HTN4

Question 1

what are the 4 classes of sympathoplegic agents for HTN?

Answer 1

1. Beta-Blockers
2. Alpha-1 Blockers
3. Alpha-2 Agonists
4. Adrenergic blocking agents

Question 2

ACE-I’s are eliminated where, except for which one is hepatically eliminated

Answer 2

all renally eliminated

except fosinopril has some hepatic elimination

Question 3

nitric oxide has what effect on PVR

Answer 3

decreases PVR

nitric oxide is a vasodilator

Question 4

what catecholamine receptors are found on the presynaptic cell?

Answer 4

alpha2

Question 5

what receptors are on post synaptic vascular smooth muscle cells

Answer 5

alpha1 receptors

Question 6

what receptors are responsible for chronotropic action

Answer 6

beta1

Question 7

what receptor activation increases liver’s release of renin

Answer 7

beta 1

Question 8

what are beta blockers effect on chronotropic and inotropic effects?

Answer 8

decrease both

Question 9

chronotropic effects refers to what specifically?

Answer 9

heart reate

Question 10

inotropic effects refer to what specifically

Answer 10

stroke volume

Question 11

list the adverse effects of beta blockers

Answer 11

HBBEEF
hypoglycemia
bradycardia
exacerbate heart failure
bronchoconstriction (B2 rec)
depression
ED
fatigue

Question 12

how do BB’s worsen HF?

Answer 12

by decreasing CO

Question 13

which BB’s are B1 selective

Answer 13

NEVER BE BAMA
Nebivolol
Bisoprolol
Betaxolol
Acebutolol
Metroprolol
Atenolol

Question 14

why should BB’s not be stopped abruptly

Answer 14

receptor upregulation leads to rebound hypertension

Question 15

who should use BB’s with caution

Answer 15

CHAD

COPD
Heart Failure
Asthma
Diabetes

Question 16

what was the 1st BB?

Answer 16

propranolol

Question 17

what drugs can interact with metoprolol

Answer 17

SSRI’s
Bupropion
H2-antagonists

Question 18

what is metoprolol’s extended release form

Answer 18

metoprolol succinate

Question 19

what is metoprolol’s immediate release form

Answer 19

metoprolol tartrate

Question 20

what type of metabolism does metoprolol go through?

Answer 20

hepatic metabolism

CYP2D6

Question 21

how is atenolol primarily excreted

Answer 21

unchanged in urine

Question 22

what 2 nonselective BB’s are excreted in urine unchanged

Answer 22

nadolol and carteolol

Question 23

name 2 cardioselective BB’s other than metoprolol metabolized by CYP2D6

Answer 23

betaxolol and bisoprolol

Question 24

name 2 cardioslective BB’s dosed once daily due to long half life

Answer 24

betaxolol and bisoprolol

Question 25

name 3 partial agonist BB's?

Answer 25

pindolol acebutolol penbutolol

Question 26

define B-receptor partial agonist

Answer 26

binds to B receptor but produces little effect, very little side effects intrinsic sympathomoimetic activity

Question 27

name a cardioselective partial agonist BB

Answer 27

acebutolol

Question 28

what are the 2 inactive isomers of labetalol

Answer 28

SS and RS are inactive

Question 29

what is the potent alpha-blocker isomer of labetalol

Answer 29

SR = potent alpha

Question 30

what is the potent non-selective beta blocking isomer of latetalol

Answer 30

RR

Question 31

list the 4 isomers mixed in laetalol

Answer 31

``` SS = inactive RS = inactive SR = potent alpha blocker RR = poten non-selective B-blocker ```

Question 32

what are the two ismomers mixed for Carvedilol and there effects

Answer 32

``` S(-) = nonselective B-blocker and alpha-blocker R(+) = alpha-blocker ```

Question 33

how is carvedilol metabolized?

Answer 33

hepatic metabolism | 2C9 and 2D6

Question 34

what 2 isomers are mixed racemically for Nebivolol and there effects

Answer 34

``` D- = beta1 selective L- = increased NO production ```

Question 35

what is the half life of Nebbivolol

Answer 35

10 hours

Question 36

what are 3 racemically mixed vasodilating BBs

Answer 36

1. labetolol 2. carvedilol 3. nebivolol

Question 37

name a cardioselective, rapidly metabolized BB

Answer 37

esmolol

Question 38

what is esmolol's half life? | how is it metsabolized

Answer 38

9-10 minutes | RBC esteraces

Question 39

how is esmolol administered? | for what?

Answer 39

continuous IV infusion | intraoperative HTN or HTN emergency with tachycardia

Question 40

BB's are used concomitantly with HTN and what other diseases?

Answer 40

Supraventricular tachycardia heart failure angina pectoris previous MI