Bianca Moses Fall 2013

-LOLβ-Blockers

For the treatment of the symptoms of attack by ostriches…and other ailments; including

those of the cardio-pulmonary tract

-LOLβ-Blockers

-LOLβ-Blockers

Ateno



-LOLβ-Blockers

Atenolol



-LOLβ-Blockers

Atenolol

Carvedi



-LOLβ-Blockers

Atenolol

Carvedilol



-LOLβ-Blockers

Atenolol

Carvedilol

Timo



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol

Metopra



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol

Metopralol



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol

Metopralol

Proprano



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol

Metopralol

Propranolol



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol

Metopralol

Propranolol

and more…



-LOLβ-Blockers

Atenolol

Carvedilol

Timolol

Metopralol

Propranolol

and more…

-LOL



symptoms of attack by ostriches


Medulla Oblongata


Medulla Oblongata

Fight or Flight Response


Medulla Oblongata

Adrenal Glands



Medulla Oblongata

Adrenal Glands


Epinephrine


Medulla Oblongata

Adrenal Glands


Epinephrine

Sympathetic Neurons


Medulla Oblongata

Adrenal Glands


Epinephrine

Sympathetic Neurons

Norepinephrine


Medulla Oblongata

Adrenal Glands


Epinephrine

Sympathetic Neurons

Norepinephrine

β1


Medulla Oblongata

Adrenal Glands


Epinephrine

Sympathetic Neurons

Norepinephrine

β1 β2


Medulla Oblongata

Adrenal Glands


Epinephrine

Sympathetic Neurons

Norepinephrine

β1 β2 β3

β1 β2 β3Ep

inep

hrin

e

Nore

pine

phrin

e

Epin

ephr

ine

Nore

pine

phrin

e

Epin

ephr

ine

Nore

pine

phrin

e

β1 β2 β3Ep

inep

hrin

e

Nore

pine

phrin

e

Epin

ephr

ine

Nore

pine

phrin

e

Epin

ephr

ine

Nore

pine

phrin

eFight or Flight

Response Initiated

β-Blockers

β1 β2 β3

β-Blockers

β1 β2 β3

β-Blockers

Epin

ephr

ine

Nore

pine

phrin

e

β1 β2 β3

↑ ♥ Rate (Chronotropic)

↑ ♥ Force (Inotropic)

↑ ♥ Automaticity (How well ♥ cells initiate their own impulse)

↑ ♥ Output (Cardiac Output)

PUMP THAT BLOOD!!! MOVE THAT O2 NOW!!!

β1 β2 β3





β1 β2 β3

Not as much effect as β1 stimulation however





β1 β2 β3





β1 β2 β3

Smooth Muscle Constriction

β1 β2 β3

Central Arterial Constriction

=↑ Blood Pressure

=↑ Blood + O2 to essential

organs


β1 β2 β3


=↑ Blood Pressure


organs


Constriction of Vessels of non essential organs(ie. Less blood to gut)

=Less digesting

β1 β2 β3

Smooth Muscle Relaxation


=↑ Blood Pressure


organs



=Less digesting

β1 β2 β3


Airways Relax=

More air with each breath=

↑ oxygenation


=↑ Blood Pressure


organs



=Less digesting

β1 β2 β3


Airways Relax=


↑ oxygenation


=↑ Blood Pressure


organs


Sweat =

Dissipate Heat

= Cools off

body


=Less digesting

β1 β2 β3


Airways Relax=


↑ oxygenation


=↑ Blood Pressure


organs


Eyes Dilate =

More Light In=

See Threat Better

Sweat =

Dissipate Heat

= Cools off

body


=Less digesting

β1 β2 β3



=Less digesting

Airways Relax=


↑ oxygenation


=↑ Blood Pressure


organs


Eyes Dilate =

More Light In=

See Threat Better

Sweat =

Dissipate Heat

= Cools off

body

β1 β2 β3

Brown Fat

β1 β2 β3

β-Blockers

Anxiety SymptomsEssential TremorGlaucomaTheophylline OverdoseMigraine ProphylaxisAngina PectorisDysrhythmiasCongestive Heart FailureMitral Valve ProlapseMyocardial InfarctionAcute Aortic DissectionTachycardia Marfan Syndrome

