antihypertensive drug

8/9/2019 Antihypertensive Drug

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Antihypertensive drug

Antihypertensive therapy seeks to prevent the complications of high bloodpressure, such as stroke and myocardial infarction.

The antihypertensives are a class of drugs that are used to treathypertension (high blood pressure).[1] vidence suggests that reduction ofthe blood pressure by ! mm"g can decrease the risk of stroke by #$%, ofischaemic heart disease by &1%, and reduce the likelihood of dementia,heart failure, and mortality from cardiovascular disease.[&] There are manyclasses of antihypertensives, 'hich lo'er blood pressure by dierent meansamong the most important and most 'idely used are the thia*ide diuretics,the A+ inhibitors, the calcium channel blockers, the beta blockers, and the

angiotensin receptor antagonists or A-s.

/hich type of medication to use initially for hypertension has been thesub0ect of several large studies and resulting national guidelines. Thefundamental goal of treatment should be the prevention of the importantendpoints of hypertension, such as heart attack, stroke and heart failure. Theseveral classes of antihypertensives dier in side eect proles, ability toprevent endpoints, and cost. The choice of more e2pensive agents, 'herecheaper ones 'ould be e3ually eective, may have negative impacts onnational healthcare budgets.[#] As of &445, the best available evidence favorsthe thia*ide diuretics as the rst6line treatment of choice for high blood

pressure 'hen drugs are necessary.[$]

Contents

1 Available agents

o 1.1 7iuretics

http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-0http://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Ischaemic_heart_diseasehttp://en.wikipedia.org/wiki/Dementiahttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Deathhttp://en.wikipedia.org/wiki/Cardiovascular_diseasehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-1http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Clinical_endpointhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-budget-2http://en.wikipedia.org/wiki/Evidence-based_medicinehttp://en.wikipedia.org/wiki/First-line_treatmenthttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-Cochrane-3http://en.wikipedia.org/wiki/Antihypertensive#Available_agentshttp://en.wikipedia.org/wiki/Antihypertensive#Diureticshttp://en.wikipedia.org/wiki/File:Main_complications_of_persistent_high_blood_pressure.svghttp://en.wikipedia.org/wiki/File:Main_complications_of_persistent_high_blood_pressure.svghttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-0http://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Ischaemic_heart_diseasehttp://en.wikipedia.org/wiki/Dementiahttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Deathhttp://en.wikipedia.org/wiki/Cardiovascular_diseasehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-1http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Clinical_endpointhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-budget-2http://en.wikipedia.org/wiki/Evidence-based_medicinehttp://en.wikipedia.org/wiki/First-line_treatmenthttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-Cochrane-3http://en.wikipedia.org/wiki/Antihypertensive#Available_agentshttp://en.wikipedia.org/wiki/Antihypertensive#Diureticshttp://en.wikipedia.org/wiki/Myocardial_infarction


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o 1.& Adrenergic receptor antagonists

o 1.# Adrenergic receptor agonists

o 1.$ +alcium channel blockers

o 1.! A+ inhibitors

o 1.8 Angiotensin receptor antagonists

o 1.9 Aldosterone antagonists

o 1.: ;asodilators

o 1.5 +entrally acting adrenergic drugs

• &


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o epiti*ide

o hydrochlorothia*ide and chlorothia*ide

o bendro@umethia*ide

• Thia*ide6like diuretics?

o indapamide

o chlorthalidone

o metola*one

• otassium6sparing diuretics?

o amiloride

o triamterene

o spironolactone

Bnly the thia*ide and thia*ide6like diuretics have good evidence of benecialeects on important endpoints of hypertension, and hence, should usually bethe rst choice 'hen selecting a diuretic to treat hypertension. The reason'hy thia*ides6type diuretics are better than the others is (at least in part)thought to be because of their vasodilating properties.[citation needed] Althoughthe diuretic eect of thia*ides may be apparent shortly after administration,it takes longer ('eeks of treatment) for the full anti6hypertensive eect todevelop. n the Cnited Dtates, the EF+9 (The Deventh -eport of the Eoint

Fational +ommittee on revention of 7etection, valuation and Treatment of"igh lood ressure) recommends starting 'ith a thia*ide diuretic if singletherapy is being initiated and another medication is not indicated.[!] This isbased on a slightly better outcome for chlortalidone in the A>>"AT studyversus other anti6hypertensives and because thia*ide diuretics are relativelycheap.[8] A subse3uent smaller study (AF&) published after the EF+9 didnot sho' this small dierence in outcome and actually sho'ed a slightlybetter outcome for A+6inhibitors in older male patients.[9]

7espite thia*ides being cheap, eective, and recommended as the best rst6line drug for hypertension by many e2perts, they are not prescribed as often

as some ne'er drugs. Arguably, this is because they are o6patent and thusrarely promoted by the drug industry.[:]

Adrenergic receptor antagonists

http://en.wikipedia.org/wiki/Epitizidehttp://en.wikipedia.org/wiki/Hydrochlorothiazidehttp://en.wikipedia.org/wiki/Chlorothiazidehttp://en.wikipedia.org/wiki/Bendroflumethiazidehttp://en.wikipedia.org/wiki/Indapamidehttp://en.wikipedia.org/wiki/Chlorthalidonehttp://en.wikipedia.org/wiki/Metolazonehttp://en.wikipedia.org/wiki/Potassium-sparing_diureticshttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-jnc7-4http://en.wikipedia.org/wiki/Chlortalidonehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-allhat-5http://en.wikipedia.org/wiki/Antihypertensive#cite_note-anbp2-6http://en.wikipedia.org/wiki/Antihypertensive#cite_note-promotion-7http://en.wikipedia.org/wiki/Epitizidehttp://en.wikipedia.org/wiki/Hydrochlorothiazidehttp://en.wikipedia.org/wiki/Chlorothiazidehttp://en.wikipedia.org/wiki/Bendroflumethiazidehttp://en.wikipedia.org/wiki/Indapamidehttp://en.wikipedia.org/wiki/Chlorthalidonehttp://en.wikipedia.org/wiki/Metolazonehttp://en.wikipedia.org/wiki/Potassium-sparing_diureticshttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-jnc7-4http://en.wikipedia.org/wiki/Chlortalidonehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-allhat-5http://en.wikipedia.org/wiki/Antihypertensive#cite_note-anbp2-6http://en.wikipedia.org/wiki/Antihypertensive#cite_note-promotion-7


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ropranolol, the rst beta6blocker to be successfully developed• eta blockers

o atenolol

o metoprolol

o nadolol

o o2prenolol

o pindolol

o propranolol

o timolol

• Alpha blockers?

o do2a*osin

o phentolamine

o indoramin

o pheno2yben*amine

o pra*osin

o tera*osin

o tola*oline

• Gi2ed Alpha H eta blockers?

http://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nadololhttp://en.wikipedia.org/wiki/Oxprenololhttp://en.wikipedia.org/wiki/Pindololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Alpha_blockerhttp://en.wikipedia.org/wiki/Doxazosinhttp://en.wikipedia.org/wiki/Phentolaminehttp://en.wikipedia.org/wiki/Indoraminhttp://en.wikipedia.org/wiki/Phenoxybenzaminehttp://en.wikipedia.org/wiki/Prazosinhttp://en.wikipedia.org/wiki/Terazosinhttp://en.wikipedia.org/wiki/Tolazolinehttp://en.wikipedia.org/wiki/File:Propranolol.svghttp://en.wikipedia.org/wiki/File:Propranolol.svghttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nadololhttp://en.wikipedia.org/wiki/Oxprenololhttp://en.wikipedia.org/wiki/Pindololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Alpha_blockerhttp://en.wikipedia.org/wiki/Doxazosinhttp://en.wikipedia.org/wiki/Phentolaminehttp://en.wikipedia.org/wiki/Indoraminhttp://en.wikipedia.org/wiki/Phenoxybenzaminehttp://en.wikipedia.org/wiki/Prazosinhttp://en.wikipedia.org/wiki/Terazosinhttp://en.wikipedia.org/wiki/Tolazoline


