Beta Blockers, Alpha Blockers, Alpha Stimulants, Emergencies, & Urgencies Flashcards
(149 cards)
1
Q
What are the sympathetic effects on alpha 1 receptors?
A
Vasoconstriction
Increased peripheral resistance
Mydriasis
Increased closure of internal sphincter of the bladder
2
Q
What are the big differences in the beta blockers?
A
Selectivity
3
Q
How do non-selective beta-blockers work?
A
Block both beta-1 and beta-2 receptor sites.
4
Q
How do selective beta-blockers work?
A
Specifically block beta-1 receptors.
5
Q
What is an example of a non-selective beta blocker?
A
Propanolol
6
Q
What is an example of a selective beta-blocker?
A
metroprolol
7
Q
How do beta-blockers with peripheral vasodilatory effects work?
A
Adds in an alpha-1 blockade effect.
Affects nitric oxide levels.
8
Q
What is an example of a beta-blocker which adds an alpha-1 blockade effect?
A
Labetolol
Carvedilol
9
Q
What is an example of a beta-blocker that affect nitric oxide levels?
A
nebivolol
10
Q
What are the sympathetic effects of alpha-2 adrenoreceptors?
A
Inhibition of norepinephrine release
Inhibition of acetylcholine release
Inhibition of insulin release
11
Q
What are the sympathetic effects of beta-1 adrenoreceptors?
A
Tachycardia
Increased lipolysis
Increased myocardial contractility
Increased release of renin
12
Q
What are the sympathetic effects of beta-2 adrenoreceptors?
A
Vasodilation Slightly decreased peripheral resistance Bronchodilation Increased muscle and liver glycogenolysis Increased release of glucagon Relaxed uterine smooth muscle
13
Q
Why do people use metroprolol, labetolol, and carvedilol?
A
Decreased mortality found in clinical studies.
14
Q
How can we affect blood pressure within the sympathetic nervous system?
A
Blocking the beta-1 receptors.
Blocking peripheral alpha-1 receptors.
Trigger central alpha-2 receptors
15
Q
How does blockade of the beta-1 receptors reduce blood pressure?
A
Reduce heart rate
Reduce renin release
16
Q
How does blockade of the alpha-1 receptors reduce blood pressure?
A
Vasodilation
Decreased peripheral resistance
17
Q
How does triggering central alpha-2 receptors affect blood pressure?
A
Reduces sympathetic outflow to the heart.
18
Q
How do beta blockers work?
A
Activation of beta-1 adrenoreceptors on the heart
Decreased cardiac output
Decreased Renin > Decreased angiotensin II > Decreased peripheral resistance
Decreased aldosterone > Decreased sodium and water retention> decreased blood volume
*Decrease in blood pressure!
19
Q
What is an example of a non-selective beta blocker?
A
Carvedilol
Labetalol
Propanolol
20
Q
What is an example of a selective beta blocker?
A
Metroprolol
Nebivolol
21
Q
Who are the candidates for use of beta blockers?
A
Younger patients!
Higher cardiac output and cardiovascular system efficiency.
22
Q
What is the effectiveness of beta blockers?
A
No evidence for primary prevention of hypertension.
23
Q
What are the preferred HTN agents for patients with cardiovascular disease?
A
beta blockers
24
Q
At what creatinine clearance do beta-blockers eliminated renally need dose adjustments?
A
35 ml/min
25
What is a beta blocker which is eliminated renally?
Atenolol
26
What is the half life of atenolol?
6-8 hours
| Therefore dosed twice per day for clinical effectiveness.
27
What adjustments need to be made for beta blockers metabolized hepatically?
No renal dose adjustment but first pass effect issues.
28
What is a beta blocker affected by hepatic metabolism?
Metoprolol
| Carvedilol
29
What are the indications for Atenolol?
Treatment of HTN alone or in combination with other agents.
Management of angina pectoris.
Secondary prevention postmyocardial infarction.
30
What are the indications for Carvedilol?
