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pharma exam 1
n/a
133
Nursing
Undergraduate 4
06/15/2014

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Cards

Term
What are the three MAIN properties of an ideal drug
Definition
1. Effectiveness
2. Safety
3. Selectivity
Term
Name 6 additional properties that an ideal drug should have
Definition
1. Reversible action
2. Predictability
3. Ease of administration
4. Freedom from drug interactions
5. Chemical stability
6. A simple generic name
Term
Why should a study be randomized?
Definition
To eliminate allocation bias
Term
What are the stages of drug development? What defines them?
Definition
A. Preclinical testing - toxicities, pharmacokinetic properties, and potentially useful effects - Not on Humans
B. Clinical testing
1. Phase 1 - conducted with healthy volunteers unless side effects are too severe
Phase 2 & 3 - Tested in patients to determine therapeutic range, dosage range, safety, and effectiveness
Phase 4 - Post marketing surveillance
Term
What are some limitations to drug development and clinical trials?
Definition
1. Data for women and children is limited
2. It's likely that new drugs will have undetected side-effects
Term
What are the three types of drug names?
Definition
1. Chemical name
2. Generic name
3. Trade names
Term
Why is it better to use a generic drug name?
Definition
A drug generic named drug can have multiple trade names, and some OTC trade names can have different active ingredients.
Term
Who assigns non-proprietary names? Who assigns proprietary (trade) names?
Definition
The United States Adopted Names Council assigns nonproprietary names. The drug developer assigns trade names.
Term
What are the 4 pharmacokinetic processes?
Definition
Absorption - Movement of a drug from administered site to blood
Distribution - Movement of drug throughout the body. Blood flow determines delivery rate
Metabolism - The enzymation alteration of drug structure (usually in liver)
Excretion - The removal of drugs from the body
Term
What are the barriers a drug molecule must pass through, and what organs does the drug usually reach?
Definition
Cytoplasmic membrane is the major barrier. The three ways it can pass are:
1. channels and pores
2. transport systems
3. Direct penetration of the membrane itself (lipid only)

Kidneys and liver
Term
What is a tablet?
Definition
a Mixture of a drug plus binders and fillers, compressed together. The manufacturer can change the rate of disintegration and dissolution
Term
What is an enteric coated tablet?
Definition
Drugs that are covered with a material designed to dissolve in intestine but not the stomach. This protects the drug from acid and pepsin in the stomach and prevents gastric discomfort
Term
What is a sustained release tablet?
Definition
Capsules filled with tiny spheres that contain the drug. Each sphere has a coating that dissolves at variable rates.
Term
What is the first pass effect? How can it be avoided?
Definition
It is rapid hepatic inactivation of certain oral drugs, where one pass through the liver will inactivate the drug. Parenteral administration is avoids this.
Term
What is special about the blood brain barrier (BBB)? Which drugs can cross it?
Definition
Capillaries at the BBB have tight junctions, preventing drug passage. Drugs must be lipid soluble or utilize transport systems.
Term
What is "protein-binding?"?

What happens to free drug levels when another highly protein bound drug is introduced?
Definition
When a drug binds with a protein, albumin being the most common

One drug can displace albumin, increasing the free concentration of the displaced drug to increase.
Term
What is a drug "half-life"?

How many half-lives does it take for a drug to reach plateau?
Definition
Half life is the time required for the amount of drug in the body to decrease 50%

It takes 4 half-lives to reach plateau
Term
What is therapeutic range?

What is toxicity?

What type of monitoring is done for a drug with low therapeutic index?
Definition
Therapeutic range is the drug plasma level between minimum effectiveness and toxic concentration.

Toxicity is an adverse drug reaction from excessive dosing

Low therapeutic index doses are monitored more closely
Term
What is a loading dose?

What is a maintenance dose?
Definition
A loading dose is an initial large dose to rapidly plateau the drug in serum.

a maintenance dose is a smaller dose to maintain plateau
Term
What is an agonist?

What is a partial agonist?
Definition
Molecule that activates receptor

An agonist that only has moderate intrinsic activity.
Term
What is an antagonist?
Definition
Molecule that prevent receptor activation
Term
Can a drug cause a cell to perform "a new function?"
Definition
No
Term
Define therapeutic index

Is an index of 10 safer than 2?
Definition
The ratio between the LD50 (lethal response dose for 50% of population) over the ED50 (dose required for response for 50% of population)

10 is a much safer index than 5
Term
What, when continually exposed, can desensitize a cell?