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o bucindolol

o carvedilol

o labetalol

Although beta blockers lo'er blood pressure, they do not have as positive abenet on endpoints as some other antihypertensives. [5] n particular,atenolol seems to be less useful in hypertension than several other agents.[14]

They do, ho'ever, have an important role in the prevention of heart attacksin people 'ho have already had a heart attack.[11] n the Cnited Iingdom, the Eune &448 J"ypertension? Ganagement of "ypertension in Adults in rimary+areJ[1&] guideline of the Fational nstitute for "ealth and +linical 2cellence,do'ngraded the role of beta6blockers due to their risk of provoking type &diabetes.[1#]

7espite lo'ering blood pressure, alpha blockers have signicantly poorer

endpoint outcomes than other antihypertensives, and are no longerrecommended as a rst6line choice in the treatment of hypertension. [1$] "o'ever, they may be useful for some men 'ith symptoms of prostatedisease.

Adrenergic receptor agonists

• Alpha6& agonists?o clonidine

o methyldopa

o Kuanfacine

Calcium channel blockers

+alcium channel blockers block the entry of calcium into muscle cells inartery 'alls.

• dihydropyridines?o amlodipine

o felodipine

o isradipine

o lercanidipine

o nicardipine

o nifedipine

http://en.wikipedia.org/w/index.php?title=Bucindolol&action=edit&redlink=1http://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-betablockers-8http://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-atenolol-9http://en.wikipedia.org/wiki/Antihypertensive#cite_note-bbmi-10http://en.wikipedia.org/wiki/Antihypertensive#cite_note-11http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellencehttp://en.wikipedia.org/wiki/Type_2_diabeteshttp://en.wikipedia.org/wiki/Type_2_diabeteshttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-12http://en.wikipedia.org/wiki/Alpha_blockerhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-alpha-13http://en.wikipedia.org/wiki/Benign_prostatic_hyperplasiahttp://en.wikipedia.org/wiki/Benign_prostatic_hyperplasiahttp://en.wikipedia.org/w/index.php?title=Alpha-2_agonist&action=edit&redlink=1http://en.wikipedia.org/wiki/Clonidinehttp://en.wikipedia.org/wiki/Methyldopahttp://en.wikipedia.org/wiki/Guanfacinehttp://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Dihydropyridinehttp://en.wikipedia.org/wiki/Amlodipinehttp://en.wikipedia.org/wiki/Felodipinehttp://en.wikipedia.org/wiki/Isradipinehttp://en.wikipedia.org/wiki/Lercanidipinehttp://en.wikipedia.org/wiki/Nicardipinehttp://en.wikipedia.org/wiki/Nifedipinehttp://en.wikipedia.org/w/index.php?title=Bucindolol&action=edit&redlink=1http://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Beta_blockerhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-betablockers-8http://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-atenolol-9http://en.wikipedia.org/wiki/Antihypertensive#cite_note-bbmi-10http://en.wikipedia.org/wiki/Antihypertensive#cite_note-11http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellencehttp://en.wikipedia.org/wiki/Type_2_diabeteshttp://en.wikipedia.org/wiki/Type_2_diabeteshttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-12http://en.wikipedia.org/wiki/Alpha_blockerhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-alpha-13http://en.wikipedia.org/wiki/Benign_prostatic_hyperplasiahttp://en.wikipedia.org/wiki/Benign_prostatic_hyperplasiahttp://en.wikipedia.org/w/index.php?title=Alpha-2_agonist&action=edit&redlink=1http://en.wikipedia.org/wiki/Clonidinehttp://en.wikipedia.org/wiki/Methyldopahttp://en.wikipedia.org/wiki/Guanfacinehttp://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Dihydropyridinehttp://en.wikipedia.org/wiki/Amlodipinehttp://en.wikipedia.org/wiki/Felodipinehttp://en.wikipedia.org/wiki/Isradipinehttp://en.wikipedia.org/wiki/Lercanidipinehttp://en.wikipedia.org/wiki/Nicardipinehttp://en.wikipedia.org/wiki/Nifedipine


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o nimodipine

o nitrendipine

• non6dihydropyridines?

o diltia*em

o verapamil

ACE inhibitors

+aptopril, the prototypical A+ inhibitor

A+ inhibitors inhibit the activity of Angiotensin6converting en*yme (A+), anen*yme responsible for the conversion of angiotensin into angiotensin , apotent vasoconstrictor.

• captopril• enalapril

• fosinopril

• lisinopril

• perindopril

• 3uinapril

• ramipril

• trandolapril

• bena*epril

Angiotensin II receptor antagonists

http://en.wikipedia.org/wiki/Nimodipinehttp://en.wikipedia.org/wiki/Nitrendipinehttp://en.wikipedia.org/wiki/Diltiazemhttp://en.wikipedia.org/wiki/Verapamilhttp://en.wikipedia.org/wiki/Captoprilhttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Angiotensin-converting_enzymehttp://en.wikipedia.org/wiki/Angiotensinhttp://en.wikipedia.org/wiki/Vasoconstrictorhttp://en.wikipedia.org/wiki/Captoprilhttp://en.wikipedia.org/wiki/Enalaprilhttp://en.wikipedia.org/wiki/Fosinoprilhttp://en.wikipedia.org/wiki/Lisinoprilhttp://en.wikipedia.org/wiki/Perindoprilhttp://en.wikipedia.org/wiki/Quinaprilhttp://en.wikipedia.org/wiki/Ramiprilhttp://en.wikipedia.org/wiki/Trandolaprilhttp://en.wikipedia.org/wiki/Benazeprilhttp://en.wikipedia.org/wiki/File:Captopril_skeletal.svghttp://en.wikipedia.org/wiki/File:Captopril_skeletal.svghttp://en.wikipedia.org/wiki/Nimodipinehttp://en.wikipedia.org/wiki/Nitrendipinehttp://en.wikipedia.org/wiki/Diltiazemhttp://en.wikipedia.org/wiki/Verapamilhttp://en.wikipedia.org/wiki/Captoprilhttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Angiotensin-converting_enzymehttp://en.wikipedia.org/wiki/Angiotensinhttp://en.wikipedia.org/wiki/Vasoconstrictorhttp://en.wikipedia.org/wiki/Captoprilhttp://en.wikipedia.org/wiki/Enalaprilhttp://en.wikipedia.org/wiki/Fosinoprilhttp://en.wikipedia.org/wiki/Lisinoprilhttp://en.wikipedia.org/wiki/Perindoprilhttp://en.wikipedia.org/wiki/Quinaprilhttp://en.wikipedia.org/wiki/Ramiprilhttp://en.wikipedia.org/wiki/Trandolaprilhttp://en.wikipedia.org/wiki/Benazepril


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;alsartan, an angiotensin receptor antagonist

Angiotensin receptor antagonists 'ork by antagoni*ing the activation ofangiotensin receptors.

• candesartan• eprosartan

•

irbesartan• losartan

• olmesartan

• telmisartan

• valsartan

Aldosterone antagonists

Aldosterone receptor antagonists?

