Updated: 2/11/2020

Beta-Blockers

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  • β-Blocker Selectivity
      • Nonselective β-Antagonists (β1 = β2)
      • Drug
      • Effect
      • Clinical Applications
      • Toxicity
      • Propranolol, nadolol, timolol
      • Lowers BP and HR
      • Reduces renin secretion
      • Decreases cardiac ouptut and increases peripheral resistance
      • Hypertension
      • Arrhythmias
      • Angina pectoris
      • Migraines
      • Hyperthyroidism
      • Glaucoma (timolol)
      • Bradycardia
      • Fatigue
      • Worsening asthma
      • Vivid dreams
      • β1-Selective Antagonist (β1 > β2)
      • Drug
      • Effect
      • Clinical Applications
      • Toxicity
      • Metoprolol, atenolol, betaxolol
      • Lowers BP and HR
      • Reduces renin secretion
      • Hypertension
      • Arrhythmias
      • Angina pectoris
      • Same toxicity as nonselective ß-antagonists but safer in asthma
      • Esmolol
      • Very rapid onset of action (10 min half-life)
      • Rapid control of supraventricular arrhythmias, BP, and thyrotoxicosis
      • Bradycardia
      • Hypotension
      • Nonselective α- and β-Antagonists (β1 = β2≥ α1 > α2)
      • Drug
      • Effect
      • Clinical Applications
      • Toxicity
      • Labetalol, carvedilol
      • Heart failure
      • Fatigue
      • Partial β-Agonists (β1 = β2 Blockade with Some β-Agonist Activity)
      • Drug
      • Effect
      • Clinical Applications
      • Toxicity
      • Acebutolol, pindolol, carteolol
      • Lowers HR less than the effect on BP
      • Hypertension
      • Arrhythmias
      • Hypotension but less tachycardia than alpha blockers such as phentolamine
  • Mechanism of Action for Clinical Application
      • Mechanism of Action for Clinical Application
      • Clinical Application
      • Mechanism
      • Hypertension
      • ↓ Cardiac output
      • ↓ Renin secretion by blocking β-receptor on JGA cells
      • Angina pectoris
      • ↓ O2 consumption by ↓ heart rate and contractility
      • SVT (propranolol, esmolol)
      • ↓ AV conduction velocity
      • MI
      • ↓ Mortality
      • CHF
      • Slows progression
      • Glaucoma (timolol)
      • ↓ Secretion of aqueous humor

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(M1.PH.14.44) A 62-year-old male is rushed to the emergency department (ED) for what he believes is his second myocardial infarction (MI). His medical history is significant for severe chronic obstructive pulmonary disease (COPD) and a prior MI at the age of 58. After receiving aspirin, morphine, and face mask oxygen in the field, the patient arrives to the ED tachycardic (105 bpm), diaphoretic, and normotensive (126/86). A 12 lead electrocardiogram shows ST-elevation in I, aVL, and V5-V6. The attending physician suspects a lateral wall infarction. Which of following beta-blockers should be given to this patient and why?

QID: 100847

Propranolol, because it is a non-selective ß-blocker

13%

(19/148)

Metoprolol, because it is a selective ß1 > ß2 blocker

65%

(96/148)

Atenolol, because it is a selective ß2 > ß1 blocker

6%

(9/148)

Labetalol, because it is a selective ß1 > ß2 blocker

6%

(9/148)

Nadolol, because it is a selective ß1 > ß2 blocker

1%

(1/148)

M 3 D

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Evidence (7)
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