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drug adverse effects of beta-adrenergic receptor antagonists

Adverse effects: 1) bronchospasm 2) bradycardia 3) decreased cardiac output 4) negative inotropic effects 5) abrupt withdrawal may precipitate arrhythmia or angina 6) may mask symptoms of hypoglycemia - non-selective beta blockers can inhibit glucose release & increase sensitivity to insulin by impairing adrenergic response - effect is uncommon & usually mild [13] 7) unopposed alpha adrenergic activity may potentiate coronary artery vasospasm, peripheral arterial vasospasm 8) lethargy 9) confusion & diminished ability to concentrate 10) impotence 11) potentiation of Raynaud's phenomenon 12) nightmares 13) insomnia 14) depression is [2], but is not [1,11], & might be [3] an adverse effect of beta-blockers 15) may diminish effect of sulfonylureas 16) hyperkalemia (extracellular shift of K+) 17) metabolic alkalosis 18) increased triglycerides 19) diminished HDL cholesterol 20) may exacerbate psoriasis [4] 21) may increase risk of developing diabetes mellitus [5] 22) NO ADVANTAGE IN PREVENTING MYOCARDIAL INFARCTION OR DEATH WHEN USED TO TREAT HYPERTENSION [6] 23) beta-blocker-associated reduction in heart rate increases risk of cardiovascular events & death in hypertensive patients [7] 24) increases risk of stroke in elderly patients [8] 25) no fetal heart risk from Mom's beta-blocker usage [9] 26) xerosis resulting in pruritus [] Overdose: 1) supportive therapy: a) IV access b) continuous cardiac monitoring 2) bradycardia a) atropine generally not useful (not vagally mediated) b) glucagon 2-4 mg IV over 1-2 minutes, then start infusion at 2-5 mg/hr (do not exceed 10 mg/hr); 1] may cause nausea/vomiting 2] monitor for vagally-mediated bradycardia c) ventricular pacing 3) hypotension a) calcium gluconate 3-9 g IV through peripheral line b) calcium chloride 1-2 g IV over 10 minutes through a central venous catheter is alternative (caution: sclerosing agent) c) high-dose insulin euglycemia therapy d) intra-aortic balloon pump

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DRUGS: beta adrenergic receptor antagonist FORM: drug adverse effects beta adrenergic receptor antagonist

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998
  2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 158-59
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 474-75, 491
  4. The Washington Manual of Medical Therapeutics, 33rd edition Foster C et al (eds) Lippincott, Williams & Wilkins, Philadelphia, 2010, pg 969
  5. Journal Watch 20(9): 72, 2000 Gress TW et al Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 342:905, 2000 PMID: 10738048
  6. Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet. 2005 Oct 29-Nov 4;366(9496):1545-53. PMID: 16257341 - Beevers DG. The end of beta blockers for uncomplicated hypertension? Lancet. 2005 Oct 29-Nov 4;366(9496):1510-2. No abstract available. PMID: 16257329
  7. Bangalore S et al Relation of Beta-Blocker Induced Heart Rate Lowering and Cardioprotection in Hypertension J Am Coll Cardiol. 2008; 52:1482-1489 PMID: 19017516
  8. Bangalore S et al. Beta-blockers for primary prevention of heart failure in patients with hypertension: Insights from a meta-analysis. J Am Coll Cardiol 2008 Sep 23; 52:1062. PMID: 18848139
  9. Boyles S No Fetal Heart Risk from Mom's Beta-Blocker Use - More complete data point finger at maternal confounders. MedPage Today. April 18, 2017 - Duan L, Ng A, Chen W et al beta-Blocker exposure in pregnancy and risk of fetal cardiac anomalies. JAMA Intern Med. 2017 Apr 17 PMID: 28418448
  10. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  11. Riemer TG, Villagomez Fuentes LE, Algharably EAE et al Do beta-Blockers Cause Depression? Hypertension. 2021. March 15 PMID: 33719510 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16590
  12. DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev 2004; 23:223 PMID: 15898828
  13. NEJM Knowledge+