[Music]
so let's talk about those drugs that
directly act on the receptors let's
cover the blockers of those receptors
first so alpha blockers are non
selective and selective the non
selective alpha blockers are phenoxy
Ben's Amin and phentolamine I want you
to remember these drugs I'm only going
to pick the ones that are going that
you're going to be tested on there are
literally hundreds within each class so
let's just focus on the important ones
but you do need to know them the alpha
one selective agent of choice is present
and the alpha 2 selective agent is
yohimbine I've never used yohimbine in
clinical practice but I always remember
it because it's the one that we had to
memorize for exams let's talk about beta
blockers now the non selective
prototypical beta blocker is propranolol
beta one selective agent the example
that we always use as atenolol which is
kind of an older beta blocker and
replaced by newer ones but it's the
prototypical one that I want you to
remember beta 2 selective beta blockers
is butoxide which is almost never used
clinically but it's important for
research and is the pro it is the
prototypical drug so you do need to know
it beta blockers that start with the
letters A to M are generally those drugs
that tend to be beta one selective and
useful for cardiac inhibition ASA butyl
all atenolol bisoprolol esmolol
labetalol metoprolol those are the
commonly used clinical ones but if you
remember a 2m is beta one selective and
for the heart you'll you'll be a long
way the cut the beta blockers have start
with C C stands for cardiac and these
are the drugs we tend to use in cardiac
failure so the prototypical drug of the
heart failure beta blockers is
carvedilol and the reason why carvedilol
is so unique is because it has combined
alpha and beta activity so it helps
those patients in heart failure
seemingly more than the other beta
blockers now beta blockers that start
with letters between N and said or N and
Z tend to be non selective they
blockers nadolol and the bivolo Pindell
all propranolol timolol these are all
non selective beta blockers let's go
into more detail with the beta one
blockers remember that the more
selective the drug is for the beta one
receptor the better it is for the lung
because you have fewer lung side-effects
remember you don't want to have beta 2
blocking activity with your beta blocker
with rhythm control it's great for
braking supraventricular tachycardias
preventing ventricular tachycardias and
it helps with rate control in atrial
fibrillation we also use beta 1 blockers
in heart failure but only after the
patient has been stabilized I often use
beta blockade in blood pressure control
and interestingly enough we can use
propranolol for anxiety
propranolol was one of the first drugs
of the beta blocker class and we
discovered that people who tended to get
stage fright or anxious in front of a
crowd would often take propranolol it
would help calm down that thumping heart
sensation and people did quite well I
still use this in my practice to treat
patients who get stage fright and you'd
be surprised how many times I have to
treat people for it a little secret
that's kind of fun if you take
propranolol before a lie-detector test
you'll you it's possible that you'll
pass the lie-detector test without
getting in trouble but just don't tell
the FBI I said that what about beta
blockers in pregnancy so labetalol is
the most used blood pressure drug in
pregnancy we have over a million woman
years of experience using labetalol as
blood pressure control I use it all the
time in my pregnant hypertensive
patients it's a beautiful drug it's nice
it's balanced it's got both alpha and
beta activity and the nice thing about
that is that it prevents reduced
placental flow it has a huge wide
therapeutic window so we can go anywhere
from a hundred milligrams a day to 2,400
milligrams a day and people have
tolerated it based on their dose
[Music]
you