Term
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Definition
| blockers of beta 1: increase heart rate increase contractility; increase renin release |
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Term
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Definition
beta 2 blocker cause relaxation of vascular bronchial and uterine smooth muscle ; increase glycogenolysis; increase insulin release; increase tremor
**** bronchial**** and ****uterine smooth muscle*** |
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Term
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Definition
| blockers of beta 3 increase lipolysis increase urinary bladder relaxation |
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Term
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Definition
| alpha 1 blockers cause vasoconstriction, mydriasis ( pupil dialation) , piloerection( hair standing up) and increase in glycogenolysis |
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Term
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Definition
| decrease neuronal transmitter release, increase platelete aggregation, decrease lipolysis decrease insulin release |
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Term
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Definition
Antagonize (block) the B1 and B2 receptors
Decrease heart rate
Decrease contractility
Decrease renin release (decrease angiotensin II) |
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Term
| Mechanisms specific to heart failure |
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Definition
Restore heart rate variability( patients see a big difference in resting heart rate)
Prevent arrhythmia occurrence
Prevent/slow remodeling process (hypertrophy)
Inhibit renin secretion
NE still in heart in MI
patients need to be advised that effects are bad at first but get better over time |
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Term
| Beta blockers place in therapy |
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Definition
Have long been considered one of drugs of choice for initial therapy
Recent data shows less of a stroke benefit than other classes; clinically important increase in new diabetes
No longer liked for hyper tension PB because it increases diabetes |
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Term
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Definition
Gold standard for heart failure (and post-MI)
Symptoms will worsen initially, but slow improvement
Slow titration: 3.125-6.25-12.5-25-50 or 12.5-25-50-100-200 ( push until you see side effects stop)
Target dosing shown to be effective **** Important because Heart failure if you dont have target dose*****
High blood pressure use low dose until HPB comes in line *****exercise intolerance***** |
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Term
| Beta blockers remaining questions |
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Definition
Remaining questions:
Role in therapy? ... younger patients, HF risk, angina
What about newer beta-blockers?
**** you cant rely on symptoms because all patients will feel worse initially***** |
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Term
Selective Agents
Metoprolol
Atenolol
Bisoprolol
Betaxolol
Nebivolol
Acebutolol
Esmolol |
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Definition
| beta 1 most important group, selective cardio affinity for beta 1 receptor --good for pulmonary effect---Relatively selective especially in big doses ---dont give to people with COPD---Mild to high dose will show bronchial effect |
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Term
| Intrinsic Sympathomimetic Activity (ISA) |
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Definition
Pindolol
Acebutolol
Mimic sympathetic partially NO HF NO NO ANGINA
Beneficial decreased side effects |
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Term
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Definition
Carvedilol (alpha1-antagonist)***in addition to blocking alpha it also blocks beta****
Nebivolol (increased NO)
Labetolol (alpha1-antagonist) |
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Term
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Definition
Inhibit transmembrane influx of calcium
Act at SA/AV node &/or vascular smooth muscle
Vasodilation &/or Decreased heart rate
Other effects specific to class
***2main groups**
Diltiazem and Verapamil (very limited)
Negative inotropic and chronotropic effects
Dihydropyridines
No effects on conduction in vivo |
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Term
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Definition
| Blocks entry into cell and is essential for muscle contraction**** works by relaxing the vascular muscle |
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Term
| Calcium channel blockers group1 |
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Definition
| Verapamil Diltiazem stronger on heart vascular |
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Term
| calcium channel blockers group 2 |
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Definition
| dihydropyridines (DHP)do nothing on heart but great on vasodilation |
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Term
| Calcium Channel Blockers Common Adverse Effects |
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Definition
Headache ***brain does not like**
Flushing ***vasodilating**
Pedal edema***especially dependent edema- common with DHP***
Constipation*****verapamil***
Hypotension ***both**
Reflex tachycardia ***more with DHP***
Bradycardia, AV Block, CHF ********effects heart---hint verapamil & diltiazem******* said as a reminder |
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Term
| Calcium Channel Blockers Drug Interactions |
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Definition
Verapamil and Diltiazem ***can directly slow enzymes that effect other drugs***
Can cause many drug interactions
Change metabolism and/or transport of drugs
Nifedipine, Felodipine, others
Subject of many interactions
Sensitive to changes caused by other drugs
******victims and perpetrators ******* |
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