Cardio pharm- alpha agonists/blockers, beta blockers

alpha 1 receptors _______

vasodilate

vasoconstrict

VASOCONSTRICT

MUST KNOW THIS

BC then its easy to figure out, if something is an alpha1 AGONIST, it vasoconstricts

if something is an alpha1 ANTAGONIST, it prevents vasoconstriction

and this makes sense- we know that alpha1 receptors are important mediators of sympathetic nervous system response, and when were in fight or flight, our blood vessels constrict

beta1 receptors are located where

in the heart!!!! and kidneys too but for this exam focus on the heart

we have 1 heart, so B1 is in the heart

beta2 receptors are located where

lungs

we have 2 lungs, so beta2 areceptors are in the lungs (and also our blood vessels)

alpha2 receptors do what

THINK OPPOSITE OF ALPHA1

alpha1 receptors looooove vasoconstricting bc they are involved in our sympathetic ns/fight or flight

alpha2 is like alpha1's sister who wants to be nothing like alpha1, so what does it do? it decreases the sympathetic ns activity by DECREASING CATECHOLAMINE (NOREPINEPHRINE) RELEASE

meaning, an alpha2 agonist will decrease sympathetic activity by decreasing catecholeamine release, which lowers BP

clonidine is

alpha1 agonist

alpha1 antagonist

alpha2 agonist

alpha2 antagonist

alpha2 agonist

for clondine's use in HTN, best form is

oral

IV

transdermal patch

trandermal patch

note that for adhd it is oral

T/F: rebound HTN and tachycardia are AEs of clonidine (alpha2 agonist)

T

alpha2 agonist (clonidine) can cause rebound HTN and tachycardia which is why we must do a GRADUAL STOP

clonidine has a boxed warning for

hypotension and bradycardia if given epidural- so dont use for OBGYN situations

which alpha2 agonist can be used during pregnancy

methyldopa

think, its DOPE that u can use it methylDOPEa during pregnancy

what exaclty does ti mean to be an alpha1 blocker

we are blocking alpha1 receptor's effect of vasoconstriction, so we are VASODILATING,thus, decreasing BP

nasal congestion, priapism, and postural hypotension/reflex tachycardia are AEs of

prazosin, doxazosin, terazosin (alpha 1 blockers)

clonidine, methyldopa (alpha 2 agonists)

phentolamine (alpha 1 and 2 blocker)

prazosin, doxazosin, terazosin (alpha 1 blockers)

why? bc we are blocking VC, so causing VD, which rapidly decreases BP, hence the postural hypotension/reflex tachycardia

the nasal congestion is bc alpha1 receptors vasoconstrict the vessels in then nose, and now we've blocked that vasoconstriction so the nose blood vessels dilate/congests the nose

priapism - if we VD and increase blood flow, harder for erection to go down

which HTN med class do we give a pt with HTN and benign prostatic hyperplasia (BPH)

alpha 1 blockers (prazosin, doxasozin, terazosin)

prazosin, doxazosin, terazosin are

alpha1 blockers

alpha2 blockers

alpha 2 agonists

alpha 1 agonists

alpha 1 blockers

they all end in sin, so s1n, block alpha1

bisoprolol, betaxolol, atenolol, acebutol, esmolol, metoprolol are

cardioselective beta blockers

non selective beta1/beta2 blockers

mixed alpha2/beta1/beta2 blockers

cardioselective , meaning they block B1 which is in the heart

how do we know these are cardioselective

cram the pance BEAM mneumonic

think of a beam of light, it has a narrow and focused target (the heart, B1 receptors)

Betaxolol

Bisoprolol

Esmolol

Atenolol

Acebutolol

Metoprolol

and remember, think LOL im (beta )blocked

so beta blockers end in LOL

what are the ISA beta blockers mean and why is this important

intrinsic sympathomimetic activity, meaning-the ability of certain beta-blockers to both block and stimulate beta-adrenergic receptors.

Beta blockers with ISA SHOULD BE AVOIDED AFTER AN MI

THINK THIS ISA PROBLEM IF U USE AN ISA BETA BLOCKER AFTER AN MI

ISA-Acebutolol, Pindolol, Labetalol, so do NOT USE THESE AFTER AN MI

*important* what are the beta blockers with ISA activity and what does this mean

Acebutolol, pindolol, labetalol

this means u CANNOT USE AFTER AN MI bc they have ISA activity

THINK THIS ISA PROBLEM IF U USE AN ISA BETA BLOCKER AFTER AN MI

*important* which 3 beta blockers lower mortality risk in heart failure with reduced ejection fraction

bisoprolol, metoprolol, carvedilol

biso

met

car

moa for B1 blockers (cardioselective beta blockers)

they increase coronary perfusion time

which beta blocker is metabolized by red blood cell esterase enzymes and therefore is short acting and quickly metabolized

Esmolol

remeber, beta blockers end in LOL so we know the answer will end in LOL

but which one?

