Beta Blockers Flashcards
What are the non selective beta blockers?
Propanolol, pindolol, nadolol, timolol, carteolol, and sotalol
What do selective beta blockers block?
B1
What are the selective beta blockers?
Metoprolol, atenolol, acebutolol, betaxolol bisoprolol, esmolol
What drug is a selective b1 antagonist and a selective b2 agonist?
Celiprolol
Repeated this slide a lot…. IDK
What are the two beta blockers that also block a1 and b2
Labetalol and carvedilol
What broad patient population should we be careful with in beta blockers?
Respiratory patients, like asthma or COPD
What can some beta blockers actually do in the absence of Epi/NE?
Agonists to beta receptors. Probably not very clinically relevant
What does blocking beta 1 cause?
Decreases contractility, making it a negative ionotrope
Decreases heart rate, making it a negative chronotropic
How does beta blockers reduce TPR, despite the body having a compensatory sympathetic outflow to B1 blockage?
Multiple theories- This is the most important one
B1 receptors on JG cells getting blocked, leading to decreased renin
Whats the acute phase response of beta blockers? Chronic response?
TPR might go up, CO might go down, but chronically BP is reduced r/t B1 blockage in JG cells
What patient population should beta blockers be avoided in?
Generally COPD or asthma
What is the metabolic effect of beta blockers?
Will promote catecholamines due to activation of SNS< promoting glycogenolysis and mobilization glucose in response to hypoglycemia
What are the ADEs of beta blockers?
Increase in airway resistance
CNS- Fatigue, sleep disturbances, depression metabolism- Blunts recognition of hypoglycemia
Sexual dysfunction
What are most beta blockers metabolized by?
CYP450
Do beta blockers help everyone?
No. Some patients, like some with angina, will not tolerate the decrease in contractility
Are BBs good for MIs?
YES
Are BBs good for heart failure?
Initially were contraindicated, but now they are used commonly
How are BBs good for aneurysm?
Reduces pressure being exerted against the artery wall by reduction in hr and bp
How is BBs good for glaucoma?
Reduces aqueous humor production
What is the memory tool to memorize non selective bbs?
Previously purple- Propanolol People- Pindolol Can-carteolol Not-nadolol Take-Timolol Some-sotalol
Which non selective bb is significantly metabolized by CYP450 2D6? And has significant first pass metabolism
Propanolol
Why is is a problem for propanolols metabolism?
Significant genetic variants in metabolism
Like ultra fast metabolizer or poor metabolizer
What is the problem with sotalol?
Blocks K currents, can cause torsades
Whats the memory aid in selective BBs?
MAABBE
Metoprolol, atenolol, acebutolol, betaxolol, bisoprolol, esmolol
Cuz maabbe you could use these in pulmonary patients
Why is metoprolol first?
Significant CYP450 2D6 metabolism, significant genetic variance, first pass metabolism
Why is esmolol last?
Brief block, rapid blockade used IV in the ICU.
I used this in the guy that was a prisoner and had a ruptured mitral valve
Is nebivolol selective or not?
Selective
What is unique about nebivolol?
Causes vasodilation via stimulation of NO release
What makes labetalol and carvedilol unique?
Blocks a1 at therapeutic concentrations
Celiprolol is a selective or not?
Selective for B1 and mild B2 AGONIST
What is wrong with celiprolol?
Increases risk for aortic dissection in Ehlers Danlos syndrome