Management of HTN.
Mild-to-Severe heart failure of ischemic or cardiomyopathic origin.
Left ventricular dysfunction following myocardial infarction (clinically stable with LVEF < or = to 40%.
31
How do you adjust the dose of Atenolol for renal impairment?
Dose once per day.
32
What are the indications for metroprolol succinate?
Treatment of hypertension.
Treatment of angina pectoris.
To reduce mortality/hospitalization in patients with heart failure (stable NYHA Class I or III) already receiving ACE inhibitors, diuretics, and/or digoxin.
33
What is the brand name for Carvedilol?
Coreg
| Coreg CR
34
What is the brand name for Metroprolol succinate?
Toprol XL
35
What is the brand name for Nebivolol?
Bystolic
36
What are the indications for nebivolol?
Treatment of hypertension alone or in combination with other agents.
37
What are the adverse effects of beta blockers?
Many side effects on cardiac tissue:
- Bradycardia
- Hypotension
- Atrioventricular nodal conduction block
Bronchoconstriction
Hypoglycemia
38
Are beta blockers contraindicated in controlled asthma or controlled COPD?
No
39
Metroprolol Ext. Rel
100 mg
| One tablet daily
40
Carvedilol
12.5 mg
| One tablet twice a day
41
Why should you watch a diabetic on a beta blocker?
Beta blockers can mask the symptoms of diabetes.
| Decrease heart rate.
42
Bystolic
20 mg
| One tablet daily
43
What are the beta blockers to use?
Metroprolol
Carvedilol
Bystolic
44
What is the extended release of Metroprolol?
Metroprolol succinate
45
What does the lipid and water solubility of beta bockers determine?
the degree of penetration of the blood-brain barrier.
46
What is the max dosing of metroprolol extended release?
400 mg
47
Theoretically, what effects can beta blockers have on the central nervous system?
Lethargy
Nightmares
Confusion
Depression
48
What are the characteristics of water soluble beta blockers?
Less tissue penetration
| Longer biological half-lives
49
Coreg CR
25 mg
| One tablet per day
50
What is the mechanism of action for alpha blockers?
Block peripheral post synaptic adrenergic receptors resulting in arterial/venous vasodilation.
51
How long do you continue beta-blocker therapy before determining the effectiveness of therapy?
4-6 weeks
52
What are the adverse drug reactions of alpha blockers?
first dose syncope
| peripheral edema
53
How do alpha blockers work?
Affect both arteriolar and venous resistance of vessels.
Dependent on the magnitude on sympathetic system activity.
54
What can be the body's blood pressure response to alpha-1 blockade?
Increase in heart rate
Increase in cardiac output
Increased fluid retention
55
Which alpha blocker has the longest half life of the hypertension agents?
Doxazosin
56
What are the three alpha blockers?
Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura)
57
What are the indications for Prozasin?
Treatment of hypertension.
58
What are the indications for Terazosin?
Management of mild-to-moderate hypertension alone or in combination with other agents such as diuretics or beta-blockers.
Benign prostate hyperplasia.
59
What are the indications for doxazosin?
Treatment of hypertension as monotherapy or in conjunction with diuretics, ACEI, beta-blockers, or calcium antagonists.
Treatment of urinary outflow obstruction and/or obstructive or irritative symptoms associated with benign prostate hyperplasia.
60
Commercial name for Prozasin
Minipress
61
Commercial name for Terazosin
Hytrin
62
Commercial name for Doxazosin
Cardura
63
What are the adverse drug reactions of alpha blockers?
Orthostatic hypertension - increased fall risk. Easing into therapy or dose changes.
Aggravators - nasal congestion, headache, reflex tachycardia, peripheral edema.
Non-selective alpha blockade - smooth muscle of the base of the urinary bladder
64
Doxazosin
8 mg
| One capsule daily
65
What is an example of an alpha blocker to remember?
Doxazosin
66
Do alpha blockers have a favorable effect on lipid profile?
