ADRENERGIC BLOCKING - Labetalol (Normodyne,

AGENTS Trandatee)
- Also called as sympatholytic,  Prototype and available in
adrenolytics and adrenergic IV and oral forms
antagonist  Treat HPN and can be
- Prevent norepinephrine release used w diuretics
from the nerve terminal or from Pharmacokinetics
the adrenal medulla from - Well absorbed and distributed
activating the receptor which systematically
blocks SNS effects: - Metabolized in the liver and
 Lower BP, slower pulse excreted in urine and feces
rate and increase renal Contraindications
perfusion with decreased - Bradycardia, heart blocks, shock
renin levels and CHF
ALPHA AND BETA - Pregnancy and Lactation
ADRENERGIC BLOCKING Caution
AGENTS - Diabetes and bronchospasm
- primarily used to treat cardiac- Adverse Effects
related conditions - Dizziness, insomnia, depression,
- Amiodarone (Cordarone) fatigue, and vertigo (CNS effects)
 Oral and IV and is used - Anorexia, diarrhea, nausea (Loss
during emergencies of balancing sympathetic effect on
 Only used as GI tract)
antiarrhythmic - Cardiac Arrhythmias,
(disruptions of the normal hypotension, CHF, Pulmonary
rhythm of the heart) edema, CVA (lack of stimulatory
- Carvedilol (Coreg) effects and loss of vascular tone in
 Oral: Combination therapy CV system)
for HPN and CHF Drug-Drug Interactions
 Left ventricular function - + enflurane, halothane or
after MI isoflurane anaesthetics = excessive
- Guanadrel (Hylorel) hypotension
 HPN that does not respond - + diabetic agents = increasing
to thiazides effect leading to hypoglycemia
- Guanethide (Ismelin) - Carvedilol + verapamil or
 HPN and renal HPN diltiazem = conduction system
disturbance
ALPHA-ADRENERGIC having trouble in maintaining
VBLOCKING AGENTS blood flow to the heart muscle
- Phentolamine - MI: heart muscle becomes
 Prototype necrotic because of less oxygen
 Used to diagnose supply
pheochromocytoma Adverse Effects
(tumour of the chromaffin - Hypotension, orthostatic
cells of the adrenal hypotension, angina, MI, CVA,
medulla that periodically tachycardia
releases large amounts of Drug-Drug Interactions
norepinephrine into the - Ephedrine/Epinephrine +
system leading to severe Phentolamine = decreased
hypertension and hypertensive and vasoconstrictive
tachycardia) effects
Therapeutic Actions and - Phentolamine + alcohol =
Indications increased hypotension
- Alpha 1: blocks postsynaptic Nursing Responsibilities
Alpha 1 adrenergic receptors - Inject phentolamine into the area
 Decreases sympathetic of extravasation of epinephrine
tone – vasodilation – and dopamine to prevent local cell
lowers BP death
- Alpha 2: blocks presynaptic ALPHA 1 SELECTIVE
alpha 2 receptors preventing BLOCKING AGENTS
feedback control of norepinephrine - Specific affinity for alpha 1
release receptors
 Increase in the reflex - treatment of hypertension and
tachycardia when BP is benign prostatic hypertrophy
lowered - Doxazosin: prototype
Pharmacokinetics BETA – ADRENERGIC
- Rapidly absorbed after IV and BLOCKING AGENTS
IM and excreted in the urine - Treat CV problems such as HN,
Contraindications angina and migraine
- Coronary artery disease: - prevent reinfarction after MI
coronary arteries are already - Propranolol (Inderal)
narrowed and damaged thus  Treat HPN, angina,
prevention of reinfarction,
 prophylaxis for migraines
and essential tremors
- Sotalol (Betapace)
 Treat life threatening
arrhythmias
- Timolol (Blocadren, Timoptic)
 HPN, reduce IOP in open
angle glaucoma
Pharmacokinetics
- Absorption in the GI tract and
undergo hepatic metabolism
Drug-Drug Interactions
- + clonidine = paradoxical
hypertension
- + NSAIDS = decreased
antihypertensive effect
= + epinephrine = initial
hypertension then bradycardia
BETA 1 – SELECTIVE
ADRENERGIC BLOCKING
AGENTS
- Do not block beta 2 receptors
thus do not block bronchodilation
making it suitable for:
 Patients with lung disease,
rhinitis, smokers w methimazole = increase effect of
asthma, COPD
- Treat hypertension, angina, and
cardiac arrythmias
- Acebutolol (Sectral), Betaxolol
(Kerlone), Bisoprolol (Zebeta)
 Treat HPN
- Atenolol (Tenormin)
 MI. Chronic angina and
HPN
- Betaxolol (Betoptic)
 Ophthalmic agent
 Ocular hypertension
 Open angle glaucoma
- Esmolol (Brevibloc)
 Treat supraventricular
tachycardia
- Metropolol (Lopressor, Toprol)
 HPN, angina, CHF,
prevent reinfarction
 Early acute MI treatment
and treatment of stable of
and symptomatic HF
Drug-Drug Interaction
- + clonidine, NSAIDs, rifampin or
barbiturates: can decrease antiHPN
effect
- + epinephrine = hypertension
then bradycardia
- lidocaine = increase serum level
and toxicity of lidocaine
- + prazosin = postural
hypotension (orthostatic)
- +verapamil, cimetidine,
B1 selective blocker
Nursing Responsibilities
- Give oral form with food