Sympatholytics

Question 1

What are the 3 classes of sympatholytics?

Answer 1

peripheral adrenergic receptor blocker
central α2 agonists
neurotransmitter depleters

Question 2

What are the subclasses of the peripheral adrenergic receptor blockers?

Answer 2

α1 blockers
β blockers
mixed α + β blockers (vasodilating β blockers)

Question 3

What are the α1 blocker agents?

Answer 3

Prazosin
Terazosin
Doxazosin

Question 4

α1 receptor antagonists block what?

Answer 4

post-synaptic α1 receptor

Question 5

α1 receptors naturally cause vaso________ on vascular smooth muscle.

Answer 5

vasoconstriction

Question 6

Blocking the α1 receptor causes what?

Answer 6

vasodilation

Question 7

The decrease in BP from α1 blockers initially causes ________ _________.

Answer 7

sympathetic stimulation or baroreceptor reflex

Question 8

What are some results of sympathetic stimulation?

Answer 8

Increased HR and CO

Increase in plasma renin activity/release

Question 9

In the use of α1 blockers renal blood flow is _______.

Answer 9

unchanged

Question 10

α1 blockers can cause ______ _______, or what is known as the “first dose effect”.

Answer 10

postural hypotension

Question 11

Inhibition of smooth muscle contraction with the use of α1 blockers occurs in what other areas of the body?

Answer 11

urinary bladder sphincter
prostate
seminal vesicles
uterus

Question 12

What other conditions are α1 blockers indicated?

Answer 12

BPH

Question 13

What are the adverse effects of α1 blockers?

Answer 13

Peripheral vasodilation: dizziness, postural hypotension, edema, palpitations, fatigue, nasal congestion
Anaphylaxis
Priapism

Question 14

What are some drug interactions with α1 blockers?

Answer 14

combining with other antihypertensives can cause hypotension

Verampamil causes increased Terazosin levels

Question 15

What is the ending for α1 blockers?

Answer 15

-zosin

Question 16

What groups are α1 blockers contraindicated?

Answer 16

pregnancy

those with pheochromocytoma (adrenal tumor)

Question 17

α1 blockers are/are not recommended for monotherapy?

Answer 17

are not

Question 18

What populations may benefit from α1 blockers over other agents?

Answer 18

HTN diabetics
gout
BPH

Question 19

What are the β blocker agents?

Answer 19

Propranolol
Metoprolol
Atenolol

Question 20

What is the ending for β blockers?

Answer 20

-olol

Question 21

What is the MOA for β blockers?

Answer 21

Blocking the β receptors reduces cardiac contractility and HR to reduce CO. β blockers also reduce the secretion of renin and lower plasma Ang II levels.

Question 22

What is the most effective β blocker in treating HTN?

Answer 22

They are all equally effective.

Question 23

How do β blockers effect the BP in normotensive patients?

Answer 23

no change

Question 24

Pure β receptor antagonists _____ CO and cause and immediate reflex _______ in TPR.

Answer 24

reduce

increase

Question 25

Partial β receptor antagonists produce a ______ in CO but BP falls due to a _______ in TPR.

Answer 25

lesser decrease than pure β receptor antagonists | decrease

Question 26

What are the vasodilating β blockers?

Answer 26

Labetolol Carvedilol Nebivolol

Question 27

Vasodilating β blockers provide effective therapy in what stages of HTN?

Answer 27

all stages of HTN

Question 28

In what cases are β blockers an appropriate first choice therapy?

Answer 28

post MI heart failure arrhythmias angina

Question 29

Can you combine β blockers with ACEIs or ARBs?

Answer 29

no - its redundant

Question 30

Are diuretics needed in combination with β blockers?

Answer 30

no

Question 31

What are the adverse effects of β blockers?

Answer 31

bronchoconstriction bradycardia masks symptoms of hypoglycemia fatigue/dizziness/depression

Question 32

Which subclass of sympatholytics are preferred in diabetics?

Answer 32

Vasodilating β blockers

Question 33

What are the dosing considerations for β blockers?

Answer 33

start low, titrate up, titrate down

Question 34

What drug interaction blunts the hypotensive effect of β blockers?

Answer 34

NSAIDS

Question 35

What drug interaction can cause a hypertensive crisis?

Answer 35

epinephrine

Question 36

What is the most concerning ADR with β blockers?