What, when continually exposed, can cause a cell to become super sensitive
Definition
A cell can be desensitized by continual exposure to an agonist.

A cell can become super sensitive with antagonists by more receptor synthesis
Term
What two drugs together cause an increased therapeutic effect?

What is that effect?
Definition
Ampicillin and Sulbactam

kill more bacteria together
Term
What two drugs together cause an increased adverse effect?

What is that effect?
Definition
Aspirin and warfarin decreases warfarin's anti-coagulant properties and increases bleeding risk
Term
What two drugs together cause an reduced therapeutic effect?

What is that effect?
Definition
Propranolol blocks albuterol's ability to dilate the bronchi
Term
What two drugs together cause a reduced adverse effect?

What is that effect?
Definition
Naloxone blocks dangerous respiratory depression from morphine
Term
What does it mean to have a "potentiative interaction"
Definition
a potentiative interaction can intensify therapeutic effects or intensify adverse effects

An enhancement of the effect of one agent by another to create an effect greater than their parts.
Term
What is an inducing agent?

What is an inhibiting agent?
Definition
Inducing agents are promoting.

Inhibiting agents reduce.
Term
How does grapefruit juice affect drug levels?
Definition
Grapefruit juice inhibits an isozyme of p450 (CYP3a4) in the liver and intestinal wall. This inhibition decreases intestinal metabolism of many drugs, making them more available for absorption, increasing drug levels is blood
Term
When considering meals, when should and PO drug be given?
Definition
1 hour before or 2 hours after
Term
Can some foods impact drug action?
Definition
Yes.

Warfarin inhibits vit K clotting factors.

Over consumption of vitamin K will diminish warfarin's therapeutic effect
Term
What is an adverse effect?

How does it compare to toxicity?
Definition
Any noxious, unintending, and undesired effect at normal doses.

Toxicity is adverse drug reaction from excessive dosing.
Term
Define idiosyncratic
Definition
An uncommon drug response resulting frm a genetic predisposition
Term
Define iatrogenic disease
Definition
Disease originating from healthcare
Term
Define Allergic reaction
Definition
An immune response that is determined by degree of sensitization to the immune system, not from drug dosage.
Term
Define Tolerance
Definition
Decreased responsiveness to a drug from repeated drug dosages
Term
Define Dependence
Definition
State where a long term exposure to drugs will result in an abstinence syndrome if drug is discontinued.
Term
Describe an unusually long reaction to anesthetic because of deficiency of succinylcholinesterase
Definition
idiosyncratic effect
Term
What reaction is a patient with urticaria, wheezing, and low blood pressure experiencing?
Definition
Allergic reaction
Term
Classify parkinson's syndrome symptoms caused by an antipsychotic medication
Definition
An iatriogenic disease
Term
What is abstinence syndrome?
Definition
Abrupt withdrawl from a drug that one has physical dependance
Term
Is the placenta a barrier to drug distribution?

What kind of drugs cross the placenta?
Definition
Placenta is essentially the same as a cell membrane. Clinically, it's considered that all drugs can reach the fetus.

Lipid soluble drugs will cross the placenta more readily that polar and ionized.
Term
Are drugs in pregnancy well-studied?

Are drugs in lactation well studied?
Definition
Drugs in pregnancy are not well studied in their effects on mother and fetus.

Drugs may be excreted in breast milk, and possibly passed to the infant. Many of these drugs are unknown, so a protocol to mitigate risk is in place
Term
Should all drugs be withheld during pregnancy?
Definition
No, leaving asthma and epilepsy untreated puts the mother's health in danger and could result in injury to the fetus as well.
Term
During which period are most teratogenic effects likely to occur?
Definition
The most sensitive period is the embryotic period. First trimester. Fetal periods are less sensitive.

