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Flashcards in HTN: A/B Blockers Deck (16)
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1

What are the long-acting (QD) alpha blockers? Short acting?

-Long acting: terazosin, doxazosin**
-Short acting: prazosin

2

Alpha-blocker MOA

-a1 selective--> decrease arterial psi by dilating resistance and capacitance vessels
-Greatest BP reduction when upright
-Fluid retention common when not pair with diuretic**

3

Alpha-blocker indications

-BPH--> less use now with Tammy
-Expulsive therapy for ureteral stones
-HTN--> less use given poor data
-Prazosin used in combat vets with PTSD but poor data

4

Alpha-blocker Pearls

-Less tachy but more postural hypoTN (esp in first few doses)**
-AVOID vasodilators (nitrates, PDE5) and decongestants (increase bladder neck tone and urinary retention)

5

Alpha-blocker ADR

-Postural hypoTN/dizziness VERY common in 1st few doses** (take at bedtime)
-Drowsiness/fatigue
-Nasal congestion/rhinitis**
-Retro ejac
-Floppy iris syndrome

6

What are the non-selective B-blockers?

-Propranolol**
-Nadolol
-Timolol
-Ass with bronchospasm

7

What are the selective B-blockers?

-Metoprolol Tartrate (IR) & Metoprolol Succinate (ER, used in HF)**
-Atenolol
-Esmolol
-Betaxolol
-Bisoprolol
-Less likely to cause bronchospasm

-Best for post-AMI, HF, AF, etc

8

B-blockers with vasodilation?

-Used for CHF > HTN
-Carvedilol**
-Labetalol
-Nebivolol

9

B-Blocker MOA

-Competitive inhibitors of catecholamines at B-receptors

-B1 (heart): increase HR, contractility, AV conduction
-B2 (Bronchial/peripheral SM > heart): vasodilation and bronchodilation

10

B-Blocker Cardiac Indications

-HTN
-Stable/unstable angina (for sx and exercise tolerance)
-Post-AMI (at least 2-3 yrs)
-Systolic HF/HFrEF (indefinitely)
-Certain arrhythmias (AF)
-Periop CV risk

11

B-Blocker non-cardiac Indications**

-Propranolol for proliferating infantile hemangioma
-Migraine
-Essential tremor
-Sx mgmt of pheochromocytoma/hyperthyroid

12

B-Blocker Pearls

-Monotherapy less sensitive in blacks**
-Taper 1-3 wks--> accelerated angina, AMI, death if abrupt stop (pts w ischemic HD)**
-Don't give to pts on cocaine
-Generally less effective in preventing CV events (esp CVA) compared to ACE, ARB, CCB**

13

B-blockers and HF

-Carvedilol
-Metoprolol succinate if symptomatic hypoTN or ventricular arrhythmia
-Long term use= reduced hospitalizations, improves sx, QOL and survival
-STABLE patients with EF 40% or less

14

B-Blockers Precautions/CI

-Asthma/COPD (non-selective)
-2nd or 3rd degree AV block
-Sick Sinus Syndrome (unless used with pacer)
-Brady <50 bpm

15

B-Blocker Drug interactions

-Propranolol, metoprolol, carvedilol 2D6 subs
-Careful with CCB and antiarrhythmics
-Anti-HTN and vasodilators
-Blunts effects of Epi (EpiPen)**

16

B-Blocker ADRs

-Brady
-Hyperkalemia (non-selective agents)
-Fatigue/exercise intolerance
-ED
-Floppy iris (carvedilol and labetalol)
-Bronchospasm (non-selective agents)
-May mask/delay recovery from hypoglycemia--> edu with diabetics is vital**