Beta Blockers Flashcards
What beta blockers have intrinsic sympathomimetic activity (ISA)?
Acebutolol
Celiprolol
What B-Blockers are without ISA?
Atenolol
Metoprolol
Esmolol
Bisoprolol
Betaxolol
Bevantolol
Nebivolol
Acebutolol, atenolol, metoprolol, and esmolol are all ________ beta blockers
-Which selectivity?
Cardioselective
-B1
What’re the effects of B1 Beta blockers?
Decreases heart rate, contractility, and AVN conduction
Which beta blocker is the only beta blocker that causes NO-mediated vasodilation?
Nebivolol
Indications of cardioselective B1 beta blockers?
Coronary heart disease, compensated heart failure, and arrhythmias
What’re some nonselective beta blockers with ISA?
Pindolol
Penbutolol
Oxprenolol
What’re some nonselective beta blockers without ISA?
Propranolol
Nadolol
Sotalol
Timolol
Tertalol
What’re some nonselective beta blockers with additional alpha blocking action?
Labetolol
Bucindolol
Carvedilol
What’re the effects of nonselective beta blockers with and without ISA?
Blocks B1,2, and 3 receptors
Sotalol (NS B-Blocker) also blocks ____ channels resulting in an _________ effect
Potassium
Antiarrhythmic
What’re the side effects of nonselective beta blockers?
Bronchoconstriction, vasoconstriction, hypo/hyper glycemia, bradycardia and syncope
Indications of:
-Propranolol
-Sotalol
-Timolol
-Prop: Essential tumor, portal HTN, migraine prophylaxis, thyroid storm
-Sot: cardiac arrhythmias
-Timolol: Glaucoma
Nonselective beta blockers are the _______ to cardioselective beta blockers
Alternative
What’re the effects of NS B-Blockers with alpha blocking action?
They’re potent vasodilators and improve endothelial function and vascular remodeling
Due to alpha-blocking action:
Vasodilation causes —> 1._____ peripheral vascular resistance, 2.______ preload, 3._______ after load, and 4. _______ renal blood flow
1-3: Decreased
4. Increased
NA B-Blockers with additional alpha blocking action _______ portal HTN and pressure gradient in hepatic venous
Reduce
Indications of NS B-Blockers with Alpha action?
Pregnancy induced HTN (labetolol)
Esophageal varisces (prophylactic use)
With the exception of Nebivolol, all cardioselective beta blockers begin with letters ____ to _____, while NS B-Blockers begin with letters ______ to ______
A-M
N-Z
What types of organs are affected by B1 receptors?
Heart and Kidneys
What’re the effects of the B-Adrenergic blockade on the heart?
Anti-arrhythmic effect
Anti-ischemic effect
Anti remodeling effect
What is the anti-ischemic effect of the B1-Blockade? (Physiologically explain what happens to rate, contractility, BP, and result)
Decreased HR, contractility, BP, oxygen consumption, resulting in anti ischemic effect
Explain the antiarrhythmic effect of the B1 blockade
Decreased AVN conduction, increased AVN refractory time, and decrease heart rate
Explain the process of the B1 blockade on the kidneys (what cells does it act on and what happens)
Acts in the juxtaglomerular cells causing decreased renin, decreased angiotensin 2 conversion, decreased water resorption and decreased BP
What organs do B2 receptors affect?
Smooth muscle, ciliary body of the eye, pancreatic beta cells, skeletal muscle, liver, lipoprotein lipase enzyme
What’re the effects of the B-adrenergic blockade on smooth muscles?
-Vasculature
-Bronchioles
-Vasoconstriction
-Bronchoconstriction
What is the effect on the ciliary body of the eye from the beta adrenergic blockade?
Causes decreased aqueous humor production resulting in decreased intraocular pressure
What’s the effect of the beta adrenergic effect on the beta cells of the pancreas?
Decreased insulin release resulting in hyperglycemia and new onset diabetes
What effect does the beta-adrenergic blockade have on skeletal muscle?
Decreased glucose uptake (decreased insulin sensitivity)
What effect does the beta-adrenergic blockade have on the liver?
Decreased hepatic glycogenolysis causing hypoglycemia (esp. in diabetic patients)
What effect does the beta-adrenergic blockade have on lipoprotein lipase enzyme?
Inhibits lipoprotein lipase causing hyperlipidemia (increased triglycerides, reduced HDL)
What is the main site of action of the B3 receptor?
Adipose tissue
What effect does the beta-adrenergic blockade have on adipose tissue?
Reduced lipolysis causing weight gain
Beta blockers competitively ______ adrenergic substances at B receptors
Inhibit
Adverse effects of: NS and selective B-Blockers on:
- Cardiac
Bradycardia, bradyarrhythmia (AV block),
ventricular tachyarrhythmia (torsades),
worsening HF,
worsened vasospasm due to propranolol use
Orthostatic hypotension
Adverse effects of: NS and selective B-Blockers on:
-CNS
Fatigue/lethargy
Sleep disorders
Depression, hallucinations
Siezures
Adverse effects of: NS and selective B-Blockers on:
-Cutaneous
Psoriasis
Adverse effects of: NS B-Blockers on:
-Pulmonary
Bronchoconstriction (esp. patientd with asthma and reactive airway disease)
Adverse effects of: NS B-Blockers on:
-Perioheral vasculature
Peripheral vasoconstriction:
- Erectile dysfunction
- Secondary raynaud phenomenon
Adverse effects of: NS B-Blockers on:
-Metabolic
Hypertriglyceridemia
Hyper/hypo glycemia
Weight gain
Beta blockers should be introduced _______ with _____ increases in dosage and ______ tapered off when no longer needed
Gradually with slow increased
Slowly tapered off
Beta blocker withdrawal is caused by?
Sudden termination of beta blockers
How to prevent beta blocker withdrawal?
Taper dose over 7-10 days
What’re some indications of beta blockers?
HTN, CAD, Heart failure, and Arrhythmias
What’re the specific indications for propranolol?
Essential tumor, migraine prophylaxis, portal HTN, hyperthyroidism and thyroid storm, infantile hemangioma, and akathisia
What drug would be given for hypertensive crisis?
IV labetolol
