Question | Answer |
general MOA of Alpha-blockers | they antagonize vasoCON --> vasoDIL |
general indications of Alpha-blockers | HTN, BPH |
general ADRs of alpha-blockers | orthostatic hypoTN, activate RAA--> Na retention, compensatory tachy, inhib/retrograde ejacualtion, nasal congestion |
Selective Alpha-1 blockers indicated for HTN, BPH | prazosin, doxazosin, terazosin, tamsulosin, alfusozin, sildosin |
3 selective Alpha-1 blockers indicated for BOTH HTN and BPH | prazosin, doxazosin, terazosin |
prazosin indication, unique SE | short-acting Alpha-1 blocker. Lay down and watch for first-dose effect-->severe hypoTN-->possible LOC |
longer acting selective Alpha-1 blockers (2) for HTN and BPH | doxazosin, terazosin |
what 2 selective Alpha-1 Blockers have unique SE of HA | terazosin, tamsulosin |
What 3 selective Alpha-1 blockers treat BPH only | tamsulosin, alfuzosin, silodosin |
tamsulosin | shorter acting, BPH only Alpha-1 Blocker |
alfuzosin | well tolerated, less dizziness, CYP3A4 metabolized BPH only Alpha-1 blocker |
sildosin | new drug, only BPH, less likely-->hypoTN, selective Alpha-1 Blocker (also CYP3A4) |
Indications for non-selective Alpha-1, Alpha-2 blockers | pre-op to decrease BP, pheochromocytoma |
Non-selective A-1, A-2 given IV for pre-op BP lowering, pheochromocytoma | phentolamine |
non-selective A-1, A-2 give orally, used ONLY for pheochromocytoma | phenoxybenazamine |
General MOA of Beta blockers | by lowering HR/Force/AV conduction, blood moves slower-->supplying more oxygen to heart -->coronary arteries can more adequately perfuse myocardium-->decreases angina |
General indications of Beta Blockers | angina, HTN, dysrhythmias, MI, HF |
General ADRs of Beta-blockers | Beta-1 overshoots --> brady, decreased CO, AV heart block. watch for rebound cardiac excitation when stopped abruptly
Beta-2 blockers -->bronchoCON, decreased glycogenolysis |
carvedilol | non-selective B-1, B-2 blocker that has short-term A-1 blocking |
indication of carvedilol | CHF (not indicated for HTN as A-1 blocking short term) |
labetalol | nonselective B-1, B-2 blocker with long term A-1 blocking |
indication of labetalol | HTN bwo long-acting additional A-1 blocking |
propanolol | nonselective B-1, B-2 ONLY blockers, lipid soluble-->BBB-->CNS effects/ high first pass effect |
unusual SE of propanolol | CNS effects - bad dreams, hallucinations, sedation or insomnia, depression |
unique MOA of selective B-1 blockers | selectivity is lost at high doses, and then it can block B-2 as well |
metoprolol | B-1 only blocker, less lipid solubility, less CNS effects |
atenolol | B-1 only blocker, not metabolized in liver (no first pass effect), unusual total renal excretion |
nibivolol | B-1 only blocker, has nitric oxide releasing properties |
nibivolol indications | HTN bwo ntric oxide properties which confer the vasoDIL |
general MOA of In-direct adrenergic blockers | these CENTRALLY ACTING Alpha-2 blockers reduce sympathetic output from brain stem -> periphery |
Alpha-2 antagonists can cross BBB. What is their net effect | they stimulate A-2 receptors in brain to decrease sympathetic output -->less vasoCON-->decrease blood pressure |
clonidine | selective A-2 blocker |
clonidine indication and preferred route | HTN, transdermal patch |
clonidine ADRs | 40% sedation, can have rebound HTN upon withdrawal |
guanabenz + guanfacine | clonidine look alikes indicated for HTN |
methyldopa | not for Parkinsons! hardly ever used A-2 blocker. similar to clondine. used to decrease BP, some pre-eclasmia |