• eplerenone• spironolactone

Aldosterone antagonists are not recommended as rst6line agents for bloodpressure,[!] but spironolactone and eplerenone are both used in thetreatment of heart failure.

Vasodilators

;asodilators act directly on the smooth muscle of arteries to rela2 their 'allsso blood can move more easily through them they are only used inhypertensive emergencies or 'hen other drugs have failed, and even so arerarely given alone.

Dodium nitroprusside, a very potent, short6acting vasodilator, is mostcommonly used for the 3uick, temporary reduction of blood pressure inemergencies (such as malignant hypertension or aortic dissection).[1!][18]

http://en.wikipedia.org/wiki/Valsartanhttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/Angiotensin_receptorhttp://en.wikipedia.org/wiki/Candesartanhttp://en.wikipedia.org/wiki/Eprosartanhttp://en.wikipedia.org/wiki/Irbesartanhttp://en.wikipedia.org/wiki/Losartanhttp://en.wikipedia.org/wiki/Olmesartanhttp://en.wikipedia.org/wiki/Telmisartanhttp://en.wikipedia.org/wiki/Valsartanhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Eplerenonehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-jnc7-4http://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Eplerenonehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Hypertensive_emergencyhttp://en.wikipedia.org/wiki/Sodium_nitroprussidehttp://en.wikipedia.org/wiki/Malignant_hypertensionhttp://en.wikipedia.org/wiki/Aortic_dissectionhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-Brunton-14http://en.wikipedia.org/wiki/Antihypertensive#cite_note-Varon-15http://en.wikipedia.org/wiki/File:Valsartan.svghttp://en.wikipedia.org/wiki/File:Valsartan.svghttp://en.wikipedia.org/wiki/Valsartanhttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/Angiotensin_receptorhttp://en.wikipedia.org/wiki/Candesartanhttp://en.wikipedia.org/wiki/Eprosartanhttp://en.wikipedia.org/wiki/Irbesartanhttp://en.wikipedia.org/wiki/Losartanhttp://en.wikipedia.org/wiki/Olmesartanhttp://en.wikipedia.org/wiki/Telmisartanhttp://en.wikipedia.org/wiki/Valsartanhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Eplerenonehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-jnc7-4http://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Eplerenonehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Hypertensive_emergencyhttp://en.wikipedia.org/wiki/Sodium_nitroprussidehttp://en.wikipedia.org/wiki/Malignant_hypertensionhttp://en.wikipedia.org/wiki/Aortic_dissectionhttp://en.wikipedia.org/wiki/Antihypertensive#cite_note-Brunton-14http://en.wikipedia.org/wiki/Antihypertensive#cite_note-Varon-15


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"ydrala*ine and its derivatives are also used in the treatment of severehypertension, although they should be avoided in emergencies.[18] They areno longer indicated as rst6line therapy for high blood pressure due to sideeects and safety concerns, but hydrala*ine remains a drug of choice ingestational hypertension.[1!]

Centrally acting adrenergic drugs

+entral alpha agonists lo'er blood pressure by stimulating alpha6receptors inthe brain 'hich open peripheral arteries easing blood @o'. +entral alphaagonists, such as clonidine, are usually prescribed 'hen all other anti6hypertensive medications have failed.


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The choice bet'een the drugs is to a large degree determined by thecharacteristics of the patient being prescribed for, the drugs= side6eects,and cost.


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o 1.$ +alcium6sparing diuretics

o 1.! Bsmotic diuretics

o 1.8 >o' ceiling diuretics

• & Cses

• # Gechanism of action

• $ Adverse eects

Types

igh ceiling loop diuretics

"igh ceiling diuretics are diuretics that may cause a substantial diuresis P upto &4%[1] of the ltered load of Fa+l and 'ater. This is huge 'hen comparedto normal renal sodium reabsorption 'hich leaves only Q4.$% of lteredsodium in the urine.

>oop diuretics have this ability, and are therefore often synonymous 'ithhigh ceiling diuretics. >oop diuretics, such as furosemide, inhibit the body=sability to reabsorb sodium at the ascending loop in the kidney 'hich leads toa retention of 'ater in the urine as 'ater normally follo's sodium back intothe e2tracellular @uid (+


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• Aldosterone antagonists? Dpironolactone, 'hich is a competitiveantagonist of aldosterone. Aldosterone normally adds sodium channelsin the principal cells of the collecting duct and late distal tubule of thenephron. Dpironolactone prevents aldosterone from entering theprincipal cells, preventing sodium reabsorption. A similar agent is

potassium canreonate.

• pithelial sodium channel blockers? amiloride and triamterene.

Calcium#sparing diuretics

The term Jcalcium6sparing diureticJ is sometimes used to identify agents thatresult in a relatively lo' rate of e2cretion of calcium.[&]

The reduced concentration of calcium in the urine can lead to an increasedrate of calcium in serum. The sparing eect on calcium can be benecial in

hypocalcemia, or un'anted in hypercalcemia.

The thia*ides and potassium6sparing diuretics are considered to be calcium6sparing diuretics.[#]

• The thia*ides cause a net decrease in calcium lost in urine.[$]

• The potassium6sparing diuretics cause a net increase in calcium lost inurine, but the increase is much smaller than the increase associated'ith other diuretic classes.[$]

y contrast, loop diuretics promote a signicant increase calcium e2cretion. [!]

This can increase risk of reduced bone density.[8]

$smotic diuretics

+ompounds such as mannitol are ltered in the glomerulus, but cannot bereabsorbed. Their presence leads to an increase in the osmolarity of theltrate. To maintain osmotic balance, 'ater is retained in the urine.

Klucose, like mannitol, is a sugar that can behave as an osmotic diuretic.Cnlike mannitol, glucose is commonly found in the blood. "o'ever, in certainconditions such as diabetes mellitus, the concentration of glucose in the

blood e2ceeds the ma2imum reabsorption capacity of the kidney. /hen thishappens, glucose remains in the ltrate, leading to the osmotic retention of'ater in the urine. Cse of some drugs, especially stimulants may alsoincrease blood glucose and thus increase urination.

%o& ceiling diuretics

http://en.wikipedia.org/wiki/Aldosterone_antagonisthttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Competitive_antagonisthttp://en.wikipedia.org/wiki/Competitive_antagonisthttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Potassium_canreonatehttp://en.wikipedia.org/wiki/Epithelial_sodium_channel_blockerhttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Diuretic#cite_note-pmid7794709-1http://en.wikipedia.org/wiki/Hypocalcemiahttp://en.wikipedia.org/wiki/Hypercalcemiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-pmid15165661-2http://en.wikipedia.org/wiki/Diuretic#cite_note-isbn0-7817-4118-1-3http://en.wikipedia.org/wiki/Diuretic#cite_note-isbn0-7817-4118-1-3http://en.wikipedia.org/wiki/Diuretic#cite_note-pmid12492451-4http://en.wikipedia.org/wiki/Diuretic#cite_note-pmid16355285-5http://en.wikipedia.org/wiki/Mannitolhttp://en.wikipedia.org/wiki/Glomerulushttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Drughttp://en.wikipedia.org/wiki/Stimulanthttp://en.wikipedia.org/wiki/Aldosterone_antagonisthttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Competitive_antagonisthttp://en.wikipedia.org/wiki/Competitive_antagonisthttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Potassium_canreonatehttp://en.wikipedia.org/wiki/Epithelial_sodium_channel_blockerhttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Diuretic#cite_note-pmid7794709-1http://en.wikipedia.org/wiki/Hypocalcemiahttp://en.wikipedia.org/wiki/Hypercalcemiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-pmid15165661-2http://en.wikipedia.org/wiki/Diuretic#cite_note-isbn0-7817-4118-1-3http://en.wikipedia.org/wiki/Diuretic#cite_note-isbn0-7817-4118-1-3http://en.wikipedia.org/wiki/Diuretic#cite_note-pmid12492451-4http://en.wikipedia.org/wiki/Diuretic#cite_note-pmid16355285-5http://en.wikipedia.org/wiki/Mannitolhttp://en.wikipedia.org/wiki/Glomerulushttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Drughttp://en.wikipedia.org/wiki/Stimulant


