Cp Ii Nitrates & Alpha Blockers

Front 1

What is prinzmetal's angina?

Back 1

variant angina (oxygen delivery dec. b/c of reversible coronary vasospasm)

Front 2

What drugs address demands of preload and afterload?

Back 2

nitrates and CCBs

Front 3

What drugs address the demands of HR and contractility?

Back 3

beta-blockers and some CCBs

Front 4

MOA of nitrates?

Back 4

cause vasodilation via: releasing NO which activates guanylyl cyclase which inc. cGMP which relaxes all smooth muscles! yay

Front 5

What one thing do you need to know about nitrate therapy?

Back 5

tolerance develops w/ continuous administration. need 8-12 hours nitrate free per day

Front 6

antianginal beneficial effects of nitrates are due to what 3 things?

Back 6

1. pronounced dilation of large veins (inc. preload)
2. preferential dilation (of large epicardial arteries to redistribute coronary blood flow from normal to ischemic areas)
3. mild arteriolar dilation (dec. afterload)

Front 7

Common AE of nitrates?

Back 7

throbbing headache

others are: hypotension, dizziness, weakness, rash, tachycardia due to sympathetic activation, and methemoglobinemia

Front 8

One major drug interaction of nitrates?

Back 8

ED drugs (PDE5 inhibitors): sildenafil, tadalafil, vardenafil

Profound vasodilation & hypotension is used with erectile dysfunction drugs.

"Sil Taps the Vagina" -afil

Front 9

various uses for Nitrates?

Back 9

Big ones: all forms of angina - acute and unstable angina - SL NTG take every 5 min up to 3 doses

Take for angina of effort, variant angina, and unstable angina.

Take isosorbide dinitrate in combo with hydralazine as a direct vasodilator for HF

Front 10

Best drug for emergency HTN situation?

Back 10

nitroprusside (POTENT vasodilator)... but continuous IV only

onset - 30 sec
peak - 2 min
disappears - 3 min

Front 11

What is nitroprusside metabolized to that could (rarely) cause AE's?

Back 11

cyanide and then to thiocyanate, caution with pts that have renal and hepatic impairment

Front 12

3 main responses of alpha-1 stimulation?

Back 12

1. contraction of most vascular smooth muscle
2. contraction of urinary bladder
3. contraction of prostate

Front 13

What drug irreversibly inhibits alpha-1 receptors?

Back 13

phenoxybenzamine, therefore has a longer duration of effect

Front 14

Magnitude of cardiovascular effects of alpha-1 antagonism depends largely on what?

Back 14

the activity of the sympathetic nervous system at the time, if the pt is seated or supine, and has marked effects in hypovolemia

Front 15

What is yohimbine used for?

Back 15

erectile dysfunction (alpha-2 antagonist)

Front 16

Pt. has adrenal medullary tumor (or sympathetic neuron tumor). What can you give to treat?

Back 16

phenoxybenzamine; short-term: phentolamine

Front 17

70-80% of alpha-receptors in the prostate are what subtype?

Back 17

alpha-1A

Front 18

What 2 clinical settings do you want to use SELECTIVE alpha-blockers?

Back 18

HTN and benign prostatic hypertrophy

Front 19

What alpha-1 blocker must be taken w/ food?

Back 19

alfuzosin

Front 20

Biggest AE of alpha-1 selective blockers?

Back 20

marked postural hypotension and syncope (others: dizziness, sexual dysfunction)

Front 21

What alpha-1 selective blockers are useful for treating HTN?

Back 21

doxazosin, prazosin, and terazosin

Front 22

3 biggest AE's of tamsulosin?

Back 22

impaired ejaculation, orthostasis, and intraoperative floppy iris syndrome

Front 23

Which classes of drugs what increase coronary and regional myocardial blood flow?

Back 23

vasodilators, especially CCBs

Front 24

Besides angina & HF, what are other uses for nitrates?

Back 24

to control hypotension in anesthesia induction, pain associated with anal fissures or hemorrhoids, uterine relaxant to expel placenta, and for impotence

Front 25

What is the main beneficial effect of nitrates?

Back 25

Decrease in Bp, ventricular volume, & ejection time, which results in reduced myocardial O2 requirement

Front 26

What are 2 harmful nitrate effects?

Back 26

reflex increase in HR & contractility, which increases myocardial O2 requirement.

reduced diastolic perfusion due to reflex tachy, which reduces myocardial perfusion

Front 27

What is the difference between nitrates & nitroprusside regarding tolerance?

Back 27

No tolerance to nitroprusside develops

Front 28

What are vasodilator related AE of nitroprusside?

Back 28

hypotension, headache, dizziness, palpitations, and diaphoresis

Front 29

What are cyanide related AE of nitroprusside?

Back 29

sever lactic acidosis, anorexia, nausea, fatigue, disorientation, shallow breathing, hypothyroidism, happens with higher doses > 24-48 hrs

Front 30

Drug interactions with nitroprusside - with sympathomimetic drugs

Back 30

dopamine, dobutamine, epinephrine, norepinephrine

Front 31

what does alpha 2 stimulation effect?