Diminish risk of atherosclerosis by this mechanism and reduction of effect of cathecholamines in stimulation of vascular smooth muscle hypertrophy
67
What is the maximum dose for doxazosin?
>16 mg per day
68
Where do alpha stimulants work?
The brain
69
How do alpha stimulants work?
Block signals out of the central nervous system.
70
What are the alpha stimulants?
Methyldopa
Clonidine
Guanfacine
Guanabenz
71
What are the indications for Methyldopa?
Management of moderate-to-severe hypertension.
72
What are the indications for Clonidine?
Management of hypertension (monotherapy or as adjunctive therapy).
Tablets or patch
73
What are the indications for Guanfacine?
Management of hypertension.
74
What are the indications for Guanabenz?
Used alone or in combination with other classes of antihypertensive agents in the management of hypertension.
75
Commercial name for Methyldopa
Aldomet
76
Commercial name for Clonidine
Catapres
77
Commercial name for Guanfacine
Tenex
78
What are the adverse drug reactions for alpha stimulants?
dry mouth
bradycardia
orthostatic hypotension
sedation
79
What are alpha stimulants also used for?
Addiction treatment
Clonidine: Psychosis, Restless Leg Syndrome, Ulcerative colitis
80
What can occur with abrupt withdrawal of an alpha stimulant?
Life-threatening hypertensive crisis
81
Do alpha stimulants have metabolic effects of beta blockers and thiazides?
No!
82
Clonidine
200 mcg
| one tablet twice a day
83
What are the alpha stimulants to remember?
Clonidine
Catapres TTS
Methyldopa
84
Catapres TTS
0.2 mg/ 24 hours
| apply one patch once every 7 days
85
Methyldopa
500 mg
| one tablet twice per day
86
Minoxidil
5 mg
| one tablet daily
87
What is an example of a direct vasodilator?
Minoxidil
| Hydralazine
88
How does Minoxidil work?
Increase in nitric oxide levels.
Increaed nitric oxide = increased vasodilation = decreased blood pressure
89
What are the adverse drug reactions of Minoxidil?
Standard side effects for an antihypertensive
Pericarditis and pericardial effusion that could progress to tamponade.
Increase oxygen deman and exacerbation of angina.
Some sodium and water retention.
90
Anti-hypertensive agent used in pregnancy
Methyldopa
or
beta blocker
91
How does Hydralazine work?
Opening up potassium channels in vascular smooth muscle.
| Increased nitric oxide levels.
92
When can you write for Minoxidil?
After you've used 3 antihypertensive agents and still have not met goal of therapy.
93
What is Minoxidil also known as?
Rogaine
94
Hydralazine
50 mg
one tablet twice a day
Initially 4 times per day until maintenance is achieved.
95
Why must you give a beta blocker to blunt the effect of Hydralazine?
blood pressure drops significantly enough to cause reflex tachycardia.
96
What are the adverse drug reactions of hydralazine?
Headache
| Lupus-like syndrome
97
What is the half life of hydralazine?
Short!!
Frequent daily doses.
No extended release form.
98
hypertensive emergencies
severe elevations in blood pressure
often higher than 220/140 mmHg
99
What does a hypertensive emergency require?
requires immediate attention and blood pressure reduction
100
hypertensive emergency
marked elevation in blood pressure
usually higher than 180/110 mmHg
101
What are the signs and symptoms of hypertensive urgency?
headache
SOB
pedal edema
102
How is a hypertensive urgency handled?
oral agents
103
What oral drugs are appropriate for hypertensive emergency?
Captopril
Clonidine*
Labetalol
Amlodipine
104
What injectable drugs are appropriate for hypertensive emergency?
