Nonselective (?1, ?2)
Cardioselective (?1)
Mixed (? ,?)
Cardioselective and vasodilatory
Miscellaneous
Beta blocker types
Prolonged PR segment on EKG
2nd or 3rd degree heart block
HR <60 bpm, SBP <90 mmHg
Shock/LV failure
Severe reactive airway disease
Class contraindications
-olol
Nonselective B1 and B2
Bradycardia
Heart block
Bronchospasm
Vasoconstriction
Mask symptoms of hypoglycemia
Key side effects of nonselective B1 and B2
Hypertension
Arrhythmias
Thyrotoxicosis
Propanolol indications
Hypertension
Nadolol and timolol indications
Propanolol
Non-selective B1 and B2
Metoprolol tartrate
Metoprolol succinate
Atenolol
Cardioselective (B1)
Hypertension
Acute MI
Angina
Heart failure
Indications for Cardioselective (B1)
Carvedilol
Labetalol
Mixed (alpha, beta) blockers
___________ affects both alpha and beta receptors. Using beta blockers in cocaine is controversial. Must use a mixed beta blocker to prevent unopposed alpha constriction
Must taper gradually to avoid rebound HTN, tachycardia, sweating, generalized malaise
Cocaine
Nebivolol
Cardioselective and vasodilatory
Hypertension
Cardioselective and vasodilatory
Must taper gradually to avoid rebound HTN, tachycardia, sweating, generalized malaise, and increased risk of MI, death, and angina in patients with CAD
**
Cardioselective and vasodilatory
Prodrug hydrolyzed by red blood cell esterases
� Short half-life
� Used for hypertensive emergencies, pre- and post- operation
Esmolol
Are partial agonists
Lessor effects on heart rate and cardiac output than other agents
Pindolol, acebutolol, penbutolol
Intrinsic Sympathomimetic Activity (ISA)
Clonidine
Methyldopa
Central alpha2 agonists
Hypotension
Sedation
Dry mouth
Constipation
Urinary retention
Blurred vision
Central alpha2 agonist side effects
Oral lichenoid type lesions sometimes observed
Clonidine side effects
Hypertension
Central alpha 2 agonist indications
Commonly used to treatment maladaptive behaviors in children with autism spectrum disorders (ASD)
Clonidine & guanfacine
Muscle relaxant for spasticity, pain (off-label)
Tizanidine
Doxazosin
Prazosin
Alpha 1 blockers
Orthostatic hypotension
Alpha1 blockers side effects
-zosin
Alpha 1 blockers
HTN
BPH
Indications for alpha 1 blockers
Generally well tolerated but monitor vital signs due to cardiovascular
effects
Stress can compromise cardiovascular function; determine patient risk
Watch for orthostatic hypotension!
Use vasoconstrictors with caution, in low doses, and with careful
aspir
Adrenergic drugs- dental considerations
NSAIDS, indomethacin, and salicylates may reduce antihypertensive effect; limit
to 5 days, monitor blood pressure
Decreased effectiveness of sympathomimetics (epinephrine, levonordefrin)
Drug interactions of adrengerics
-dipine
Dihydropyridine CCBs
Reflex tachycardia
Peripheral edema
Flushing
Gingival overgrowth
Side effects of dihydropyridine CCBs
HTN
Dihydropyridine CCBs
Better at managing isolated HTN in elderly
African Americans may have better response to agent
Preferred for combination with BB to avoid excessive bradycardia or heart block in HTN
Dihydropyridine CCBs
Diltiazem
Verapamil
Non-dihydropyridine CCBs
Bradycardia
Heart block
Peripheral edema
Constipation
Nonidydropyridine CCBs key side effects
HyperTension
Non-dihydropyridine CCBs
Used for rate control properties
A beta blocker+non-dihydropyridine CCB has increased risk for heart block
Effective at managing tachyarrhythmias
AHA recommends as alternative to BB in patients with stable angina, ACS
Avoid in patients with HF or LV systo
Non-dihydropyridine CCBs
~90% due to infections (viral, bacterial or
fungal)
Drug-induced EM makes up less than 10% of cases.
� NSAIDs
� Sulfonamides
� Anti-epileptics
� Antibiotics
Mucosal erosions and crusts on the lips of a patient with erythema multiforme.
Hemorrhagic crustin
Erythema multiforme
Monitor vital signs and consider stress reduction
Side effects: occasional gingival enlargement (especially with
nifedipine and amlodipine, less likely with diltiazem) so monitor
Drug interactions of concern to dentistry
� NSAIDs okay
� May see increased
Calcium channel blocker dental considerations
NSAIDS, indomethacin, and salicylates may reduce antihypertensive effects;
limit to 5 days, monitor blood pressure
Ototoxicity: Loop diuretics and aminoglycosides
NSAIDS (especially indomethacin) can decrease the diuretics and Beta blocker
hypotensive res
Drug interactions and adverse effects