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The term Jlo' ceiling diureticJ is used to indicate that a diuretic has a rapidly@attening dose eect curve (in contrast to Jhigh ceilingJ, 'here therelationship is close to linear). t refers to a pharmacological prole, not achemical structure. "o'ever, there are certain classes of diuretic 'hichusually fall into this category, such as the thia*ides.[9]

'ses

n medicine, diuretics are used to treat heart failure, liver cirrhosis,hypertension and certain kidney diseases. Dome diuretics, such asaceta*olamide, help to make the urine more alkaline and are helpful inincreasing e2cretion of substances such as aspirin in cases of overdose orpoisoning. 7iuretics are often abused by suerers of eating disorders,

especially bulimics, in attempts at 'eight loss.

The antihypertensive actions of some diuretics (thia*ides and loop diuretics in particular) are independent of their diuretic eect. That is, the reduction inblood pressure is not due to decreased blood volume resulting fromincreased urine production, but occurs through other mechanisms and atlo'er doses than that re3uired to produce diuresis. ndapamide 'asspecically designed 'ith this in mind, and has a larger therapeutic 'indo'for hypertension ('ithout pronounced diuresis) than most other diuretics.

(echanism o) action

+lassication of common diuretics and their mechanisms of action?

E*amples (echanism

%ocation+numberedin distance

alongnephron,

# thanol, /ater

inhibits

vasopressin secretion

1.

Acidi)ying salts +a+l&, F"$+l 1.

Arginine vasopressinreceptor - antagonists

amphotericin ,lithium citrate

inhibitvasopressin=saction

!. collectingduct

http://en.wikipedia.org/wiki/Dose-response_relationshiphttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-isbn0-8493-7774-9-6http://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Liver_cirrhosishttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Kidney_diseasehttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Alkalinehttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Drug_overdosehttp://en.wikipedia.org/wiki/Eating_disorderhttp://en.wikipedia.org/wiki/Bulimichttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Indapamidehttp://en.wikipedia.org/wiki/Ethanolhttp://en.wikipedia.org/wiki/Waterhttp://en.wikipedia.org/wiki/Vasopressinhttp://en.wikipedia.org/wiki/Salthttp://en.wikipedia.org/wiki/Arginine_vasopressin_receptor_2http://en.wikipedia.org/wiki/Arginine_vasopressin_receptor_2http://en.wikipedia.org/wiki/Amphotericin_Bhttp://en.wikipedia.org/wiki/Lithium_citratehttp://en.wikipedia.org/wiki/Collecting_ducthttp://en.wikipedia.org/wiki/Collecting_ducthttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Dose-response_relationshiphttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-isbn0-8493-7774-9-6http://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Liver_cirrhosishttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Kidney_diseasehttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Alkalinehttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Drug_overdosehttp://en.wikipedia.org/wiki/Eating_disorderhttp://en.wikipedia.org/wiki/Bulimichttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Indapamidehttp://en.wikipedia.org/wiki/Ethanolhttp://en.wikipedia.org/wiki/Waterhttp://en.wikipedia.org/wiki/Vasopressinhttp://en.wikipedia.org/wiki/Salthttp://en.wikipedia.org/wiki/Arginine_vasopressin_receptor_2http://en.wikipedia.org/wiki/Arginine_vasopressin_receptor_2http://en.wikipedia.org/wiki/Amphotericin_Bhttp://en.wikipedia.org/wiki/Lithium_citratehttp://en.wikipedia.org/wiki/Collecting_ducthttp://en.wikipedia.org/wiki/Collecting_duct


13/32

A.uaretics Koldenrod, Euniperncreases blood@o' in kidneys

1.

/a#e*changer antagonists

dopamine[:]promote FaH e2cretion

&. pro2imaltubule[:]

Carbonic anhydrase inhibitors

aceta*olamide[:],dor*olamide

inhibit "H secretion,resultantpromotion of FaH and I H e2cretion

&? pro2imaltubule

%oop diuretics

bumetanide[:],ethacrynic acid[:],furosemide[:],torsemide

inhibit the Fa6I6&+l symporter

#. medullarythickascendinglimb

$smotic diureticsglucose (especiallyin uncontrolleddiabetes), mannitol

promote osmoticdiuresis

&. pro2imaltubule,descendinglimb

"otassium#sparingdiuretics

amiloride,spironolactone,triamterene,potassiumcanrenoate.

inhibition ofFaHRIHe2changer?Dpironolactoneinhibitsaldosterone action, Amiloride

inhibits epithelialsodium channels[:]

!. corticalcollectingducts

Thia!idesbendro@umethia*ide,hydrochlorothia*ide

inhibitreabsorption byFaH R+l 6 symporter

$. distalconvolutedtubules

0anthinescaeine,theophylline

inhibitreabsorption ofFaH, increaseglomerularltration rate

1. tubules

+hemically, diuretics are a diverse group of compounds that either stimulateor inhibit various hormones that naturally occur in the body to regulate urineproduction by the kidneys. "erbal medications are not inherently diuretics. They are more correctly called a3uaretics.

