Beta-Adrenergic Blockers in Cardiac Disorders
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Questions and Answers

What effect does blockade of beta receptors have on the sinoatrial (SA) node?

  • Decreases heart rate (negative chronotropism) (correct)
  • Increases heart rate (positive chronotropism)
  • Increases conduction velocity (positive dromotropism)
  • Has no effect on heart rate

    • How does beta blockade affect contractility in the atria and ventricles?

  • Has no effect on contractility
  • Increases contractility (positive inotropism)
  • Decreases contractility (negative inotropism) (correct)
  • Increases conduction velocity (positive dromotropism)

    • What effect does beta blockade have on the renin-angiotensin-aldosterone system (RAAS)?

  • Increases renin release, leading to more angiotensin II and aldosterone
  • Decreases renin release, leading to less angiotensin II and aldosterone (correct)
  • Increases angiotensin II but decreases aldosterone
  • Has no effect on the RAAS

    • What is the primary effect of beta blockade on the lungs?

    <p>Bronchoconstriction</p> Signup and view all the answers

    How does beta blockade affect lipid metabolism?

    <p>Increases triglycerides and cholesterol, decreases HDL</p> Signup and view all the answers

    What is the primary mechanism by which beta blockers reduce intraocular pressure?

    <p>Decreasing aqueous humor production</p> Signup and view all the answers

    What is the effect of beta blockade on glucose metabolism?

    <p>Increases glucose production and decreases glucose uptake</p> Signup and view all the answers

    Which of the following adverse effects is not commonly associated with beta blockade?

    <p>None of the above</p> Signup and view all the answers

    Which beta blocker is known to have the highest central nervous system (CNS) penetration?

    <p>Propranolol</p> Signup and view all the answers

    How does beta blockade affect peripheral vascular resistance in the long term?

    <p>Decreases peripheral vascular resistance</p> Signup and view all the answers

    Which of the following is a major difference among beta-adrenergic antagonists (blockers)?

    <p>Their selectivity for beta1- and beta2-receptor sites</p> Signup and view all the answers

    What term is commonly used to refer to beta-adrenergic antagonists in health-care literature?

    <p>Beta blockers</p> Signup and view all the answers

    Where is the highest concentration of beta1 adrenergic receptors located?

    <p>The heart</p> Signup and view all the answers

    Which of the following systems are affected by the blockade of beta-adrenergic receptors?

    <p>Cardiovascular, renal, respiratory systems, and the eyes</p> Signup and view all the answers

    What neurotransmitters influence heart rate and myocardial contraction when bound to beta1 adrenergic receptors?

    <p>Norepinephrine and epinephrine</p> Signup and view all the answers

    Which of the following effects is NOT mentioned as a result of beta-adrenergic receptor blockade?

    <p>Gastrointestinal effects</p> Signup and view all the answers

    What is the main reason why the use of beta blockers as initial therapy for older adults should be restricted?

    <p>They may precipitate or exacerbate type 2 diabetes</p> Signup and view all the answers

    What was the finding of a meta-analysis that included 1,883 people with diabetes?

    <p>The use of beta blockers in patients with diabetes was found to improve survival</p> Signup and view all the answers

    What is the main reason why the use of beta blockers during pregnancy is controversial?

    <p>They can cause early labor and restricted fetal growth</p> Signup and view all the answers

    Which of the following beta blockers is listed as Pregnancy Category D?

    <p>Atenolol</p> Signup and view all the answers

    Which of the following is NOT a common cardiovascular adverse reaction associated with beta blockers?

    <p>Tachycardia</p> Signup and view all the answers

    What is the main reason why beta blockers are recommended for most hyperthyroid patients?

    <p>They are effective in relieving symptoms such as palpitations, tachycardia, tremors, anxiety, and heat intolerance</p> Signup and view all the answers

    What is the main reason why beta blockers have a role in the management of ischemic and congestive cardiac disorders in patients with diabetes?

