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Afsha NEW CV > beta adrenoreceptor blocking drugs (hypertension) > Flashcards

beta adrenoreceptor blocking drugs (hypertension) Flashcards

1
Q

they work by blocking beta adrenoreceptors in the following 5 organs

A

heart
peripheral vasculature
bronchi
pancreas
liver

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2
Q

what is intrinsic sympathomimetic activity in BB?

A

the capacity to which beta blockers STIMULATE as well as block adrenergic receptors

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3
Q

name 4 BB with intrinsic sympathomimetic activity (aka they can stimulate as well as block adrenergic receptors)

hint: PACO

A

celiprolol
acebutolol
pindolol
oxprenolol

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4
Q

PACO

A

way to remember the 4 BB with intrinsic sympathomimetic activity (aka stimulate and block adrenergic receptors)
these also are less likely to cause bradycardia and coldness of extremities

celiprolol, acebutolol, pindolol, oxprenolol

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5
Q

PACO

Celiprolol hydrochloride, pindolol, acebutolol, and oxprenolol hydrochloride have intrinsic sympathomimetic activity.

Therefore, they will cause less of the following (2)

A

less bradycardia
less coldness of the extremities

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6
Q

name some BB that will cause less bradycardia and less coldness of extremities

A

CAcPO
celiprolol, acebutolol, pindolol, oxprenolol

they have instric sympathomimetic activity (stimulate and block the adrenergic receptor)

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7
Q

water soluble BB are less likely to enter the brain and therefore less likely to cause sleep distrubance and night mare. name them

A

CANS
sotalol
atenolol
nadolol
celiprolol

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8
Q

CANS (caterpillars)

A

watering cans

way to remember water soluble BB; less likely to cross brain = less likely to cause nightmare/sleep problems

sotalol, atenolol, nadolol, celiprolol

caterpillars to remember ATenolol

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9
Q

where are the water soluble BB (SANC, less likely to cause sleep problems) excreted?

A

kidneys
dose reduction often needed in RI

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10
Q

name 4 BB that have intrinsically longer duration of action and only need to be given OD

A

ABC-N

atenolol, bisoprolol, celiprolol, nadalol

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11
Q

ABC-N

A

way to remember the beta blockers that have intrinsically longer duration of action and need to be given only once daily.

atenolol
bisoprolol
celiprolol
nadolol

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12
Q

why are BB contraindicated in 2nd or 3rd degree heart block

A

bc they slow the heart and can depress myocardium

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13
Q

true or false - care is needed when initiating BB in pt with stable HF

A

true because can initially worsen symptoms of HF
go low and slow!

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14
Q

can you use BB in pt with worsening unstable HF

A

no

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15
Q

which ones are licensed in HF

A

bisop
carved
nebiv

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16
Q

these 4 BB also have arteriolar vasodilating action and therefore lower peripheral resistant BUT there is no evidence that they have adv over other BB in the treatment of hypertension

A

CCLN
celiprolol carvedilol labetalol nebivolol

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17
Q

CCLN

A

celiprolol carvedilol labetalol nebivolol
these 4 BB also have arteriolar vasodilating action and therefore lower peripheral resistant BUT there is no evidence that they have adv over other BB in the treatment of hypertension

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18
Q

why should BB be avoided in pt with Hx asthma

A

can precipitate bronchospasm

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19
Q

cardioselective BB (5)

BNAMA or BAtMAN

A

bisoprolol, nebivolol, atenolol, metoprolol, acebutolol (lesser effect)

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20
Q

BB should be avoided in Hx asthma bc they can precipitate bronchospasm. However when no suitable alternative, pt with well controlled asthma or COPD (w/o significant reversible airways obstruction) may need to recieve treatment with BB for a co-existing condition (e.g. HF or following MI). in this case you can use a cardioselective (note not cardiospecific) BB initiated at a low dose by a specialist and closely monitor pt for adverse effects.

the following BB are cardioselective bc they have less effect on B2 (bronchial) receptors and so will have lesser effect on airways resistance

A

atenolol
acebutolol (less extent)
bisop
carved
metoprolol

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21
Q

are BB contraindicated in diabetes

A

no
cardioselective ones are preferred: metoprolol, carvedilol, atenolol, bisoprolol, acebutolol (less extent)

22
Q

true or false - BB can affect carb metabolism

A

true
cause hypo or hperglycaemia in pt with or w/o diabetes
can interfere with metabolic and autonomic responses to hypoglycaemia - mark symptoms e.g. tachycardia

23
Q

when should BB be avoided in pt with DM

A

frequent episodes of hypoglycaemia
because BB mask the symptoms

24
Q

avoid the following for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.

A

BB esp when combined with thiazide diuretic (thiazides exacebrate diabetes)

25
Q

what is BB + phenoxybenzamine combination used for

A

Beta-blockers can be used to control the pulse rate in patients with phaeochromocytoma. However, they should never be used alone as beta-blockade without concurrent alpha-blockade may lead to a hypertensive crisis. For this reason phenoxybenzamine hydrochloride should always be used together with the beta-blocker.

26
Q

does the dose of BB need to be high in hypertension

A

generally not

27
Q

how do BB relieve symptoms and improve exercise tolerance in pt with angina

A

By reducing cardiac work beta-blockers improve exercise tolerance and relieve symptoms in patients with angina.

