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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)

2- β- adrenergic antagonist

1)  COP (β1 effect) (cardiac level)

Actions 2)  sympathetic outflow from CNS (general)
3) Inhibit renin release from kidney ➔  angiotensin I & secretion of

aldosterone.
st
1) Currently recommended as 1 line therapy for hypertension. With
concomitant diseases present especially in post M.I patients or

Uses patients with previous M.I. ➔localized death of certain part in the
heart.
2) Effective in ttt hypertension in white & young compared to elderly

populations
1) patients of acute heart failure (worsen symptoms) or peripheral

used cautiously vascular diseases (D.M, gangrene)
with 2) Patients having asthma. β2 blockers worsen asthma
(bronchoconstriction)

Conditions that 1- CHF, occlusive peripheral vascular diseases that are most
discourage the commonly found in diabetics & elderly patients.
use (NOT
USED) 2- Chronic obstructive pulmonary diseases

A- Non-selective β-blocker B- Selective β1 -Blocker

Metoprolol & Atenolol ➔ most common
Propranolol
prescribed

✓ Inderal (propranolol) 6-8 ✓ Increase NO production causing V.D
st
times/daily as it suffering from 1  Nebivolol ➔ Extra effect ➔ induction of NO
pass metabolism (endothelium derived relaxing factor) [EDRF]
✓ propranolol & Nadolol ➔ C.I in ✓  COP
asthmatic patients due to their ✓ Induction of NO in B.V ➔ V.D ➔  peripheral

blockade of β2 mediated resistance
bronchodilation.
Side Effects

1- Alteration of lipid metabolism ➔  HLDL (good cholesterol) &  plasma TGs (bad

cholesterol)
2- sharp withdrawal ➔induce angina, M.I & even sudden death in patients with ischemic

heart diseases due to up-regulation ➔a result of continual blockade,
Therefore, the dose must be tapered over 2-3 weeks in patient with hypertension &

ischemic heart disease. (Dose must decrease gradually)

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