    <p>They have been proven effective in the management of these disorders in patients with diabetes</p> Signup and view all the answers

    Which of the following is the most common central nervous system and psychiatric adverse reaction associated with beta blockers?

    <p>Fatigue and weakness</p> Signup and view all the answers

    What is the recommended approach to reducing the risk of adverse drug reactions with beta blockers?

    <p>Start with low doses and increase them slowly, usually at no shorter than weekly intervals</p> Signup and view all the answers

    Which of the following beta blockers is excreted in breast milk in larger amounts compared to other beta blockers?

    <p>Atenolol</p> Signup and view all the answers

    What advice can help reduce dry mouth as a side effect of beta blockers?

    <p>Chewing sugarless gum</p> Signup and view all the answers

    Which of the following is a potential side effect of beta blockers with significant CNS penetration?

    <p>Confusion</p> Signup and view all the answers

    What is the one indication of hypoglycemia that is not masked by beta blockers?

    <p>Sweating (Diaphoresis)</p> Signup and view all the answers

    Why are beta blockers contraindicated in the first trimester of pregnancy?

    <p>They may affect the developing fetus</p> Signup and view all the answers

    Which factor may often cause nonadherence to a beta blocker treatment regimen?

    <p>Inhibition of ejaculation and impotence</p> Signup and view all the answers

    For hypertensive patients taking beta blockers, what additional intervention is encouraged for blood pressure reduction?

    <p>Smoking cessation</p> Signup and view all the answers

    Which beta blocker is proven to be effective in managing exercise-induced angina associated with idiopathic hypertrophic subaortic stenosis?

    <p>Propranolol</p> Signup and view all the answers

    What is the recommended action if a dose of atenolol, metoprolol, or nadolol is missed?

    <p>Take the missed dose up to 8 hours before the next scheduled dose</p> Signup and view all the answers

    Which beta blocker can be crushed and mixed with food, including oral solutions and semisolids?

    <p>Propranolol</p> Signup and view all the answers

    What is the recommended action if a patient taking beta blockers experiences acute chest pain?

    <p>Call 911 and go to the nearest hospital</p> Signup and view all the answers

    Which of the following is NOT a recommended action to reduce postural hypotension in patients taking beta blockers?

    <p>Consuming caffeinated fluids</p> Signup and view all the answers

    What is the recommended frequency for assessing blood pressure and pulse in patients taking beta blockers?

    <p>Biweekly</p> Signup and view all the answers

    What is the primary reason for teaching patients to report wheezing or difficulty breathing to their healthcare provider immediately when taking beta blockers?

    <p>To monitor for potential adverse effects</p> Signup and view all the answers

    What is the effect of food intake on the bioavailability of propranolol and metoprolol?

    <p>Food intake enhances the bioavailability of propranolol but not metoprolol</p> Signup and view all the answers

    What is the primary recommendation for patients taking beta blockers who experience dizziness and drowsiness?

    <p>Avoid driving or operating heavy machinery</p> Signup and view all the answers

    What is the primary reason for monitoring serum creatinine and/or creatinine clearance before initiating beta blocker therapy?

    <p>To assess the patient's renal function and determine if dosage adjustments are needed</p> Signup and view all the answers

    What is the primary route of metabolism for most beta blockers?

    <p>Extensive liver metabolism and elimination via bile and feces</p> Signup and view all the answers

    For which population does nebivolol have a longer half-life?

    <p>Poor metabolizers (PM)</p> Signup and view all the answers

    Which beta blocker requires dosage adjustment based on creatinine clearance (CrCl) below a specific value?

    <p>All of the above</p> Signup and view all the answers

    Which of the following beta blockers is contraindicated for patients with respiratory conditions like bronchospasm?

    <p>All beta blockers are contraindicated in bronchospastic conditions</p> Signup and view all the answers

    Which of the following statements about nebivolol is true?

