LEC - 7.2 - Beta & Calcium Blockers

Question 1

Location of Beta Receptors:

Answer 1

Heart (stimulation)

Bronchial, uterine, and vascular smooth muscle (relaxation)

Adipose tissue (lipolysis)

Question 2

2 types of Beta Blockers:

Answer 2

Nonselective

Cardioselective

Question 3

These drugs have similar antihypertensive effects irrespective of additional properties
Inhibit the secretion of renin and the formation of angiotensin I

Answer 3

Beta Adrenergic Blockers

Question 4

Therapeutic applications of Beta Blockers

Answer 4

decreases cardiac workload and can ease the symptoms of angina pectoris. By slowing conduction through the mycardium, they treat dysrhythmias. They are also included in the treatment of heart failure, MI and migraine.

Question 5

These beta blockers block both beta1 and beta2 receptors and so affect the heart, lungs, vascular smooth muscles, kidneys, GI, etc

Answer 5

Nonselective Beta Blockers

Question 6

These bete blockers work by blocking beta-1 receptors, which prevents epinephrine from binding to these receptors. As a result, these medications block the effects of epinephrine, also known as adrenaline, in order to decrease heart rate and the contractility of the heart

Answer 6

Cardioselective Beta Blockers

Question 7

Examples of Nonselective Beta Blockers:

Answer 7

ropranolol
nadolol
timolol
pindolol
labetolol
carvedilol

Question 8

Examples of Cardioselective Beta Blockers:

Answer 8

metoprolol
atenolol
esmolol
betaxolol

Question 9

Non Cardiovascular Uses for Beta Blockers:

Answer 9

Migraine
In anxiety provoking situations
Glaucoma
Hyperthyroidism
Pheocromocytoma
Alcohol withdrawal
Oesophageal varices

Question 10

Advantages of Beta Blockers

Answer 10

No postural hypotension
No salt and water retention
Low incidence of side effects
Low cost
Once a day regimen
Preferred in young non-obese patients, prevention of sudden cardiac death in post infarction patients and progression of CHF

Question 11

Side effects of Beta Blockers:

Answer 11

Fatigue, lethargy or decreased work capacity
Loss of libido or impotence
Cognitive defects like forgetfulness

Question 12

Adverse effects of Beta Blockers:

Answer 12

Bronchoconstriction
Bradycardia
Cold extremeties
CNS side effects
Heart Failure
Hypoglycemia
Rebound hypertension

Question 13

Advantages of cardio-selective over non-selective:

Answer 13

Safe for use in:
Asthma
Diabetes mellitus
Peripheral vascular disease
Preferred in young non-obese hypertensive
Angina pectoris and post angina patients
Post MI patients – useful in preventing mortality
In old persons, carvedilol, which has a vasodilatory action can be given

Question 14

Lowers BP directly by blocking the sympathetic receptor in arterioles causing the vessels to dilate

Answer 14

Alpha Adrenergic Blockers

Question 15

These drugs are not the first-line drugs for HTN because long-term clinical trials have shown them to be less effective at reducing the incidence of serious cardiovascular events than diuretics.

Answer 15

Alpha Adrenergic Blockers

Question 16

Non selective alpha blockers like ___ and ___ are not used in chronic essential hypertension but only in pheochromocytoma (vascular tumor of chromaffin tissue of the adrenal medulla).

Answer 16

phenoxybenzamine and phentolamine

Question 17

Non selective alpha blockers like phenoxybenzamine and phentolamine are not used in chronic essential hypertension but only in ___ (vascular tumor of chromaffin tissue of the adrenal medulla).

Answer 17

pheochromocytoma

Question 18

vascular tumor of chromaffin tissue of the adrenal medulla

Answer 18

pheochromocytoma

Question 19

Specific alpha-1 blockers like ___, ___, and ___ are used in chronic essential hypertension

Answer 19

prazosin, terazosin and doxazosine

Question 20

Specific alpha-1 blockers like prazosin, terazosin and doxazosine are used in ___

Answer 20

chronic essential hypertension

Question 21

___ is effective against benign prostatic hypertrophy (BPH)

Answer 21

Tamsulosin

Question 22

Tamsulosin is effective against ___

Answer 22

benign prostatic hypertrophy (BPH)

Question 23

Therapeutic Uses of Alpa-Blockers:

Answer 23

Reduction in mean BP
Does not produce tachycardia since presynaptic auto or alpha-2 receptors are not inhibited
Autoregulation of Na+ release remains intact

Question 24

Adverse effects of Alpa-Blockers:

Answer 24

Prazosin causes postural hypotension so start with 0.5 mg at bed time with increasing dose and up to 10 mg daily
Fluid retention in monotherapy
Headache, dry mouth, weakness, blurred vision, rash, drowsiness and failure of ejaculation in males

Question 25

___ causes postural hypotension so start with 0.5 mg at bed time with increasing dose and up to 10 mg daily

Answer 25

Prazosin

Question 26

Prazosin causes postural hypotension so start with ___ mg at bed time with increasing dose and up to ___ mg daily

Answer 26

0.5 10

Question 27

Current status of Alpa-Blockers:

Answer 27

Improvement of carbohydrate metabolism so beneficial for diabetics since it lowers LDL and increases HDL Not used as first line agent Used in addition with other conventional drugs which are failing such as diuretic or beta blocker

Question 28

Other example:

Answer 28

Minipress Prazopress

Question 29

these drugs prevent the movement of calcium into the cardiac and smooth muscle cells when the cells are stimulated Blocking of calcium interferes with the muscle cell’s ability to contract, leading to a loss of smooth muscle tone, vasodilation, and a decrease in peripheral resistance

Answer 29

Calcium Channel Blockers

Question 30

Calcium channel blockers are effective in the treatment of ___

Answer 30

angina

Question 31

Examples of Calcium Channel Blockers available in the Philippines:

Answer 31

Amlodipine (Norvasc) Felodipine (Plendil ER) Nifedipine ( Adalat, Calcibloc) Diltiazem ( Dilzem) Nicardipine (Cardepine)

Question 32

Potential Side Effects of Calcium Blockers:

Answer 32

Dizziness or lightheadedness Low blood pressure Heart rhythm problems Dry mouth Edema (swelling of ankles, feet, or lower legs) Headache

Question 33

Potential Side Effects of Calcium Blockers:

Answer 33

Nausea Fatigue Skin rash Constipation or diarrhea Gastroesophageal reflux disease

Question 34

Advantages of Calcium Blockers:

Answer 34

Unlike with diuretics, there is no adverse metabolic effects but mild adverse effects like dizziness, fatigue, etc. No sedation or CNS effect Can be given to asthma, angina and PVD patients No renal and male sexual function impairment No adverse fetal effects and can be given in pregnancy Minimal effect on quality of life

Question 35

CCBs are not 1st line of antihypertensive unless indicated but rather the use of ACE Inhibitors/diuretics/beta blockers. However it is been used because of excellent tolerability and high efficacy

Answer 35

NA

Question 36

Preferred in elderly because it prevents stroke

Answer 36

Calcium Channel Blockers

Question 37

CCBs are next to ACE inhibitors in inhibition of ___ and prevention of ___

Answer 37

albuminuria diabetic nephropathy

Question 38

CCBs nteract with ___ causing an increase level of calcium channel blockers to toxic dose

Answer 38

grapefruit juice