β1 β2 β3

β-Blockers

Use With Caution In

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic Impairment

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic Impairment Metabolized by liver and excreted by kidneys

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic ImpairmentDiabetes Mellitus

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic ImpairmentDiabetes Mellitus

β-blockers mask hypoglycemia symptoms

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic ImpairmentDiabetes Mellitus Geriatrics

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic ImpairmentDiabetes Mellitus Geriatrics

Enhanced effects

β1 β2 β3

β-Blockers

Use With Caution InRenal ImpairmentHepatic ImpairmentDiabetes MellitusGeriatricsAsthma Patients

β1 β2 β3

β-Blockers


Constricts airways

β1 β2 β3

β-Blockers

Contraindications


β1 β2 β3

β-Blockers

ContraindicationsUncompensated CHFPulmonary edemaCardiogenic shockBradycardiaHeart Block


β1 β2 β3

β-Blockers


May ↑ these labs


β1 β2 β3

β-Blockers


May ↑ these labsBUNSerum LipoproteinK+TriglyceridesUric Acid LevelsANA titersBlood Glucose Levels


β1 β2 β3

β-Blockers




Primarily labs monitoring liver function

β1 β2 β3

β-Blockers


↑ myocardial depression



β1 β2 β3

β-Blockers


↑ myocardial depressionGeneral anesthesia

IV PhenytoinVerapamil



β1 β2 β3

β-Blockers




↑ Bradycardia



β1 β2 β3

β-Blockers




↑ BradycardiaDigoxin



β1 β2 β3

β-Blockers





↑ HTN



β1 β2 β3

β-Blockers





↑ HTNOther antihypertensives

Acute –OH ingestionnitrates



β1 β2 β3

β-Blockers







Unopposed α adrenergic stimulation



β1 β2 β3

β-Blockers







Unopposed α adrenergic stimulationAmphetamines

CocaineEphedrine

EpinephrinePhenylephrine

pseudophedrine



β1 β2 β3

β-Blockers

Side Effects/Adverse Rxns

β1 β2 β3

β-Blockers

Extension of therapeutic effect

Side Effects/Adverse Rxns

β1 β2 β3

β-Blockers

Side Effects/Adverse Rxns FatigueWeaknessArrhythmiasBradycardiaCHFPulmonary EdemaErectile dysfunctionAnaphylaxis (rare)Nasal StuffinessBronchospasm/wheezingOrthostatic hypotension

Extension of therapeutic effect

β1 β2 β3

β-BlockersSymptoms of Toxicity


β1 β2 β3

β-BlockersSymptoms of ToxicityBradycardiaSevere DizzinessFaintingSevere DrowsinessDyspneaBluish FingernailsSeizures

Side Effects/Adverse RxnsFatigueWeaknessArrhythmiasBradycardiaCHFPulmonary EdemaErectile dysfunctionAnaphylaxis (rare)Nasal StuffinessBronchospasm/wheezingOrthostatic hypotension

β1 β2 β3


AssessmentSide Effects/Adverse Rxns FatigueWeaknessArrhythmiasBradycardiaCHFPulmonary EdemaErectile dysfunctionAnaphylaxis (rare)Nasal StuffinessBronchospasm/wheezingOrthostatic hypotension

β1 β2 β3



AssessmentMonitor BP and HR

β1 β2 β3


AssessmentMonitor BP and HR hold med, call MD, if apical pulse is <50bpm


β1 β2 β3



Assess for orthostatic hypotension


β1 β2 β3



Assess for orthostatic hypotension teach pt to stand up slowly


β1 β2 β3



Assess for orthostatic hypotension teach pt to stand up slowlyMonitor I/O and daily weights


β1 β2 β3



Assess for orthostatic hypotension teach pt to stand up slowlyMonitor I/O and daily weights assess chest sounds and for edema


β1 β2 β3




Vitals q5-15 post parenteral administration


β1 β2 β3




Vitals q5-15 post parenteral administrationadminister atropine if needed


β1 β2 β3





Side Effects/Adverse Rxns FatigueWeaknessArrhythmiasBradycardiaCHFPulmonary EdemaErectile dysfunctionAnaphylaxis (rare)Nasal StuffinessBronchospasm/wheezingOrthostatic hypotension For pulse <40bpm, ↓CO = atropine 0.25-0.5 mg IV

