beta blockers 2

Question 1

preganglionic fibers are

Answer 1

myelinated, rapid

Question 2

post ganglionic

Answer 2

un-myelinated, slower

Question 3

sns arise from

Answer 3

thoracolumbar outflow

Question 4

adrenal medulla releases

Answer 4

epinephrine

Question 5

pns arise from

Answer 5

craniosacral outflow

Question 6

2 types pns receptors

Answer 6

nicotinic, muscarinic

Question 7

what breaks down acetylcholine

Answer 7

acetylcholinesterase to choline and acetic acid

Question 8

norepinephrine is broken down by what in the nerve synapse

Answer 8

MAO or sequestered in storage vesicles for release

Question 9

norepi that diffuses away from synapse is inactivated by

Answer 9

COMT

Question 10

beta 1 effects with agoinism

Answer 10

increased HR
increased conduction
increased contractility
increased renin releast
(ALL EFFECTS ON HEART)

Question 11

beta 2 effects with agonism

Answer 11

skeletal muscle relaxation
bronchodilation
gluconeogenesis
glycogenolysis
vasodilation (some)

Question 12

alpha1 actions with agonsm

Answer 12

works on arterial blood vessels
increases constriction
increases BP
can cause reflex bradycardia secondary to baroreceptor mediated reflex

Question 13

alpha2 actions with agonism

Answer 13

negative feedback, when receptor is activated there is a decrease in norepi release, when blocked NE release increases

Question 14

s/e alpha block

Answer 14

orththostatic hypertension, baroreceptor med. tachycardia

Question 15

which alpha blocker causes covalent binding

Answer 15

phenoxybenzamine

Question 16

which alpha blockers are reversible

Answer 16

prazosin, yohimbe, phentolamine

Question 17

phenolamine

Answer 17

nonselective alpha blocker. tx htn emergency, hyperreflexia, pheochromo, reversible binding

Question 18

effects of phentolamine

Answer 18

decreased bp due to vasodilation (peripheral), hr increased, co increased

Question 19

phenoxybenzamine

Answer 19

nonselective alpha blocker

Question 20

uses phenoxybenzamine

Answer 20

excesive vasoconstriction secondary to shock but only after volume rescucitation

Question 21

effects phenoxybenzamine

Answer 21

vasodilation, decreased bp

Question 22

what cannot happen with phenoxybenzamine

Answer 22

compensatory vasoconstriction, get large drops in bp

Question 23

1/2 life phenoxybenzamine

Answer 23

24 hours

Question 24

onset phenoxybenzamine

Answer 24

60 minutes

Question 25

onset phentolamine

Answer 25

2 min, duration 10-15

Question 26

prazosin

Answer 26

selective alpha 1, less liekely to cause tachycardia. dilates arteries and veins

Question 27

yohimbe

Answer 27

selective alpha 2, increased release norepinephrine used to treat idiopathic orthostatic htn

Question 28

gold standard beta blocker

Answer 28

propanolol

Question 29

do b blockers cros bbb

Answer 29

yes and placenta can cause hypoglycemia, bradycardia and hypotension in fetus

Question 30

what are all beta antagonists derived from

Answer 30

isoproterenol

Question 31

partial antagonist

Answer 31

presece of intrinsic sympathomim activity

Question 32

pure antagonist

Answer 32

absence of intrinsic sympatho activity

Question 33

beta blockers with intrinsic activity

Answer 33

timolol, pindolol, acebutalol

Question 34

selective beta blockers beta 1

Answer 34

metoprolol, esmolol, atenolol

Question 35

metoprolol effects

Answer 35

negative inotrope and chronotrope. 10% protein binding, 1/2 time 3-4 hours

Question 36

atenolol

Answer 36

renal excretion 1/2 time 6-7 hours | no insulin induce hypoglycemia, may be used in diabetics

Question 37

esmolol

Answer 37

5 min onset, 10-30 min duration 1/2 life 9 minutes. rapid ester hydrolysis

Question 38

propanolol

Answer 38

pure antagonist, decreases hr and cardiac output,decreases peripheral vascular return, increase myocardial o2, but with decrease hr and contractility decreases myocardial o2

Question 39

propanolol metabolism

Answer 39

hepatic, 70% on first pass, 90-95% protein bound 1/2 time 2-3 hours

Question 40

nadolol

Answer 40

no metabolism, excreted unchanged in urine, 1/2 time 20-40 hours

Question 41

pindolol

Answer 41

partial antagonist, minimal resting bradycardia 40-60% protein bound, 1/2 time is 3-4 hours

Question 42

timolol

Answer 42

elimination 1/2 time 4 hours, tx glaucoma

Question 43

contraindications to beta blockers

Answer 43

prexist av block or heart failure not caused by tachycardia, diabetics secondary to hypoglycemia masking

Question 44

if give beta blocker to hypovolemic pt with compensatory tachy what happens

Answer 44

profound drops in bp

Question 45

effects on heart represent

Answer 45

removal sns innervation

Question 46

weak left ventricle after beta blocker may

Answer 46

go into heart failure

Question 47

what happens with epi and beta blockers

Answer 47

may enhance vasodilatory effect

Question 48

pvd and beta blockers

Answer 48

may have cold hands/feet

Question 49

s/s excess myocardial depression

Answer 49

decreased hr, decreased co, hypotension, cardiogenic shock, bronchospasm, vent depression, seizures, prolonged intravent contraction

Question 50

tx myocardial depress

Answer 50

atropine 7mcg/kg then beta agonist isoproterenol or pure agonist glucadon which stimulates adenylate cyclase and intracellular cmp, pacer or HD

Question 51

potassium and beta blockers

Answer 51

when beta blocked stops facilitation of k intracellularlly and can increase k level

Question 52

s/e labetalol

Answer 52

orthostatic hypotension, heart block, chf

Question 53

labetalol is

Answer 53

alpha1 selective, beta1 and beta2 nonselective

Question 54

1/2 time labetalol

Answer 54

5-8 hours, prolonged with liver disease onset 5-10 minutes

Question 55

actions labetalol

Answer 55

decrease bp and svr, stops reflex tachycardia, co unchanged

Question 56

dose of labetalol

Answer 56

0.1-0.5mg/kg