E for Esmolol, E for RBC Esterase

which 3 beta blockers do u AVOID post MI

acebutolol, pindolol, labetalol

why? bc they have ISA

what is a huge contraindication for cardioselective beta1 blockers

bradycardia, myocardial depression, worsening of ACUTE DECOMPENSATED heart failure

why? beta-1 blockers have a negative inotropic effect, so they decrease heart contractility- WE DONT WANT THIS TO OCCUR IF SOMEONE'S HEART IS BARELY PUMPING.

arrhytmia with sotalol and precipitation of MI in IHD and tachyarrythmia with an abrupt stop are boxed warnings for

beta1 blockers

if you have a diabetic patient with HTN and CAD, and need to put them on a beta blocker, should u use cardioselective or noncardioselective?

CARDIOSELECTIVE (so BEAM- betaxolol, bisoprolol, esmolol, atenolol, metoprolol)

try to avoid non selective beta blockers (AKA NOT BEAM) bc they MASK SYMPTOMS OF HYPOGLYCEMIA

when someone is hypoglycemic they are shaky, have high heart rate, etc, and a non selective beta blocker prevents those symptoms , so someone can be hypoglyecmic and not even know, veryyyyy bad

what are the 2 mixed alpha2/beta1/beta2 blockers

carvedilol and labetalol

carvedilol and labetalol couldnt care less which receptor they block, theyll do it all

what are the main uses of carvedilol

POST MI

think CARvedilol is a CARdiologists dream medication to use after an MI bc it helps lower mortality

it is also used for stable angina, a fib, heart failure with reduced EF

when u think of carvedilol think of it as the beta blocker that can be used in ppl w heart problems

and remember its one of the 3 beta blockers that has been proven to reduce mortality in heart failure (the 3 are bisoprolol, metoprolol, carvedilol)

this class of HTN meds end in zosin

alpha1 blockers

this beta blocker is often used in hyptertensive emergencies, but ABSOLUTELY CANNOT BE USED AFTER AN MI

labetalol

*important*

which HTN meds can be used during pregnancy

Hydralazine

Nifedipine

Metoprolol

Hydrochlorothiazide

Labetolol

Methyldopa

How

Nice

My

Husband

Loves

Me

which type of beta blockers should not be used in someone w lung issues/asthma/copd

nonselectie beta blocker bc remmeber b1 is in heart, b2 is in lungs, so if we target both, we are affecting heart and lungs, and b2 blocking can cause vasoconstricton in lungs

what are the cardioselective betablockers

BEAM!!

Betoxalol

Bisoprolol

Esmolol

Atenolol

Acebutolol

Metoprolol

is propranalol a non cardioselective beta blocker

yes!! makes sense- propranalol isnt cardioselective, meaning it affects beta1 and beta2, this is why it has many uses (high BP, anxiety, etc)

Carvedilol affects which receptors

beta1 only

beta2 only

beta1 and beta 2 only

beta 1, beta2, and alpha1

beta 1, beta2, and alpha1

remember, Carvedilol and Labetalol couldnt Care Less what receptor they target

what are non cardiovascular uses of beta blockers

essential tremors, glaucoma, prophylaxis for migraine

these receptors are located in smooth muscles in blood vessels

beta1

beta2

alpha2

beta2

think beta2- lungs, blood vessels (and others, but these are the 2 most important for now)

prazosin, doxazosin, terazosin are _________

alpha1 blockers

alpha1 agonists

alpha2 blockers

alpha2 agonosits

alpha1 blockers

think prazos1n, doxazos1n, terazos1n, alpha1 blocker

how do we know not alpha1 agonist?

we dont have any alpha1 agonists to know for HTN;why? bc remember alpha1 receptors' jobs are to VASOCONSTRICT- in someone with HTN, we wouldnt want to do that!!!! we want to block that aka cause vasodilation, hence why we have alpha1 blockers

remember, alpha1 think fight or flight, sympathetic ns- so we want to inhibit this with an alpha1 blocker

why are alpha1 blockers specifically at risk for causing priapism compared to beta blockers, calcium channel blockers, etc

bc alpha1 receptors are located in the blood vessels, prostate and urethral sphincter, and iris dilator muscle

what are the 3 beta blockers that can reduce mortality in heart failure with reduced EF

biso, think beso, kiss

met

car

bisoprolol, metoprolol, carvedilol

think of someome talking about their new car they just saved up for, "I love my car(vedilol) so much I gave it a beso(prolol) when I met(oprolol) it"

T/F: labetalol is commonly given as a first line beta blocker post MI

F

absolutely not!!! it is part of the ISA category meaning this ISA PROBLEM if u give it post MI

ISA include- acebutol, pindolol, labetalol