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Pharmacology > Exam 2: Beta-Blockers > Flashcards

Exam 2: Beta-Blockers Flashcards

1
Q

Beta blockers block beta-receptors. There are B1 receptors and B2 receptors. Where in the body are the B1 and B2 receptors found?

A

B1 is found in the heart and kidneys

B2 is found in the lungs, GI tract, vascular smooth muscle, skeletal muscle and the ciliary body of the eye.

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2
Q

What specifically do BB’s block?

A

Epinephrine and Norepinephrine

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3
Q

BBs effect the NS by suppressing what part of the NS response?

A

SNS: Fight or Flight response

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4
Q

Normal SNS responses are increased HR, strength of contractions, and blood glucose via glycogenolysis.

So what are the effects of BBs?

A

-decreased HR

-Decreased strength of contractions

-Decreased blood glucose

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5
Q

Juxta-glomerular cells are found in your kidneys. Which type of beta receptors are found in the Juxta-glomerular cells?

A

B1 receptors

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6
Q

The juxta-glomerular cells in the kidney release a specific chemical involved with blood pressure. What is this chemical called?

A

Renin

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7
Q

The B2 receptors are found in your lungs, specifically in the “blank”

A

Bronchioles

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8
Q

What do BBs end in that tell you they are a Beta Blocker?

A

“lol” or “olol”

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9
Q

There are 2 types of Beta Blockers: Selective and Nonselective.

Selective BBs target “blank” receptors, while Nonselective target “blank” receptors

A

Selective BBs target B1

Nonselective target B1 and B2

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10
Q

True or False:

Selective Beta Blockers are cardio selective

A

True

Selective BBs are cardio selective and only affect the B1 receptors

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11
Q

Which of the meds are selective BBs and which are nonselective BBs?

-Atenolol
-Propranolol
-Sotalol
-Esmolol
-Metoprolol
-Timolol

A

Selective: Atenolol, Esmolol, Metoprolol

Nonselective: Propranolol, Esmolol, Timolol

Selective: AEM
Nonselective: PST

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12
Q

Choose which Side effect of BBs is MOST affiliated with either Selective, or Nonselective:

Decreased…
-Heart Rate
-Blood pressure
-Peripheral Vasoconstriction
-Intraocular pressure
-Strength of heart contractions
-Bronchoconstriction
-Hypo/Hyperglycemia

A

-HR, BP, and strength of heart contractions are selective

-IO pressure, Bronchoconstriction, peripheral vasoconstriction, and hypo/hyperglycemia is nonselective

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13
Q

MOA: Both B1 and B2 receptors effect the heart, specifically the “blank” tissue

a.) Arterial smooth
b.) Cardiac nodal
c.) Myocardial muscle
d.) Agonist receptor

A

b.) Cardiac nodal tissue

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14
Q

The Cardiac Nodal tissue is responsible for the conduction of the “blank” system.

This is why BBs are good for treating “blank” by lowering the heart rate

A

the CNT is responsible for the conduction of the electrical system of the heart

This is why BBs are good for dysrhythmias by lowering the heart rate

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15
Q

Since BBs affect the CNT of the heart by lowering the HR, a nurse should monitor the patient for what?

What should the nurse do with the BBs if the HR is beyond the normal range?

A

Bradycardia

Withold the meds if the HR is too low

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16
Q

Checking for a heart block is important in ALL HTN meds, but specifically BBs. What would a nurse look at to check for a heart block?

A

A patients EKG

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17
Q

Like CCBs, BBs are good for lowering the O2 consumption of the heart that can cause a heart failure.

How does a BB achieve a patient lower O2 needs for the heart?

A

The BBs (specifically B1) lowers heart contraction strength, which result in weaker contractions.

This causes a negative Ionotropic effect which decreases the hearts need for additional O2

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18
Q

Are BBs good for patients with uncompensated heart failure?

A

NO, only fully compensated.

19
Q

How do BBs work with the Kidneys to lower BP?

A

B1 receptors in the kidneys bind with BBs to stop the kidneys from releasing Renin.

This Renin works with the RAAS to release aldosterone and increase BP.