Adverse e1ects

http://en.wikipedia.org/wiki/Aquareticshttp://en.wikipedia.org/wiki/Goldenrodhttp://en.wikipedia.org/wiki/Juniperhttp://en.wikipedia.org/wiki/Na-H_exchangerhttp://en.wikipedia.org/wiki/Na-H_exchangerhttp://en.wikipedia.org/wiki/Dopaminehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Carbonic_anhydrase_inhibitorshttp://en.wikipedia.org/wiki/Carbonic_anhydrase_inhibitorshttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Dorzolamidehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Bumetanidehttp://en.wikipedia.org/wiki/Bumetanidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Ethacrynic_acidhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Torsemidehttp://en.wikipedia.org/wiki/Na-K-2Cl_symporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_symporterhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Osmotic_diuretichttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Mannitolhttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Descending_limb_of_loop_of_Henlehttp://en.wikipedia.org/wiki/Descending_limb_of_loop_of_Henlehttp://en.wikipedia.org/wiki/Potassium-sparing_diuretichttp://en.wikipedia.org/wiki/Potassium-sparing_diuretichttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Potassium_canrenoatehttp://en.wikipedia.org/wiki/Potassium_canrenoatehttp://en.wikipedia.org/wiki/Na%2B/K%2B-ATPasehttp://en.wikipedia.org/wiki/Na%2B/K%2B-ATPasehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Epithelial_sodium_channelhttp://en.wikipedia.org/wiki/Epithelial_sodium_channelhttp://en.wikipedia.org/wiki/Epithelial_sodium_channelhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Cortical_collecting_ductshttp://en.wikipedia.org/wiki/Cortical_collecting_ductshttp://en.wikipedia.org/wiki/Cortical_collecting_ductshttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Bendroflumethiazidehttp://en.wikipedia.org/wiki/Bendroflumethiazidehttp://en.wikipedia.org/wiki/Hydrochlorothiazidehttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Distal_convoluted_tubuleshttp://en.wikipedia.org/wiki/Distal_convoluted_tubuleshttp://en.wikipedia.org/wiki/Distal_convoluted_tubuleshttp://en.wikipedia.org/wiki/Xanthinehttp://en.wikipedia.org/wiki/Caffeinehttp://en.wikipedia.org/wiki/Theophyllinehttp://en.wikipedia.org/wiki/Glomerular_filtration_ratehttp://en.wikipedia.org/wiki/Glomerular_filtration_ratehttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Herbshttp://en.wikipedia.org/wiki/Aquareticshttp://en.wikipedia.org/wiki/Aquareticshttp://en.wikipedia.org/wiki/Goldenrodhttp://en.wikipedia.org/wiki/Juniperhttp://en.wikipedia.org/wiki/Na-H_exchangerhttp://en.wikipedia.org/wiki/Na-H_exchangerhttp://en.wikipedia.org/wiki/Dopaminehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Carbonic_anhydrase_inhibitorshttp://en.wikipedia.org/wiki/Carbonic_anhydrase_inhibitorshttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Dorzolamidehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Bumetanidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Ethacrynic_acidhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Torsemidehttp://en.wikipedia.org/wiki/Na-K-2Cl_symporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_symporterhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Thick_ascending_limbhttp://en.wikipedia.org/wiki/Osmotic_diuretichttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Mannitolhttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Descending_limb_of_loop_of_Henlehttp://en.wikipedia.org/wiki/Descending_limb_of_loop_of_Henlehttp://en.wikipedia.org/wiki/Potassium-sparing_diuretichttp://en.wikipedia.org/wiki/Potassium-sparing_diuretichttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Potassium_canrenoatehttp://en.wikipedia.org/wiki/Potassium_canrenoatehttp://en.wikipedia.org/wiki/Na%2B/K%2B-ATPasehttp://en.wikipedia.org/wiki/Na%2B/K%2B-ATPasehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Epithelial_sodium_channelhttp://en.wikipedia.org/wiki/Epithelial_sodium_channelhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Cortical_collecting_ductshttp://en.wikipedia.org/wiki/Cortical_collecting_ductshttp://en.wikipedia.org/wiki/Cortical_collecting_ductshttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Bendroflumethiazidehttp://en.wikipedia.org/wiki/Bendroflumethiazidehttp://en.wikipedia.org/wiki/Hydrochlorothiazidehttp://en.wikipedia.org/wiki/Sodium-chloride_symporterhttp://en.wikipedia.org/wiki/Distal_convoluted_tubuleshttp://en.wikipedia.org/wiki/Distal_convoluted_tubuleshttp://en.wikipedia.org/wiki/Distal_convoluted_tubuleshttp://en.wikipedia.org/wiki/Xanthinehttp://en.wikipedia.org/wiki/Caffeinehttp://en.wikipedia.org/wiki/Theophyllinehttp://en.wikipedia.org/wiki/Glomerular_filtration_ratehttp://en.wikipedia.org/wiki/Glomerular_filtration_ratehttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Herbshttp://en.wikipedia.org/wiki/Aquaretics


14/32

The main adverse eects of diuretics are hypovolemia, hypokalemia,hyperkalemia, hyponatremia, metabolic alkalosis, metabolic acidosis andhyperuricemia [:]. ach are at risk of certain types of diuretics and present'ith dierent symptoms.

Adversee1ect Diuretics Symptoms

"ypovolemia• loop diuretics[:]

• thia*ides[:]

• lassitude[:]

• thirst[:]

• muscle cramps[:]

• hypotension[:]

hypokalemia

• aceta*olamides[:]

• loop diuretics[:]

• thia*ides[:]

• muscle 'eakness[:]

• paralysis[:]

• arrhythmia[:]

"yperkalemia

• amilorides[:]

• triamterenes[:]

• spironolactone[:]

• arrhythmia[:]

• muscle cramps[:]

• paralysis[:]

hyponatremia• thia*ides[:]

• furosemides[:]

• +FD symptoms[:]

o coma[:]

metabolicalkalosis

• loop diuretics[:]

• thia*ides[:]

• arrhythmia[:]

• +FD symptoms[:]

metabolicacidosis

• aceta*olamides[:]

• amilorides[:]

• triamterene[:]

• Iussmaul respirations[:]

• muscle 'eakness

• neurologicalsymptoms[:]

o lethargy

o

comao sei*ures

o stupor

hypercalcemia • thia*ides[:] • gout

• tissue calcication[:]

http://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypokalemiahttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Hyponatremiahttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Hyperuricemiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Adverse_effecthttp://en.wikipedia.org/wiki/Adverse_effecthttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Lassitudehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thirsthttp://en.wikipedia.org/wiki/Thirsthttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_crampshttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hypotensionhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hypokalemiahttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Paralysishttp://en.wikipedia.org/wiki/Paralysishttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_cramphttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Paralysishttp://en.wikipedia.org/wiki/Paralysishttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hyponatremiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/w/index.php?title=CNS_symptoms&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=CNS_symptoms&action=edit&redlink=1http://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/w/index.php?title=CNS_symptom&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=CNS_symptom&action=edit&redlink=1http://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Kussmaul_respirationshttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/w/index.php?title=Neurological_symptoms&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Neurological_symptoms&action=edit&redlink=1http://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Seizureshttp://en.wikipedia.org/wiki/Stuporhttp://en.wikipedia.org/wiki/Hypercalcemiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Calcificationhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Hypokalemiahttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Hyponatremiahttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Hyperuricemiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Adverse_effecthttp://en.wikipedia.org/wiki/Adverse_effecthttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Lassitudehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thirsthttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_crampshttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hypotensionhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hypokalemiahttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Paralysishttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Spironolactonehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_cramphttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Paralysishttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Hyponatremiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/w/index.php?title=CNS_symptoms&action=edit&redlink=1http://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Metabolic_alkalosishttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/w/index.php?title=CNS_symptom&action=edit&redlink=1http://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Acetazolamidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Amiloridehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Triamterenehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Kussmaul_respirationshttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/w/index.php?title=Neurological_symptoms&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Neurological_symptoms&action=edit&redlink=1http://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Seizureshttp://en.wikipedia.org/wiki/Stuporhttp://en.wikipedia.org/wiki/Hypercalcemiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Calcificationhttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7


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• fatigue

• depression

• confusion

• anore2ia

• nausea

• vomiting

• constipation

• pancreatitis

• increased urination

hyperuricemia

• thia*ides[:]

• loop diuretics[:]• gout[:]

See also

• antidiuretic

Beta blocker

Dkeletal formula of propranolol, the rst clinically successful beta blocker

Beta blockers (sometimes 'ritten as 2#blocker) is a class of drugs used forvarious indications, but particularly for the management of cardiac

arrhythmias, cardioprotection after myocardial infarction (heart attack), andhypertension. ropranolol 'as the rst clinically useful beta adrenergic receptor antagonist. nvented by Dir Eames /. lack, it revolutioni*ed themedical management of angina pectoris and is considered to be one of themost important contributions to clinical medicine and pharmacology of the&4th century.[1] eta blockers may also be referred to as beta#adrenergicblocking agents, beta#adrenergic antagonists, or beta antagonists.

