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Fall Pharm Block 2 > Beta Blockers > Flashcards

Beta Blockers Flashcards

1
Q

Differentiate selective from non-selective beta blockers.

A

Selective: block only beta-1

Non-selective: block both beta-1 and beta-2

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2
Q

What is ISA in relation to beta blockers?

A

ISA = intrinsic sympathomimetic activity. Some beta blockers have some mild beta agonist properties. They still have more beta antagonist effects but the are less potent beta antagonists.

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3
Q

What is MSA in relation to beta blockers?

A

MSA = membrane stabilizing activity. These beta blockers also inhibit fast sodium channels

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4
Q

What is the risk of beta blockers with MSA and when are they used?

A

Risk: prolonged QT - dysrhythmias
Use: eye drops for glaucoma - less stinging in eyes

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5
Q

What is the most commonly prescribed beta blocker containing ISA?

A

pindolol

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6
Q

List some examples of beta blockers that are renally cleared and hapeatically cleared.

A

renally (hydrophilic): atenolol

hepatically (lipohilic): carvedilol, labetalol

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7
Q

What is the benefit of beta blockers that have alpha-1 antagonism and give some examples.

A

More potent beta blockers s/p vasodilation - useful in cocaine OD. Exs: carvbedilol, labetalol

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8
Q

What is the advantage of beta blockers that release nitric oxide?

A

More potent beta blockers s/p vasodilation

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9
Q

Give two examples of commonly used beta-1 selective beta blockers.

A

atenolol and metoprolol

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10
Q

What happens to selective beta blockers at high doses?

A

They lose selectivity

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11
Q

Explain why patients on beta blockers must have them withdrawn slowly over a relatively long period of time.

A

While on beta blockers, the heart upregulates beta 1 receptors and increases their sensitivity. Sudden withdrawal of the medication can lead to tachycardia and hypertension.

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12
Q

What is the effect of beta blockers on lipid panels?

A

Worsens lipid panel - esp non-selective BBs.

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13
Q

What is the effect of beta blocker medications on patients with heart failure?

A

Benefit bc of a decrease in HR which inc filling time.

Down side is BBs have a negative inotropic effect.

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14
Q

List three other cautions for people taking beta blocker medications.

A

May cause fatigue, depression, and sexual dysfunction. Effect worsens with lipiphilicity of BB, especially propranolol.

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15
Q

What are the indications for atenolol?

A

AMI, angina, HTN, migraine prophylaxis

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16
Q

What is unique about the pharmacodynamics of carvedilol?

A

Non-selective beta blocker with some alpha-1 blockade (IE, some vasodilation)

17
Q

What are the indications for carvedilol?

A

HTN, portal HTN, A-fib, CHF (mortality dec shown)

18
Q

What is unique about the pharmacokinetics of esmolol?

A

It is eliminated via plasma esterases (in blood), meaning the drug will have a short 1/2 life and can only be given IV.

19
Q

What are the indications for esmolol?

A

intra- and post-op HTN, A-fib, aortic dissection

20
Q

What 3 beta blockers are used for CHF?

A

Carvedilol, Metoprolol XL, Bisoprolol

21
Q

What is unique about the pharmacodynamics of labetalol?

A

Nonselective beta blocker that also has alpha-1 blockade (more alpha-1 than carvedilol)

22
Q

What is the primary use for labetalol?

A

HTN emergency

23
Q

What is unique about the pharmacodynamics of nebivolol?

A

Selective beta blocker with that stimulates some NO release?

24
Q

What are the indications for nebivolol?

A

HTN, migraine prophylaxis

25
Q

What is the father of all beta blockers?

A

propranolol

26
Q

What are the indications for use of propranolol?

A

Tremor, anxiety, aggression, pheochromocytoma, thyroid storm, portal HTN, among others

27
Q

What beta blocker is used for glaucoma and what mechanism of action benefits these patients?

A

Timolol: reduces production of aqueous humor and facilitates movement of aqueous humor.

28
Q

Name 3 alpha-1 blockers and state the caution with these medications?

A

Doxazosin, Prazosin, Terazosin. They are very potent vasodilators that cause postural HypoTN and falls.

29
Q

List three selective (bladder specific) alpha-1 blockers and describe their use.

A

Afluzosin, Silodosin, Tamsulosin. Blockade of alpha-1 in the bladder promotes urination - used in BPH.

30
Q

What is the mechanism of action of clonidine?

A

Centrally acting alpha-2 agonist –> dec release of epi and norepi from the synapse and decreases BP

31
Q

When is clonidine used as an antihypertensive?

A

Last line anti-HTN

32
Q

What is a secondary effect of clonidine?

A

Also mucks with reward pathway in brain –> used for addidction, ADHD, smoke cessation, etc.

Fall Pharm Block 2 (8 decks)

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