1. Adrenergic Antagonists
Saja Hamed, Ph.D

2. Alpha- adrenergic antagonists: Therapeutic applications:
essential hypertension: by blocking alpha1 receptors on arterioles and veins  vasodilation
reversal of toxicity from alpha1 agonists
Benign prostatic hyperplasia:
Block alpha1 receptors  reduced contraction of smooth muscle in the bladder neck and prostatic capsule  Reduce urinary urgency
Saja Hamed, Ph.D

3. Alpha- adrenergic antagonists: Therapeutic applications:
Pheochromocytoma:A catecholamine-secreting tumor
Raynaud’s disease:
Peripheral vascular disorder characterized by vasospasm in the toes and fingers  local sensation if cold and pain
Saja Hamed, Ph.D

4. Alpha- adrenergic antagonists: Adverse effects:
orthostatic hypotension:
blockade of alpha receptors on veins reduced venous toneblood accumulate in veins when patient assumes erect position reduced return of blood to the heart reduced cardiac output  decrease BP
reduce blood flow to brain lightheadedness, dizziness
Saja Hamed, Ph.D

5. Alpha- adrenergic antagonists: Adverse effects:
reflex tachycardia:
blockade of vascular alpha1 receptors vasodilation reduce BP baroreceptor initiate a reflex increase in heart rate via the ANS
Nasal congestion: dilate blood vessels in the nasal mucosa
Saja Hamed, Ph.D

6. Alpha- adrenergic antagonists: Adverse effects:
Inhibition of ejaculation:
Blockade of alpha 1 receptors
Can cause impotence
Reversible when the alpha blocker is withdrawn
Can be a major reason for noncompliance change the medication
Saja Hamed, Ph.D

7. Alpha- adrenergic antagonists: a. Prazosin:
selective blockade of alpha1-adrenergic receptors
hypertension: dilate arterioles and veins
relaxation of smooth muscle in bladder neck and prostatic capsule
Saja Hamed, Ph.D

8. Alpha- adrenergic antagonists: a. Prazosin:
Adverse effects:
orthostatic hypotension, reflex tachycardia, inhibition of ejaculation, and nasal congestion
first dose effect:
1% of patients
lose consciousness minutes after receiving their first dose
result of sever postural hypotension
minimize it by using small initial dose (1mg or less)
beginning the treatment: avoid driving and other hazardous activity for hours
administer the initial dose at bed time
Saja Hamed, Ph.D

9. Alpha- adrenergic antagonists: b. Phentolamine:
blocks alpha1 and alpha2 receptors
treatment of pheochromocytoma
prevention of tissue necrosis following extravasation of drugs that produce alpha1-mediated vasoconstriction
Saja Hamed, Ph.D

10. Alpha- adrenergic antagonists: b. Phentolamine:
Adverse effects:
Like prazosin
Produces greater reflex tachycardia than prazosin due to alpha2 blockade
Overdose can produce profound hypotension  elevate BP with NE. Epinephrine should not be used?
Saja Hamed, Ph.D

11. Beta- adrenergic antagonists: Therapeutic applications:
Angina pectoris: by blocking beta1 receptors in the heart decrease cardiac work
Hypertension:
Beta adrenergic blocking agents are drugs of choice for hypertension
Cardiac dysrhythmias:
Blocking cardiac beta1 receptors  decrease the rate of sinus nodal discharge and suppress conduction of atrial impulses through the AV node
Saja Hamed, Ph.D

12. Beta- adrenergic antagonists: Therapeutic applications:
Myocardial infarction:
MI: region of myocardial necrosis caused by localized interruption of blood flow to the heart wall
Migraine:
If taken prophylactically they can reduce the frequency of migraine attack
Saja Hamed, Ph.D

13. Beta- adrenergic antagonists: Adverse effects:
bradycardia
reduced cardiac output:
- by decreasing heart rate and force of contraction
- beta blockers must be used with great caution in patients with heart failure or reduced cardiac reserve
Saja Hamed, Ph.D

14. Beta- adrenergic antagonists: Adverse effects:
AV heart block:
Rebound excitation:
- Increased cardiac activity in response to abrupt cessation of beta blocker therapy
- Long term use of beta blockers  sensitize the heart to catecholamines
- If withdrawn abruptly  anginal pain or dysrhythmias
- Withdraw gradually taper the dose over a period of 1 to 2 weeks (Note:warn patients against abrupt cessation. Carry adequate supply of beta blockers when traveling(
Saja Hamed, Ph.D

15. Beta- adrenergic antagonists: Adverse effects:
Bronchoconstriction:
Beta2 blockers are contraindicated in asthma
Inhibition of glycogenolysis:
If diabetic patient requires a beta-blocker, a beta1-selective agent should be chosen
Saja Hamed, Ph.D

16. Beta- adrenergic antagonists: a. Propranolol (Inderal®):
nonselective beta adrenergic antagonists
highly lipid soluble
Therapeutic uses:
hypertension
angina pectoris
cardiac dysrhythmias
myocardial infarction
migraine headache
Saja Hamed, Ph.D

17. Beta- adrenergic antagonists: a. Propranolol (Inderal®):
Adverse effects:
refer to previous adverse effects
in addition CNS effects:
- depression and insomnia
- nightmares and hallucinations
- used with care in patients with a history of depression
Saja Hamed, Ph.D

18. Beta- adrenergic antagonists: a. Propranolol (Inderal®):
Precautions and contraindications:
should be avoided in patients with a history of anaphylaxis
must be used with caution by diabetic patients:
- suppress glycogenolysis
- masking tachycardia
- warn the patients that tachycardia is no longer an indication of hypoglycemia
- should be taught alternative signs: sweating, hunger, fatigue, poor concentration)
Saja Hamed, Ph.D

19. Beta- adrenergic antagonists: a. Propranolol (Inderal®):
Drug Interactions:
calcium channel blockers:
cardiac effect of certain calcium channel blockers (e.g. verapamil) are identical to those of propranolol
impeded early recognition of insulin induced hypoglycemia
Note: the dosage must be adjusted by monitoring the patient’s response and not by relying on dosing information in a drug reference
Saja Hamed, Ph.D

20. Beta- adrenergic antagonists: b. Metoprolol:
Cardioselective agent
Preferred for patients with asthma or diabetes
Hypertension, angina pectoris, myocardial infarctions
Deprive the diabetic patient of early indication of hypoglycemia
Saja Hamed, Ph.D

21. Beta- adrenergic antagonists: c. Pindolol::
partial agonist activity intrinsic sympathomimetic activity (ISA)
binding to a receptors produces limited degree of receptor activation while preventing strong agonists from binding to the receptor to cause full activation
have very little effect on resting heart rate and cardiac output
preferred for patients with bradycardia
C.I. in MI
Saja Hamed, Ph.D

22. Saja Hamed, Ph.D

23. Saja Hamed, Ph.D

24. Saja Hamed, Ph.D