Answer 36

New onset diabetes

Question 37

What conditions are the use of β blockers most supported in?

Answer 37

heart failure | post MI

Question 38

What are the central α2 agonist agents?

Answer 38

α-methyldopa clonidine guanabenz guanfacine

Question 39

What is the MOA of central α2 agonists?

Answer 39

By acting on the presynaptic α2 receptor, central NT release is decreased. Sympathetic outflow is reduced and BP is decreased.

Question 40

Why are central α2 agonists not 1st line?

Answer 40

ADRs

Question 41

Methyldopa is an analog of what?

Answer 41

DOPA

Question 42

What is the MOA of methyldopa?

Answer 42

Acts in the brainstem to reduce sympathetic outflow

Question 43

Is methyldopa degraded by monoamine oxidase?

Answer 43

no

Question 44

Methyldopa has _____ effect on CO and HR except in _____.

Answer 44

little | elderly

Question 45

In the use of α2 agonists the baroreceptor reflex is ____ ______.

Answer 45

turned down

Question 46

In the use of α2 agonists, renal blood flow and function is ________.

Answer 46

unaffected

Question 47

In the use of α2 agonists plasma renin levels ______.

Answer 47

decrease

Question 48

α2 agonists should be combined with _______ to maintain efficacy.

Answer 48

diuretic

Question 49

What medication is preferred for HTN in pregnant women?

Answer 49

Methyldopa

Question 50

What are the adverse effects of Methyldopa?

Answer 50

CNS: sedation, depression, dry mouth, ↓ libido, Parkinsonian signs, hyperprolactinemia, bradycardia Hepatotoxicity Hemolytic anemia

Question 51

α2 agonists _____ CO and ______ TPR.

Answer 51

decrease | decrease

Question 52

Guanfacine is _____ selective for α2 receptors than clonidine and guanabenz.

Answer 52

more

Question 53

Which α2 agonist is available in a patch?

Answer 53

clonidine

Question 54

What are the adverse effects of α2 agonists?

Answer 54

CNS: sedation, dry mouth, sleep disturbances, bradycardia, sexual dysfunction

Question 55

What is a main concern about discontinuing α2 agonists?

Answer 55

withdrawal syndrome

Question 56

What does α2 agonist overdose look like?

Answer 56

opioid overdose

Question 57

What are the minor sympatholytic agents?

Answer 57

Guanadrel | Reserpine

Question 58

Guanadrel specifically targets what?

Answer 58

postganglionic adrenergic neurons

Question 59

Guanadrel is taken up into ________ via the ___ _____.

Answer 59

presynaptic terminal | NE transporter

Question 60

Guanadrel ______ NE in NT granuals.

Answer 60

replaces

Question 61

Guanadrel has ______ agonist activity.

Answer 61

no

Question 62

What drug interaction will blunt effectiveness of Guanadrel?

Answer 62

TCAs cocaine chlorpormazine

Question 63

What population is Guanadrel contraindicated?

Answer 63

pheochromocytoma | CHF

Question 64

Guanadrel causes vaso_____, __ TPR, minor __ in renal blood flow and GFR.

Answer 64

vasodilation decrease decrease

Question 65

What are the adverse effects of Guanadrel?

Answer 65

orthostatic hypotension exercise intolerance volume expansion weakness, lassitude, sexual dysfunction, diarrhea

Question 66

Guanadrel is not used as monotherapy due to what?

Answer 66

orthostatic hypotension

Question 67

Reserpine binds to ___ ______ _____.

Answer 67

NT storage vesicles

Question 68

Reserpine impairs ______, ________, ________ neurotransmission.

Answer 68

adrenergic dopaminergic serotonergic

Question 69

Reserpine depletes NTs peripherally, centrally, or both?

Answer 69

both

Question 70

Reserpine ___ TPR ___CO ___HR

Answer 70

decreases decreases decreases

Question 71

In the use of Reserpine, orthostatic hypotension is/isn't a problem.

Answer 71

is not

Question 72

In the use of Reserpine, plasma renin levels ______.

Answer 72

decrease

Question 73

What are the adverse effects of Reserpine?

Answer 73

sedation, inattention, nasal congestion, sexual dysfunction, suicidal depression

Question 74

Reserpine should/shouldn't be combined with a diuretic?

Answer 74

should