Agents

Non-Selective Beta Blockers

• Carteolol
• Nadolol (Corgard, Anabet, Solgol, Corzide, Alti-Nadolol, Apo-Nadol, Novo-Nadolol) (see Nadolol)
• Penbutolol
• Pindolol (Visken, Betapindol, Blockin L, Blocklin L, Calvisken, Cardilate, Decreten, Durapindol, Glauco-Visken, Pectobloc, Pinbetol, Prindolol, Pynastin)
• Propafenone (Rhythmol) (see Propafenone): with additional Class 1C antiarrhythmic properties (inhibits sodium channels)
• Propanolol (Inderal) (see Propanolol)
• Sotalol (Betapace, Betapace AF, Sotalex, Sotacor) (see Sotalol): with additional Class III antiarrhythmic properties (inhibits potassium channels)
• Timolol (Blocadren, Timoptic) (see Timolol)

Cardioselective (β1-Selective) Beta Blockers

• Acebutolol (Sectral, Prent) (see Acebutolol)
• Atenolol (Tenormin) (see Atenolol)
• Betaxalol (Betoptic, Lokren, Kerlone) (see Betaxalol)
• Bisoprolol (Concor, Zebeta) (see Bisoprolol)
• Esmolol (Brevibloc) (see Esmolol)
• Metoprolol (Lopressor) (see Metoprolol)
• Nebivolol (Bystolic) (see Nebivolol)
• Practolol: although structurally similar to propanolol, it is no longer used in humans (due to adverse effect of oculomucocutaneous syndrome)

Beta Blockers with Intrinsic Sympathomimetic Activity (β-Adrenergic Receptor Antagonism + Low Level β-Adrenergic Receptor Agonism)

• Acebutolol (see Acebutolol)
• Carteolol
• Celiprolol
• Mepindolol
• Oxprenolol
• Penbutolol
• Pindolol (Visken, Betapindol, Blockin L, Blocklin L, Calvisken, Cardilate, Decreten, Durapindol, Glauco-Visken, Pectobloc, Pinbetol, Prindolol, Pynastin)

Beta Blockers with Alpha Blocking Activity

• Carvedilol (Coreg) (see Carvedilol)
• Labetalol (Normodyne, Trandate) (see Labetalol)

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Pharmacology

• Bronchial Smooth Muscle β2-Adrenergic Receptors
  • Mediate Bronchodilation
• Gastrointestinal β2-Adrenergic Receptors
  • Mediate Slowing of Peristalsis
  • Mediate Slowing of Secretions
• Hepatic β2-Adrenergic Receptors
  • Mediate Gluconeogenesis
  • Mediate Glycogenolysis
  • Mediate Lipolysis
• Ocular Ciliary Muscle β2-Adrenergic Receptors
  • Mediate Flow of Aqueous Humor
  • Mediate Accommodation
• Urinary Bladder Detrusor Muscle β2-Adrenergic Receptors
  • Mediate Detrusor Muscle Relaxation
• Uterine Muscle β2-Adrenergic Receptors
  • Mediate Uterine Relaxation (Tocolysis)
• Vascular Smooth Muscle β2-Adrenergic Receptors
  • Mediate Vasodilation

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Clinical Manifestations

Cardiovascular Manifestations

Bradycardia (see xxxx)

• Epidemiology
  • XXXX

Congestive Heart Failure (CHF) (see Congestive Heart Failure): due to negative inotropy

• Heart Block
  • First Degree Heart Block (see First Degree Heart Block)
  • Second Degree Heart Block (see Second Degree Heart Block)
  • Third Degree Heart Block (see Third Degree Heart Block)

Hypotension (see xxxx)

• Epidemiology
  • XXXX

Pulmonary Manifestations

• Bronchospasm (see Obstructive Lung Disease)

Other Manifestations

• Delirium (see Delirium)
• Hypoglycemia (see Hypoglycemia)

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Treatment

• Glucagon
  • Dose: 3-10 mg IV, then 2-5 mg/hr drip
  • Enhances myocardial contractility and AV conduction
  • Increases heart rate
• Nasogastric Lavage: indicated if performed within 1-2 hrs of ingestion
• Charcoal
• Hemodialysis
• Cardiac Pacing
• IV Fluid Resuscitation

Hyperinsulinemia-Euglycemia Therapy for Calcium Channel Blocker Intoxication (see Calcium Channel Blockers)

Rationale

• Hyperinsulinemia-Euglycemia Therapy Results in Positive Inotropic Effects in the Treatment of Calcium Channel Blocker Intoxication (J Pharmacol Exp Ther, 1993) [MEDLINE] (NEJM, 2001) [MEDLINE] (Intensive Care Med, 2007) [MEDLINE] (Am J Crit Care, 2007) [MEDLINE]

Administration

• Correct Hypoglycemia and Hypokalemis Prior to Starting Hyperinsulinemia-Euglycemia Therapy
• Titrate Up to Max of 10 U/kg/hr
  • Then Titrate D50W Drip to Maintain Glucose >200 mg/dL

Adverse Effects

• Hypotension (see Hypotension)
  • Especially in the Setting of Amlodipine Overdose
    • Dihydropyridine (Amlodipine, Nifedipine) Intoxication Generally Causes Arterial Vasodilation and Reflex Tachycardia
    • Diltiazem/Verapamil Intoxication Generally Cause Peripheral Vasodilation, Negative Cardiac Inotropy, and Bradycardia
    • However, as the Dose is Increased, This Selectivity of These Agents is Lost, Resulting in Negative Cardiac Inotropy and Bradycardia in the Setting of Dihydropyridine Overdose

Clinical Efficacy

• xxxx

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References

General

• xxx

Treatment

• XXX