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Beta Blockers

Presentation about beta blockers

Moran Mund

on 25 February 2013

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Transcript of Beta Blockers

Aspirin and other NSAIDs - counteract BP effects of bB

Thioridazine or Chlorpromazine - may cause hypotension and abnormal heart rhythms due to reduce elimination.

Clonidine - dangerous elevation in BP - in concurrent use or discontinuation of one.

Phenobarbital - may increase breakdown and reduce blood levels of certain bB. Hypertrophic Cardiomyopathy





Alcovol withdrawal Hypertention basic strusture of Propranolol let's talk about them... { a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium (stable AP)

most commonly due to atherosclerosis of the epicardial coronary artery. Ischemic Heart Disease AP or equivalent ischemic discomfort with at least one of: Acute Coronary Syndrome bB PO should be administrated within 24h

early bB use decrease infract size, may help prevent dangerous arrhythmias and reduce reinfraction. not to worry there's more... CONTRAINDICATIONS BETA BLOCKERS In summary... competative inhibitors of beta adrenergic receptors.
effect many locations in the body
most resemble in structure.
their selectivity is dose related.
used majorly in cardial disorders
some are partial agonist as well
some has also a-adrenergic blockade effect Cardiovascular: Tachyarrhythmia cardiovascular endocrinal Idications: neurological alcohol withdrawal only cardiovascular indications?? most of the indication for bB are cardio vascular. However, there are many different conditions in which is indicated to use bB there are alot more Nomenclature: Generic names usually end with "lol" or "olol"

competative agents of catacholamine b-adrenergic receptors

Some agents may function also as partial agonist Cirrhosis regardless of the cause, the pathologic features consist of the development of fibrosis which leads to architectural distortion. this results in a decrease in hepatocellular mass and thus function and an alternation of blood flow. causes of cirrhosis slowly progressive, optic neuropathy that usually is associated with chronic elevation of intraocular pressure. Glaucoma non cardiovascular... that's not all folks... Side Effects beta Blockers 1.) Cardiac Heart Failure
Bradycardia and/or AV block
Beta blocker withdrawal 2.) Non Cardiac drug interactions Non selective:

cardioselective: Clinical uses General
info more clinical
uses Problems summing
it up... can you think of some? Increase airway resistance
Exacerbation of peripheral artery disease
Facilitation of hypoglycemia
Depression, Fatigue, sexual dysfunction
Lipid metabolism
Weight gain
Vivid dreams (in toxicity) respiratory tract increase airway resistance the Blockade common beta adrenergic blockers initial treatment should be in low doses in order to avoid withdrawal symptoms if untolerated

treatment should be terminated gradually over several days to prevent adrenergic withdrawal symptoms increase sinus rhythm
increase automaticity of AVn

inotropic effect
dromotropic effect Increase Renin secreation skeletal and smooth muscles relaxation
vasodilator Glucose balance:
increase insulin secretion
increase glycogenolysis and glyconeogenesis } CO BP BP Autonomic Nervous System sympathetic vs. parasympathetic

epinephrin vs. norepinephrin

receptors Arrhythmia
CM cardio - vascular - HTN bB provide relief by reducing myocardial oxygen demand (inhibits increase in HR, AP, and myocardial contractility)

more significant during exercise

to achieve max. benefit, it is frequently necessary to combine agents (nitrate, CCB, bB) Due to abnormalities of impulse formation and/or abnormalities of impulse propagation. narrow complex tachycardia
- a. fib/flutter (rate control)
- AVNRT/AVNT (rhythm control)

Polymorphic VT relatively little effect on the normal heart at rest 3-10h high slows conduction through AVn

should be used in accessory pathway occurs at rest (or minimal exertion), usually > 10m.
sever and of new on set
it occurs with crescendo pattern Congestive Heatr Failure occurs when the heart is unable to provide sufficient pump action to distribute blood flow to meet the needs of the body

systolic = depressed EF. diastolic = preserved EF.

Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy 2nd line of therapy (ACEi & diuretics)
for symptomatic patients or asymptomatic with EF<40%
used to slow disease progration and symptomatic treatment. decreasing CO, due to reduction of HR and contractility. CNS effect and inhibition of renin release particularly effective in HTN patients with tachycardia.
their hypotensive potency is enhanced by coadministation with diuretics. non selective bB

reduces portal vein pressure

decrease the incidence of first esophageal varices' bleeding

decrease mortality rate associated with bleeding Topical beta-blockers reduce the intraocular pressure (IOP) by blockade of sympathetic nerve endings in the ciliary epithelium causing a fall in aqueous humour production moderate-severe left ventricular failure

pulmonary edema


2nd or 3rd degree AV block

hypotension / signs of poor peripheral perfusion

reactive airway disease (asthma) IV/PO propranolol: Deralin, Prolol
timolol: nyolol, tiloptic, v-optic
sotalol: soctacor atenolol: Normiten, Normalol
metoprolol: Lopressor, neobloc, metropress
bisoprolol: Cardiloc, concor, bisolol
esmolol: brevibloc peak concentration - 1-3h after oral administration.
extensive hepatic "first pass" effect. metabolize in liver and kidneys.
rapidly distributed and have large Vd. cardiovascular lower HR
lower CO
lower BP use with caution in insulin dep. diabetes patients. especialy in patients with inadequate glucagon reserve and in pacreatectomized. in the eye reduce intraocular pressure should be avoided with asthma inhibits lipolysis

partialy inhibits glycogenolysis endocrine effect
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