http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Confusionhttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Constipationhttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Increased_urinationhttp://en.wikipedia.org/wiki/Hyperuricemiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Antidiuretichttp://en.wikipedia.org/wiki/Skeletal_formulahttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Beta_receptorhttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/James_W._Blackhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-propranolol-0http://en.wikipedia.org/wiki/File:Propranolol-2D-skeletal.pnghttp://en.wikipedia.org/wiki/File:Propranolol-2D-skeletal.pnghttp://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Confusionhttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Constipationhttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Increased_urinationhttp://en.wikipedia.org/wiki/Hyperuricemiahttp://en.wikipedia.org/wiki/Thiazidehttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Loop_diuretichttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Gouthttp://en.wikipedia.org/wiki/Diuretic#cite_note-boron875-7http://en.wikipedia.org/wiki/Antidiuretichttp://en.wikipedia.org/wiki/Skeletal_formulahttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Beta_receptorhttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/James_W._Blackhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-propranolol-0


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Contents

• 1 harmacology o 1.1 S6-eceptor antagonism

o 1.& ntrinsic sympathomimetic activity

o 1.# 16-eceptor antagonism

o 1.$ Bther eects

• & +linical use

o &.1 +ongestive heart failure

o &.& An2iety and performance enhancement

• # Adverse eects

• $ To2icity

• ! 2amples of beta blockers

o !.1 Fon6selective agents

o !.& S16Delective agents

o !.# S&6Delective agents

• 8 Adverse eects

• 9 +omparative information

o 9.1 harmacological dierences

o 9.& ndication dierences

"harmacology

There are three kno'n types of beta receptor, designated S1, S& and S#. S16Adrenergic receptors are located mainly in the heart and in the kidneys. S &6Adrenergic receptors are located mainly in the lungs, gastrointestinal tract,liver, uterus, vascular smooth muscle, and skeletal muscle. S#6receptors arelocated in fat cells.

2amples of beta6blockers include? acebutolol, bisoprolol, esmolol,propranolol, atenolol, labetalol, carvedilol, metoprolol, and nebivolol.

http://en.wikipedia.org/wiki/Beta_blocker#Pharmacologyhttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B2-Receptor_antagonismhttp://en.wikipedia.org/wiki/Beta_blocker#Intrinsic_sympathomimetic_activityhttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B11-Receptor_antagonismhttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B11-Receptor_antagonismhttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B11-Receptor_antagonismhttp://en.wikipedia.org/wiki/Beta_blocker#Other_effectshttp://en.wikipedia.org/wiki/Beta_blocker#Clinical_usehttp://en.wikipedia.org/wiki/Beta_blocker#Congestive_heart_failurehttp://en.wikipedia.org/wiki/Beta_blocker#Anxiety_and_performance_enhancementhttp://en.wikipedia.org/wiki/Beta_blocker#Adverse_effectshttp://en.wikipedia.org/wiki/Beta_blocker#Toxicityhttp://en.wikipedia.org/wiki/Beta_blocker#Examples_of_beta_blockershttp://en.wikipedia.org/wiki/Beta_blocker#Non-selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B21-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B21-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B21-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B22-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B22-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B22-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#Adverse_effects_2http://en.wikipedia.org/wiki/Beta_blocker#Comparative_informationhttp://en.wikipedia.org/wiki/Beta_blocker#Pharmacological_differenceshttp://en.wikipedia.org/wiki/Beta_blocker#Indication_differenceshttp://en.wikipedia.org/wiki/Acebutololhttp://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Esmololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nebivololhttp://en.wikipedia.org/wiki/Beta_blocker#Pharmacologyhttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B2-Receptor_antagonismhttp://en.wikipedia.org/wiki/Beta_blocker#Intrinsic_sympathomimetic_activityhttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B11-Receptor_antagonismhttp://en.wikipedia.org/wiki/Beta_blocker#Other_effectshttp://en.wikipedia.org/wiki/Beta_blocker#Clinical_usehttp://en.wikipedia.org/wiki/Beta_blocker#Congestive_heart_failurehttp://en.wikipedia.org/wiki/Beta_blocker#Anxiety_and_performance_enhancementhttp://en.wikipedia.org/wiki/Beta_blocker#Adverse_effectshttp://en.wikipedia.org/wiki/Beta_blocker#Toxicityhttp://en.wikipedia.org/wiki/Beta_blocker#Examples_of_beta_blockershttp://en.wikipedia.org/wiki/Beta_blocker#Non-selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B21-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#.CE.B22-Selective_agentshttp://en.wikipedia.org/wiki/Beta_blocker#Adverse_effects_2http://en.wikipedia.org/wiki/Beta_blocker#Comparative_informationhttp://en.wikipedia.org/wiki/Beta_blocker#Pharmacological_differenceshttp://en.wikipedia.org/wiki/Beta_blocker#Indication_differenceshttp://en.wikipedia.org/wiki/Acebutololhttp://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Esmololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nebivolol


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2#3eceptor antagonism

Dtimulation of S1 receptors by epinephrine induces a positive chronotropic and inotropic eect on the heart and increases cardiac conduction velocityand automaticity. Dtimulation of S1 receptors on the kidney causes renin

release. Dtimulation of S& receptors induces smooth muscle rela2ation,induces tremor in skeletal muscle, and increases glycogenolysis in the liver and skeletal muscle. Dtimulation of S# receptors induces lipolysis.

eta blockers inhibit these normal epinephrine6mediated sympathetic actions, but have minimal eect on resting sub0ects. That is, they reduce theeect of e2citementRphysical e2ertion on heart rate and force of contraction,dilation of blood vessels and opening of bronchi, and also reduce tremor andbreakdo'n of glycogen.

t is therefore e2pected that non6selective beta blockers have an

antihypertensive eect. The antihypertensive mechanism appears to involvereduction in cardiac output (due to negative chronotropic and inotropiceects), reduction in renin release from the kidneys, and a central nervoussystem eect to reduce sympathetic activity (for those S6blockers that docross the blood6brain barrier, e.g. ropranolol).

Antianginal eects result from negative chronotropic and inotropic eects,'hich decrease cardiac 'orkload and o2ygen demand. Fegative chronotropicproperties of beta blockers allo' the lifesaving property of heart rate control.eta blockers are readily titrated to optimal rate control in many pathologicstates.

The antiarrhythmic eects of beta blockers arise from sympathetic nervoussystem blockade P resulting in depression of sinus node function andatrioventricular node conduction, and prolonged atrial refractory periods.Dotalol, in particular, has additional antiarrhythmic properties and prolongsaction potential duration through potassium channel blockade.

lockade of the sympathetic nervous system on renin release leads toreduced aldosterone via the renin angiotensin aldosterone system 'ith aresultant decrease in blood pressure due to decreased sodium and 'aterretention.

