Rx Files Beta Blockers Flashcards
Mechanism of action of BB
blockades effects of epinephrine and norepinephrine on beta adrenergic receptors
Beta 1 receptors act on the ______.
heart
Beta 2 receptors act on the _______.
lungs
Beta 1 blockade causes what?
negative chronotropy and inotropy which results in decreased HR and decreased BP
Beta 2 blockade causes what?
mild bronchoconstriction and vasoconstriction
What does intrinsic sympathomimetic activity mean?
beta blockers with some beta agonism
What does membrane-stabilizing activity mean?
inhibition of myocardial fast sodium channels
Potential detriment of membrane-stabilizing activity?
widen QRS complex –> potential for dysrhythmias
What BBs have ISA?
- acebutolol
- carteolol
- labetalol
- oxprenolol
- penbutolol
- pindolol
What BBs have MSA?
- acebutolol
- betaxolol
- carvedilol
- oxprenolol
- propranolol
What BBs are lipophilic?
- bisoprolol
- carvedilol
- labetalol
- metoprolol
- nebivolol
- oxprenolol
- penbutolol
- pindolol
- timolol
Which BBs are renally cleared?
- atenolol
- bisoprolol
- carteolol
- nadolol
- sotalol
Which beta blockers have alpha 1 antagonism?
- carvedilol
- labetalol
Which beta blockers have nitric oxide release?
- bisoprolol
Which BBs are beta 1 selective?
- acebutolol
- atenolol
- betaxolol
- bisoprolol
- esmolol
- metoprolol
- nebivolol
What are patient education points to make about BBs?
- withdrawal of therapy must be done slowly due to receptor upregulation
- caution in pulmonary disease (especially non-selective)
- higher doses of EPI/NE needed for anaphylaxis
- may mask signs of hypoglycemia
- may worsen lipid panel
- caution in HF (negative inotrope)
- may cause depression, fatigue, and sexual dysfunction
Acebutolol brand
Sectral
Acebutolol is non/selective with what special properties?
selective
ISA and MSA
not lipophilic
Acebutolol indications
- HTN
- ventricular arrhythmias
Acebutolol dosage
100 - 400 mg PO BID
How is acebutolol eliminated?
renal and hepatic
Atenolol brand
Tenormin
Atenolol is non/selective with what special properties?
selective
no ISA or MSA or lipophilicity
Atenolol indications
- AMI
- angina
- HTN
- migraine ppx
Atenolol dosage
50 - 200 mg PO daily
How is atenolol eliminated?
renal
Bisoprolol brand
Zebeta
Bisoprolol is non/selective with what special properties?
selective
lipophilic
Bisoprolol indications
- HTN
- migraine ppx
- CHF
- A.Fib ppx in cardiac surgery
Bisoprolol dosage
2.5 - 20 mg PO daily
How is bisoprolol eliminated?
renal and hepatic
Carvedilol brand
Coreg
Carvedilol is non/selective with what special properties?
nonselective
alpha 1 blockade
MSA
lipophilic
Carvedilol indications
- HTN
- CHF
- portal HTN
- A.fib
Carvedilol dosage
3.125 - 25 mg PO BID
How is carvedilol eliminated?
hepatic
How is Coreg CR dosed?
daily carvedilol dose x 1.6
Esmolol brand
Brevibloc
Esmolol non/selective with what special properties?
selective
no ISA, MSA, or lipophilicity
Esmolol indications
- intra/post-op HTN
- A.fib
- aortic dissection (DoC)
Esmolol dosage
50 - 300 mcg/kg/min
What dosage form is esmolol available in?
IV only
How is Esmolol eliminated?
plasma esterases
Labetalol brand
Normodyne
Trandate
Labetalol is non/selective with what special properties?
nonselective
alpha 1 blockade
ISA
lipophilic
What dosage form is labetalol available in?
IV and PO
Labetalol indications
HTN
HTN emergency and urgency
cocaine overdose
Labetalol IV bolus dosage
10 - 80 mg IV q10min
Labetalol IV infusion dosage
not often used
0.5 - 2 mg/min
Labetalol PO dosage
200 - 2400 mg/day divided in 2-3 doses
How is labetalol eliminated?
hepatic
Metoprolol brand
Lopressor
Toprolol XL
Metoprolol is non/selective with what special properties?
non selective
lipophilic
Metoprolol indications
- AMI
- HTN
- angina
- migraine ppx
- anxiety
- A.fib ppx in cardiac surgery
Metoprolol IV bolus dosage
1.25 - 5 mg q2-5 min (max dose 15 mg IV)
Metoprolol tartrate dosage
6.25 - 100 mg BID-TID
Metoprolol succinate dosage
25 mg daily to 200 mg BID
How is Metoprolol eliminated?
hepatic
Metoprolol IR to XL dosing
daily IR dose x 0.77
Nadalol brand
Corgard
Nadalol is non/selective with what special properties?
nonselective
Nadalol indications
- angina
- HTN
- migraine ppx
- portal HTN
Nadolol dosage
40 - 160 mg PO daily
How is nadolol eliminated?
hepatic
Nebivolol brand
Bystolic
Nebivolol is non/selective with what special properties?
selective
stimulates NO release
lipophilic
Nebivolol indications
- HTN
- migraine ppx
Nebivolol dosage
5 - 40 mg daily
How is Nebivolol eliminated
hepatic
Propranolol brand
Inderal
Propranolol is non/selective with what special properties?
nonselective
MSA
Propranolol indications
- angina
- A. fib
- tremor
- HTN
- Migraine ppx
- pheochromocytoma
- AMI
- aggression
- anxiety
- thyroid storm
- portal HTN
- many others
Propranolol dosage
10 - 80mg PO BID-QID
How is propranolol eliminated?
hepatic
Sotalol brand
Betapace
Sotalol is non/selective with what special properties?
nonselective
independent antiarrhythmic activity
Sotalol indications
atrial and ventricular arrhythmias
angina
HTN
Sotalol dosage
80 - 160mg PO BID
Why must sotalol be started inpatient?
risk of Torsades de pointes
How is sotalol eliminated?
renal
Timolol brand
Betimol
Timoptic
Timolol is non/selective with what special properties?
nonselective
Timolol indications
- HTN
- migraine ppx
- ocular HTN
- open-angle glaucoma
- AMI
- angina
- anxiety
How is timolol eliminated?
hepatic and renal
alpha 1 blockers
Doxazosin (Cardura)
Prazosin ( Minipres)
Terazosin (Hytrin)
alpha 1a blockers (bladder specific)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)
Tamsulosin (Flomax)
alpha 2 agonists
Clonidine (catapres)
Dexmedetomidine ( Precedex)