Beta Blockers

Question 1

What beta blockers have intrinsic sympathomimetic activity (ISA)?

Answer 1

Acebutolol
Celiprolol

Question 2

What B-Blockers are without ISA?

Answer 2

Atenolol
Metoprolol
Esmolol
Bisoprolol
Betaxolol
Bevantolol
Nebivolol

Question 3

Acebutolol, atenolol, metoprolol, and esmolol are all ________ beta blockers
-Which selectivity?

Answer 3

Cardioselective
-B1

Question 4

What’re the effects of B1 Beta blockers?

Answer 4

Decreases heart rate, contractility, and AVN conduction

Question 5

Which beta blocker is the only beta blocker that causes NO-mediated vasodilation?

Answer 5

Nebivolol

Question 6

Indications of cardioselective B1 beta blockers?

Answer 6

Coronary heart disease, compensated heart failure, and arrhythmias

Question 7

What’re some nonselective beta blockers with ISA?

Answer 7

Pindolol
Penbutolol
Oxprenolol

Question 8

What’re some nonselective beta blockers without ISA?

Answer 8

Propranolol
Nadolol
Sotalol
Timolol
Tertalol

Question 9

What’re some nonselective beta blockers with additional alpha blocking action?

Answer 9

Labetolol
Bucindolol
Carvedilol

Question 10

What’re the effects of nonselective beta blockers with and without ISA?

Answer 10

Blocks B1,2, and 3 receptors

Question 11

Sotalol (NS B-Blocker) also blocks ____ channels resulting in an _________ effect

Answer 11

Potassium
Antiarrhythmic

Question 12

What’re the side effects of nonselective beta blockers?

Answer 12

Bronchoconstriction, vasoconstriction, hypo/hyper glycemia, bradycardia and syncope

Question 13

Indications of:
-Propranolol
-Sotalol
-Timolol

Answer 13

-Prop: Essential tumor, portal HTN, migraine prophylaxis, thyroid storm

-Sot: cardiac arrhythmias

-Timolol: Glaucoma

Question 14

Nonselective beta blockers are the _______ to cardioselective beta blockers

Answer 14

Alternative

Question 15

What’re the effects of NS B-Blockers with alpha blocking action?

Answer 15

They’re potent vasodilators and improve endothelial function and vascular remodeling

Question 16

Due to alpha-blocking action:
Vasodilation causes —> 1._____ peripheral vascular resistance, 2.______ preload, 3._______ after load, and 4. _______ renal blood flow

Answer 16

1-3: Decreased
4. Increased

Question 17

NA B-Blockers with additional alpha blocking action _______ portal HTN and pressure gradient in hepatic venous

Answer 17

Reduce

Question 18

Indications of NS B-Blockers with Alpha action?

Answer 18

Pregnancy induced HTN (labetolol)
Esophageal varisces (prophylactic use)

Question 19

With the exception of Nebivolol, all cardioselective beta blockers begin with letters ____ to _____, while NS B-Blockers begin with letters ______ to ______

Answer 19

A-M
N-Z

Question 20

What types of organs are affected by B1 receptors?

Answer 20

Heart and Kidneys

Question 21

What’re the effects of the B-Adrenergic blockade on the heart?

Answer 21

Anti-arrhythmic effect
Anti-ischemic effect
Anti remodeling effect

Question 22

What is the anti-ischemic effect of the B1-Blockade? (Physiologically explain what happens to rate, contractility, BP, and result)

Answer 22

Decreased HR, contractility, BP, oxygen consumption, resulting in anti ischemic effect

Question 23

Explain the antiarrhythmic effect of the B1 blockade

Answer 23

Decreased AVN conduction, increased AVN refractory time, and decrease heart rate

Question 24

Explain the process of the B1 blockade on the kidneys (what cells does it act on and what happens)

Answer 24

Acts in the juxtaglomerular cells causing decreased renin, decreased angiotensin 2 conversion, decreased water resorption and decreased BP

Question 25

What organs do B2 receptors affect?

Answer 25

Smooth muscle, ciliary body of the eye, pancreatic beta cells, skeletal muscle, liver, lipoprotein lipase enzyme

Question 26

What’re the effects of the B-adrenergic blockade on smooth muscles? -Vasculature -Bronchioles

Answer 26

-Vasoconstriction -Bronchoconstriction

Question 27

What is the effect on the ciliary body of the eye from the beta adrenergic blockade?

Answer 27

Causes decreased aqueous humor production resulting in **decreased intraocular pressure**

Question 28

What’s the effect of the beta adrenergic effect on the beta cells of the pancreas?

Answer 28

Decreased insulin release resulting in hyperglycemia and new onset diabetes

Question 29

What effect does the beta-adrenergic blockade have on skeletal muscle?

Answer 29

Decreased glucose uptake (decreased insulin sensitivity)

Question 30

What effect does the beta-adrenergic blockade have on the liver?

Answer 30

Decreased hepatic glycogenolysis causing hypoglycemia (esp. in diabetic patients)

Question 31

What effect does the beta-adrenergic blockade have on lipoprotein lipase enzyme?

Answer 31

Inhibits lipoprotein lipase causing hyperlipidemia (increased triglycerides, reduced HDL)

Question 32

What is the main site of action of the B3 receptor?

Answer 32

Adipose tissue

Question 33

What effect does the beta-adrenergic blockade have on adipose tissue?

Answer 33

Reduced lipolysis causing weight gain

Question 34

Beta blockers competitively ______ adrenergic substances at B receptors

Answer 34

Inhibit

Question 35

Adverse effects of: NS and selective B-Blockers on: - Cardiac

Answer 35

Bradycardia, bradyarrhythmia (AV block), ventricular tachyarrhythmia (torsades), worsening HF, worsened vasospasm due to propranolol use Orthostatic hypotension

Question 36

Adverse effects of: NS and selective B-Blockers on: -CNS

Answer 36

Fatigue/lethargy Sleep disorders Depression, hallucinations Siezures

Question 37

Adverse effects of: NS and selective B-Blockers on: -Cutaneous

Answer 37

Psoriasis

Question 38

Adverse effects of: NS B-Blockers on: -Pulmonary

Answer 38

Bronchoconstriction (esp. patientd with asthma and reactive airway disease)

Question 39

Adverse effects of: NS B-Blockers on: -Perioheral vasculature

Answer 39

Peripheral vasoconstriction: - Erectile dysfunction - Secondary raynaud phenomenon

Question 40

Adverse effects of: NS B-Blockers on: -Metabolic

Answer 40

Hypertriglyceridemia Hyper/hypo glycemia Weight gain

Question 41

Beta blockers should be introduced _______ with _____ increases in dosage and ______ tapered off when no longer needed

Answer 41

Gradually with slow increased Slowly tapered off

Question 42

Beta blocker withdrawal is caused by?

Answer 42

Sudden termination of beta blockers

Question 43

How to prevent beta blocker withdrawal?

Answer 43

Taper dose over 7-10 days

Question 44

What’re some indications of beta blockers?

Answer 44

HTN, CAD, Heart failure, and Arrhythmias

Question 45

What’re the specific indications for propranolol?

Answer 45

Essential tumor, migraine prophylaxis, portal HTN, hyperthyroidism and thyroid storm, infantile hemangioma, and akathisia

Question 46

What drug would be given for hypertensive crisis?

Answer 46

IV labetolol