Intrinsic sympathomimetic activity

Also referred to as intrinsic sympathomimetic eect, this term is usedparticularly 'ith beta blockers that can sho' both agonism and antagonismat a given beta receptor, depending on the concentration of the agent (betablocker) and the concentration of the antagoni*ed agent (usually an

http://en.wikipedia.org/wiki/Epinephrinehttp://en.wikipedia.org/wiki/Chronotropichttp://en.wikipedia.org/wiki/Inotropichttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Glycogenolysishttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Lipolysishttp://en.wikipedia.org/wiki/Sympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Glycogenhttp://en.wikipedia.org/wiki/Antihypertensivehttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Sympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Chronotropichttp://en.wikipedia.org/wiki/Inotropichttp://en.wikipedia.org/wiki/Chronotropichttp://en.wikipedia.org/wiki/Sinus_nodehttp://en.wikipedia.org/wiki/Atrioventricular_nodehttp://en.wikipedia.org/wiki/Atrium_(anatomy)http://en.wikipedia.org/wiki/Refractory_period_(cardiac)http://en.wikipedia.org/wiki/Sotalolhttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Potassium_channelhttp://en.wikipedia.org/wiki/Renin-angiotensin_systemhttp://en.wikipedia.org/wiki/Epinephrinehttp://en.wikipedia.org/wiki/Chronotropichttp://en.wikipedia.org/wiki/Inotropichttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Glycogenolysishttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Lipolysishttp://en.wikipedia.org/wiki/Sympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Glycogenhttp://en.wikipedia.org/wiki/Antihypertensivehttp://en.wikipedia.org/wiki/Reninhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Sympathetic_nervous_systemhttp://en.wikipedia.org/wiki/Chronotropichttp://en.wikipedia.org/wiki/Inotropichttp://en.wikipedia.org/wiki/Chronotropichttp://en.wikipedia.org/wiki/Sinus_nodehttp://en.wikipedia.org/wiki/Atrioventricular_nodehttp://en.wikipedia.org/wiki/Atrium_(anatomy)http://en.wikipedia.org/wiki/Refractory_period_(cardiac)http://en.wikipedia.org/wiki/Sotalolhttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Potassium_channelhttp://en.wikipedia.org/wiki/Renin-angiotensin_system


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endogenous compound such as norepinephrine). Dee partial agonist for amore general description.

Dome beta blockers (e.g. o2prenolol, pindolol, penbutolol and acebutolol)e2hibit intrinsic sympathomimetic activity (DA). These agents are capable of

e2erting lo' level agonist activity at the S6adrenergic receptor 'hilesimultaneously acting as a receptor site antagonist. These agents, therefore,may be useful in individuals e2hibiting e2cessive bradycardia 'ith sustainedbeta blocker therapy.

Agents 'ith DA are not used in post6myocardial infarction as they have notbeen demonstrated to be benecial. They may also be less eective thanother beta blockers in the management of angina and tachyarrhythmia.[&]

45#3eceptor antagonism

Dome beta blockers (e.g. labetalol and carvedilol) e2hibit mi2ed antagonismof both S6 and 16adrenergic receptors, 'hich provides additional arteriolar vasodilating action.

$ther e1ects

eta blockers decrease nocturnal melatonin release, perhaps partlyaccounting for sleep disturbance caused by some agents.[#]

eta blockers protect against social an2iety? Jmprovement of physicalsymptoms has been demonstrated 'ith beta6blockers such as propranololho'ever, these eects are limited to the social an2iety e2perienced inperformance situations.J (e2ample? an ine2perienced symphony soloist) [$]

eta blockers can impair the rela2ation of bronchial muscle (mediated bybeta6&) and so should be avoided by asthmatics.t causes constipation.

They can also be used to treat glaucoma because they decrease intraocularpressure by lo'ering a3ueous humor secretion.[!]

Clinical use

>arge dierences e2ist in the pharmacology of agents 'ithin the class, thusnot all beta blockers are used for all indications listed belo'.

http://en.wikipedia.org/wiki/Norepinephrinehttp://en.wikipedia.org/wiki/Partial_agonisthttp://en.wikipedia.org/wiki/Oxprenololhttp://en.wikipedia.org/wiki/Pindololhttp://en.wikipedia.org/wiki/Penbutololhttp://en.wikipedia.org/wiki/Acebutololhttp://en.wikipedia.org/wiki/Receptor_agonisthttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Tachyarrhythmiahttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Rossi-1http://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Adrenergic_receptorhttp://en.wikipedia.org/wiki/Arteriolehttp://en.wikipedia.org/wiki/Melatoninhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid10335905-2http://en.wikipedia.org/wiki/Beta_blocker#cite_note-anxiety-3http://en.wikipedia.org/wiki/Intraocular_pressurehttp://en.wikipedia.org/wiki/Intraocular_pressurehttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pharmnemonics-4http://en.wikipedia.org/wiki/Norepinephrinehttp://en.wikipedia.org/wiki/Partial_agonisthttp://en.wikipedia.org/wiki/Oxprenololhttp://en.wikipedia.org/wiki/Pindololhttp://en.wikipedia.org/wiki/Penbutololhttp://en.wikipedia.org/wiki/Acebutololhttp://en.wikipedia.org/wiki/Receptor_agonisthttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/Bradycardiahttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Tachyarrhythmiahttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Rossi-1http://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Adrenergic_receptorhttp://en.wikipedia.org/wiki/Arteriolehttp://en.wikipedia.org/wiki/Melatoninhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid10335905-2http://en.wikipedia.org/wiki/Beta_blocker#cite_note-anxiety-3http://en.wikipedia.org/wiki/Intraocular_pressurehttp://en.wikipedia.org/wiki/Intraocular_pressurehttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pharmnemonics-4


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ndications for beta blockers include?

• "ypertension• Angina

• Gitral valve prolapse

• +ardiac arrhythmia

• Atrial brillation

• +ongestive heart failure

• Gyocardial infarction

• Klaucoma

• Gigraine prophyla2is

• Dymptomatic control (tachycardia, tremor) in an2iety andhyperthyroidism

• ssential tremor

• haeochromocytoma, in con0unction 'ith 6blocker

eta blockers have also been used in the follo'ing conditions?

• "ypertrophic obstructive cardiomyopathy• Acute dissecting aortic aneurysm

• Garfan syndrome (treatment 'ith propranolol slo's progression ofaortic dilation and its complications)

• revention of variceal bleeding in portal hypertension

• ossible mitigation of hyperhidrosis

• Docial an2iety disorder and other an2iety disorders

Congestive heart )ailure

Although beta blockers 'ere once contraindicated in congestive heart failure,as they have the potential to 'orsen the condition, studies in the late 1554ssho'ed their positive eects on morbidity and mortality in congestive heartfailure.[8] [9] [:] isoprolol, carvedilol and sustained6release metoprolol arespecically indicated as ad0uncts to standard A+ inhibitor and diuretic therapy in congestive heart failure.

http://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Mitral_valve_prolapsehttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Prophylaxishttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Tremorhttp://en.wikipedia.org/wiki/Anxietyhttp://en.wikipedia.org/wiki/Hyperthyroidismhttp://en.wikipedia.org/wiki/Essential_tremorhttp://en.wikipedia.org/wiki/Phaeochromocytomahttp://en.wikipedia.org/wiki/Alpha_blockerhttp://en.wikipedia.org/wiki/Cardiomyopathyhttp://en.wikipedia.org/wiki/Aortic_aneurysmhttp://en.wikipedia.org/wiki/Marfan_syndromehttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Hyperhidrosishttp://en.wikipedia.org/wiki/Social_anxiety_disorderhttp://en.wikipedia.org/wiki/Anxiety_disordershttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid10714728-5http://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid11835035-6http://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid12390947-7http://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Diuretichttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Mitral_valve_prolapsehttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Prophylaxishttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Tremorhttp://en.wikipedia.org/wiki/Anxietyhttp://en.wikipedia.org/wiki/Hyperthyroidismhttp://en.wikipedia.org/wiki/Essential_tremorhttp://en.wikipedia.org/wiki/Phaeochromocytomahttp://en.wikipedia.org/wiki/Alpha_blockerhttp://en.wikipedia.org/wiki/Cardiomyopathyhttp://en.wikipedia.org/wiki/Aortic_aneurysmhttp://en.wikipedia.org/wiki/Marfan_syndromehttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Hyperhidrosishttp://en.wikipedia.org/wiki/Social_anxiety_disorderhttp://en.wikipedia.org/wiki/Anxiety_disordershttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid10714728-5http://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid11835035-6http://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid12390947-7http://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/ACE_inhibitorhttp://en.wikipedia.org/wiki/Diuretic


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eta blockers are primarily kno'n for their reductive eect on heart rate,although this is not the only mechanism of action of importance incongestive heart failure. eta blockers, in addition to their sympatholytic 1activity in the heart, in@uence the reninRangiotensin system at the kidneys.eta blockers cause a decrease in renin secretion, 'hich in turn reduce the

heart o2ygen demand by lo'ering e2tracellular volume and increasing theo2ygen carrying capacity of blood. eta blockers sympatholytic activityreduce heart rate, thereby increasing the e0ection fraction of the heartdespite an initial reduction in e0ection fraction.

