Part 2.2.2 - Autonomic Drugs - Sympatholytics

Classifications of SYMPATHOLYTICS:

Alpha Blockers

Beta Blockers

a. Direct-Acting

b. Peripherally Acting

a. Direct-Acting

Classifications of SYMPATHOLYTICS:

Adrenergic Neuronal Blockers

a. Direct-Acting

b. Peripherally Acting

b. Peripherally Acting

Sympatholytics that block alpha receptors mainly cause ________.

a. Bronchodilation
b. Relaxation
c. Tremors
d. Lipolysis

b. Relaxation (blocking alpha receptors)

Blocking beta receptors may result in ________.

a. Cardiac depression
b. Mydriasis
c. Vasoconstriction
d. Increased renin secretion

a. Cardiac depression (blocking beta receptors)

Phenoxybenzamine is classified as a ________ alpha blocker.

(Multiple answer)

a. Reversible blocker
b. Nonselective blocker
c. Irreversible blocker
d. Noncompetitive blocker

e. Alpha 1 selective blocker

f. Alpha 2 selective blocker

b. Nonselective blocker
c. Irreversible blocker
d. Noncompetitive blocker

Phentolamine is a ________ alpha blocker.

(Multiple answer)

a. Reversible blocker
b. Nonselective blocker
c. Irreversible blocker
d. Noncompetitive blocker

e. Alpha 1 selective blocker

f. Alpha 2 selective blocker

a. Reversible blocker

b. Nonselective blocker

Yohimbine is a ________ alpha blocker.

(Multiple answer)

a. Reversible blocker
b. Nonselective blocker
c. Irreversible blocker
d. Noncompetitive blocker

e. Alpha 1 selective blocker

f. Alpha 2 selective blocker

a. Reversible blocker

f. Alpha 2 selective blocker

Prazosin, Doxazosin, Terazosin, Tamsulosin, and Alfuzosin are ________ alpha blocker.

(Multiple answer)

a. Reversible blocker
b. Nonselective blocker
c. Irreversible blocker
d. Noncompetitive blocker

e. Alpha 1 selective blocker

f. Alpha 2 selective blocker

a. Reversible blocker

f. Alpha 2 selective blocker

Drug used pre-surgically for pheochromocytoma to prevent hypertensive crisis

a. Phentolamine
b. Yohimbine
c. Phenoxybenzamine
d. Tamsulosin

c. Phenoxybenzamine

-used prior to surgical removal of tumor to prevent hypertensive crisis

Drug commonly used during surgery for pheochromocytoma

a. Prazosin
b. Phentolamine
c. Phenoxybenzamine
d. Yohimbine

b. Phentolamine

Drug used for mastocytosis because of histamine blockade

a. Phenoxybenzamine
b. Tamsulosin
c. Terazosin
d. Doxazosin

a. Phenoxybenzamine

- too much masts cells that store histamine

Drug used for carcinoid tumor because of 5-HT blockade?

a. Yohimbine
b. Prazosin
c. Phenoxybenzamine
d. Alfuzosin

c. Phenoxybenzamine

Occurs when a catecholamine secreting tumor of cells derived from the adrenal medulla

a. Carcinoid Tumor

b. Pheochromocytoma

c. Mastocytosis

b. Pheochromocytoma

Drug may be used for Raynaud syndrome

a. Phentolamine
b. Tamsulosin
c. Yohimbine
d. Terazosin

a. Phentolamine

Occurs when there is an accidental local infiltration of alpha agonists and sympathomimetic poisoning

a. Erectile Dysfunction

b. Pheochromocytoma

c. Raynaud Syndrome

c. Raynaud Syndrome

Drug locally administered for erectile dysfunction

a. Phentolamine
b. Tamsulosin
c. Phenoxybenzamine
d. Doxazosin

a. Phentolamine

Drug used orally for erectile dysfunction

a. Yohimbine
b. Terazosin
c. Prazosin
d. Alfuzosin

a. Yohimbine

Drugs used for hypertension as a vasodilator

(Multiple answers)

a. Terazosin
b. Alfuzosin
c. Doxazosin
d. Tamsulosin

e. Prazosin

a. Terazosin

c. Doxazosin

e. Prazosin

Drugs used for Benign prostatic hyperplasia (BPH):

(Multiple answers)

a. Terazosin
b. Alfuzosin
c. Doxazosin
d. Tamsulosin

e. Prazosin

b. Alfuzosin

d. Tamsulosin

-Used as an alternative to surgery

A common toxicity of adrenergic antagonists is reflex ________.

a. Bradycardia
b. Tachycardia
c. Sedation
d. Tremors

b. Tachycardia

Other Toxicities:

• Reflex Tachycardia

• Orthostatic Hypotension

• Nausea and Vomiting

Beta Blockers Effects:

