BetaBlockers

Question 1

Beta Blockers approved for use for?

Answer 1

FDA-approved for a wide variety of uses, including treatment for heart failure, left ventricular dysfunction after an MI, HTN, anxiety, migraines, hyperthyroidism, and essential tremor

Question 2

Effects of BBlockers

Answer 2

lower CO, decrease BP, decrease RAS, and decrease peripheral vascular resistance (SVR/PVR)

Question 3

Renal effects of Beta Blockers

Answer 3

lowers blood pressure by decreasing the activation of RAS causing less angiotensin II–mediated vasoconstriction and aldosterone-mediated volume expansion

Question 4

Respiratory Effects of BetaBlockers

Answer 4

Beta2 blockers inhibit endogenous adrenergic bronchodilation receptors in the lungs, causing bronchial constriction

Question 5

Ocular effects of betablockers

Answer 5

Both beta1 and beta2 receptors are located on the ciliary body and when activated produce aqueous humor. BB block this reducing intraocular pressure.

Question 6

When are BetaBlockers contraindicated

Answer 6

contraindicated in patients with atrioventricular block bc of the potential to decrease heart rate and myocardial contractility resulting in worsening cardiac output and heart failure.

Question 7

Which betablocker generations should be used in caution with diabetics because of masking hypoglycemia

Answer 7

First- and second-generation beta blockers

Question 8

Abrupt with drawl from beta blockers can cause?

Answer 8

A thyroid storm
And concern for life-threatening arrhythmias, hypertension, and MI

Question 9

Which drugs when interacting with BetaBlockers can create additive hypotension

Answer 9

other antihypertensives, especially calcium channel blockers, and with ingestion of alcohol or nitrates

Question 10

Are beta blockers a first-line antihypertensive?

Answer 10

No, unless the patient has ischemic cardiac disease or heart failure

Question 11

How soon after a NSTEMI should a beta blocker be started

Answer 11

should be initiated in the first 24 hours after a NSTEMI

Question 12

Which 3 beta blockers have the longest half lives

Answer 12

Atenolol, nadolol, and nebivolol have the longest half-lives, allowing for daily dosing.

Question 13

Which 4 beta blockers need to be renally dosed

Answer 13

Atenolol, nadolol, and nebivolol (long half life BBS) and Acebutolol

Question 14

What is the protocol for beta blockers and pregnancy

Answer 14

Risk verse benefit considerations during pregnancy

Question 15

Which sign of hypoglycemia is not masked by beta blockers

Answer 15

diaphoresis

Question 16

What are the FirstGeneration non-cardioselective beta blockers we need to know

Answer 16

Propranolol and Nodalol

Question 17

Which two beta-blockers are very lipid soluble and can cross the BBB

Answer 17

Propranolol and Carvedilol

Question 18

Propranolol is approved for use with two conditions

Answer 18

Migraines and Angina with idiotrophic cardiomyopathy

Question 19

Which beta blockers increase bioavailability with food

Answer 19

Propranolol and Metoprolol

Question 20

What are the second generation - cardioselective beta blockers we need to know?

Answer 20

Metoprolol, Atenolol, Nebivolol

Question 21

Which second-generation beta blocker is the most cardioselective?

Answer 21

Atenolol

Question 22

What is different about Nebovolol’s MOA from other BBs?

Answer 22

Unlike other beta-blocker is also produces endothelium-derived nitric oxide-dependent vasodilation

Question 23

At high doses - can second-generation beta blockers block beta 2 receptors?

Answer 23

Yes

Question 24

What are the third generation beta blockers? What is their MOA

Answer 24

Carvedilol and Labetalol

alpha1 blockade is predominant, which makes these mediations less likely to cause significant bradycardia or decrease in cardiac output and decreases the reflex vasoconstriction that is noted with beta blockers alone

Question 25

Carvedilol is often used for?

Answer 25

HTN, and carvedilol is also used to reduce progression of heart failure and to treat left ventricular dysfunction after MI & afib

Question 26

Describe the metabolism of carvedilol and labetalol (PO)

Answer 26

Third-generation beta blockers carvedilol and labetalol have rapid hepatic first-pass metabolism resulting in bioavailability around 30% and are metabolized primarily in the liver by P450 enzymes

Question 27

Third gens, although rare, need what sort of monitoring?

Answer 27

Liver monitoring. Rarely cause hepatic dysfunction but needs to be monitored.

Question 28

Labetalol is contraindicated in?

Answer 28

Pts with bronchospastic disease

Question 29

When labetalol is administered in conjunction with nitroglycerin, the labetalol can decrease?

Answer 29

the reflexive tachycardia induced by nitro

Question 30

What can labetalol do to a urine drug test?

Answer 30

Labetalol can cause a false-positive test for amphetamines when screened in urine

Question 31

How should beta blockers be discontinued

Answer 31

beta blockers should be titrated over 2 to 3 weeks, decreasing the dose every 4 days

Question 32

Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:
1. Increasing heart rate to improve cardiac output
2. Reducing vascular smooth muscle tone
3. Increasing aldosterone-mediated volume activity
4. Reducing aqueous humor production

Answer 32

2. Reducing vascular smooth muscle tone

Question 33

Which of the following adverse effects are less likely in a beta1-selective blocker?
1. Dysrhythmias
2. Impaired insulin release
3. Reflex orthostatic changes
4. Decrease Triglycerides and cholesterol

Answer 33

2. Impaired insulin release

Question 34

Beta blockers are the drugs of choice for exertional angina because they:
1. Improve myocardial oxygen supply by vasodilating the coronary arteries
2. Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
3. Both 1 and 2
4. Neither 1 nor 2

Answer 34

2. Decrease myocardial oxygen demand by decreasing heart rate and vascular
   resistance

Question 35

To prevent life-threatening events from rapid withdrawal of a beta blocker:
1. The dosage interval should be increased by 1 hour each day.
2. An alpha blocker should be added to the treatment regimen before withdrawal.
3. The dosage should be tapered over a period of weeks.
4. The dosage should be decreased by one-half every 4 days.

Answer 35

4. The dosage should be decreased by one-half every 4 days.

Question 36

Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?
1. Histamine 2 blockers
2. Quinolones
3. Serotonin re-uptake inhibitors
4. All of the above

Answer 36

4. All of the above

Question 37

Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
1. White
2. Asian
3. African American
4. Native American