Back 31

acts of blood vessels & skeletal muscle and results in vasoconstriction

Front 32

Name 2 non-selective alpha receptor antagonist

Back 32

Phenoxybenzamine & phentolamine

"Phenox & Phento are NOT SELECTIVE about where they Pee Pee"

Front 33

Name 5 alpha 1 selective alpha receptor antagonist

Back 33

Prazosin, Terazosin, Doxazosin, Alfuzosin, and Tamsulosin

"PRincess TERA only DOnates alpha-1 selective ALFalfa TAMiflu"

--osin

Front 34

Where are alpha-1A receptors located?

Back 34

prostate and bladder neck

Front 35

where are alpha-1B receptors located?

Back 35

vascular smooth muscle

Front 36

Name 1 alpha receptor antagonists that is alpha-2 selective

Back 36

Yohimbine

"with alpha 2 you need 2: YOu and Him"

Front 37

What are cardiovascular effect of alpha 1 antagonists?

Back 37

fall in BP due to decreased vascular resistance, NO reflex tachycardia, also reduces smooth muscle tone in prostate and neck of bladder

Front 38

what are pharmacologic effects of selective alpha 2 antagonism?

Back 38

increase sympathetic outflow and potentiate release of NE from nerve endiings.

alpha-2A blocks platelet aggregation in vitro, facilitate insulin release, increase penile blood inflow, decrease penile blood outflow, used to treat erectile dysfunction

Front 39

MOA of phenoybenzamine

Back 39

irreversible binding, inhibits reuptake of released NE by presynaptic adrenergic nerve terminals, blocks histamine, acetylcholine, and serotonin receptors

Front 40

clinical effects of phenoxybenzamine

Back 40

use to reduce BP when sympathetic tone high

vasodilation, decreased BP, reflex tachy, incresed cutaneous blood flow

Front 41

What do you know about phenoybenzamine's half life?

Back 41

t 1/2 is long = 24 hrs because of irreversible binding

oral formula

Front 42

What can you use phenonybenzamine for?

Back 42

pheochromocytoma to decreased BP, use for BPH (not anymore), and for Raynaud's, frostbite, and acrocyanosis because of increased cutaneous blood flow

Front 43

What are 3 AE of phen
oxybenzamine?

Back 43

postural hypotension, reflex tachy, and reversible inhibition of ejeculation

Front 44

Name a nonselective, competitive inhibitor of alpha receptors and its MOA

Back 44

Phentolamine - competitively inhibits alpha 1 and 2 receptors. Also blocks serotonin (5-HT) receptors, cause release of histamine fr mast cells, and block K+ channels

Front 45

How would you administer phentolamine to your patient?

Back 45

IV only

Front 46

CV effects of phentolamine?

Back 46

vasodilation and decreased BP

Front 47

Other therepeutic uses for phentolamine?

Back 47

short term control for HTN in pheochromocytoma and to relieve pseudo-obstruction of bowel in the same disease. Treat HTN due to clonidine withdrawal

Front 48

In which patients should you be careful about using phentolamine?

Back 48

Those with a history of coronary artery disease or peptic ulcer bc AE are hypotension, reflex tachy, and GI stimulation causing abdominal pain, nausea, and exacerbation of peptic ulcer

Front 49

Which alpha 1 receptor antagonist can effect all 3 types of receptors: alpha-1A, alpha-1B, and alpha-1D?

Back 49

Prazosin, Terazosin, Doxazosin, Alfuzosin

All the -zosins

Front 50

Which alpha 1 receptor antagonist drugs only distribute to the bladder and prostate?

Back 50

Alfuzosin and Tamsulosin

"Alfalfa Tamiflu are weird like that, and only go to the prostate and bladder."

Front 51

Which alpha 1 receptors does Tamsulosin antagonize?

Back 51

alpha-1A and alpha-1D

Front 52

What are symptoms of Benign Prostetic Hyperplasia?

Back 52

hesitancy, weakness of urinary stream, intermittent urinary stream, feeling of incomplete bladder emptying, bladder irritability

Front 53

What are the major effect of alpha 1 receptor antagonists?

Back 53

decreased PVR and venous return to heart, which leads to decreased cardiac preload, usually no increase in HR

relaxed bladder for increased urine flow

decrease size of prostate by apoptotic properties in prostate smooth muscle

Front 54

What favorable effects does alpha 1 selective receptor antagonists have on serum lipids?

Back 54

increase HDL, and decreased in LDL and TG

Front 55

What is the dose for alpha 1 selective receptor antagonists and what is the exception?

Back 55

once daily at bedtime except for

prazosin 2-3 x day
alfuzosin must be taken with food

Front 56

Which alpha 1 selective receptor antagonists do you use for HTN? 3

Back 56

Prazosin, Terazosin, and Doxazosin

Front 57

Which 4 alpha 1 selective receptor antagonists do you use for BPH?

Back 57

all except Prazosin:

Terazosin, Doxazosin, Alfuzosin, and Tamsulosin

Front 58

Which alpha 1 selective receptor antagonist do you not use for HTN and why?

Back 58

Alfuzosin and Tamsulosin because they have little effect on blood pressure and have uroselectivity

Front 59

When should you not give Alfuzosin to a pt?

Back 59

If the pt has moderate to sever hepatic dysfunction because it is metabolized via P450 3A4