(-) Dromotropism = ____

(-) Inotropism = _____

(-) Chronotropism = ____

Choices:

a. Lesser rate

b. Lesser conduction velocity

c. Lesser force

(-) Dromotropism = Lesser conduction velocity

(-) Inotropism = Lesser force

(-) Chronotropism = Lesser rate

Beta Blockers are classified based on:

a. Based on selectivity

b. Based on their miscellaneous action

c. Both

c. Both

Based on selectivity

• B1-selective

• Non-selective

Based on their miscellaneous action

• Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

• Beta blocker with Membrane Stabilizing Action ( MSA )

• Beta blocker with Alpha-1 blocking effect

• Most cardio selective Beta blocker among Beta blockers

[Based on selectivity]

Non-selective beta blockers:

(Multiple Answers)

a. Metoprolol

b. Nadolol

c. Sotalol

d. Betaxolol

e. Timolol

f. Propranolol

Nadolol

Sotalol

Timolol

Propranolol

mnemonics: “NSTP”

[Based on selectivity]

B1-Selective or Cardioselective

(Multiple Answers)

a. Metoprolol

b. Acebutolol

c. Celiprolol

d. Betaxolol

e. Atenolol

f. Bisporolol

g. Esmolol

All

“MAC BABE”

[Based on their miscellaneous action]

Beta blockers with Intrinsic Sympathomimetic Activity (ISA) include:

(Multiple Answers)

a. Celiprolol

b. Carteolol

c. Labetalol

d. Propranolol

e. Bisporolol

f. Acebutolol

g. Penbutolol

h. Atenolol

Celiprolol

Carteolol

Labetalol

Acebutolol

Penbutolol

“bigyan ng ISAng CLAPP”

[Based on their miscellaneous action]

Beta blockers with Membrane Stabilizing Action ( MSA ) include:

(Multiple Answers)

Pindolol

Propranolol

Acebutolol

Labetalol

Metoprolol

All

“MSA = PPALM”

[Based on their miscellaneous action]

Beta blockers with Alpha-1 blocking effect include:

(Multiple Answers)

a. Carvedilol

b. Labetalol

c. Nebivolol

a. Carvedilol

b. Labetalol

[Based on their miscellaneous action]

Most cardio selective Beta blocker among Beta blockers is:

a. Carvedilol

b. Labetalol

c. Nebivolol

c. Nebivolol

“Cardio selective = Nebi♡olol”

[Based on their miscellaneous action]

Beta blocker with ß₁ antagonism and ß₂ agonism effect

a. Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

b. Beta blocker with Membrane Stabilizing Action (MSA)

c. Beta blocker with Alpha-1 blocking effect

d. Most cardio selective Beta blocker among Beta blockers

a. Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

[Based on their miscellaneous action]

They possess local anesthetic effect

a. Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

b. Beta blocker with Membrane Stabilizing Action (MSA)

c. Beta blocker with Alpha-1 blocking effect

d. Most cardio selective Beta blocker among Beta blockers

b. Beta blocker with Membrane Stabilizing Action (MSA)

[Based on their miscellaneous action]

Not prepared as ophthalmic drops due to inhibition of blinking reflex resulting to drying of the eyes leading to corneal injury

a. Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

b. Beta blocker with Membrane Stabilizing Action (MSA)

c. Beta blocker with Alpha-1 blocking effect

d. Most cardio selective Beta blocker among Beta blockers

b. Beta blocker with Membrane Stabilizing Action (MSA)

-not instilled in the eyes

[Based on their miscellaneous action]

Vasodilating effect

a. Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

b. Beta blocker with Membrane Stabilizing Action (MSA)

c. Beta blocker with Alpha-1 blocking effect

d. Most cardio selective Beta blocker among Beta blockers

c. Beta blocker with Alpha-1 blocking effect

[Based on their miscellaneous action]

It has a vasodilating effect due to increase of Nitric oxide

a. Beta blocker with Intrinsic Sympathomimetic Activity (ISA)

b. Beta blocker with Membrane Stabilizing Action (MSA)

c. Beta blocker with Alpha-1 blocking effect

d. Most cardio selective Beta blocker among Beta blockers

d. Most cardio selective Beta blocker among Beta blockers

Beta blockers are considered ________ line agents in the management of hypertension in patients with history of post myocardial infarction.

a. Second
b. Third
c. First
d. Last

c. First

Beta blockers are used in the treatment of ________ pectoris.

a. Variant
b. Angina
c. Unstable
d. Vasospastic

b. Angina (CSAP)

Which drugs are used in the management of congestive heart failure?

a. Bisoprolol

b. Dopamine

c. Yohimbine

d. Phentolamine

e. Metoprolol succinate

f. Carvedilol

g. Propranolol

h. Nebivolol

Bisoprolol

Metoprolol succinate

Carvedilol

Nebivolol

(memorize this)

Beta blockers belong to Arrhythmia Class ___agents

a. Class I

b. Class II

c. Class III

b. Class II

-except sotalol (Class III)

Drug useful in chronic management of stable angina

a. Propranolol
b. Timolol
c. Nadolol
d. Pindolol

a. Propranolol

1st line agent in the management of hypertension in patients with a history of post myocardial infarction

a. Propranolol
b. Timolol
c. Nadolol
d. Pindolol

a. Propranolol

-protective effect on the myocardium; can protect a patient against a second heart attack (prophylaxis)reduces infarct size and hasten recovery

