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Beta Blockers (Pharmacology (Some β-B have arteriolar dilating effects…
Beta Blockers
Pharmacology
Some β-B have arteriolar dilating effects which ↓TPR
Block α1 receptors
Carvedilol, labetalol, nebivolol
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Lipophilic compounds more likely to → CNS effects
Propranolol, metoprolol
Hydrophilic compounds may accumulate in renal failure
Atenolol, sotalol
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Side Effects
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Peripheral vasoconstriction
- cold extremities
- worsened Raynaud’s/PVD
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Metabolic
- ↓HDL
- ↑ TGs
- ↑ risk of new onset DM (esp.
with thiazides)
Drug
Cardioselective
- Bisoprolol
- Atenolol
- Metoprolol
- Esmolol
- Nebivolol
Non-selective
- Carvedilol
- Propranolol
- Sotalol
- Labetalol
ISA
- Acebutolol
- Pindolol
- Oxprenolol
Vasodilating
- Carvedilol
- Labetalol
- Nebivolol
MOA
Actions via β1 → ↓ CO
- ↓↓ heart rate
- ↓ contractility
- small ↓ BP: central effect + ↓ renin
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Effects
- ↑ diastolic perfusion
- ↓ O2 demand
- ↓ afterload
Physiology
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β2 receptors:
Bronchi, GIT: SM relaxation
Skeletal muscle: arteriolar dilatation
Liver + skeletal muscle: glycogenolysis and
gluconeogenesis
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Principal Indications
- Angina
- Heart failure
- Acute MI
- Arrhythmias
- HTN
- Long QT syndrome
- Prophylaxis vs. variceal haemorrhage
- Migraine prophylaxis
- Thyrotoxicosis
- Glaucoma
- Anxiety