Beta Blockers Flashcards
(39 cards)
How to MOAs work? Are they older or newer?
block Epi and NE effects on beta adrenergic receptors.
older & cheap
Blocking B1 has what effects on the heart?
Negative chronotropy–decreased HR
Negative inotropy –decreased BP
Blocking B2 has what effects on the lungs and PV?
Bronchoconstriction (mild)
Vasoconstriction (mild)
What is MSA? What effects does it have?
Membrane stabilizing activity–inhibits myocardial fast Na channels –> numbing effects
What is ISA? Is it safer?
Intrinsic sympathomimetic activity–beta blockers with some beta agonism (door bell). May increase BP at times, so probably not safer.
What % of BB end in -olol? and which receptors do they block?
99% B1-B2
“-alol” and “-ilol” block which receptors? Are they more or less potent?
A1, B1, B2. More potent because they have vasodilating effects from A1 blockade.
Give an example of a BB with ISA. What are they used for?
Pindolol. Patients who tend to bottom out may benefit from these.
Give an example of a BB with MSA. What are they used for?
Acebutolol and propranolol. Eye drops for glaucoma.
Give an example of a lipophilic BB. What are they used for?
Carvedilol, nebivolol, penbutolol. Used for seizures, delerium.
Give an example of a BB with A1 antagonism. What are they used for?
Carvedilol, labetalol. Useful in treating cocaine overdose because they block B1, which drops BP and HR, and A1, which vasodilates and helps to decrease BP too.
Give an example of a BB with NO release. What are they used for? Are they more or less potent?
Nebivolol. Used post MI. More potent because they have NO vasodilatory effects as well.
General rule: as you increase the dose, the selectivity of a drug ___________.
Decreases.
Give an example of a B1 Selective BB.
Acebutolol, atenolol, betoxolol. bisoprolol, metoprolol, nebivolol
Why withdraw BB therapy slowly?
Once on BB therapy, the heart up regulates adrenergic receptors. If you stop the treatment all of the sudden, the this excess of receptors will cause the heart to be overly sensitive to E and NE. This is an emergent situation!
Why are you cautious with BB in patients with pulmonary disease? What therapy is best in these patients?
Because BB block B2. B2 normally bronchodilate. So BB will cause bronchoconstriction. Selective B1 BB are best.
Why should patients with severe allergies carry 2 Epi pens if they are on BB? Which therapy is best for these patients?
Because blocking the receptors decreases their sensitivity to an Epi pen if they need it. So, having double the dose is important. Selective B1 are best.
What is the connection between BB and hypoglycemia?
BB mask the side effects of hypoglycemia–tremor, high HR, HA, sweating.
What is the caution with BB and lipids? Which BB are involved the most?
BB may worsen the lipid panel. Nonselective BB are mostly involved.
Why should you be cautious with BB and heart failure?
Decreasing inotropy will exacerbate an already struggling heart.
What are 3 other side effects of BB that you should keep in mind?
depression, fatigue, sexual dysfunction
Explain the CHF debate with BB. Which drugs are approved for CHF?
Although BB can decrease HR and increase fill time, they also decrease inotropy, which exacerbate HF. Bisoprolol, Carvedilol, Metoprolol.
Which BB are approved for migraines PPX?
Atenolol, Bisoprolol, Metroprolol, Nadolol, Nebivolol, Propranolol, Timolol
The C in Carvedilol stands for what?
CHF–studies found that it decreases mortality in CHF