28
Q

true or false - you can abruptly withdraw BB for angina

A

false

There is some evidence that sudden withdrawal may cause an exacerbation of angina and therefore gradual reduction of dose is preferable when beta-blockers are to be stopped.

29
Q

Several studies have shown that some beta-blockers can reduce the recurrence rate of myocardial infarction. However, uncontrolled heart failure, hypotension, bradyarrhythmias, and obstructive airways disease render beta-blockers unsuitable in some patients following a myocardial infarction.

These 2 may reduce early mortality after IV and subseuqent oral adminsitation in the acute phase

A

Atenolol and metoprolol tartrate

30
Q

Several studies have shown that some beta-blockers can reduce the recurrence rate of myocardial infarction. However, uncontrolled heart failure, hypotension, bradyarrhythmias, and obstructive airways disease render beta-blockers unsuitable in some patients following a myocardial infarction. Atenolol and metoprolol tartrate may reduce early mortality after intravenous and subsequent oral administration in the acute phase, while THESE 4 have protective value when started in the early convalescent phase.

A

acebutolol, metoprolol tartrate, propranolol hydrochloride, and timolol maleate

31
Q

how do BB act as anti arrhtyhmic drugs

A

principally by attenuating the effects of the sympathetic system on automaticity and conductivity within the heart

32
Q

use of BB + digoxin in AF

A

They can be used in conjunction with digoxin to control the ventricular response in atrial fibrillation, especially in patients with thyrotoxicosis.

33
Q

BB are used to control this type of arrhtyhmia following MI

A

SVT

34
Q

……. is a relatively cardioselective beta-blocker with a very short duration of action, used intravenously for the short-term treatment of supraventricular arrhythmias, sinus tachycardia, or hypertension, particularly in the peri-operative period. It may also be used in other situations, such as acute myocardial infarction, when sustained beta-blockade might be hazardous.

A

esmolol

35
Q

…….. a non-cardioselective beta-blocker with additional class III anti-arrhythmic activity, is used for prophylaxis in paroxysmal supraventricular arrhythmias. It also suppresses ventricular ectopic beats and non-sustained ventricular tachycardia. It has been shown to be more effective than lidocaine in the termination of spontaneous sustained ventricular tachycardia due to coronary disease or cardiomyopathy. However, it may induce torsade de pointes in susceptible patients.

A

sotalol

36
Q

this BB can induce TDP in susceptible patients

A

sotalol

37
Q

discuss the use of nebiv, carved, bisop in HF

A

Beta-blockers may produce benefit in heart failure by blocking sympathetic activity. Bisoprolol fumarate and carvedilol reduce mortality in any grade of stable heart failure; nebivolol is licensed for stable mild to moderate heart failure in patients over 70 years. Ideally, treatment should be initiated by those experienced in the management of heart failure.

38
Q

use of BB in thyrotoxicosis

A

Beta-blockers are used in pre-operative preparation for thyroidectomy. Administration of propranolol hydrochloride can reverse clinical symptoms of thyrotoxicosis within 4 days. Routine tests of increased thyroid function remain unaltered. The thyroid gland is rendered less vascular thus making surgery easier.

39
Q

use of these 2 BB in primary prevention of decompensated cirrhosis

A

Carvedilol [unlicensed use] and propranolol hydrochloride [unlicensed use] may be used for primary prevention of decompensated cirrhosis; carvedilol is considered first-choice as it has fewer side-effects and a greater effect on portal vein pressure.

40
Q

use of these 2 to prevent bleeding from oesophageal varices

A

Carvedilol [unlicensed use] and propranolol hydrochloride

41
Q

can they be given with anti arrhtyhmics dronedarone, amiodarone, fleicainide, propafenone

A

Dronedarone is predicted to increase the risk of cardiovascular adverse effects when given with Propranolol. Manufacturer advises use with caution or avoid.

42
Q

interaction with adrenaline

A

Propranolol is predicted to increase the risk of hypertension and bradycardia when given with Noradrenaline/norepinephrine. Manufacturer advises caution.

43
Q

theophylline interaction

A

Propranolol is predicted to increase the risk of bronchospasm when given with Theophylline. Manufacturer advises avoid.

44
Q

verapamil interaction

A

Verapamil increases the risk of cardiovascular adverse effects when given with Propranolol. Manufacturer advises avoid intravenous Verapamil.

45
Q

diltiazem interaction

A

Diltiazem is predicted to increase the risk of cardiodepression when given with Propranolol. Manufacturer advises monitor.

46
Q

state some common symptoms of all

A

bradycardia (slow HR)
confusion
depression
dizziness
dry eye (reversible on discont)
ED
headache
HF
peripheral coldness
peripheral vascular disease
rash (reversible on discont)
sleep disorders
syncope

47
Q

overdose of propranolol can induce…

A

ventricular tachyarrhythmias secondary to prolongation of QRS duration

48
Q

overdosage with this BB in particular may cause coma and convulsions

A

propranolol

49
Q

overdose of sotalol can induce …

A

ventricular tachyarrhythmias secondary to prolongation of QT interval

50
Q

therapeutic OD with BB may cause the following symptoms

A

lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate.

Afsha NEW CV (40 decks)

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