Exam 2 Flashcards
(22 cards)
Beta blockers-How do they reduce blood pressure?
decrease the heart rate, contractility, force, cardiac output
decrease renin secretion in kidney for vasodilation
What patients are beta blockers used for?
Pts that have had a heart attack that can’t tolerate an increase in HR. Just reduce CO.
Prevent tachycardic arrhythmias.
Congestive heart failure. Compensatory cardiac hypertrophy (overgrowth of heart muscle)
Not main: Hypertension Pts that have sympathetic NS activated more than others. Need other meds though.
Pts with Asthma/COPD
When can you not use beta-1 blockers?
Insulin-dependent diabetecs.
Diabetics in general not contraindicated.
Hypoglycemia (heart rate is going up, get shaky) symptoms masked by Beta1 blockers.
What are side effects of beta1 blockers?
bradycardic arrhythmias fatigue and exercise intolerance (can't increase heart rate) withdrawal syndrome (rebound tachycardia because of supersens, MI, 2 weeks problematic, must be tapered)
Beta1 inverse agonists
metoprolol, atenolol
cause EVEN worse supersensitization
Beta1 partial agonist/antagonist
acebutolol (weak)
little desensitization and supersensitization
A weak partial agonist acts as a antagonist in the presence of a full agonist (NE)
Beta1 antagonist
Esmolol
very short acting.
Uses for non-selective beta blockers?
symptoms of hyperthyroidism performance anxiety prophylactic prevention of migraines tremors, familial palsy glaucoma (decrease aq humor production) hypertension tachycardic arrythmias
beta2 selective antagonists
NONE
non-selective beta antagonist Side effects
exercise intolerance
Malaise (sedation, fatigue, depression)-people that are prone to depression
physically and mentally crappy but cannot just drop the drugs, severe withdrawals.
Important thing to remember about antagonists
don’t do anything unless they are in the presence of an agonists
Non-selective beta antagonist agents
Timolol- glaucoma
Sotalol- cardioprotective, no sedative effects doesn’t cross BBB
propranolol- CLASSIC, prototype. nervous, tremors, glaucoma, hypertensive
Non-selective beta partial antagonist/agonist
Pindolol
similar advantages to acebutolol
What are Alpha 1 antagonists used for?
cause vasodilation, heart rate increase, and drop in blood pressure. Benign prostatic hyperplasia Hypertension Congestive heart failure Reynaud's syndrome and frostbite Reduce nightmares in PTSD pts
When can Alpha1 antagonists not be used?
When a patient can’t tolerate a rise in heart rate
What are side effects of alpha1 antagonists?
raise HR (tachycardia)
syncope or orthostatic hypotension, Faint!
nasal congestion
inhibit ejaculation
Alpha1 antagonists
Prazosin, Terazosin, Alfuzosin-hypertension, BPH
Tamulosin, Silodosin-BPH
Beta1 antagonist + vasorelaxant
Nebivolol
causes release of NO from vascular epithelium
anti-hypertension med
Alpha1, beta-non-selective hypertension meds
Labetolol
RR block beta1, partial agonist of beta2
SR, SS block alpha1
RS: no activity
Carvedilol
S: beta blocker
R and S alpha1 blocker
What are non-selective alpha1 and alpha2 antagonists used for?
pheochromocytoma (in combo with propranolol)-adrenal tumor that secretes epinephrine
CANNOT give these drug on their own. They must be given with a non selective beta blocker!
Dirty drugs: block serotonin, histamine, and muscarinic activity
What are side effects of non-selective alpha1 and alpha2 antagonist?
like alpha1 selective antagonists
Much more tachycardia (increase in HR) because block inhibition of baroreflex and block inhibition of NE release
Non-selective alpha1 and alpha2 agents
Phentolamine-competitive, quick reversal of dentist numbing, GI side effects
Phenoxybenzamine-irreversible, >24 hours of effectiveness, reversal=new receptor synthesis
