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Cardiology > Rx: Beta-Blockers > Flashcards

Rx: Beta-Blockers Flashcards

1
Q

Major clinical CV indications for Beta-Blockers?

*General- all not created best for every indication

A
  1. HTN (often used w/ either a diuretic or vasodilator)
  2. Ischemic Heart Disease
    - reduce angina freq, and improve exercise tolerance
    - Decrease cardiac work, reduce 02 demand, slow + regularize HR
    (Timolol, Propanolol, or metoprolol)
  3. Supraventricular (above AV node) and Ventricular Arrhythmias
    - beta blockers increase AV nodal refractory period => slow ventricular response rates in atrial flutter and fibrillation
  4. CHF (Metoprolol ER, bisoprolol, carvedilol)
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2
Q

Off-target CNS effects of Beta-Blockers

A
  1. mental disorders
  2. Fatigue
  3. vivid dreams

*lipophilic agents (less common w/ hydrophilic beta-blockers)

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3
Q

Non-selective beta-Blockers

A

Nadolol
Pindolol
Propanolol
Timolol

“OLOLs” (N –>T) *except Nebivolol

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4
Q

Class II antiarrhythmic compounds

A

“2-PAC”
Propanolol
Acebutolol
Carvedilol

MOA: Bind and block fast Na+ channels responsible for rapid depolarization of fast-response cardiac action potentials (=> decrease in amplitude of action potentials)

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5
Q

Off-target “glucose” effects

A

*Lipophillic agents

  1. Hypoglycemia
    - beta-2 receptors stim hepatic glycogen breakdown and pangreatic glucagon release
  2. Diabetics
    - beta-1 blockers mask the tachycardia that serves as a warning sign for insulin-induced hypoglycemia
    * Beta-blockers need to be used cautiously in diabetics
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6
Q

Non-CV uses of Beta-blockers

A
  1. essential tremor
  2. Thyrotoxicosis
  3. Anxiety
  4. Prophylactic for Migraines
  5. Glaucoma (topical)
  6. Secondary prophylactic of bleeding for esophageal varicies
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7
Q

Adverse effects of Sotalol (antiarrhythmic agent) overdose?

A

Prolongs QT interval and may cause Torsade de poimtes (specific arrhythmia) and Ventricular Fibrilation

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8
Q

Beta-Blockers w/ extended actions

A

Carvedilol
Nebivolol
Labetalol
Betaxolol

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9
Q

Extended Actions of Nebivolol? (2)

A
  1. Nitric Oxide (NO) production

2. Antioxidant activity

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10
Q

Extended action of Bextaxolol?

A

Ca2+ entry blocker

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11
Q

Location and effect of Beta-2 stimulation?

A

Beta-2 = Lungs

Vasodilation
bronchodilation

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12
Q

Extended actions of Carvedilol? (3)

A
  1. Ca2+ entry blocker
  2. Alpha-1 antagonist
  3. Antioxidant activity
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13
Q

Drugs w/ Intrinsic Sympathomemetic activity

A
  1. Acebutulol
  2. Pindolol
    (partial agonists)

Given when PT can’t handle bradycardia or diminished inotropy

**Disadventageous in context of secondary prevention of MI

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14
Q

Extended action of Labetalol ?

A

Alpha-1 antagonist

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15
Q

Adverse effects of ISA drug overdose?

A

Tachycardia and Hypertension

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16
Q

Location and effect of stimulation of Beta-1 receptors?

A

Beta-1 = Heart

Increases: C.O. and BP

  1. Accelerated heart rate
  2. increase contractile force
  3. Increase speed of contraction
  4. increase conduction speed
  5. Renin release
  6. lipolysis
17
Q

Adverse effects of beta-blockers with extended actions overdose?

A

Hypotension (via direct vasodilation)

18
Q

Beta-1 selective drugs

A 
Acebutolol
Atenolol
Betaxolol
Esmolol
Metroprolol

“OLOLs” (A –> M)

19
Q

Off-target lipid profile effects of beta-blockers?

A

*varies by individual agent
1. increase TGs, and decrease plasma HDLs
(ISA drugs and those w/ cardio-selectivity have less effect)

20
Q

General Adverse effects of Beta-blocker overdose?

A

General: Bradycardia and Bradyarrhythmia

*underlying CV or pulmonary disease places patient at increased risk of lethal outcome

21
Q

Off-target Pulmonary effects of Beta-blockers?

A

Beta-2 receptors have important role in tx of bronchospasm of asthma and COPD

  • NON-SPECIFIC Beta-Blockers CONTRAINDICATED in asthmatics and caution in COPD patients
  • *Selective Beta-Blockers should also be cautioned in the PTs due to dose-related cross-over to beta-2 receptors
22
Q

T or F: Beta-blockers tx can be stopped abruptly

A

False

Abrupt discontinuation of beta-blocker tx is ill advised. Doses should be tapered over time

*Upregulation in beta-receptor expression can lead to rebound and life-threatening cardiotoxic effects

23
Q

Adverse effects of propranolol overdose?

A

Seizures and coma

24
Q

What is Intrinsic sympathomimetic activity

A

Partial agonists - provide some cardio stim but prevent excess

i.e. beta blockers that can show both agonism and antagonism

Cardiology (15 decks)

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