1. Beta-blockers

Question 1

BBs with ISA (agents, indication, CI)

Answer 1

“CAPP”: carteolol, acebutolol, penbutolol, pindolol

Indication: consider in patients who need some BP lowering, failed other first lines and has a a low HR (

Question 2

Beta-1 selective blockers (6)

Answer 2

AMEBBA: atenolol, metoprolol, esmolol, bisoprolol, betaxolol, acebutolol

Question 3

acebutolol (brand, dosing)

Answer 3

Sectral

200-1200 mg/day in 1-2 divided doses

Question 4

atenolol (brand, dosing)

Answer 4

Tenormin

25-100 mg daily

Question 5

betaxolol (brand, dosing)

Answer 5

generic only

5-20 mg daily

Question 6

bisoprolol (brand, dosing)

Answer 6

Zebeta

2.5-20 mg daily

Question 7

esmolol (brand, dosing)

Answer 7

Breviblock (injection)

0.5-1 mg/kg bolus followed by 50-150 mcg/kg/min infusion, titrate as needed

Question 8

metoprolol tartrate (brand, dosing)

Answer 8

Lopressor (tablet, injection)

100-450 mg/day in 2-3 divided doses

Question 9

metoprolol succinate extended release (brand, dosing)

Answer 9

Toprol XL (tablet)
HTN: 25-100 mg daily, max 400 mg daily
HF: 12.5-25 mg daily, target 200 mg daily

Question 10

Beta-1 selective BBW

Answer 10

Do not withdraw abruptly, particularly in ppts w/ CVD; gradually taper over 1-2 wks to avoid acute tachycardia, HTN, and/or ischemia

Question 11

Beta-1 selective CI

Answer 11

Sinus bradycardia, 2nd or 3rd degree heart block or sick sinus syndrome w/o functioning artificial pacemaker or cardiogenic shock, active asthma exacerbation

Question 12

Beta-1 selective warnings (4)

Answer 12

–Caution in pts w/ DM particularly with recurrent hypoglycemia, asthma, severe COPD, or peripheral vascular disease and Raynaud’s disease
–May mask signs of hyperthyroidism
–May potentiate hypoglycemia and/or mask s/sx (except sweating and hunger)
–May aggravate psychiatric conditions

Question 13

Beta-1 selective SEs

Answer 13

Dec. HR, hypotension, fatigue, dizziness, depression

Dec. libido, impotence, hyperglycemia, hypertriglyceridemia, dec. HDL (some specific for non-selective)

Question 14

Beta-1 monitoring

Answer 14

HR (dec. dose if HR

Question 15

Metoprolol [tartrate/succinate] should be taken with food.

Metoprolol [tartrate/succinate] should be taken preferably with or following a meal.

Answer 15

Tartrate

Succinate

Question 16

Beta-1 selective blockers are pregnancy category __

Answer 16

B (acebutolol)
C
D (atenolol)

Question 17

Metoprolol tartrate IV:PO ratio

Answer 17

1:2.5

Question 18

MOA of beta-blockers, including ISA

Answer 18

Competitively block the beta-1 and beta-2 adrenergic receptors, resulting in decreases in BP, HR, myocardial contractility and myocardial oxygen demand
ISA (intrinsic sympathomimetic activity): partially stimulate beta receptors while blocking against additional stimulation; don’t dec. HR