The two weeks after conception are not susceptible to teratogenesis
Term
Do drugs used at, or near term, affect the baby? How about Opiates?
Definition
Yes, all drugs during pregnancy affect the baby. Opiate addiction during pregnancy will pass it on to the neonate.
Term
What happens when narcotics are given to the mother just prior to delivery?
Definition
It can depress the respiratory rate of the newborn
Term
How does pregnancy affect drug absorption?
Definition
Absorption may increase because tone and mobility of bowels decrease, causing drugs to spend longer in the intestine.
Term
How does pregnancy affect drug distribution?
Definition
Distribution increases for some drugs because the plasma volume soubles
Term
How does pregnancy affect drug metabolism?
Definition
Drug metabolism is increased for some drugs like antiepileptics.
Term
What is the effect of absorption, distribution, and metabolism on kidney function during pregnancy?
Definition
Renal blood flow is doubled by the third trimester, resulting in a large increase in GFR. Drugs are eliminated at an accelerated rate.
Term
What happens to plasma volume during pregnancy?
Definition
Plasma volume doubles.
Term
What advice would be recommended for a nursing mother.
Definition
Take drugs immediately after breast feeding, choose drugs with a short half life, choose drugs that tend to be excluded from milk, and avoid drugs that are known to be hazardous
Term
Why are children so sensitive to drug effects?
Definition
Kidneys and liver are immature and the blood brain barrier isn't completely formed. All five pharmacokinetic processes are immature.
Term
Why are children sensitive to drug effects? (kidneys, liver, blood brain barrier)
Definition
The kidneys are immature and the blood brain barrier isn't completely formed.

All five pharmacokinetic processes are immature.
Term
What are the four pharmacokinetic processes?
Definition
1. Drug absorption
2. Drug distribution
3. Drug metabolism
4. Drug excretion
Term
What is pharmacodynamics?
Definition
The nature and intensity of the response once the drug has reached the site of action.
Term
How is drug ABSORPTION different in newborns (first 30 days of life) and infants (first year of life)?
Definition
PO administration is unpredictable beause of delayed gastric emptying due to a higher pH in the stomach.

IM is slow and erratic for the first few days of life

subQ can increase toxicity because of thin skin
Term
How is drug DISTRIBUTION different in newborns (first 30 days of life) and infants (first year of life)?
Definition
Protein binding is affected as albumin concentration is low and other substances compete to bind it.

Blood brain barrier is immature, causing drugs to reach the brain in higher doses than adults
Term
How is drug METABOLISM different in newborns (first 30 days of life) and infants (first year of life)?
Definition
Metabolism is affected by a low hepatic metabolism, becoming normal at the 1 YOA.
Term
How is drug EXCRETION different in newborns (first 30 days of life) and infants (first year of life)?
Definition
Excretion is low due to low poorly developed kidneys until the 1 YOA
Term
What are considerations with topical drugs in infants compared to older children and adults?
Definition
Infant's skin is thinner, greater risk for toxicity
Term
How is gastric pH different between a 1 year old and a 4 year old?

Does it affect drug absorption?
Definition
Gastric pH is much higher in a one year old vs a four year old. Drug absorption via PO will be altered due to delayed gastric emptying
Term
When does the kidney function of a child mature to adult level?
Definition
1 YOA
Term
How are albumin levels different in newborns/infants compared to older children?
Definition
Albumin levels are lower in newborns and infants than older children.

Drug dosages must account for lower albumin binding
Term
What can aspirin cause in children?
Definition
Severe intoxication from overdose. Reye's syndrome if they have chickenpox
Term
What can glucocorticoids (i.e. prednisone) cause in children?
Definition
High glucocorticoid doses can cause growth supression
Term
What can sulfonamide antibiotics cause in children?
Definition
A buildup of bilirubin levels that causes Kenicterus
Term
How do you most accurately determine dose for a pediatric patient? how accurate is this?
Definition
Body surface forumla. Initial dose is at best an approximation.
Term
How is drug ABSORPTION different in elderly patients?
Definition
Total absorption does not change. Rate of absorption may be slower due to delayed gastric emptying and reduced splanchnic blood flow
Term
How is drug DISTRIBUTION different in elderly patients?
Definition
An increased % body fat makes a storage depot for lipid soluble drugs

A decrease in total body water results in water soluble drugs being more concentrated

Reduced serum albumin
Term
How is drug METABOLISM different in elderly patients?
Definition
Hepatic metabolism decreases with age.

Half life of some drugs may increase

First pass may be diminished
Term
How is drug EXCRETION different in elderly patients?
Definition
Renal function decreases

Drug acculturation is secondary to reduced renal excretion and is the most important cause of adverse drug effects in elderly.