    <p>Nebivolol is well-tolerated in patients with asthma and COPD</p> Signup and view all the answers

    Beta blockers are contraindicated in patients with AV block because:

    <p>They decrease heart rate and myocardial contractility, reducing cardiac output</p> Signup and view all the answers

    Which of the following statements about beta blockers in older adults is true?

    <p>Beta blockers should be used with caution in older adults due to limited cardiac and renal reserves</p> Signup and view all the answers

    According to meta-analyses, how do beta blockers compare to other first-line therapies for cardiovascular disorders in patients aged 60 or older?

    <p>Beta blockers are less efficacious, especially for stroke prevention</p> Signup and view all the answers

    Which of the following statements about nebivolol's metabolism is true?

    <p>Nebivolol's metabolism involves multiple pathways, including glucuronidation, hydroxylation, dealkylation, and oxidation</p> Signup and view all the answers

    What is the difference in the maximum drug concentration (Cmax) and AUC of the active d-isomer of nebivolol between extensive metabolizers (EM) and poor metabolizers (PM)?

    <p>Cmax is 5-fold higher and AUC is 10-fold higher in PMs than EMs</p> Signup and view all the answers

    Which of the following beta blockers has the longest half-life, allowing for once-daily dosing?

    <p>Atenolol</p> Signup and view all the answers

    Which beta blocker is known to have the greatest selectivity for beta1 receptors compared to other beta1-selective blockers?

    <p>Atenolol</p> Signup and view all the answers

    Which beta blocker is primarily excreted through the kidneys and requires dosage adjustments in renal failure?

    <p>Nadolol</p> Signup and view all the answers

    Which beta blocker is known to have the least significant first-pass effect, resulting in more consistent bioavailability?

    <p>Atenolol</p> Signup and view all the answers

    Which beta blocker is considered to be the most beta1-selective, making it more appropriate for patients with COPD or asthma?

    <p>Atenolol</p> Signup and view all the answers

    Which beta blocker is known to have the shortest half-life, requiring more frequent dosing?

    <p>Propranolol</p> Signup and view all the answers

    Which beta blocker is known to have the greatest potential for central nervous system (CNS) adverse effects due to its ability to cross the blood-brain barrier?

    <p>Propranolol</p> Signup and view all the answers

    Which beta blocker is considered to have the least significant first-pass effect, resulting in higher bioavailability?

    <p>Nadolol</p> Signup and view all the answers

    Which beta blocker is known to have the greatest selectivity for beta2 receptors, making it less appropriate for patients with COPD or asthma?

    <p>Pindolol</p> Signup and view all the answers

    Which beta blocker is known to have the most significant first-pass effect, resulting in greater variability in bioavailability?

    <p>Propranolol</p> Signup and view all the answers

    What is the initial drug therapy recommended for hypertension (HTN) according to the text?

    <p>Thiazide diuretic</p> Signup and view all the answers

    Which patients benefit the most from beta blockers in post-MI prophylaxis?

    <p>Patients with anterior MIs</p> Signup and view all the answers

    Which drug is mentioned to reduce 3-month mortality by 36% in patients with suspected or definite MI?

    <p>Metoprolol</p> Signup and view all the answers

    Why are beta blockers used in post-MI prophylaxis according to the text?

    <p>To prevent primary arrhythmic events</p> Signup and view all the answers

    Which of the following is NOT true about the use of beta blockers in HTN management?

    <p>Beta blockers are the preferred first-line therapy for all patients</p> Signup and view all the answers

    What is the mechanism of action of propranolol in migraine headache prophylaxis?

    <p>Increase in extracellular serotonin levels</p> Signup and view all the answers

    Which beta blocker did not produce an increase in mortality rates at doses up to 320 mg/day in post-MI patients with a history of recent MI and no ventricular arrhythmias?

    <p>Sotalol</p> Signup and view all the answers

    Which patient group may receive the greatest benefits from long-term beta blocker use after a late presentation with a large infarct size and reduced left ventricular ejection fraction (LVEF)?

    <p>Patients with reduced LVEF</p> Signup and view all the answers

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