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Pharm Autonomic NS

Combined Alph- and Beta-Adrenergic Blockers

QuestionAnswer
Alpha blockade predominates so they are less likely to cause significant reductions in HR and CO
Two drugs in this category: carvedilol[Coreg], labetalol[Normodyne]
They combine selective alpha 1 and nonselective beta
They decrease BP standing BP is more affected than supine
They decrease myocardial oxygen demand and lower cardiac workload
single dose of labetolol has no effect on sinus rate, intraventricular conduction or qrs duration
no significant effect on serum lipoproteins
Contraindicated in pts with bronchospastic component, overt NYHA class IV HF, greater than first degree block,and severe bradycardia
Coreg has been shown to be effective in class II and III HF b/c of its limited effects on HR, myocardial contractility, while improving hemodynamics and cardiac performance
similar to cautions of BBs in diabetes and thyroid disease, hepatic impairment
risk for orthostatic hypotension higher than with beta blockers
Lab tests affected by labetolol reversible increase in transaminases, and BUN, false + for amphetamines
used to treat essential HTN alone or in combination with thiazides. dose adjustments based on standing BP
use in CHF tx: Coreg in class II, III HF of ischemic or cardiomyopathy origin inconjunction with diuretics and ACEIs to reduce progression of disease and increase survival [not recommended in all guidelines]
labetolol has been use to tx withdrawal HTN associated with clonidine
these drugs must be tapered when discontinued just like alphas and betas used seperately
labetolol may be used when a pt cannot tolerate changes in HR but needs beta blockade [post MI prophylaxis]
Created by: heatherbrown2020