Creatine clearance is ideal to measure elderly kidney function
Term
Is absorption changed in the elderly?
Definition
The rate of absorption becomes slower.
Term
Which organ almost universally declines in function in the elderly?
Definition
The kidneys
Term
Why is creatinine clearance used to measure kidney function in the elderly?
Definition
Lean muscle mass declines in parallel with kidney function.
Term
What happens to body composition as a patient becomes elderly?
Definition
Increased body fat % and decrease lean muscle mass
Term
Are serum albumin levels higher or lower in the elderly?
Definition
Serum albumin is lower in the elderly.
Term
What happens to plasma volume in the elderly?
Definition
Total body water decreases, resulting in decreased plasma volume
Term
What considerations are there for administering morphine PO to an elderly pt?
Definition
Reduced liver mass, reduced hepatic blood flow, and decreased hepatic enzymes will reduce the effect of first pass.

A lower dose should be considered
Term
Why are adverse drug reactions and drug-drug reactions much more common in the elderly?
Definition
Adverse reactions are 7x more likely.

Drug accumulation secondary to renal failure, poly pharmacy, greater use of drugs with low therapeutic index, inadequate supervision, poor pt adherence.

The blood brain barrier becomes leaky in the elderly.
Term
What should the interval and dose be like in the elderly, compared to normal adults.
Definition
Doses should be lower, the intervals longer.
Term
What receptor(s) are on the HEART?

What do they do?
Definition
β1

- increased heart rate
- increased contractile force
- increased electrical conduction
- decreased delay of AV node

ONE BIG heart!
Term
What receptor(s)are on the LUNGS?

What do they do?
Definition
β2 - Bronchi Dilation

Muscarinic - Bronchi Constriction
Term
What receptor(s)are on the KIDNEYS?

What do they do?
Definition
Dopamine - Increases renal blood flow

β1 - Activates RAAs cycle
Term
What receptor(s)are on LIVER and SKELETAL MUSCLE?

What do they do?
Definition
β2 - Upregulates gluconeogenesis
Term
What receptor(s)are on the EYES?

What receptor(s) are on the LENS OF THE EYE?

What do they do?
Definition
Eye
α1 - dilates pupils
Muscarinic - constricts pupils

Lens
α and βs - Far field vision
Musarinic - short field vision
Term
What receptor(s)are on the SALIVARY GLANDS?

What do they do?
Definition
Muscarinic - if blocked causes dry mouth
Term
What receptor(s)are on the BLADDER? What do they do?
Definition

α1 - cause bladder sphincter contraction

muscarinic - if activated, voiding occurs

Term
Of the following: α1, β1, β2, muscarinic, and dopamine;

are they in the sympathetic or parasympathetic branch?
Definition
α1 - Sympathetic

β1 - Sympathetic

β2 - Sympathetic branch

dopamine - sympathetic branch

muscarinic - Parasympathetic
Term
Of the following: α1, β1, β2, and dopamine;

What transmitters bind to these?
Definition
Epinephrine activates all α's and β's

Norepinephrine activates all α's and β1

Dopamine activates α1, β1, and dopamine receptors
Term
What transmitter binds to muscarinic receptors?
Definition
Acetylcholine
Term
Define a sympathomimetic drug
Definition
A drug that mimics the effect of the sympathetic nervous system
Term
Define a parasympathomimetic drug
Definition
A drug that mimics the effects of the parasympathetic nervous system
Term
What are baroreceptors responsible for?

Where are they located?
Definition
They regulate the blood pressure

They are located in the carotid sinus and aortic arch
Term
For Bethanechol, What is it's:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Important drug interactions
Definition
1) Mechanism - Direct-acting muscarinic agonist. The drug reversibly binds to receptor

2) Urinary retention, gastrointestinal uses

3) Increased U/O

4) Cardivascular system, alimentary system, urinary tract, exacerbation of asthma, dysrhythmias in hyperthyroid pt

5) N/A
Term
For Atrophine, What is it's:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Important drug interactions
Definition
1) Muscarinic antagonist that blocks muscarinic receptors, preventing activation

2) Used for preanesthetic medication, eye disorders, bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, asthma, biliary colic.

