fingers and it starts to turn cold and white and you’re worried about necrosis, what drug is given to reverse that?

Phentolamine

What is labetalol used for?

Given IV for hypertensive Emergencies

What are the benefits of B blockers that have ISA?

May reduce risk of bronchoconstriction and bradycardia Lipid panels stay normal

What drug is used directly in the eye to treat glaucoma, but should NOT be given to asthmatics in case they swallow a bit, since it is a non-selective B-blocker?

Timolol (Timoptic)

B1 receptors (increase/decrease) renin secretion

Increase

What will an a2 blocker cause?

Increased NE release Increased secretion of insulin

What is the main use of Carrvedilol (Coreg)?

- hypertension - CHF-extends life - Post MI Cardiologists LOVE Carvedilol!!!! One of the MOST prescribed drugs

Drugs that block a1 receptors can cause these effects:

Decrease blood pressure Orthostatic hypotension Miosis Make it easier to urinate Inhibit ejaculation

What is meant by a B-blocker having ISA (intrinsic sympathetic activity)

It has some partial agonist activity - will stimulate the receptors when sympathetic activity is low - but, will reduce the effects when activity is high (lots of NE and Epi floating around)

What class of drugs is often prescribed to men with BPH to help them urinate?

Alpha blocker

What drugs will increase the effect of propranolol?

Ones that inhibit P450 Cimetidine*** And chlorpromazine

What class of drugs will inhibit lipolysis, preventing you from using your fat stores for energy?

B-blockers

What kind of B blocker should you take if you would like to preserve your exercise tolerance?

B1 selective

If your pt is on a-blockers and you give them norepinephrine, what will happen?

Alpha effects will be blocked/ | NE has alpha and beta effects

What kind of beta blockers will have fewer effects on your lipid panel?

B blockers with ISA (Instrinsic sympathetic activity)

What will happen if your patient is on phenoxybenzamine and you give them a SHIT TON of norepinephrine?

Nothing. Phenoxybenzamine is irreversible and can not be overcome

What condition do we treat with Metyrosine?

Pheochromocytoma

Is it OK to give Carevedilol and Labetalol to asthmatics?

NO they are non-specific B blockers

Which receptors does Yohimbine affect?

Blocks α2 receptors

If your pateitn is on prazosin and you give them a SHIT TON of norepinephrine, what will happen?

You will see effects of NE, like increased HR and BP, since prazosin is reversible/competitive alpha antagonist

What do we use the “zosins” for? | Prazosin, terazosin, doxazosin, alfuzosin

Treating HTN | Decreases vascular resistance

A1 receptor stimulation normally produces these types of physical effects:

Vasoconstriction Mydriasis Decreased GI tone Contraction of bladder sphincters Ejaculation (Soooo what would happen if you blocked these....)

Should you give Carvedilol to your patient with end stage CHF to extend his life?

No, do not give in end stage CHF OK the rest of the time in CHF and post MI

What is the only beta blocker you can say is a vasoDILATOR due to it releasing NO?

Nebivolol (Bystolic)

What are the 2 reasons alpha blockers can cause reflex tachycardia?

1. Decreased BP tells baroreceptors to increase sympathetic stimulation and decrease vagal tone 2. If the drug also blocks a2 receptors, NE release will be increased and cause further stimulation of B receptors in the heart

What populations should you be careful giving B-blockers to?

- asthmatics | - Type I diabetics- hard to recover from hypoglycemia

Why do you still have to be cautious with asthmatics when giving B1-selective blockers?

The selectivity decreases as the dose goes up

Will an alpha blocker make it easier or harder to urinate?

Easier

Will phentolamine cause cardiac stimulation?

Yes, due to the increased NE release (a2 blockade) and the baroreceptor reflex

Why doesn’t tamsulosin cause orthostatic hypotension like all the other a blockers?

It is selective for α1A subtype !! ``` α1A = prostate α1B= blood vessels ```

What drug will Yohimbine interfere with?

Clonidine- BP will jump Yohimbine= a2 blocker Clonidine= a2 agonist

What does Guanethidine do?

Inhibits release of NE from nerve terminals

What drug willl decrease mortality after an MI and improve symptoms of angina

Propranolol | Decreases O2 demand

What is a side effect of labetalol (normodyne)?

Hepatotoxicity (Maybe the reason it’s only used for hypertensive emergencies?

What does reserpine do?

Completely eliminates all of your sympathetic systems: Depletes NE, dopamine, and serotonin Terrible drug, not used clinically

What effect do B-blockers have on intraocular pressure?>

Decreases -lowers the production of aqueous humor

What happens to the iris if you give an alpha blocker?

Miosis | Relaxation of the iris radial muscle

Will B-blockers stimulate/inhibit glycogenolysis?

Inhibit

If your patient is on a-blockers, what will happen if you give them phenylephrine?

Phenylephrine is a pure alpha agonist, so its effects will be totally blocked

What class of drugs is associated with a “first dose phenomenon”?

Alpha blockers: Phentolamine Phenoxybenzamine Prazosin Terazosin Doxazosin Alfuzosin (NOT tamsulosin- very little effect on BP)

Which B-blocker can enter the CNS and can cause sedation?

Propranolol | It is lipid soluble

Wanna see a list of all the things propranolol does?

Decrease BP with chronic use Decrease mortality following MI Improves angina Anti arrhythmic Early CHF lower HR for hyperthyroidism Prevent migrainss Decrease portal vein pressure/reduce bleeding in cirrhosis Decrease stage fright

Adrenergic Blocking Agents Flashcards

(82 cards)