Propranolol is used for prophylaxis in acute ________ headache.

a. Cluster
b. Migraine
c. Sinus
d. Tension

b. Migraine

Propranolol is used in the management of sympathetic symptoms of ________.

a. Diabetes
b. Hyperthyroidism
c. Asthma
d. Glaucoma

b. Hyperthyroidism

Protects against serious cardiac arrhythmias (due to thyroid storm)

a. Propranolol
b. Timolol
c. Nadolol
d. Pindolol

a. Propranolol

Management of Stage Fright

a. Propranolol
b. Timolol
c. Nadolol
d. Pindolol

a. Propranolol

Drug that has a very long duration of action

a. Timolol
b. Nadolol
c. Propranolol
d. Betaxolol

b. Nadolol

Drug that reduces the production of aqueous humor in the eye

a. Timolol
b. Propranolol
c. Pindolol
d. Acebutolol

a. Timolol

Topically used in the treatment of chronic open angle glaucoma

(Multiple Answers)

a. Timolol
b. Nadolol
c. Propranolol
d. Betaxolol

a. Timolol

d. Betaxolol

-decreases the secretion of aqueous humor by the ciliary body

Which drug is still the DOC for emergency lowering of IOP in acute glaucoma?

a. Timolol
b. Betaxolol
c. Pilocarpine
d. Nadolol

c. Pilocarpine

Selective Beta1 antagonists are useful in hypertensive patients with impaired ________ function.

a. Renal
b. Pulmonary
c. Hepatic
d. GI

b. Pulmonary

First line therapy for chronic stable angina

a. Selective Beta 1 antagonist

b. Selective Beta 2 antagonist

c. Non-selective agonist

Selective Beta 1 antagonist

Beta blockers with ISA are effective in hypertensive patients with moderate bradycardia, because a further decrease in heart rate is less pronounced in these drugs.

a. Acebutolol and Pindolol
b. Timolol and Nadolol
c. Propranolol and Timolol
d. Carvedilol and Nebivolol

a. Acebutolol and Pindolol

Not used for stable angina and arrhythmias due to their partial agonist effect

a. Acebutolol and Pindolol
b. Timolol and Nadolol
c. Propranolol and Timolol
d. Carvedilol and Nebivolol

a. Acebutolol and Pindolol

Drug used as an alternative to methyldopa in pregnancy-induced hypertension

a. Propranolol
b. Timolol
c. Labetalol
d. Nadolol

c. Labetalol

Drug used in hypertensive emergencies

a. Labetalol
b. Pindolol
c. Betaxolol
d. Timolol

a. Labetalol

-it can rapidly lower blood pressure

Toxicity associated with beta blockers

a. Bronchodilation
b. Hypoglycemia augmentation
c. Mydriasis
d. Lipolysis

b. Hypoglycemia augmentation

This toxicity may occur with beta blockers

a. Bradycardia
b. Tachypnea
c. Mydriasis
d. Vasodilation

a. Bradycardia

Which respiratory toxicity may occur with beta blockers?

a. Bronchodilation
b. Bronchoconstriction
c. Hyperventilation
d. Apnea

b. Bronchoconstriction

Toxicity associated with beta blockers

a. Bronchodilation
b. Dyslipidemia

c. Mydriasis
d. Lipolysis

b. Dyslipidemia

Adrenergic neuronal blockers inhibit the storage of ________.

a. Dopamine
b. Serotonin
c. NE
d. Histamine

c. NE

Inhibition of storage results in ___ NE ready to be released.

a. decreased

b. increased

a. decreased

Drug that inhibits storage of NE

a. Bretylium
b. Guanadrel
c. Reserpine
d. Guanethidine

c. Reserpine

Reserpine may cause CNS depression due to decreased mood regulators like ____ and ________.

a. Serotonin and Histamine
b. Acetylcholine and NE
c. Serotonin and NE
d. Dopamine and NE

c. Serotonin and NE

Reserpine may cause EPS due to decreased ________ levels.

a. Serotonin
b. Dopamine
c. Histamine
d. GABA

b. Dopamine

Drug inhibit release resulting in lesser amount of NE binding to the receptor?

(Multiple Answers)

a. Guanadrel
b. Prazosin
c. Bretylium
d. Guanethedine

Bretylium

Guanadrel

Guanethedine

“BGG”

Drug associated with pharmacologic sympathectomy

a. Guanethedine
b. Dopamine
c. Acebutolol
d. Betaxolol

a. Guanethedine

Pharmacologic sympathectomy is characterized by marked postural ________.

a. Hypertension
b. Hypotension
c. Tachycardia
d. Bradycardia

b. Hypotension

Pharmacologic sympathectomy may cause impaired ________.

a. Vision
b. Respiration
c. Ejaculation
d. Digestion

c. Ejaculation