B. 8- β-receptor antagonists

Question 1

classify the direct-acting sympatholytics- β blockers

Answer 1

non-selective
selective (cardio-selective)- β1 selective
combined 𝝰 and β receptor antagonists

Question 2

name the non selective β blockers

Answer 2

"Please tell people sorry" (we don't treat HF..)
Propranolol
timolol
pindolol
sotalol

Question 3

which non selective β blocker is also a K channel antagonist?

Answer 3

sotalol

Question 4

list the selective β blockers

Answer 4

“But maybe not..” (we do treat HF)
Bisoprolol
Metoprolol
Nebivolol

Esmolol
Acebutolol
atenolol

Question 5

which selective β blocker is the most β1 selective?

Answer 5

Bisoprolol

Question 6

what are the 2 important 𝝰 and β receptor blockers and how are they given?

Answer 6

Carvedilol -oral

Labetalol- IV

Question 7

which β blocker is a weak partial β agonist? (intrinsic sympathomimetic activity)

Answer 7

pindolol
Acebutalol

*less likely to cause bradycardia (β1) and change in plasma lipids (β2)

Question 8

which β blocker is given topically?

Answer 8

timolol

Question 9

which β blockers have a local anesthetic effect (inhibit Na channels) ?

Answer 9

propranolol
pindolol
metoprolol

Question 10

which β blockers are highly lipid-soluble? (freely enters the CNS)

Answer 10

propranolol
Nebivolol
Bisoprolol

Question 11

what is the duration of action of propranolol?

Answer 11

4-6 hours

Question 12

what is the duration of action of sotalol?

Answer 12

7 hours

Question 13

what are the indications for propranolol (6)

Answer 13

1. Stable angina ( HR ↓–> diastolic perfusion ↑, O₂ demand ↓)
2. anti-arrhythmic class II (treatment and prophylaxis)
3. hypertension
4. thyrotoxicosis
5. Migraine (prophylaxis)
6. Essential tremor

Question 14

indication for timolol

Answer 14

glaucoma (↓ aqueous humor production)

Question 15

which β blockers is given for hypertensive treatment in asthmatic/COPD patients?

Answer 15

pindolol

acebutolol

Question 16

which β blocker should be avoided in HF?

Answer 16

pindolol

*This is related to CHF and not AHF which β blockers are anyway contraindicated

Question 17

what are the indications for metoprolol, bisoprolol, and nebivolol?

Answer 17

Hypertension
congestive heart failure (reduce mortality)
angina pectoris
anti-arrhythmic class II
acute coronary syndrome (ACS)
HOCM

Question 18

indications for Esmolol?

Answer 18

• arrhythmias associated with thyroid-storm or perioperative (acute management)
• hypertensive emergencies

Question 19

which β blocker has a NO-dependent vasodilating action?

Answer 19

Nebivolol

Question 20

how is Esmolol given?

Answer 20

IV

Question 21

What is the indication for Carvedilol?

Answer 21

Congestive heart failure (reduce mortality)

Question 22

indication for Labetalol

Answer 22

Hypertension

hypertensive emergencies

Question 23

SE of β blockers

Answer 23

cardioselective:
bradycardia 
AV block
non selective:
Bronchospasm (COPD exacerbation)
sexual dysfunction
CNS sedation, lethargy
sleep disturbances, nightmares 
hypoglycemia
hyperlipidemia

Question 24

which β blockers are the lowest lipid-soluble? (less likely to enter the CNS)

Answer 24

Atenolol
Sotalol
Acebutolol

Question 25

Contraindication of β blockers

Answer 25

Acute heart failure
cardiogenic shock
asthma and COPD require caution
Diabetics require caution 
untreated pheochromocytoma
symptomatic hypotension
psoriasis (provoke an autoimmune response)

Question 26

how do we manage acute β blockers overdose?

Answer 26

Glucagon

*positive ionotropic and chronotropic effects, not through β1 receptor activation, but through glucagon receptors (Gs)