β1 β2 β3





Patient and Family Teaching


β1 β2 β3





Patient and Family TeachingAbrupt withdrawal can cause life

threatening arrhythmias, HTN or MI


β1 β2 β3







Check pulse and BP 2x/wkIf HR <50bpm, hold dose and call MD


β1 β2 β3








Notify if having difficulty breathing, wheezing, coldHands/feet, confusion, dizzy


β1 β2 β3









Change positions slowly


β1 β2 β3










Don’t double dose if you miss one Take ASAP or up to 4 hours before the next dose


β1 β2 β3











Take as directed, even if you feel well


β1 β2 β3











Take as directed, even if you feel well

Monitor glucose closely. ↓ glucose symptoms may be masked


β1 β2 β3

AcebutololAtenololBetaxololBisprolol

CeliprololEsmololMetoprololNebivolol

β1 β2 β3

AlprenololBucindololCarteololCarvedilolLabetalolNadololOxprenololPenbutololPindololPropranololSotalolTimolol

AcebutololAtenololBetaxololBisprolol

CeliprololEsmololMetoprololNebivolol

β1 β2 β3

β-BlockersMetoprolol PO

Beloc, Beloc-ZOK, betaloc Durules, Betaloc-Zok, lopresor, Lopresor SR, Lopressor, Metoprol, Novo-metoprol, Seloken-ZOK, Toprol

β1 β2 β3


β1 β2 β3


…effects of ↓♥rate, ↓BP, suppression of arrhythmias

β1 β2 β3


Labeled Uses


β1 β2 β3


Labeled UsesManagement of HTNPrevention and mgmt of MIMgmt of stable, symptomatic Class 1, 3 ♥ failureAngina


β1 β2 β3



Off Label Uses


β1 β2 β3



Off Label UsesVentricular arrhythmiasVentricular tachycardia

Migraine prophylaxisDrug induced akathisia

Aggressive behaviorTremorsanxiety…effects of ↓♥rate, ↓BP, suppression of arrhythmias

β1 β2 β3




25mg, 50mg, 100mg



Aggressive behaviorTremorsanxiety

β1 β2 β3




25mg, 50mg, 100mg 15 min onsetUnknown peak5-8 hr duration3-7 hr ½ life




β1 β2 β3




25mg, 50mg, 100mg 15 min onsetUnknown peak5-8 hr duration3-7 hr ½ lifeFull effect not seen for 3-4 weeksMostly metabolized by liverAdminister with meals




β1 β2 β3







Anti-Anginal/HTN25mg/day → 100mg/day

May ↑ After 1 week

β1 β2 β3









Heart Failure12.5mg → 25mg/day

Can be doubled q2 weeksMax 200mg

β1 β2 β3











MI Treatment25mg → 50mg 15 min after last IV dose

Every 6 hrs for 48 hrsThen 100mg 2x daily for 3mo min.

β1 β2 β3











MI Treatment25mg → 50mg 15 min after last IV dose

Every 6 hrs for 48 hrsThen 100mg 2x daily for 3mo min.

Migraine Prevention50-100mg, 2-4x/day

β1 β2 β3

β-BlockersMetoprolol IV

β1 β2 β3



β1 β2 β3


Labeled UsePrevention and mgmt of MI


β1 β2 β3




1mg/mL

β1 β2 β3




1mg/mL

For MI, suggested dose is 5mg q2 min for 3 doses, followed by oral dosing.

Following this order, how many total mLs of metoprolol would be administered?

β1 β2 β3




1mg/mL

For MI, suggested dose is 5mg q2 min for 3 doses, followed by oral dosing.

Following this order, how many total mLs of metoprolol would be administered?