3) Xerostomia (dry mouth), blurred vision and photophobia, elevation of intraocular pressure, urinary retention, constipation, anhidrosis, tachycardia, asthma

4) Reduced muscarinic activation

5) Avoid atropine with other drugs capable of causing muscarinic blockade
Term
What is Pilocarpine?
Definition
A muscarinic agonist

Used to treat glaucoma by increasing outflow of aqueous humor
Term
What are symptoms of muscarinic toxicity
Definition
Profuse saliva production, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension
Term
What agent would relieve the symptoms of muscarinic toxicity
Definition
Atropine, a muscarinic antagonist
Term
Why are anticholinergic drugs effective in treating urge incontinence and OAB?
Definition
They prevent breakdown of acetycholine (which activates muscarinic receptors)
Term
What does anticholinergic poisoning look like?
Definition
Can't see, Can't spit, Can't pee, Can't shit.
Term
What drug treats anticholinergic poisoning?

What is its mechanism?
Definition
Physostigmine

Inhibits actylcholinesterase, preventing the breakdown of actylcholine.
Term
For the catecholamine Epinephrine, What is it's:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Important drug interactions
Definition
1)αs and βs
2) Delay absorption of local anesthetics, control superficial bleeding, elevate blood pressure, bronchodilation in allergic reaction, mydriasis,

3)vasoconstriction, bronchodilation

4)HTN, dysrhytmias, angina pectoris, necrosis following extravasation, hyperglycemia in diabetics

5) MAO inhibitors, Tricyclic antidepressants, α and β blockers, general anesthetics
Term
For the catecholamine Norepinephrine, What is it's:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Important drug interactions
Definition
1) αs and β1 agonist
2) Hypotensive states and cardiac arrest
3) Same as all epi, except β2 mediated
4) Tachydysrhytmias, angina, HTN, local necrosis on extravasation
5) MAO inhibitors, tricyclic antidepressants, general anesthetics, and α and β blockers

DOES NOT CAUSE HYPERGLYCEMIA in diabetics
Term
For the catecholamine Isoproterenol, What is it's:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Important drug interactions
Definition
1) β1 and β2 agonist
2) Cardiovascular disorders, Asthma (no longer used, β2 only is better), Bronchospasms
3)
4) Tachydysrhytmia, angina pectoralis, hyperglycemia in diabetics
5) MAO inhibitors, Tricyclic antidepressants, α and β blockers, general anesthetics
Term
For the catecholamine Dopamine, What is it's:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Important drug interactions
Definition
1) Dopamine, β1, and α1 at high doses agonist
2) Shock, Heart failure, acute renal failure
3) increased cardiac output, Increased renal bloodflow and u/o
4) Tachycardia, dysrhytmia, and anginal pain
5) MAO inhibitors, Tricyclic antidepressants, general anesthetics
Term
What receptors are resposible for Epinephrine, Norepinephrine, Isoproterenol, and Dopamine actions:

1) BP
2) HR
3) Contractile force (positive inotropic effect)
Definition
1) α1 caused vasoconstriction, increasing BP
2) β1 increases HR
3) β1 increases contractile force
Term
What do Epinephrine, Norepinephrine, Isoproterenol, and Dopamine do to the bronchi?
Definition
All that activate β2 receptors cause bronchodilation; Epinephrine and Isoproterenol
Term
Which of Epinephrine, Norepinephrine, Isoproterenol, and Dopamine increase U/O?
Definition
Dopamine receptor activation increases u/o
Term
What are symptoms of anaphylactic shock?

How long does epinephrine's effects last when administered to one with anaphylaxis?
Definition
Hypotension, bronchoconstriction, and edema the glottis.

Effects of epinephrine last 10-20 minutes
Term
How are catecholamines metabolized?

Can catecholamines be administered orally?
Definition
They are metabolized by MAO (monoamine oxidase) and COMT (Catechol-O-methyl transferase), enzymes found in the liver/intestinal walls

Orally, catecholamines are broken down before they can reach systemic circulation
Term
If a solution of catecholamines is discolored brown, what does it mean?
Definition
Oxidation has occurred and it should be discolored. Dobutamine is the exception, but must be used within 24 hrs of the appearance of discoloration.
Term
What does dose-dependant effects with dopamine and albuterol mean?
Definition
Different doses, different receptors can be activated.