20
Q

Which of the BB receptor types can lower intraocular pressure by binding with receptors in the ciliary body?

A

B2 nonselective types

21
Q

Since B2 receptor BBs can lower IOP in the eye, what would BBs be good for in treating, besides HTN or HF?

A

Glaucoma

22
Q

Under NO circumstances are BBs to be given to patients with Asthma or COPD. Why is that?

A

The lungs have B2 receptor sites that BBs can latch on to.
BBs can then cause Bronchoconstriction and lead to bronchospastic asthma attacks and lowered O2 levels.

23
Q

Are BBs good for Diabetic patients? Why or why not?

A

No, because BBs can inhibit the bodies response to hypo/hyperglycemia and the DM patient won’t be able to recognize when their bodies are affected by too much or too little sugar.

24
Q

What reproductive effects can BBs cause in men?

A

Erectile dysfunction

25
Q

What are 4 signs of a BB overdose?

A

-Bradycardia
-Hypotension
-Lethargy from lowered blood perfusion
-Heart block, like a 2nd or 3rd degree

26
Q

Fill in this mnemonic for BETA BLOCKERS:

“B”

A

Bradycardia (or Blocks-heart)
monitor

27
Q

Fill in this mnemonic for BETA BLOCKERS:

“E”

A

Exacerbate HF

Monitor lung sounds (crackles in base), weight gain, and swelling

28
Q

Fill in this mnemonic for BETA BLOCKERS:

“T”

A

Taper off…over 2 weeks

Slowly stop meds. Can cause rebound hypertension or angina is suddenly stopping

29
Q

Fill in this mnemonic for BETA BLOCKERS:

“A”

A

Asthma & COPD

NO NONSELECTIVE BB’s

30
Q

Fill in this mnemonic for BETA BLOCKERS:

“B”

A

Blood Glucose

BBs in diabetics can cause hyper/hypoglycemia

31
Q

Fill in this mnemonic for BETA BLOCKERS:

“L”

A

Lowers BP

Monitor for Hypotension

32
Q

Fill in this mnemonic for BETA BLOCKERS:

“O”

A

Orthostatic Hypotension

33
Q

Fill in this mnemonic for BETA BLOCKERS:

“C”

A

Circulation is impared

Due to peripheral vasoconstriction

34
Q

Fill in this mnemonic for BETA BLOCKERS:

“K”

A

Know s/s of overdose

35
Q

A patient is prescribed a beta blocker for a cardiac condition. You know this medication blocks the beta receptors in the body so ____________ and __________ cannot bind to the receptor site and elicit a _______ ________ _________ response.

A. angiotensin II and angiotensin I; sympathetic nervous system
B. dopamine and norepinephrine; parasympathetic nervous system
C. norepinephrine and epinephrine; sympathetic nervous system
D. dopamine and acetylcholine; parasympathetic nervous system

A

The answer is C. Beta blockers block the beta receptors in the body so norepinephrine and epinephrine cannot bind to the receptor site and elicit a sympathetic nervous system response.

36
Q

Beta 1 receptors can be found in the? Select all that apply:

A. GI tract
B. Uterus
C. Heart
D. Lungs
E. Kidneys
F. Vascular smooth muscle

A

The answers are C and E. Beta 1 receptors can be found in the HEART and KIDNEYS.

37
Q

Beta 2 receptors can be found in the? Select all that apply:
A. Heart
B. Lungs
C. GI system
D. Kidneys
E. Vascular smooth muscle
F. Skeletal muscle

A

The answers are B, C, E, and F. Beta 2 receptors can be found in the lungs (bronchioles), GI system, vascular smooth muscle, skeletal muscle and even the ciliary body of the eye (not listed).

38
Q

A patient is admitted with a dysrhythmia. The physician prescribes Propranolol. Which statement by the patient requires the nurse to hold the ordered dose and notify the physician for further orders?

A. “I use an inhaler at home for asthma.”
B. “My heart feels like it is racing, and I feel very weak.”
C. “I had caffeine this morning with breakfast.”
D. “I smoke 2 packs of cigarettes per day.”

