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RBF: 1) Drugs > Lecture 14 - Beta blockers > Flashcards

Lecture 14 - Beta blockers Flashcards

1
Q

What is the mechanism of action of beta blockers?

A

Beta blockers bind to beta receptors (beta-1 or beta-2) in various locations and stop NE and epinephrine from binding to the receptors and causing the following effects:

  1. Heart - increased HR, increased contractility.
  2. Blood vessels - dilation.
  3. Kidneys - renin release.
  4. Lungs - relaxation of bronchi.
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2
Q

What are beta blockers used for?

A
  1. Hypertension.
  2. Angina.
  3. Heart failure.
  4. Arrhythmias (AF, atrial flutter, SVT).
  5. Thyrotoxicosis.
  6. Migraine prophylaxis.
  7. Anxiety.
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3
Q

List beta blockers?

A
  1. Metoprolol.
  2. Atenolol.
  3. Propranolol.
  4. Carvedilol.
  5. Labetalol.
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4
Q

Describe metoprolol?

A

It is an oral beta-1 blocker that’s lipid soluble (short half life) and is metabolised by the liver.

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5
Q

What is metoprolol used for?

A
  1. Hypertension.
  2. Angina.
  3. Heart failure.
  4. Arrhythmias.
  5. MI.
  6. Hyperthyroidism.
  7. Migraine prophylaxis.
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6
Q

Why do patients not use metoprolol?

A

They do not take if they have the following:

  1. Asthma.
  2. Uncontrolled heart failure.
  3. Hypotension.
  4. Marked bradycardia.
  5. 2nd or 3rd degree AV block.
  6. Cardiogenic shock.
  7. Metabolic acidosis.
  8. Severe peripheral arterial disease.
  9. Bronchospasm.
  10. Myasthenia gravis.
  11. History of obstructive airways.
  12. Pregnant.
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7
Q

What are the adverse effects of metoprolol?

A
  1. GI disturbances.
  2. Bradycardia.
  3. Heart failure.
  4. Hypotension.
  5. Coldness of extremities.
  6. Conduction disorders.
  7. Peripheral vasoconstriction.
  8. Bronchospasm.
  9. SOB.
  10. Headache.
  11. Sleep disturbances.
  12. Dizziness.
  13. Depression.
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8
Q

Describe atenolol?

A

It is an oral beta-1 blocker that is both lipid and water soluble and is metabolised by the kidneys.

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9
Q

What is atenolol used for?

A
  1. Hypertension.
  2. Angina.
  3. Arrhythmias.
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10
Q

Why do patients not use atenolol?

A

They do not take if they have the following:

  1. Asthma.
  2. Uncontrolled heart failure.
  3. Marked bradycardia.
  4. Hypotension.
  5. 2nd or 3rd degree AV block.
  6. Cardiogenic shock.
  7. Metabolic acidosis.
  8. Renal impairment.
  9. Pregnancy.
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11
Q

What are the adverse effects of atenolol?

A
  1. GI disturbances.
  2. Bradycardia.
  3. Heart failure.
  4. Hypotension.
  5. Conduction disorders.
  6. Coldness of extremities.
  7. Peripheral vasoconstriction.
  8. Bronchospasm.
  9. SOB.
  10. Headache.
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12
Q

Describe propanolol?

A

Beta-1 and beta-2 blocker that is lipid soluble (short half life) and excreted by the liver.

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13
Q

What is propanolol used for?

A
  1. Hypertension.
  2. Angina.
  3. Post MI.
  4. Arrhythmias.
  5. Thyrotoxicosis.
  6. Essential tremor.
  7. Migraine prophylaxis.
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14
Q

Why do patients not take propanolol?

A

They do not take if they have the following:

  1. Asthma.
  2. Uncontrolled heart failure (acute).
  3. Marked bradycardia.
  4. Hypotension.
  5. History of obstructive airways.
  6. 2nd or 3rd degree AV block.
  7. Cardiogenic shock.
  8. Metabolic acidosis.
  9. Pregnant.
  10. Hepatic impairment.
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15
Q

What are the adverse effects of propanolol?

A
  1. GI disturbances.
  2. Bradycardia.
  3. Acute heart failure.
  4. Hypotension.
  5. Conduction disorders.
  6. Coldness of extremities.
  7. Bronchospasm.
  8. SOB.
  9. Headache.
  10. Fatigue.
  11. Sleep disturbances.
  12. Nightmares.
  13. Dizziness.
  14. Depression.
  15. Thrombocytopenia.
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16
Q

Explain how beta blockers are used for hypertension?

A

They decrease arterial blood pressure by decreasing cardiac output (by reducing HR) and inhibiting the release of renin by the kidneys.

17
Q

Explain how beta blockers are used for angina and MI?

A

Because they decrease HR, contractility, BP and reduce the work of the heart and the oxygen demand of the heart it increases the oxygen supply/demand ratio. This can relieve a patient of anginal pain that is caused by a reduction oxygen supply/demand ratio (typically due to coronary artery disease).

18
Q

Why do we not give beta blockers to people with acute heart failure but to those with chronic heart failure?

A

In the acute stage of heart failure beta blockers have a negative inotropic effect (decrease the force of contraction of heart muscle - decrease in contractility). This is bad because you can rapidly worsen their condition as these people are dependent on the responsive sympathetic drive. In chronic stable heart failure beta blockers have a positive inotropic effect (increase the force of contraction).

19
Q

What other hypertensive drug do you need to be careful of when on beta blockers?

A

Verapamil - this is because there is a marked negative chronotropic effect (massive decrease in HR on both drugs).

20
Q

What beta blockers do you use for angina?

A
  1. Metoprolol.

2. Atenolol.

21
Q

What beta blockers do you use for heart failure?

A
  1. Carvedilol.
  2. Metoprolol.
  3. Bisoprolol.
22
Q

What beta blockers do you use for hypertension?

A
  1. Atenolol.

2. Metprolol.

RBF: 1) Drugs (8 decks)

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