Dopamine:
low dose, only dopamine receptors
medium dose, dopamine and α1
High dose, dopamine, α1, and β1

Albuterol:
When dose is increased, it loses β2 specificity and activates β1 as well
Term
What does concerning about edema at an IV site when administering catecholamines?
Definition
The IV is leaking into the surrounding tissue. The catecholamines won't break down in the skin and can cause extravasation and local necrosis.
Term
Are non-catecholamines metabolized by MAO and COMT?
Definition
They are not readily metabolized by MAO and COMT
Term
Do catecholamines or non-catecholamines cross the BBB more readily?
Definition
Non-catecholamines are less polar, allowing them to cross the BBB easier than catecholamines
Term
What is the typical use for the non-catecholamine ephedrine?
Definition
Ephedrine, a mixed drug, improves hemodynamic status of patients in shock.

phenylephrine
Term
What is the typical use for the non-catecholamine phenylephrine?
Definition
phenylephrine, common in cold medications, is used as a nasal decongestant
Term
What is the typical use for the non-catecholamine Terbutaline?
Definition
Asthma treatment via β2 bronchodilation
Term
What is albuterol used for?

How does it work?

What are its side effects?

Dose dependancy?
Definition
Albuterol treats asthma

Activates β2 receptors to cause bronchodilation

minimal side effects at small doses, tremors and tachycardia rare

At high doses, albuterol activates β1 as well
Term
What is prazosin (minipress)?

What does it do?

What is it used for?
Definition
A α blocker, competitive antagonist.

Causes dilation of the arterioles and veins and relaxation of bladder neck.

Approved for HTN only.
Term
What is phentolamine?

What is it used for?
Definition
A α blocker competitive antagonist

Pheochromocytoma (tumor of adrenal gland tissue), prevention of necrosis following extravasation, reversal of soft tissue anesthesia
Term
After administration of prazosin (minipress) or phentolamine, why should pt be cautious standing up?
Definition
Orthostatic hypotension is an adverse effect of α blocking.
Term
After administration of prazosin (minipress) or phentolamine, how is male sexual function affected?
Definition
α blocking can inhibit ejaculation.
Term
For general betablockers, define:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
Definition
1) β antagonist
2) Angina pectoris, HTN, cardiac dysrhytmias, MI, heart failure, hyperthyroidism, migraine, stage fright, pheochromocytoma, glaucoma

3) Reduced HR, reduced force of contraction, Reduced velocity of AV impulse conduction
4)β1 - Bradycardia, Reduced cardiac output, precipitation of heart failure, AV heart block, rebound cardiac excitation

β2 - Bronchoconstriction, glycogenolysis inhibition
Term
For Propranolol, define: 1) Mechanism 2) Medical indication 3) Expected Response 4) Adverse Effects 5) Drug interactions
Definition

1) β1 and β2 blocker

2) Angina pectoris, HTN, cardiac dysrhytmias, MI, heart failure, hyperthyroidism, migraine, stage fright, pheochromocytoma, glaucoma

3) β1 - reduces HR, reduces heart contraction force, AV impulse suppression, Can block RAAs from kidneys

β2 - Bronchoconstriction, vasoconstriction, and reduced glycogenolysis

4) β1 - Bradycardia, AV heart block, heart failure, rebound cardiac excitation β2 - Bronchoconstriction, inhibition of glycogenolysis, CNS effects, HTN effects

 

5) Do not use with Ca++ channel blockers. Do not use with insulin, Obscures insulin induced hypoglycemia symptoms

Term
For Metoprolol, define:

1) Mechanism
2) Medical indication
3) Expected Response
4) Adverse Effects
5) Drug interactions
Definition
1) β1 blocker

2) HTN, but can be used for angina pectoralis, heart failure, MI. Useful with a pt with asthma/COPD


3) β1 - reduces HR, reduces heart contraction force, AV impulse suppression, Can block RAAs from kidneys

4) Bradycardia, reduced C/O, AV heart block, rebound cardiac excitation following abrupt withdrawl

5) Do not use with Ca++ channel blockers. Do not use with insulin, Obscures insulin induced hypoglycemia symptoms
Term
Why is heart disease a consideration with beta blockers?
Definition
The adverse effects could be fatal.

They prevent the heart from excessive sympathetic stimulation and protect against dysrhythmias. They can make heart block worse.
Term
What are some cautions when giving a diabetic beta blockers?
Definition
β2 blocking can inhibit glycogenolysis, eliminating a corrective measure for hypoglycemia.

They can also mask tachycardia associated with hypertension
Term
Should beta blockers be tapered?
Definition
If they are not tapered, rebound excitation can occur, increasing cardiac activity.

This can cause anginal pain or ventricular dysrhythmias.
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