L8

Question 1

4 A1 blocker effects

Answer 1

1. ↓BP
2. Dilate eye
3. Relax GU smooth muscle
4. ↓Viscous salivation

Question 2

3 A2 blocker effects

Answer 2

Blocks A2 autoreceptor that normally stops NE release

1. ↑NE - sympathetic effects (↑HR)
2. ↑Insulin
3. ↑GI motility

Question 3

What are the effects of non-selective A1 & A2 block?

Answer 3

A1 block effects
+
B effects - ↑NE release (tachycardia, etc)

Question 4

What kind of drugs are ergot alkaloids? Name 2.

Answer 4

Partial A1 and serotonin agonists
From infected grains
1. Ergotamine
2. Ergonovine

Question 5

Use ergotamine

Answer 5

Vasoconstrict to abort migraine headaches

Question 6

Use ergonovine

Answer 6

W/ oxytocin

Vasoconstrict POST-partum uterus -> prevent hemorrhage

Question 7

What is ergotism?

Answer 7

Too much ergot in system

Vasospasm -> painful limbs -> peripheral gangrene

Question 8

What are the 2 A1 & 2 non-selective blockers? What are the differences between them?

Answer 8

1. Phenoxybenzamine
   - Irreversible
   - Long acting
2. Phentolamine
   - Competitve
   - Short acting

Question 9

Major use of A1 & 2 non-selective blockers

Answer 9

Before/during surgical resection of catecholamine secreting tumors
(1st alpha block, 2nd beta)

Question 10

Do you use A1/2 non selective blockers to manage 1ary HTN?

Answer 10

NO

Question 11

3 uses of prazosin and terazosin

Answer 11

A1 blockers

1. 1ary HTN but not 1st line
2. Vasodilate for peripheral vasc diseases
3. Relax urinary smooth muscle
   - Pee out kidney stones

Question 12

How does tamsulosin act differently than other A1 blockers?

Answer 12

A1a specific - in vascular smooth muscle most A receptor are b type
- Doesn’t change BP as much
Selectively relaxes urinary tract smooth muscle

Question 13

Pathophys of benign prostatic hyperplasia - what can you use to treat it

Answer 13

Causes constriction of upper urethra –> incomplete bladder emptying –> ↑urinary freq
Use any of the A1 blockers

Question 14

7 adverse effects of A1 blockers

Answer 14

1. Postural hypotension - try to take meds at bedtime
2. Nasal congestion since dilating
3. Intraop floppy iris syndrome since relaxing smooth muscle of iris, avoid these drugs pre-cataract surg
4. Retrograde ejaculation
5. Delayed ejaculation
6. Priapism = sustained, painful erection
7. Dry mouth

Question 15

Explain sympa activity vs A blocker activity at erectile tissue

Answer 15

Sympa = bind A receptor - contract vascular & trabecular smooth muscle –> faccid
A blocker = dilate smooth muscle –> ↑blood flow & collapse veins - erection

Question 16

What are the expected cardiac outcomes of B blockers?

Answer 16

↓HR, CO
↓O2 demand
↓AV conduction velocity

Question 17

Effects of B blockers on electrolytes

Answer 17

Hypoglycemia

Hyperkalemia

Question 18

Other effects of B blockers

Answer 18

↓Renin
Vasoconstriction
Bronchoconstriction
↓Tremors since ↑K uptake into muscle = muscle weakness
↑Mast cell degranulation

Question 19

5 CV indications to use B blockers

Answer 19

Angina of effort
Post-infarction
Arrhythmias
Systolic HF
1ary HTN

Question 20

Which thyroid condition means you can use B blockers

Answer 20

Hyperthyroidism - short term management

Question 21

Why use B blockers for glaucoma?

Answer 21

↓Aqueous inflow –> ↓IOP

Use topically

Question 22

How would you take B blockers for migraines?

Answer 22

Prophylactic

Question 23

Adverse CV effects of B blockers

Answer 23

↓Exercise capacity
Bradycardia
AV conduction block
Exacerbate HR
Peripheral vasoconstriciton = cold extremities
Withdraw B super sensitivity - ↑ed risk for CAD pts

Question 24

Non-CV adverse effects of B block

Answer 24

1. Asthma/COPD bronchoconstriction
2. Mast cell destablize via B2 receptors - don’t use E to manage anaphylaxis
3. Blunted signs or delayed recovery of hypoglycemia - don’t get the responsive sympo-adrenal discharge
4. Exercise induced hyperkalemia as B2 ↑s K uptake in skeletal muscle –> weakness

Question 25

What do you need to worry about with topical B blocker application?

Answer 25

Getting into systemic circulation

Question 26

If a pt has a condition of adrenergic excess, what can result from use of B blockers?

Answer 26

Hypertensive emergency

Question 27

What is the difference between high and low lipid soluble beta blockers? - How excreted - Membrane crossing

Answer 27

``` High = eliminated by liver metabolism, crosses BBB & placenta Low = renal excretion ```

Question 28

Which pts would greatly benefit from use of partial B agonists?

Answer 28

Bradycardia | Partial conduction block

Question 29

What is the major advantage of using a B1 selective blocker?

Answer 29

Leave B2 alone = less risk non-CV adverse events | As you increase B1 selective blocker dose, this benefit decreases

Question 30

Which B blocker is used in eye drops?

Answer 30

Timolol = noselective blocker

Question 31

What are 2 B1 selective blockers?

Answer 31

Atenolol | Metoprolol

Question 32

What are 2 non-selective B blockers with additional vasodilator actions?

Answer 32

Carvedilol | Labetalol - alpha1 and B blocker

Question 33

What is the body's response to BB given IV in an acute setting?

Answer 33

↓↓CO ↑TPR - Not due to B2 block, due to reflex vasocontriction post ↓CO No change BP

Question 34

What is the body's response to BB given PO over a longer period of time?

Answer 34

↓TPR --> ↓BP - Not secondary to ↓CO - independent - Doesn't bring you back to baseline, residual vasoconstriction means pts will complain of cold extremities

Question 35

Which BB is used in heart failure to prevent myocyte cell death? Mechanism?

Answer 35

Carevdilol | Signals through B arretins -> inhibits apoptosis -> ↑cardiomyocyte survival

Question 36

2 uses of B2 blockers

Answer 36

Chronic glaucoma - ↓aqueous inflow | ↓tremors