16. ESSENTIAL HYPERTENSION
• Alone or in combination with
diuretics
• Rationale
– Decrease in HR,CO
,myocardial contractility.
– Decrease renin release
Dose:
20-40mg TDS
17. Congestive heart
failure
Useful in mild to moderate heart
failure
Introduced gradually
Can antagonise damaging effect due
to β1 overactivity
CI in severe heart failure
CANNOT PUMP
SUFFICIENT BLOOD
18. ANGINA PECTORIS
DECREASES OXYGEN DEMAND
INCREASES EXERCISE
TOLERANCE
CI:PRINZMETAL’S ANGINASENSATION OF CHEST PAIN
IMBALANCE BTW OXYGEN
DEMAND AND SUPPLY
19. CARDIAC ARRHYTHMIAS
• Used in SVT associated with thyrotoxicosis,
• Digitalis toxicity
Mechanism:
• Membrane stabilising effect
IRREGULAR
HEARTBEAT
TACHYCARDIA
PALPITATIONS
31. COLD EXTREMITIES
Loss of β2 receptor
mediated cutaneous
vasodilataton in extremities
CONTRA INDICATED
IN
REYNAUD’S
DISEASE
BLOOD VESSELS IN EXTREMITIES
CONSTRICT IN RESPONSE TO
TEMPERATURE:
TURN BLUE OR WHITE
33. HEART FAILURE
Cardiac patients need
sympathetic drive to support
heart to maintain proper
cardiac output
Beta blockers block this
support
Contraindicated in
SEVERE HEART FAILURE
34. HYPOGLYCEMIA
Beta blockers mask the
symptoms of
hypoglycemia like tremors
,sweating and tachycardia
CONTRAINDICATED IN
PATIENTS ON INSULIN AND
OHA
35. REBOUND HYPERTENSION
CHRONIC THERAPY OF BETA BLOCKERS
UPREGULATION IN NUMBER OF RECEPTORS
NEWLY FORMED RECEPTORS ARE HYPER
RESPONSIVE TO CATECHOLAMINES
REBOUND HYPERTENSION ON STOPPING THE
DRUG
DOSE SHOULD BE GRADUALLY TAPERED
40. • Metaprolol:
• Completely absorbed orally
• BA less due to first pass metabolism
Atenolol:Does not cross BBB
Bisoprolol:Used in hypertension and angina
42. • ESMOLOL:
• Ultra short acting beta 1 antagonist
• Given IV in urgent settings when beta1
blockade of short duration is desired.
• Eg:
• SVT,AF
• completely withdrawn
if adverse effects like bradycardia
or heart failure occur
43. • BETAXOLOL
• Used as eye drops in glaucoma
• Less efficacious than Timolol
• Safer in asthmatics and diabetics
44. NON SELECTIVE BLOCKERS WITH ISA
PINDOLOL
OXPRENOLOL
ADVANTAGES:
Lesser bradycardia and myocardial
depression
45. SELECTIVE BLOCKERS WITH ISA
• ACEBUTOLOL
• CELIPROLOL
• Celiprolol:
• Partial agonist at beta 2 receptors
• Used in hypertensives with asthma
47. LABETELOL
• Blocks alpha1 and beta receptors
• Fall in BP due to alpha 1 and beta1
blockade
• Uses:
• Pheochromocytoma
• Rebound hypertension after clonidne
withdrawal
48. Carvedilol
• Blocks alpha and beta receptors
• USES:
• Essential hypertension
• CHF
• Reduces mortality in MI
56. LIPID INSOLUBLE BETA BLOCKERS
• EXCRETED BY KIDNEY
• LONG DOA
• CI IN RF
• NADOLOL
• SOTALOL
• ATENOLOL,ACEBUTOLOL
• BETAXOLOL,BISOPROLOL
• CELIPROLOL
• NOT SOLUBLE ABC
57. • Longest acting beta blocker: NADOLOL
• Shortest acting: ESMOLOL
• Beta blocker with cardioselectivity, ISA, MSA and lipid
solubility: ACEBUTOLOL
• Most commonly used beta blocker in chronic CHF:
CARVEDILOL(has antioxidant and antimitogenic
property)
58. All are non selective beta blockers
except:
a)Propranolol
b)Timolol
c)Sotalol
d)Carvedilol
Ans: d
Carvedilol alpha +beta blocker
59. All are cardioselective beta blockers except:
a)Atenolol
b)Esmolol
c)Bisoprolol
d)Labetalol
Ans:d
NEW
BETA
BLOCKERS
ACTING
EXCLUSIVELY
AT
MYO
CARDIUM
62. Beta blockers with ISA are:
a)Propranolol
b)Oxprenolol
c)Esmolol
d)Butoxamine
Ans: b
63. Beta blocker with cardioselectivity,membrane stabilsing
property and ISA:
a)Carvedilol
b)Atenolol
c)Acebutolol
d)Metoprolol
Ans: c
64. Propranolol can be used in all except:
a)Hyperthyroidism
b)Prinzmetal angina
c)Migraine
d)Hypertension
Ans: b
65. Beta blockers are CI in Diabetes as it :
a)Causes hyperglycemia
b)Causes seizure
c)Masks symptoms of hypoglycemia
d)Causes hypotension
Ans: c
66. An ultra short acting beta blocker:
a)Esmolol
b)Timolol
c)Atenolol
d)Pindolol
Ans: a
67. Adverse effects of beta blockers include:
a)Compensated heart failure
b)Masking the features of hypoglycemia
c)Bronchial asthma
d)All the above
Ans: d
