BETA BLOCKERS

Dr. Mozna Talpur

Classification
 Nonselective:
 Propanolol.  Beta blockers with
 Nadalol. intrinsic
 Timolol. sympathomimetic
 Cardioselective: activity:
 Esmolol.  Acebutalol.
 Metoprolol.  Carteolol
 Atenolol.  Penbutalol
 Acebutolol.  Pindolol
 Betaxolol.  Beta blockers that also
block alpha receptors:
 Carvedilol
 Labetolol
 Propanolol β-blocker:
 First Beta antagonist introduced clinically
 Standard drug to which all Beta Blockers are
compared to
 Nonselective for beta1 & beta2 receptors (equal
antagonism)
 Pure antagonist (lacks sympathomimetic intrinsic
activity)
 Optimal plasma concentration attained when resting
HR=55 to 60bpm
Propanolol
Cardiac Effects

 Decreased HR, decreased myocardial contractility,

decreased C.O. (Beta1)
 Decreases blood pressure in patient with

hypertension.
Respiratory effects:
 Increase in airway resistance particularly in patient

with asthma.
 Beta blockers must be avoided in patients with

asthma as they may not avoid the side effect.

Effects on Eye
 Decreases IOP.
 Reduce production of aqueous humor.

Metabolic and endocrine effects:

 Inhibits sympathetic stimulation of lipolysis

 Hypoglycemia mediated by Beta 2 receptors.

 Chronic use leads to ↑ VLDL ↓ HDL

Other effects
 Local anesthetic effect due to membrane stablizing
property.
 No influx of Na ions occurs inside the neuron,
heart and sk muscles.
Clinical uses
 Preventing migraine  Atrial flutter
 HTN  Atrial fibrillation.
 Prevention of MI  Angina
reduced mortality rate.  Thyrotoxicosis.
 CHF  Portal HTN
 Glaucoma  Hypertrophic
 Arrhythmias cardiomyopathy
Side Effects
 Bradycardia
 Hypotension
 Fatigue
 Cold hands and feet
 Bronchospasm
 Dizziness
 Increases VLDL
 Sudden withdrawal may lead to MI and arrhythmias
 Contraindications
 AV Block or heart failure not caused by tachycardia.
 Hypovolemic tachycardiac pt since Beta Blockade
may cause profound hypotension
 Nonselective Beta Blockers or high dose of Selective
Beta Blockers ARE NOT RECOMMENDED for pts
with
 COPD (can cause broncoconstriction),
 PVD (can cause peripheral vasoconstriction),
 Diabetes (hypoglycemia may be masked  no increase
in HR)
Over dosage
 Bradycardia
 Constriction of the airways
 Cardiac arrest
 Hypotension
 Hypoglycemia
 Coma
Treatment
 Increase heart rate (glucagon)
 I.V Fluids and medication to increase blood
pressure
 Asthma medication to reverse airway constriction
 I.V glucose to reverse hypoglycemia.
JazakALLAH khair