A

The answer is A. Propranolol is a nonselective beta blocker. Therefore, it affects beta 1 and beta 2 receptors. Beta 2 receptors are found in the lungs (specifically the bronchioles). This medication could cause bronchoconstriction in patients with asthma or COPD and should be avoided. Selective beta blockers (Atenolol, Esmolol, Metorprolol) block only beta 1 (which are found in the heart and kidneys). Therefore, they are less likely to cause bronchoconstriction.

39
Q

Select all the beta blocker medications listed below that affect ONLY beta 1 receptors:
A. Timolol
B. Atenolol
C. Metoprolol
D. Esmolol

A

The answers are B, C, D. Atenolol, Metoprolol, and Esmolol are selective and affect ONLY beta 1 receptors, which are found in the heart and kidneys. Timolol is a nonselective beta blocker and affects both beta 1 and beta 2 receptors.

40
Q

At 1000 your patient is scheduled to take a dose of Atenolol. What finding below would require you to hold the scheduled dose and notify the physician?

A. The patient’s heart rate is 120 beats per minute.
B. The patient’s blood pressure is 102/76.
C. The patient has swelling in lower extremities, dyspnea, and crackles in lung fields.

A

The answer is C. In option C, the patient is showing signs and symptoms of uncompensated heart failure (beta blockers are not used when uncompensated heart failure presents, but they can sometimes be used when the patient is in compensated/stable heart failure). The reason is because beta blockers slow down the heart rate and decrease the strength of contractions (negative inotropic effect), which can lead to heart failure in SOME patients, and this is why the nurse must monitor for this.

41
Q

A patient with diabetes and hypertension is being discharged home. The patient will be taking Sotalol and insulin per sliding scale. Which statement by the patient demonstrates they did NOT understand your discharge instructions about the side effects of Sotalol?

A. “This medication can affect my blood glucose levels.”
B. “I will monitor my heart rate and blood pressure everyday while taking this medication.”
C. “While taking this medication I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low.”
D. “I will report to my physician if I develop shortness of breath, weight gain, or swelling in my feet.”

A

The answer is C. Beta blockers can prevent tachycardia (increased heart rate). An increased heart rate is a sign for most diabetics that they are experiencing a low blood glucose level. Therefore, the patient who is taking beta blocker (especially a nonselective type) needs to be re-educated that a fast heart rate is NOT a reliable way of determining hypoglycemia and should check their blood glucose regularly.

42
Q

Which category of beta blockers block beta 1 and beta 2 receptors?
A. Selective beta blockers
B. Nonselective beta blockers

A

The answer is B. Nonselective beta blockers BLOCK beta 1 and beta 2…therefore they’re not selective. Selective beta blockers block ONLY beta 1 receptors and are sometimes referred to as cardioselective.

43
Q

A patient is prescribed Metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly?

A. “After I stop taking this medication I will let my physician know.”
B. “I take this medication with my breakfast every morning.”
C. “I will change positions slowly while I’m taking this medication.”
D. “While I’m taking this medication I will monitor my heart rate.”

A

The answer is A. The patient should NOT just stop taking the medication. It must be tapered off over a period of time (usually about 2 weeks). This will prevent the development of rebound hypertension, myocardial ischemia, and angina.

44
Q

What signs and symptoms below would demonstrate a patient is experiencing an overdose of a beta blocker medication? Select all that apply:

A. Blood pressure 200/110
B. Heart rate 35 beats per minute
C. EKG shows atrial fibrillation with rapid ventricular rate (RVR)
D. Patient is maniac and agitated
E. Dyspnea
F. Patient is severely drowsy
G. EKG shows 3rd degree AV block

A

The answers are B, E, F, and G. Signs and symptoms of beta blocker overdose would be the opposite of the effects of the sympathetic nervous system. Beta blockers slow down the heart rate (overdose: severe bradycardia…heart rate of 35 and heart block 2nd or 3rd degree), decrease blood pressure (overdose: severe hypotension), and severely drowsy (due to very slow heart rate and decreased cardiac output to the brain).

Pharmacology (19 decks)

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