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Beta-Blockers Flashcards

1
Q

What class are Beta-Blockers

A

Class 2 anti-arrhythmic agents

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2
Q

what does beta stimulation do to the heart

A

increases contraction and heart rate

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3
Q

Why do athletes take beta blockers

A

to calm them down, reduce their heart rate

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4
Q

What do beta-blockers inhibit

A

The sympathetic activation of B-adrenergic receptors

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5
Q

What does B1 agonists do

A

increased heart rate, increased contractile force, workload and AVN conduction

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6
Q

what do beta-2 agonists do

A

stimulates bronchodilation/relaxtion

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7
Q

Non-Selective B-Blockers

A

inhibits B1 and B2 (in the heart and lungs)

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8
Q

Cardio-selective beta blockers benefit?

A

lower side-effect profile s

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9
Q

What conditions are cardio-selective beta blockers preferred for?

A

coronary heart disease
compensated heart failure
acute coronary syndrome
certain arrhythmias

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10
Q

Propranolol is what type of beta blocker

A

Non selective

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11
Q

What is propranolol a first line drug for?

A

essential tremor
portal hypertension
migraine prophylaxis
thyroid storm

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12
Q

What conditions are cardio-selective B-blockers (B1 selective) indicated for

A

coronary heart disease
compensated heart failure
cardiac arrhythmias (a-fib, atrial flutter, PSVT)

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13
Q

Where does B-1 selective blockers bind

A

B1 receptors in the heart
-there are SOME in other places of the body (like the kidney)

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14
Q

What do cardioselective B1 blockers do to the heart

A

-decrease heart rate
-decrease contractility
-decrease AVN conductivity

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15
Q

What is the only drug that causes NO-mediated vasodilation

A

Nebivolol

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16
Q

What does Nebivolol do in the body

A

decreases vascular resistance by stimulating B3 receptors and activating NO synthase in the vasculature

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17
Q

Compensated heart failure is

A

heart is overcompensating to give the other organs what they need (at expense of itself)

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18
Q

Side effects of Cardioselective Beta blockers

A

bradycardia
bradyarrhythmia

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19
Q

are cardioselective beta blockers dose dependent? what does this mean for B2 receptors

A

Yes they are dose dependent
-B2 receptor blocking increases at higher doses

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20
Q

What are not side effects of cardioselective beta blockers

A

generally:
-bronchoconstriction or vasoconstriction
-interference with glycogenolysis

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21
Q

are cardioselective beta blockers safe for diabetic patients

A

yes
because it does not interfere with glycogenolysis

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22
Q

AVN is

A

Atrial ventricular node

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23
Q

Cardioselective beta blockers with ISA (drugs)

A

*acebutolol
celiprolol

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24
Q

Example of beta-blocker that stimulates NO-mediated vasodilation

A

Nitroglycerin

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25
Q

ISA

A

intrinsic sympathomimetic activity

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26
Q

Cardioselective beta blockers without ISA (drugs)

A

*Atenolol
*Metoprolol (Lopressor)
*Esmolol
Bisoprolol
Betaxolol

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27
Q

Glycogenolysis

A

Destruction of glycogen

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28
Q

where is glycogen stored mainly?

A

Liver

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29
Q

Non-selective Beta-Blockers indications

A

-cardioselective B1-blocker alternative
-angina
-essential tremor
-portal hypertension
-migraine prophylaxis
!!!!! thyroid storm !!!!!

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30
Q

Indications to use Propranolol (non-selective b-blocker)

A

Angina

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31
Q

Indications to use Sotalol (non-selective b-blocker)

A

cardiac arrhythmia

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32
Q

Indication to use timolol (non-selective b-blocker)

A

glaucoma

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33
Q

Effects of nonselective beta-blockers

A

bronchoconstriction
vasoconstriction
Hypoglycemia and hyperglycemia
bradycardia
syncope

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34
Q

Mechanism of Non-Selective Beta-blocker

A

Blocks B1, B2 and B3 receptors

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35
Q

What does Sotalol (non selective b-blocker) also blocks

A

cardiac potassium channels (anti-arrhythmic effect)

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36
Q

For what type of patients are Non-selective Beta blockers NOT suggested for

A

-history of asthma/COPD
-history with peripheral vascular disease
-

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37
Q

Why would you choose Non-selective beta blockers?

A

Because they can affect other parts of the body (and this is the desired effect when using)
“OFF LABEL USE”

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38
Q

Non-Selective beta blockers with ISA (drugs)

A

*Pindolol
Penbutolol
Oxprenolol

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39
Q

Non-selective beta blockers withOUT ISA (drugs)

A

*Propranolol (Inderal)
Nadolol
Sotalol
*Timolol
Tertalol

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40
Q

Non-Selective Beta Blockers with alpha blocking action (drugs)

A

*Labetalol
Bucindolol
*Carvedilol

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40
Q

Indications for Non-Selective Beta-blocker with alpha blocking action

A

pregnancy-induced hypertension

Esophageal variceal bleeding (prophylactic use)

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41
Q

What do Alpha1 adrenergic receptors do

A

vasoconstriction of the blood vessels
(increases BP)

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42
Q

2 Benefits of Nonselective BetaBlockers with alpha blocking action

A
  1. calms the heart down
  2. decreases the pressure in the vascular
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43
Q

What beta blocker begins with the letters A-M

A

Cardioselective B-Blocker (exception of Nebivolol)
(B1=first)

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44
Q

What beta blocker begins with the letters N-Z?

