okay so now we're on alpha one and beta receptor blockers okay so this is a drug class that does both we already talked about beta adrenergy blockers beta receptor blockers right so these are a drug that also have that affect our alpha one those are the arterials that are stimulated by epi norepinephrine as mentioned above right and then also the beta adrenergic blocker combination of the two so mechanism of action this acts in the periphery so at the heart and blood vessels so if we have a non-selective receptor blocker okay so if we have an alpha one beta receptor blocker that is non-selective okay a non-selective receptor blocker what we have here is it works on our alpha one works on our arterials right it works on the beta one which are receptors where the heart remember and it also affects beta two remember we said beta two receptors are in the lungs okay so we have smooth muscle muscle relaxation that actually occurs okay it also affects myocardial contractility so it's going to decrease the oxygen demand of those heart cells of the heart muscle cells and we call that a negative inotrope remember we had chronotropin inotrope that we talked about in the previous lecture this would be a negative ionotrope so it's going to decrease the force of myocardial contractility therapeutic effects well if a patient has heart failure it can decrease the progression of heart failure it's going to decrease blood pressure so we're going to decrease constriction decrease resistance decrease after load you've kind of all seen this so remember when we talked about beta adrenergic blockers before you're seeing the same therapeutic effects basically happening here okay except for the progression of heart failure maybe decreased heart rate so remember we call that a negative chronotrope c for conduction system right it's going to work on the electrical conduction system of the heart so decrease heart rate because we have decreased sa node firing remember that's the pacemaker of our heart and again negative chronotrode and then we have the decreased myocardial contractility and when that occurs we have a less of an o2 demand of those heart cells and remember we call that a negative iotrope all right so indications a patient with heart failure a patient with high blood pressure or angina right that's chest pain and then precautions can current use of multiple drugs affecting blood pressure because of the increased hypotensive effects if the patient has pulmonary disease or illness heart failure some cardiac dysrhythmias what we're looking at in particular is the patient who has bradycardia right if we know this drug is going to slow the heart rate down right if a patient has bradycardia that means their heart rate is less than 60 already if we give them an alpha one and beta receptor blocker we're going to decrease that heart rate even more okay may mask evidence of hypoglycemia um you see this particular with the beta adrenergic blocker component and we kind of talked about that before with the beta blockers so that shouldn't be anything really new contraindications some pulmonary disease especially those patients with like asthma right because it's a non-selective it's going to affect those receptors of the lungs so what happens is it causes bronchoconstriction those bronchioles tighten um so our their airway basically is not as patent or open and then some cardiac dysrhythmias died in adverse effects we have heart failure again some cardiac dysrhythmias already talked about that bronchospasms bronchoconstriction so they might have uh dyspnea which is difficulty breathing and wheezing fatigue and depression is also um a possibility as well as impotence so nursing actions we're going to assess their heart rate on blood pressure physical assessment we're going to look for any evidence of worsening heart failure but really we're doing a cardiopulmonary assessment right they go hand in hand patient education is basically the same here drug side effects monitoring their heart rate at home and blood pressure drugs that could affect or interact hypotensive symptoms we also want to talk to them about hypertensive symptoms if the meds not working uh renal function general side effects and symptoms and then certain blood glucose levels because remember it can basically affect the symptoms they would have if they were hypoglycemic meaning their blood sugar was low we kind of talked about that before though examples of drugs in the class so carvadolol is the only prototype that you'll need to remember for this particular class of drug