Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 18 Adrenergic Antagonists
2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Adrenergic Antagonists Cause direct blockade of adrenergic receptors With one exception, all produce reversible (competitive) blockade Most adrenergic antagonists are more selective than the adrenergic agonists. Two major groups Alpha-adrenergic blocking agents Beta-adrenergic blocking agents
3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Adrenergic Antagonists Alpha-adrenergic antagonists I: therapeutic and adverse response to alpha blockade Alpha-adrenergic antagonists II: properties of individual alpha blockers Beta-adrenergic antagonists I: therapeutic and adverse responses to beta blockade Beta-adrenergic antagonists II: properties of individual beta blockers
4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Therapeutic Applications of Alpha Blockade Essential hypertension Lowers blood pressure by blocking alpha 1 receptors on arterioles and veins, causing vasodilation Reversal of toxicity from alpha 1 agonists Benign prostatic hyperplasia Reduced contraction of smooth muscle in the bladder neck and prostatic capsule
5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Therapeutic Applications of Alpha Blockade Pheochromocytoma Catecholamine-secreting tumor Usually located in adrenal medulla Principal cause of hypertension is usually activation of alpha 1 receptors, but beta 1 receptors can also contribute Treatment: best option is surgery Inoperable tumor: alpha 1 antagonists suppress hypertension Inoperable tumor: alpha 1 antagonists suppress hypertension Surgery: before surgery, manipulation of tumor can cause massive catecholamine release Surgery: before surgery, manipulation of tumor can cause massive catecholamine release
6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Raynaud’s disease Peripheral vascular disorder Vasospasms in the toes and fingers Suppress symptoms by preventing alpha- mediated vasoconstriction Ineffective against other peripheral vascular disorders that involve inappropriate vasoconstriction Therapeutic Applications of Alpha Blockade
7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Adverse Effects of Alpha 1 Blockade Detrimental effects result from blockade of alpha 1 receptors Effects from alpha 2 receptors are minor Orthostatic hypotension Blockade of alpha receptors on veins Reduced muscle tone in the venous wall Upon standing, blood pools in the veins Return of blood to the heart reduced Cardiac output decreased: blood pressure drops
8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Adverse Effects of Alpha 1 Blockade Reflex tachycardia Reflex to increase heart rate via the autonomic nervous system (ANS) Nasal congestion Dilates the blood vessels of the nasal mucosa Inhibition of ejaculation Alpha 1 activation required for ejaculation Impotence is reversible; resolves when drug is discontinued Sodium retention and increased blood volume Reduced BP promotes renal retention of sodium and water Usually combined with diuretic when used for hypertension
9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Adverse Effects of Alpha 2 Blockade The most significant adverse effect associated with alpha 2 blockade— potentiation of the reflex tachycardia
10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Alpha-Adrenergic Antagonists II Prazosin Terazosin Doxazosin Tamsulosin Alfuzosin Phentolamine Phenoxybenzamine
11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Prazosin Actions and uses Pharmacokinetics Adverse effects Preparations, dosage, and administration
12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Terazosin Actions and uses Pharmacokinetics Adverse effects Preparations, dosage, and administration
13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Doxazosin Actions and uses Pharmacokinetics Adverse effects Preparations, dosage, and administration
14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Tamsulosin Actions and uses Pharmacokinetics Adverse effects Drug interactions Preparations, dosage, and administration
15Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Alfuzosin Actions and uses Pharmacokinetics Adverse effects Drug interactions Preparations, dosage, and administration
16Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Phentolamine Actions and uses Adverse effects Preparations, dosage, and administration
17Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Phenoxybenzamine Actions and uses Adverse effects Preparations, dosage, and administration
18Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists I Therapeutic applications of beta blockade Angina pectoris Hypertension Cardiac dysrhythmias Myocardial infarction Heart failure Hyperthyroidism Migraine Stage fright Pheochromocytoma Glaucoma
19Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists I Adverse effects of beta blockade Adverse effects involve both beta 1 and beta 2 blockade.
20Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists I Adverse effects of beta 1 blockade Bradycardia Reduced cardiac output Precipitation of heart failure AV heart block Rebound cardiac excitation
21Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists I Adverse effects of beta 2 blockade Bronchoconstriction Inhibition of glycogenolysis
22Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists II: Propranolol Pharmacologic effects Pharmacokinetics Therapeutic uses Adverse effects Bradycardia AV heart block Heart failure Rebound cardiac excitation
23Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists II: Propranolol Adverse effects (cont’d) Bronchoconstriction Inhibition of glycogenolysis CNS effects Precautions, warnings, and contraindications Severe allergy Diabetes Cardiac, respiratory, and psychiatric disorders
24Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists II: Propranolol Drug interactions Calcium channel blockers Insulin Preparations, dosage, and administration General dosing considerations Preparations Dosage
25Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists II: Metoprolol Pharmacologic effects Pharmacokinetics Therapeutic uses Adverse effects Precautions, warnings, and contraindications Preparations, dosage, and administration
26Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Beta-Adrenergic Antagonists II: Other Beta-Adrenergic Blockers Receptor specificity: selective blockade Pharmacokinetics Therapeutic uses Adverse effects Intrinsic sympathomimetic activity (partial agonist activity) Dosage and administration