A

Non-selective beta blockers
(excludes the a-blocking action drugs)
(B2=second)

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45
Q

what is a risk factor for esophageal variceal bleeding

A

alcohol use

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46
Q

Effects of Non-selective beta blocker with alpha blocking action within the BODY

A

vasodilation (decreased peripheral vascular resistance, decreased preload and afterload, increased renal blood flow)

-reduce portal hypertension and pressure gradient in hepatic venous
-improved endothelial function and vascular remodeling

47
Q

What do Non-selective beta blocker with alpha blocking action do to the portal BP

A

decreases the portal hypertension and pressure gradient in hepatic venous

48
Q

Side effects of Non-selective beta blocker with alpha blocking action

A

same side effects as non-selective beta blockers
-orthostatic hypotension

49
Q

Pharmacodynamics of Beta-Blockers

A

competitively bind to and block B-adrenergic receptors
-inhibits sympathetic stimulation of B-receptors

50
Q

Mechanism of action of ISA

A

partial agonists activity
-binds and stimulate B-adrenergic receptor (agonist effect)
-competitively inhibits the binding of EPI and NE (antagonist effect)

51
Q

What do ISA beta blockers produce

A

partial sympathetic activity while inhibiting the normal and activated sympathetic activity

52
Q

what is the Effects of ISA drugs in the body (3 things)

A

-less bradycardia & peripheral vasoconstriction (bc of mild agonist action)
-Favorable effect on lipid profile

53
Q

When are ISA drugs not indicated

A

congestive heart failure, ischemic heart disease and tachyarrhythmias

54
Q

ISA agents

A

Pindolol
acebutolol
carteolol
alprenolol

55
Q

Why are ISA agents recommended for pt’s with metabolic syndrome

A

because they have a favorable effect on lipid profile

56
Q

What type of mechanism is ISA

A

partial agonist and competitive inhibitor for alpha and beta receptors (for NE and EPI)

57
Q

Epinephrine stimulates what receptors

A

alpha and beta receptors

58
Q

what 2 drugs are especially favorable for favorable effect on lipid profile

A

pindolol and acebutolol

59
Q

Examples of metabolic syndrome

A

Hyperlipidemia and diabetes mellitus

60
Q

what three things can we use for energy

A

carbs (main)
lipids
protein

61
Q

What is defective in metabolic syndrome

A

problems processing the energy sources

62
Q

what kind of clearance do Lipophilic agents undergo

A

hepatic clearance

63
Q

What agent can cross the blood brain barrier? what does this mean in terms of effects?

A

Lipophilic agents

causers neurological adverse effects (nightmares and insomnia)

64
Q

What is the longest acting agent

A

lipophilic

65
Q

examples of lipophilic agents

A

carvedilol
labetalol
metaprolol
propranolol

66
Q

What type of clearance do hydrophilic agents undergo

A

renale clearance

67
Q

What types of agents don’t cross the blood brain barriers?

A

hydrophilic

68
Q

are hydrophilic agents short acting or long acting? how many doses are required?

A

Short acting

multiple doses

69
Q

example of hydrophilic agents

A

acebutolol
atenolol
celiprolol
pindolol
sotalol

70
Q

examples of mixed agents

A

bisoprolol
Nebivolol

71
Q

Non selective beta blockers and cardioselective beta blockers effect on the heart

A

bradycardia
bradyarrhythmia
ventricular tachyarrhythmia
worsened heart failure
vasopsasms
orthostatic hypotension

72
Q

Non selective beta blockers and cardioselective beta blockers effect on the CNS

A

fatigue
sleep disorders
nightmares
depression
hallucination
seizures

73
Q

Non selective beta blockers and cardioselective beta blockers effect on the skin

74
Q

Non selective beta blockers effect on the pulmonary system

A

Bronchoconstriction
-dyspnea
-bronchospasm
-respiratory exacerbation

75
Q

Non selective beta blockers effect on the Peripheral vasculature system

A

peripheral vasoconstriction
-ED
-secondary Raynauds
-cold extremities

76
Q

Non selective beta blockers effect on the Metabolic system

A

-hypertriglyceridemia
-hyperglycemia
-hypoglycemia
-weigh gain

77
Q

What are the clinical features of B-Blocker over dose (7)

A

bradycardia/bradyarrhythmia
cardiogenic shock
hypoglycemia
hyperkalemia
wheezing
neurological symptoms

78
Q

what is Cardiogenic shock? What does it present as?

