Beta Blockers

Question 1

What do selective beta blockers selectively block?

Answer 1

Beta-1 (heart chrontropy and inotropy)

No effect on beta-2

Question 2

What effect do non-selective beta blockers have on the heart and lungs?

Answer 2

Decrease heart rate, decrease blood pressure, bronchoconstrict, vasoconstrict

Question 3

What does it mean for a beta blocker to have intrinsic sympathomimetic activity (ISA)?

Answer 3

Beta blockers with some beta agonistic effects (blocks yet occasionally stimulates receptor)-generally less effective

Question 4

When are beta blockers with ISA used?

Answer 4

When a patient is at risk of bottoming out

Question 5

What is MSA?

Answer 5

Membrane stabilizing activity – has numbing affects due to inhibition of myocardial fast sodium channels

Question 6

What type of medicine contains MSA?

Answer 6

Eyedrops used to treat glaucoma

Question 7

Describe problems stemming from high lipophilicity of some beta blockers

Answer 7

Can penetrate blood brain barrier causing seizures and delirium

Question 8

Name a beta blocker with ISA

Answer 8

Pindolol (has an “i” in it)

Question 9

Name two beta blockers with MSA

Answer 9

Acebutolol, propranolol

Question 10

List three lipophilic beta blockers

Answer 10

Carvedilol, nebivolol, penbutolol

Question 11

Name two beta blockers with alpha-1 antagonism

Answer 11

Carvedilol, labetalol (do not end in “olol”)

Question 12

Which type of beta blockers are the more potent antihypertensives?

Answer 12

Beta blockers with alpha-1 antagonism (recognized by “ilol” or “alol” ending)

Question 13

Name a beta blocker with nitrous oxide release

Answer 13

Nebivolol (starts with N)

Question 14

Name 3 beta-1 selective beta blockers

Answer 14

Atenolol, metoprolol, nebivolol, Acebutolol, betaxolol, esmolol…

Question 15

Which patients should be careful to avoid nonselective beta blocker’s?

Answer 15

Patients with lung conditions due to beta blocker’s potential for bronchoconstriction

Question 16

Describe the mechanism of action of beta blockers

Answer 16

Blockade of epinephrine and norepinephrine effects on beta adrenergic receptors, can be beta-1 selective or nonselective

Question 17

What is the correct way to taper off of a beta blocker?

Answer 17

There is no correct way, just withdraw slowly due to receptor up regulation

Question 18

What is the concern if a patient on beta blockers goes into anaphylaxis?

Answer 18

They require higher doses of epinephrine to mediate anaphylaxis

Question 19

Why should diabetic patients be careful on beta blockers?

Answer 19

Beta blockers mask symptoms of hypoglycemia – sweating, tremor, headaches, tachycardia

Question 20

How can beta blockers negativelycontribute to heart failure?

Answer 20

Beta blockers are negative inotropes that increase fill time but decrease contractility

Question 21

What are three neurologic side effects of beta blockers

Answer 21

Depression, fatigue, sexual dysfunction

the higher the lipophilicity, the higher the risk

Question 22

List 3 beta blockers that decrease mortality in congestive heart failure

Answer 22

Metoprolol, carvedilol, Bisoprolol

Question 23

List a beta blocker that is renally eliminated

Answer 23

Atenolol

Question 24

List a beta blocker that is IV only

Answer 24

Esmolol

Question 25

List a beta blocker that is eliminated via plasma esterases

Answer 25

Esmolol (has nine minute half life, metabolized in blood, given IV only)

Question 26

List a beta blocker that can be used in hypertensive emergency

Answer 26

Labetalol (more potent alpha blocker than carvedilol)

Question 27

What medication should be used to treat Prinzmetal's angina?

Answer 27

Calcium channel blockers (vascular specific) – beta blockers worsen vasospasm

Question 28

Which is a more potent form of labetalol (nonselective beta blocker with alpha-1 blockade), PO or IV?

Answer 28

PO Labetalol is a more potent alpha blocker than IV

Question 29

Name a beta blocker that can be given in a cocaine overdose

Answer 29

Labetalol – blocks alpha-1, beta-1 and beta-2

Question 30

What form of metoprolol is indicated for CHF?

Answer 30

XL (oral) | Also comes IV and IR PO, but only XL is for CHF patients

Question 31

What are some indications of propanolol?

Answer 31

Since propranolol is lipophilic and contains MSA, it can be used to treat many conditions including angina, a fib, tremor, hypertension, migraine, pheochromocytoma, AMI, aggression, anxiety, thyroid storm, portal hypertension...

Question 32

Give an example of when to use sotalol

Answer 32

Atrial and ventricular arrhythmias, angina, hypertension – it is a nonselective beta blocker with antiarrhythmic activity

Question 33

Which nonselective beta blocker is commonly used for open angle glaucoma?

Answer 33

Timolol

Question 34

Describe the different functions of alpha-1 receptors on postsynaptic and presynaptic neurons

Answer 34

Postsynaptic – mediate vasoconstriction | Presynaptic – inhibit release of neurotransmitters

Question 35

Which alpha-1 blockers are used to treat postural hypotension?

Answer 35

Doxazosin, prazosin, terazosin (all end in zosin)

Question 36

Which alpha-1 blockers are bladder specific and used in BPH to increase urine flow?

Answer 36

Afluzosin, sildosin tamsulosin

Question 37

List the only alpha-2 agonist that decreases blood pressure

Answer 37

Clonidine

Question 38

Which alpha-2 agonist is commonly used for sedation in Neurosurgery?

Answer 38

Dexmedetomidine (Precedex)

Question 39

Why does Precedex make a good sedative? (as opposed to Fentanyl or morphine)

Answer 39

Lipophilic, CNS specific, causes very little respiratory depression Fentanyl and morphine require mechanical ventilation

Question 40

What kind of medication is Sudafed and how does it work?

Answer 40

Alpha-1 agonist – vasoconstrict capillaries to relieve nasal congestion

Question 41

What form of Sudafed is best for patients with hypertension?

Answer 41

Nasal spray – it is location specific