asmah nasser, m.d..  alpha blockers  beta blockers  alpha plus beta blockers

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  • Asmah Nasser, M.D.

  • Alpha blockersBeta blockersAlpha plus beta blockers

  • Phenoxybenzamine (Non-competitive)Phentolamine (competitive)Ergot alkaloids: ErgotamineErgotoxine

  • Non-competitive alpha adrenergic antagonist. Net effect: 1 blockage > 2 blockageUses: malignant HTN, Pheochromocytoma, HTN 2 to Clonidine Withdrawal, Cheese Reaction

  • Non-selective Competitive Alpha BlockerUsed in HTN, Cocaine induced HTN.Decreases the workload of the heart, and decreases the risk of MI

  • 1 selective: (ends with sin or cin) Prazosin, Terazosin Doxazocin, Tamsulocin 2 selective: (inhibits Negative feedback)Yohimbine

  • Effects: Blocks vaso- and aterioconstriction vasodilation and arteriodilaton Decrease in Blood pressure.Blocks alpha receptors in the eye (pupillary dilator muscle) MiosisReduces Bladder tone and allows for more motility (especially in patients with Urinary retention, BPH)

  • Drugs Arteriodilation, used in Raynaulds Phenomenon Increase Urinary Motility, used in Urinary rentention or BPH (Prazosin/Tamsulosin is most commonly used in BPH) Side effects: Nasal Congestion, Hypotension

  • YohimbinePrevents Negative feedback Increased Release of Epinephrine and NorepinephrineClaimed to be an AphrodisiacPotential uses: Impotence, Co-administrated with drug induced sexual dysfuction

  • phenoxybenzamineNon-competitive Alpha receptor antagonist - used in pheochromocytoma, malignant hypertension, Clonidine Withdrawal, Cheese SyndromePrazosin, tamsulosin, doxazosin1 selective: uses-mild to moderate HTN, BPH, Raynaudsyohimbine2 antagonist: Used in impotence

  • Eyes: Beta receptors are found in the cillary epithelium in the eye. When stimulated Produces Aqueous Humor. When blocked, decreases Aqueous Humor productionCVS: Beta 1 receptors are found in the heart. When stimulated Increase in Heart ratePulm: Beta 2 receptors Bronchodilation

  • Also known as Cardioselective Beta Blockers, decreases HRAtenololBetaxololEsmolol (short half life)AcebutalolMetoprololABEAM

  • Non Selective Beta blockersPropranololTimololPindolol Blocks beta 1 and beta 2 recepors Bronchospasms and Decrease in HRContraindicated in AsthmaticsDecreases aqueous humor production used in Open Angle glaucoma (Timolol)

  • Hypertension - mild to moderate HTNAngina pectoris -decreases cardiac work loadCardiac arrhythmiasMyocardial infarction- prevents the reinfarction, prevents the development of ventricular fibrillation

  • Glaucoma. Timolol is usedMigraine. Used for prophylaxis Thyrotoxicosis Essential tremors Congestive cardiac failure (carvedilol and labetolol)

  • Beta 2 Exacerbation of AsthmaMasks the sign of a hypoglycemic episodeBradycardia

  • Labetalol (doesnt cross Placenta, also used in pregnancy)CarvidilolBlocks alpha receptors Decrease BPBlocks beta receptors Decreases HRUsed in Severe HTN, Angina

  • What drugs can be given in HTN in pregnancy?

    Which is given orally (For home dosing)?

    Which is given IV (for immediate tx)?

  • ResperpineMOA: Prevents Storage of NE, allowing more MAO to metabolism NE/dopamine. Uses: HTNCrosses BBBSide effects: Depression, Suicidal Ideations

  • The nonselective -adrenergic blocking agent that is also a competitive antagonist at 1-adrenoceptors isa. Timololb. Nadololc. Pindolold. Acebutolole. Labetalol

  • Epineprhine =XWhen combined with an antagonist (IC or INC), a shift in the dose response curve occurs. The curve labeled X + INC would most likely occur when vascular smooth muscle is treated with NE in the presence of:

    a. Terazosinb. Phentolaminec. Labetalold. Phenoxybenzaminee. Prazosin

  • A predictably dangerous side effect of nadolol that constitutes a contraindication to its clinical use in susceptible patients is the induction ofa. Hypertensionb. Cardiac arrhythmiac. Asthmatic attacksd. Respiratory depressione. Hypersensitivity

  • All of the following drugs are used topically in the treatment of chronic wide-angle glaucoma. Which of these agents reduces intraocular pressure by decreasing the formation of the aqueous humor?a. Timololb. Echothiophatec. Pilocarpined. Isofluorphatee. Physostigmine

  • Both phentolamine and prazosina. Are competitive antagonists at 1-adrenergic receptorsb. Have potent direct vasodilator actions on vascular smooth musclec. Enhance gastric acid secretion through a histamine-like effectd. Cause hypotension and bradycardiae. Are used chronically for the treatment of primary hypotension

  • A 58-year-old male with angina is treated with atenolol. Select the mechanism of action of atenolol.a. -adrenergic agonistb. -adrenergic antagonistc. -adrenergic agonistd. -adrenergic antagoniste. Mixed and agonistf. Mixed and antagonist

  • A 75-year-old female with CHF is treated with carvedilol. Select the mechanism of action of carvedilol.a. -adrenergic agonistb. -adrenergic antagonistc. -adrenergic agonistd. -adrenergic antagoniste. Mixed and agonistf. Mixed and antagonist

  • A 35-year-old male with a pheochromocytoma is treated with labetalol. Select the mechanism of action of labetalol.a. -adrenergic agonistb. -adrenergic antagonistc. -adrenergic agonistd. -adrenergic antagoniste. Mixed and agonistf. Mixed and antagonist

  • A 65-year-old male has a blood pressure of 170/105 mmHg. Which of the following would be effective in lowering this patients blood pressure?a. Methylphenidateb. Terbutalinec. Dobutamined. Pancuroniume. Prazosinf. Scopalamine

  • Which of the following agents might mask the hypoglycemia in treated diabetics?a. An -adrenergic agonistb. An -adrenergic antagonistc. A -adrenergic agonistd. A -adrenergic antagoniste. A cholinergic agonistf. A cholinergic antagonist

  • Which of the following occurs in the treatment of glaucoma with a -adrenergic antagonist?a. Decreased aqueous humor secretionb. Pupillary dilator muscle fiber contractionc. Dilation of the uveoscleral veinsd. Direct opening of the trabecular meshworke. Circular pupillary constrictor muscle contraction

  • A 66-year-old male with a one-year history of essential hypertension has minimal response to diet and a diuretic. His blood pressure is now 160/105 mmHg. The diuretic is discontinued, and propranolol is given.a. -adrenergic antagonistb. -adrenergic antagonistc. Calcium (Ca) channel antagonistd. Carbonic anhydrase inhibitore. Histamine (H1) receptor antagonistf. H2 receptor antagonistg. MAOI

  • Which drug is used in pheochromocytoma?a. Pilocarpineb. Methylphenidatec. Propranolold. Ritodrinee. Phenoxybenzamine