A

poor perfusion
hypotension, cold/clammy extremities

79
Q

What is the treatment for beta-blocker overdose

A

-secure the airway
-correct the cardiovascular decompensation
-prevention of further beta-blocker absorption

80
Q

What treatments are included in correcting cardiovascular decompensation VIA IV ACCESS

A

-Fluids (saline) and vasopressors (epinephrine)
-Atropine
-Glucagon
-calcium salts
-high dose insulin with glucose

81
Q

What does atropine administration do?

A

corrects bradycardia

82
Q

what does glucagon administration do in b-blocker overdose treatment?

A

acts as antidote for b-blocker poisoning

83
Q

what does calcium salts administration do in b-blocker overdose treatment?

A

improves cardiac contractility

84
Q

what does High-dose insulin with glucose administration do in b-blocker overdose treatment? when is it used?

A

Last resort if nothing else worrks
-it has a positive inotropic effect

85
Q

How do you prevent further absorption of beta-blockers?

A

activated charcoal
gastric lavage
IV lipid emulsions

86
Q

When is hemodialysis indicated for B-Blocker overdose treatmetn

A

hydrophilic beta blocker overdose
dialysis removes drug completely from circulation

87
Q

What is the process for administering/stopping beta blocker treatmetn

A

administer gradually and slowly taper off when stopping

88
Q

what is hypertriglyceridemia

A

Decreased levels of HDL with B-BLocker w/o ISA

89
Q

Clinical features of Beta-Blocker withdraw (4)

A

tachycardia
tachyarrhythmia
hypertension
Acute coronary syndrome (sudden death)

90
Q

How to prevent Beta-Blocker withdrawl

A

taper the dose over 7-10 days before discontinuing

91
Q

Pathophysiology of B-Blocker treating hypertension

A

Beta blockers lower BP which decreases cardiac output and renin secretion

92
Q

Pathophysiology of B-Blocker treating Acute myocardial infarction

A

INITIATE EARLY in ALL pts without CI
-decreases the size of the infarct
-reduces early and delayed mortality rates

93
Q

When do you use B-Blocker to treat angina pectoris? Do you add any other medications

A

First line treatment for stable angina pectoris

-add ACE inhibitors or ARBS

94
Q

How do you use B-Blocker to treat heart failure? Do you add any other medications

A

Cardioselective B-blockers + ACE inhibitor/ARB + Spironolactone

95
Q

What does Spironolactone do for CHF

A

slows the progression

96
Q

How does insulin work?

A

lowers the blood glucose
allows the glucose to enter into the cell
without insulin you can’t get the glucose in

97
Q

What does not need insulin?

A

Central nervous tissue

98
Q

What do B-Blockers do for arrhythmias

A

regulate atrial flutter, atrial fibrillation, PSVT, VT and premature ventricular contractions

99
Q

What class antiarrhythmic agents are Beta Blockers? what are 3 examples

A

Class 2 antiarrhythmic agent

metoprolol
esmolol
propranolol

100
Q

What are 9 specific indications for Propranolol

A
  1. tremor
  2. migraine prophylaxis
  3. portal hypertension
  4. hyperthyroidism/thyroid storm
  5. infantile hemangioma
  6. akathisia
  7. Hypertensive crises
  8. Glaucoma
  9. Pregnancy induced hypertension
101
Q

What to do in hypertensive crisis

A

IV labetalol

102
Q

How is glaucoma treated by beta blockers? Give 2 examples

A

topical beta blockers
timolol
betaxolol

103
Q

What is the first line drug for pregnancy induced hypertension

104
Q

Absolute contraindications of BetaBlocker treatment? (6)

A
  1. Symptomatic bradycardia
  2. cardiogenic shock and HTN
  3. Pheochromocytoma
  4. Decompensated heart failure
  5. CCB combination
  6. sick sinus syndrome
105
Q

what is Pheochromocytoma?

A

tissue that produces an excess amount of EPI (mainly) and NE

106
Q

what can combining CCB and beta blockers do?

107
Q

examples of calcium channel blockers

A

diltiazem
verapamil

108
Q

Relative contraindications to using Beta Blockers

A
  1. asthma and copd
  2. psoriasis
  3. Raynaud phenomenon
  4. Pregnancy
109
Q

what drug is used to treat pregnancy induced hypertension

110
Q

What happens if Beta Blockers are administered before alpha blockers when a pheochromocytoma is present?

A

there is an unopposed alpha-adrenoceptor mediated vasoconstriction
a hypertensive crisis occurs

111
Q

what two B-Blocker medications do not illicit a hypertensive crisis when a pheochromocytoma is present?

A

carvedilol
labetalol
non selective beta blockers w/ alpha-antagonism

112
Q

what is Raynaud phenomenon

A

peripheral artery occlusive disease
-finger tips and toes get discolored

113
Q

adverse affect from administration of B-Blocker in a patient with sick sinus syndrome

A

heart block greater than first-degree

114
Q

what tissue does not conduct?

A

Dead tissue

115
Q

why is psoriasis a CI for B-Blocker

A

the reaction of psoriasis being an autoimmune disease

pharmacology (32 decks)

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