Vasodilators and Sympatholytics DSA II

Question 1

beta3 agonist

Answer 1

nebivolol

Question 2

propranolol

Answer 2

non-selective beta blocker

-decreased BP and CO

Question 3

beta1 in kidney

Answer 3

blockade inhibits renin release

Question 4

esmolol

Answer 4

not available oral

Question 5

lipophilic sympathplegics

Answer 5

propranolol and penbutolol

Question 6

asthma/COPD

Answer 6

adverse effects of beta-2 blockade with sympatholytics

Question 7

diabetes

Answer 7

glycogenolysis blocked after beta-2 blockade

-use sympatholytics w/ caution

Question 8

cardiac arrhythmias

Answer 8

caution sympatholytic use

-cardiac decompensation

Question 9

side effect of sympatholytics

Answer 9

fatigue, bradycardia, sexual dysfunction, depression

Question 10

chronic sympatholytic use

Answer 10

high lipid plasma leels

Question 11

sudden sympatholytic withdrawal

Answer 11

rebound hypertension, angina, possible MI

Question 12

drug-drug interactions sympatholytics

Answer 12

with CCBs - verapamil and diltiazem

-heart block

Question 13

HTN Tx

Answer 13

metoprolol and atenolol

-beta-1 selective antagonist

Question 14

carvedilol and labetalol

Answer 14

non-selective beta blockers

alpha 1 blockers

Question 15

heart failure Tx

Answer 15

carvedilol, bisopril, metoprolol
-reduce mortality

-may worse CHF - careful long term use

Question 16

bisoprolol

Answer 16

beta1 selective antagonist

Question 17

ISA

Answer 17

intrinsic sympathomimetic activity

-labetolol, acebutolol, nevibutolol

Question 18

non-ISA

Answer 18

no intrinsic sympathomimetic activity

-propranolol, carvedilol, metoprolol, atenolol

Question 19

ischemic heart disease Tx

Answer 19

beta blockers - reduce angina episodes

• increased exercise tolerance
• timolol, metoprolol, propranolol - prolong survival after MI

Question 20

cardiac arrhythmia Tx

Answer 20

beta blockers - supraventricular and ventricular arrhythmias

Question 21

glaucoma Tx

Answer 21

topical timolol, btaxolol, carteolol

Question 22

prazosin

Answer 22

alpha1 antagonist

• prevent constriction of arteries and veins
• BP reduced - decreased TPR
• relaxes prostate smooth m
• without diuretic - Na and water retention

does not effect alpha-2 receptor inhibition of NE release (decreased reflex tachycardia)

Question 23

men with HTN and BPH

Answer 23

prazosin

Question 24

central acting alpha-2 agonists

Answer 24

clonidine and methyldopa

-reduce sympathetic outflow from vasomotor centers of brainstem

rarely used today

Question 25

pregnancy HTN

Answer 25

methyldopa

Question 26

clonidine

Answer 26

decreases BP - via decreased CO and TPR -sedation, dry month, depression, sexual dysfunction

Question 27

methyldopa

Answer 27

lower BP by reducing TPR - analog of L-dopa - converted to alpha-methylnorepinephrine -sedation dry mouth, lack of concentration, sexual dysfunction

Question 28

HTN in pregnancy

Answer 28

stroke risk - SBP > 160 and DBP > 110 consider mother and fetus

Question 29

drugs for HTN in pregnancy

Answer 29

acute - labetalol, hydralazine, CCB, nitro | chronic - methyldopa, labetalol, nifedipine, hydralazine

Question 30

contraindicated for HTN in pregnancy

Answer 30

ACE (-), ARBs, direct renin inhibitors - fetal abnormalities nitroprusside - CN poisoning

Question 31

hypertensive emergency

Answer 31

>180/120 with acute end organ damage goal - gradual reduction of BP without excessive hypotension

Question 32

most effective for hypertensive emergency

Answer 32

sodium nitroprusside | -long term - possible CN poisoning

Question 33

cardiac ischemia or after coronary bypass surgery with hypertensive emergency

Answer 33

nitroglycerin

Question 34

hypertensive emergency meds

Answer 34

nicardipine, clevidipine - DHP-CCB fenoldopam - dilates renal arteries - good choice for pt with renal dysfunction hydralazine - pregnancy related to eclampsia

Question 35

phentolamine

Answer 35

alpha-blocker - treat pts with HTN due to elevated catecholamines - cocaine intox, pheochromocytoma

Question 36

esmolol

Answer 36

rapid, short acting beta1 blocker | -treat aortic dissection or post-op HTN

Question 37

labetolol

Answer 37

alpha and beta blocker | -safe for patients with active coronary disease

Question 38

initial monotherapy in essential HTN

Answer 38

``` thiazide ACE (-) ARB CCB **beta blockers NOT used unless specific indication ```

Question 39

black pt with essential HTN

Answer 39

better to thiazide diuretics and CCBS | -worse to ACE (-) and beta-blockers

Question 40

monotherapy vs. polytherapy in HTN

Answer 40

mono - pt compliance, decreased cost, less adverse effects poly - each drug acts on one of set of interacting mutually compensatory mechanisms -decreased toxicity (2-3 drugs at low dose as opposed to one at higher dose)

Question 41

example HTN combo drugs

Answer 41

ACE (-) and CCB -trandolapril/verapamil ACE (-) and diuretic -benazepril/HCTZ ARB and diuretic -valsartan/HCTZ beta-blocker and diuretic -propranolol/HCTZ central agent and diuretic -reserpine/chlorothiazide diuretic and diuretic -spironolactone/HCTZ

Question 42

triple drug regimens

Answer 42

thiazide diuretic, DHP-CCB, and | -ACE (-), ARB, or renin (-)