5mg x 3 = 15mg

15mg/1 x 1mL/1mg = 15mL

β1 β2 β3




1mg/mLImmediate onset20 min peak6-12 hr duration3-7 hr ½ life

β1 β2 β3




1mg/mLImmediate onset20 min peak6-12 hr duration3-7 hr ½ lifeAdminister undilutedAdminister over 1 minute

β1 β2 β3





MI Treatment5mg q2min for 3 doses

Followed by oral dosing

β1 β2 β3





MI Treatment5mg q2min for 3 doses

Followed by oral dosing

Get calculations VERIFIED

β1 β2 β3

β-BlockersCarvedilol PO

β1 β2 β3


Coreg, Coreg CR

β1 β2 β3


β1 (myocardial) & β2 (pulmonary, vascular)

β1 β2 β3


Labeled Uses


β1 β2 β3


Labeled UsesManagement of HTNCHF (ischemic cardiomyopathies)Left ventricular dysfunction after MI


β1 β2 β3




3.125mg, 6.25mg, 12.5mg, 25mg

β1 β2 β3




3.125mg, 6.25mg, 12.5mg, 25mg Within 1 hr onset1-2 hr peak12 hr duration7-10 hr ½ life

β1 β2 β3




3.125mg, 6.25mg, 12.5mg, 25mg Within 1 hr onset1-2 hr peak12 hr duration7-10 hr ½ life98% protein binding Excreted in feces and urine

β1 β2 β3




3.125mg, 6.25mg, 12.5mg, 25mg Within 1 hr onset1-2 hr peak12 hr duration7-10 hr ½ life98% protein binding Excreted in feces and urineCYP2D6 metabolized

β1 β2 β3




3.125mg, 6.25mg, 12.5mg, 25mg Within 1 hr onset1-2 hr peak12 hr duration7-10 hr ½ life98% protein binding Excreted in feces and urineCYP2D6 metabolizedFood decreases absorption

β1 β2 β3





Anti-Anginal80mg/day → 320mg/day

In 2-4 divided doses

β1 β2 β3







Anti-HTN120mg → 240mg

Twice daily

β1 β2 β3








Twice daily

Anti-Arrhythmic10mg-30mg

3-4 times a day

β1 β2 β3








Twice daily


3-4 times a day

MI Prevention180mg-240mg

Divided doses daily

β1 β2 β3








Twice daily


3-4 times a day

MI Prevention180mg-240mg

Divided doses daily

Vascular HA Prev.1mg-3mg

May be repeated after 2 min and again in 4 hours

References

Deglin, J., Vallerand, A., & Sanoski, C. (2011). Davis's drug guide for nurses. (12 ed., p. 1043). Philadelphia, Pennsylvania: F.A. Davis Company.

(n.d.). Retrieved from elevenwarriors.com/2012/02/catching-up-with-tyler-moeller

(n.d.). Retrieved from 1.bp.blogspot.com/_1p20WdeXKKs/TM_tELEfsNI/AAAAAAAAKKI/bNymO _rAnBw /s1600/AsthmaThermoplasty.gif

(n.d.). Retrieved from blogs.mcgill.ca/ossstudents/files/2012/09/adrenal-glands2.jpg

(n.d.). Retrieved from commons.wikimedia.org/wiki/File:Medulla_oblongata.png

(n.d.). Retrieved from focuseducation.com.au/CoolStuff/project/brainfront.jpg

(n.d.). Retrieved from foodandthecity.com/3-things-we-think-men-want-us-to-do-but-they-think-is-gross/

(n.d.). Retrieved from giglig.com/family/education/what-is-circulatory-system

(n.d.). Retrieved from health-for-you.biz/aromatherapy-for-bladder-infections.php

(n.d.). Retrieved from images.wisegeek.com/internal-organs.jpg

(n.d.). Retrieved from jogdoc.files.wordpress.com/2010/11/running_legs1.jpg

(n.d.). Retrieved from menshealth.com/sweat/avoid-embarassing-stains.php

(n.d.). Retrieved from mynyp.org/images/my_health/ei_2396.jpg

(n.d.). Retrieved from opm.phar.umich.edu/protein.php?pdbid=2y02

(n.d.). Retrieved from romeljoseph.files.wordpress.com/2012/01/stage-fright1.jpg

(n.d.). Retrieved from worldresources.tripod.com/image-hypertension/21.phototake_ rm_photo_of_arteries.jpg

Bianca Moses Fall 2013

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