This document discusses beta blockers, including their classification, mechanisms of action, uses, and side effects. It notes that beta blockers work by blocking beta-1 and beta-2 adrenergic receptors. They are commonly used to treat hypertension, angina, arrhythmias, and myocardial infarction. Specific drugs like metoprolol, atenolol and carvedilol are mentioned as preferred treatment options depending on the condition. Potential adverse reactions include worsening heart failure, bradycardia, bronchospasm, and metabolic effects.
26. Angina Pectoris
Decreases frequency of attacks
Increases exercise tolerance
Not suitable in vasospastic angina
27. Cardiac arrythymias
Supresses extrasystoles and tachycardias, especially
those mediated adrenergically – during anaesthesia/
digitalis induced
Controls ventricular rate in AF and atrial flutter
Esmolol - PSVT
29. Secondary prophylaxis of MI
Prevents reinfarction
Prevents sudden ventricular fibrillation at subsequent
attack of MI
30. Myocardial salvage during MI
Limit infarction size by reducing O2 consumption
Prevents arrhythmias
Can be administered only those who are not in
shock/cardiac failure/ bradycardia
31. Congestive heart failure
Useful in selected patients with DCM
Prevents deleterious effects of sympathetic overactivity
invoked reflexly by heart failure
33. Pheochromocytoma
Used to control tachycardia and arrhythmias
Never administer unless an alpha blocker is given
– otherwise dangerous rise in BP can occur.
40. Advantages over miotics
No change in pupil size
No diminution of vision in dim light/cataract patients
Does not induced myopia
No persistant spasm of iris and ciliary muscles/ No
headache and brow pain
No IOT fluctuation
41. Perioperative Cardiovascular death
Increased sympathetic response
Imbalance in oxygen supply and demand
Plaque rupture
Thrombosis
Occlusion
42. Cardioprotective effects in
perioperative patients
Decreased oxygen demand
Increased systolic perfusion time
Suppresses arrhythmia
Stabilizes plaque
Anti inflammatory response
Inhibits apoptosis
43. In Non Cardiac surgery
Beta blockers should be titrated against
hemodynamics over a period of days before surgery
Protective against MI and have preventive/therapeutic
benefits in arrhythmias
Decreases incidence of mortality due to cardiac cause
44. In Cardiac surgery
Prevent and treat perioperative arrhythmia in CABG
and valvular disease
Beneficial in MI (age<75 years, EF >30%)
Mortality benefits of beta blockers have been
conclusively proven in large studies
45. Individual drugs
Sotalol – Class III antiarrhythmic activity
Timolol – glaucoma
Pindolol – Antihypertensive used in patients who
develop bradycardia with propanolol
Metoprolol – prefered in diabetics
46. Atenolol – MC used in hypertension and angina / once
daily dose/ does not derange lipid profile
Acebutolol - once daily dose
Bisoprolol – once daily dose in angina/CHF/SHT
47. Esmolol
Ultrashort acting (T1/2 – 10 mins)
Terminates SVT
Useful in AF/flutter
Useful in arrythmia during anaesthesia
Reduces HR and BP during and after cardiac surgery
In early treatment of MI
48. Celiprolol – safe in asthmatics
Nebivolol – delays atherosclerosis
Labetolol – alpha + beta blocker / potent hypotensive
(20-40 mg IV every 10 mins in hypertensive
emergencies)
50. Interactions
Delays recovery from hypoglycemia due to
antidiabetics
Warning signs of hypoglycemia masked
Retards lignocaine metabolism
Increases bioavailability of chlorpromazine
51. ADR
Can precipitate CHF/edema
Bradycardia (sick sinus patients are more prone)
Contraindicated in asthmatics
Exacerbates vasospastic angina
Plasma lipid profile altered
Enhances risk of of CAD
52. Sudden withdrawal of propanolol – rebound
hypertension / worsening of angina / death
Contraindicated in heart block
Tiredness and decreased exercise capacity
Worsening of peripheral vascular disease
Sexual distress
GI upset