```
sodium nitroprusside
nitroglycerin
nicardipine
hydralazine
enalaprilat
labetalol
esmolol
```
105
sodium nitroprusside
0.25-10 mcg/kg/min IV infusion
106
onset/duration of sodium nitroprusside
Immediate/ 2-3 min after infusion stop
107
ADR of sodium nitroprusside
nausea
vomiting
cyanide poisoning
108
nitroglycerin
5-100 mcg IV infusion
109
onset/duration of sodium nitroprusside
2-5 min/ 5-10 min after infusion stop
110
ADR of nitroglycerin
headache
| tachycardia
111
What is sodium nitroprusside?
a powerful intravenous vasodilator.
112
What does sodium nitroprusside dilate?
arterial and venous vessels
113
sodium nitroprusside toxicity causes...
hypotension
metabolic acidosis
arrhythmias
death
114
What limits the extent of your ability to prescribe injectable vasoactive products?
state laws and regulations
115
True or False: You are limited by state laws, regulations, etc as to the extent of your ability to prescribe oral vasoactive agents.
False!
116
hypertensive emergencies caused by acute coronary syndrome are treated with...
Nitroglycerin
Nitroprusside
Nicardipine
117
hypertensive emergencies caused by heart failure are treated with...
Nitroprusside
Nitroglycerin
IV loop diuretic
118
What is the goal of therapy in a hypertensive emergency?
20-25% reduction from starting pressure in 1-3 hours
119
hypertensive emergencies caused by acute or chronic renal failure are treated with...
Nitroprusside
Labetalol
Nicardipine
120
hypertensive emergencies caused by ischemic stroke are treated with...
Nitroprusside
Nicardipine
Labetalol
121
oral agents used to treat hypertensive emergencies include
Captopril
Clonidine
Labetalol
Amlodipine
122
Captopril
25 mg PO, repeat as needed
| SL - 25 mg
123
onset/duration of Captopril
PO: 15 - 30 minutes / 6-8 hours
SL: 10-20 min / 2-6 hours
124
ADRs of Captopril
hypotension
renal failure
bilateral renal stenosis
125
Clonidine
0.1 - 0.2 mg PO
| repeat hourly as required to total dosage of 0.6 mg
126
onset/duration of Clonidine
30-60 minut / 8-16 hours
127
ADRs of Clonidine
hypotension
drowsiness
dry mouth
128
Labetalol
200 - 400 mg PO
| repeat every 2-3 hours
129
onset/duration of Labetalol
1-2 hours/ 2-12 hours
130
ADRs of Labetalol
bronchoconstriction
heart block
orthostatic hypotension
131
Amlodipine
2.5 - 5 mg PO
132
onset/duration of Amlodipine
1-2 hours / 12-18 hours
133
ADRs of Amlodipine
tachycardia
| hypotension
134
injectable agents for hypertensive emergencies
```
Nicardipine
Hydralazine
Enalaprilat
Labetalol
Esmolol
```
135
Nicardipine
5-15 mg/hr IV infusion
136
onset/duration of Nicardipine
1-5 min / 15 - 30 min
137
ADRs of Nicardipine
tachycardia
nausea
increased intracranial pressure
138
Hydralazine
5-20 mg IV bolus;
10 - 40 mg IM
repeat every 4-6 hours
139
onset/duration of Hydralazine
10 min/ 1 hr IV 20-30 min / 4-6 hr IM
140
ADRs of Hydralazine
tachycardia
headache
aggravation of angina
141
Enalaprilat
0.625-1.25 mg every 6 hr IV
142
onset/duration Enalaprilat
within 30 min / 12-24 hours
143
ADRs of Enalprilat
renal failure in bilateral renal stenosis
144
Labetalol
20 - 40 mg IV bolus every 10 min; up to 2 mg/min IV infusion
145
onset/duration Labetalol
5-10 min / 2-6 hours
146
ADRs of Labetalol
bronchoconstriction
heart block
bradycardia
147
Esmolol
500 mcg/kg IV bolus; 50-100 mcg/kg/min IV infusion
148
onset/duration Esmolol
1-5 min/ 15-30 min
149
ADRs of Esmolol
first-degree heart block
heart failure
worsen asthma symptoms
