Name 2 non selective Alpha receptor antagonists.
Phentolamine and Phenoxybenzamine
T or F A2 receptor blockade leads to tachycardia
True. It eliminates negative feedback which leads to more NE release.
Phentolamine and Phenoxybenzamine are almost exclusively for the mgmt of what?
pheochromocytomas
What are the cholinomimetic side effects associated with alpha agonists?
hyperperistalsis, abdominal pain, and diarrhea
What can be used to treat the cholinomimetic side effects associated with alpha agonists?
atropine/ glycopyrrolate
What are the main side effects associated with the non specific B antagonist Propranolol (Inderal)?
Side effects = bronchospasm, CHF
What type of beta blocker should be used in pts w/ reactive airway disease?
B1 selective antagonist
Which anti-hypertensive is a mixed adrenergic antagonist (A1 B1 and B2)?
Labetalol
____ is an ultra short acting B1 selective antagonist.
Esmolol (BreviBloc)
Is the following a mixed, non-selective Beta, B1 selective adrenergic antagonist?
Atenolol
B1 selective antagonist
Is the following a mixed, non-selective Beta, B1 selective adrenergic antagonist?
Carvedilol.
B1 selective antagonist
Is the following a mixed, non-selective Beta, B1 selective adrenergic antagonist?
Metoprolol
B1 selective antagonist
____ is the common drug of choice for intraop HTN because decreases PVR and renin, and causes some decrease in HR.
Labetalol
This adrenergic antagonist’s short duration of action is due to its rapid redistribution (2 min) and ester hydrolysis (9 min).
Esmolol (BreviBloc)
T or F. Labetalol causes reflex tachycardia.
False. It is a mixed antagonist with alpha and beta receptor antagonism.
___ is a good choice for preventing tachycardia and hypertension during intubation and emergence.
Esmolol
What are 3 side effects associated with alpha-1 receptor blockade?
Side effects: hypotension, orthostatic hypotension, tachycardia
How does an alpha-2 receptor blockade work and what does it cause?
A2-receptor blockade -> eliminates negative feedback -> more NE release -> tachycardia
Unopposed stimulation of beta receptors may lead to _____.
HYPOTENSION
What is Clonidine?
Clonidine: centrally-acting 2-agonist that decreases CNS sympathetic output at pre-synaptic 2 receptors
Which antihypertensive agent directly causes vascular smooth muscle relaxation?
Hydralazine
Which class of antihypertensive drugs is the first-line therapy for systemic hypertension and CHF?
ACE Inhibitors
Which class of antihypertensive drugs cause hyperkalemia
ACE Inhibitors and ARBs
Which antihypertensive agent causes direct venous and arterial vasodilation, Reflex tachycardia, and breaks down in light?
Sodium Nitroprusside (SNP)
Which Nitrate is a commonly used oral nitrate for prevention of angina pectoris
A. SNP
B. NTG
C. Inhaled NO
D. Isosorbide Mononitrate (Imdur) or Dinitrate
D. Isosorbide Mononitrate (Imdur) or Dinitrate
T or F. ACEIs are associated with depression, insomnia, sexual dysfunction, and electrolyte imbalances
False. They are free from many common side effects seen with other antihypertensive
agents (depression, insomnia, sexual
dysfunction, electrolyte imbalances)
Which of the following is true regarding side effects of Sodium Nitroprusside?
A. Increased cerebral blood flow
B. Potential for coronary steal syndrome
C. Attenuates hypoxic pulmonary vasoconstriction (HPV)
D. All of the above
D. All of the above
Which class of anitHTN drugs is associated with an allergic reaction causing the rapid swelling of the dermis, subcutaneous tissue,mucosa and submucosal tissues?
ACEIs - Allergy: angioedema
How is SNP metabolized?
Sequestration of CN: CN + met-Hb -> cyanmet-Hb
What is Losartan (Cozaar)?
an ARB (Angiotensin II Receptor Blocker)
Which Nitrate is a selective pulmonary vasodilator, causes bronchodilation, and improves V/Q matching
A. SNP
B. NTG
C. Inhaled NO
D. Isosorbide Mononitrate (Imdur) or Dinitrate
C. Inhaled NO
Which antihypertensive agent is associated with Cyanide toxicity?
SNP
T or F. ACEIs should be held at least 24hrs preoperatively, but ARBs do not need to be held?
False. They should both be held at least 24hrs before surgery. These pts may be unresponsive to fluid bolus or sympathomimetic treatment of intraop hypotension.
A patient on Lisinopril may require what drug to support BP intraoperatively?
Vasopressin
What is the treatment for cyanide toxicity?
- STOP nitroprusside
- Cyanide buffers:
a. Sodium nitrate IV (OR Amyl nitrate inhaled)
b. THEN give sodium thiosulfate IV - Vit B12a (Hydroxocobalamin)
CN is converted to ____by ____. This process requires a sulfur donor, which is usually _____. The remaining CN is what causes cyanide toxicity.
thiocyanate , rhodanese enzyme, thiosulfate
Which Nitrate causes mainly venous dilation
A. SNP
B. NTG
C. Inhaled NO
D. Isosorbide Mononitrate (Imdur) or Dinitrate
B. Nitroglycerin
How do nitrates decrease BP?
They deliver NO (nitric oxide) to vascular smooth muscle which causes vasodilation. NO release is part of normal endothelial function -> autoregulation
T or F. Nitrates inhibit platelet activation, aggregation, and adhesion.
True
Which Nitrate can be used for uterine relaxation
A. SNP
B. NTG
C. Inhaled NO
D. Isosorbide Mononitrate (Imdur) or Dinitrate
B. NTG (Nitroglycerin)
Which Nitrate is associated with risk of causing met-Hgb-emia?
A. SNP
B. NTG
C. Inhaled NO
D. Isosorbide Mononitrate (Imdur) or Dinitrate
B. NTG
What is the treatment for met-Hgb-emia?
Methylene blue
____ increases coronary perfusion to ischemic subendocardium, while _____ can potentially cause coronary steal syndrome.
NTG, SNP
