Class II

Question 1

What are the four drugs of Class II?

Answer 1

• Propanolol
• Acebutolol
• Esmolol
• Sotalol

Question 2

What is the mechanism of Class II drugs?

Answer 2

• Decrease SA & AV nodal activity via decreasing cAMP, decreasing Ca++ currents
• Suppress normal pacemakers by decreasing slope of phase 4 (AV node particularly sensitive –> increased PR interval)

Question 3

What are the cardiac effects of Propranolol?

Answer 3

-Decreases Conduction velocity through SA and AV node

Question 4

What are the cardiac effects of Acebutolol?

Answer 4

-Decreases Conduction velocity through SA and AV node

Question 5

What are the cardiac effects of Esmolol?

Answer 5

• Short acting selective Beta blocker (cardiac beta 1)

- Negative chronotrope and ionotrope

Question 6

What are the cardiac effects of Sotalol?

Answer 6

• 2 isomers (L = beta blocker, D = Antiarrhythmic)
• Beta blockage at 25 mg, Antiarrhythmic at 160 mg
• Antiarrhythmetic effect lengthens repolarization or plateau phase of AP

Question 7

What are the extra cardiac effects of Propranolol?

Answer 7

None

Question 8

What are the extra cardiac effects of Acebutolol?

Answer 8

Beta blocker everywhere

Question 9

What are the extra cardiac effects of Esmolol?

Answer 9

None

Question 10

What are the extra cardiac effects of Sotalol?

Answer 10

None

Question 11

What are the Pharmacokinetics of Propranolol?

Answer 11

• Complete oral absorption w/wide body distribution

- Metabolized by liver

Question 12

What are the pharmacokinetics of Acebutolol?

Answer 12

• Well absorbed by GI

- Extensive first pass metabolism

Question 13

What are the pharmacokinetics of Esmolol?

Answer 13

• Rapid onset and remission

- Renally excreted

Question 14

What are the pharmacokinetics of Sotalol?

Answer 14

• Readily absorbed orally
• Peak plasma concentration @ 2.5-4 hours
• Renally excreted

Question 15

What is the toxicity of Propranolol?

Answer 15

• Inhibits Bronchodilation

- Possible intensification of AV block, AV dissociation and AV conduction delays

Question 16

What is the toxicity of Acebutolol?

Answer 16

• Avoid use in Patients with decompensated HF

- Possible decreased signs and Sx of hypoglycemia

Question 17

What toxicity is associated with Esmolol?

Answer 17

-Hypotension, dizziness, diaphoresis, headache, somnolence, confusion, agitation, nausea

Question 18

What toxicity is associated with Sotalol?

Answer 18

-Sinus bradycardia, chest pain, palpitations, hypotension, fatigue, dizziness, asthenia, lightheadedness, dyspnea, nausea & vomiting

Question 19

What are the therapeutic uses of Propranolol?

Answer 19

• Preferred Tx for Stable, Narrow complex supreventrivcular tachycardias
• Tx for tachycardia during CV surgery
• Management of Supraventricular or ventricular tachycardia associated with glycoside toxicity w/out AV blok

Question 20

What are the therapeutic uses of Acebutolol?

Answer 20

• Tx of frequent PVCs

- Tx of hypertension

Question 21

What are the therapeutic uses of Esmolol?

Answer 21

• Supraventricular tachycardia
• Hypertension
• Acute MI
• Unstable Angina
• Non-ST elevation MI

Question 22

What are the therapeutic uses of Sotalol?

Answer 22

-Ventricular arrhythmias & Supraventricular tachycardias