Trials have sho'n that beta blockers reduce the absolute risk of death by$.!% over a 1# month period. As 'ell as reducing the risk of mortality, thenumber of hospital visits and hospitali*ations 'ere also reduced in the trials.[5]

An*iety and per)ormance enhancement

Dome people, particularly musicians, use beta blockers to avoid stage fright and tremor during public performance and auditions. The physiologicalsymptoms of the ghtR@ight response associated 'ith performance an2iety and panic (pounding heart, coldRclammy hands, increased respiration,s'eating, etc.) are signicantly reduced, thus enabling an2ious individuals toconcentrate on the task at hand. BUcially, beta blockers are not approvedfor an2iolytic use by the C.D.


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metabolism. Gi2ed 1RS6antagonist therapy is also commonly associated 'ithorthostatic hypotension. +arvedilol therapy is commonly associated 'ithedema.[&]

+entral nervous system (+FD) adverse eects (hallucinations, insomnia,

nightmares, depression) are more common in agents 'ith greater lipidsolubility, 'hich are able to cross the blood6brain barrier into the +FD.Dimilarly, +FD adverse eects are less common in agents 'ith greatera3ueous solubility (listed belo').

Adverse effects associated 'ith S&6adrenergic receptor antagonist activity(bronchospasm, peripheral vasoconstriction, alteration of glucose and lipidmetabolism) are less common 'ith S16selective (often termedJcardioselectiveJ) agents, ho'ever receptor selectivity diminishes at higherdoses. eta blockade, especially of the beta61 receptor at the macula densainhibits renin release, thus decreasing the release of aldosterone. This causes

hyponatremia and hyperkalemia.

A &449 study revealed that diuretics and beta6blockers used for hypertensionincrease a patient=s risk of developing diabetes 'hile A+ inhibitors andAngiotensin receptor antagonists (Angiotensin -eceptor lockers) actuallydecrease the risk of diabetes.[1&] +linical guidelines in Kreat ritain, but not inthe Cnited Dtates, call for avoiding diuretics and beta6blockers as rst6linetreatment of hypertension due to the risk of diabetes.[1#]

eta blockers must not be used in the treatment of cocaine, amphetamine,or other alpha adrenergic stimulant overdose. The blockade of only beta

receptors increases hypertension, reduces coronary blood @o', leftventricular function, and cardiac output and tissue perfusion by means ofleaving the alpha adrenergic system stimulation unopposed. [1$] Theappropriate antihypertensive drugs to administer during hypertensive crisisresulting from stimulant abuse are vasodilators like nitroglycerin, diuretics like furosemide and alpha blockers like phentolamine. [1!]

To*icity

Klucagon has been used in the treatment of overdose.[18][19] Klucagon has apositive inotropic action on the heart and decreases renal vascularresistance. t is therefore useful in patients 'ith beta6blocker cardioto2icity+ardiac pacing should be reserved for patients unresponsive topharmacological therapy

http://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Orthostatic_hypotensionhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Rossi-1http://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Blood-brain_barrierhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Hyponatremiahttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/ACE_inhibitorshttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid17240286-11http://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid16809680-12http://en.wikipedia.org/wiki/Cocainehttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Stimulanthttp://en.wikipedia.org/wiki/Overdosehttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Ventricular_functionhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Toxicity.2CCocaine.3BeMedicine-13http://en.wikipedia.org/wiki/Antihypertensivehttp://en.wikipedia.org/wiki/Vasodilatorshttp://en.wikipedia.org/wiki/Nitroglycerinhttp://en.wikipedia.org/wiki/Diureticshttp://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Alpha_blockershttp://en.wikipedia.org/wiki/Phentolaminehttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Toxicity.2CAmphetamine.3BeMedicine-14http://en.wikipedia.org/wiki/Glucagonhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid2857542-15http://en.wikipedia.org/wiki/Beta_blocker#cite_note-urlToxicity.2C_Beta-blocker:_Treatment_.26_Medication_-_eMedicine_Emergency_Medicine-16http://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Orthostatic_hypotensionhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Rossi-1http://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Blood-brain_barrierhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Hyponatremiahttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/ACE_inhibitorshttp://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonisthttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid17240286-11http://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid16809680-12http://en.wikipedia.org/wiki/Cocainehttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Stimulanthttp://en.wikipedia.org/wiki/Overdosehttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Ventricular_functionhttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Toxicity.2CCocaine.3BeMedicine-13http://en.wikipedia.org/wiki/Antihypertensivehttp://en.wikipedia.org/wiki/Vasodilatorshttp://en.wikipedia.org/wiki/Nitroglycerinhttp://en.wikipedia.org/wiki/Diureticshttp://en.wikipedia.org/wiki/Furosemidehttp://en.wikipedia.org/wiki/Alpha_blockershttp://en.wikipedia.org/wiki/Phentolaminehttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Toxicity.2CAmphetamine.3BeMedicine-14http://en.wikipedia.org/wiki/Glucagonhttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-pmid2857542-15http://en.wikipedia.org/wiki/Beta_blocker#cite_note-urlToxicity.2C_Beta-blocker:_Treatment_.26_Medication_-_eMedicine_Emergency_Medicine-16


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E*amples o) beta blockers

7ichloroisoprenaline, the rst beta blocker.

/on#selective agents

• Alprenolol• ucindolol

• +arteolol

• +arvedilol (has additional 6blocking activity)

• >abetalol (has additional 6blocking activity)

• Fadolol

• enbutolol (has intrinsic sympathomimetic activity)

• indolol (has intrinsic sympathomimetic activity)

• ropranolol

• Timolol

25#Selective agents

• Acebutolol (has intrinsic sympathomimetic activity)• Atenolol

• eta2olol

• isoprolol

• +eliprolol

• smolol

• Getoprolol

• Febivolol

http://en.wikipedia.org/wiki/Alprenololhttp://en.wikipedia.org/w/index.php?title=Bucindolol&action=edit&redlink=1http://en.wikipedia.org/wiki/Carteololhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Nadololhttp://en.wikipedia.org/wiki/Penbutololhttp://en.wikipedia.org/wiki/Pindololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Acebutololhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Betaxololhttp://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Celiprololhttp://en.wikipedia.org/wiki/Esmololhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nebivololhttp://en.wikipedia.org/wiki/File:Dichloroisoprenaline.svghttp://en.wikipedia.org/wiki/File:Dichloroisoprenaline.svghttp://en.wikipedia.org/wiki/Alprenololhttp://en.wikipedia.org/w/index.php?title=Bucindolol&action=edit&redlink=1http://en.wikipedia.org/wiki/Carteololhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Labetalolhttp://en.wikipedia.org/wiki/Nadololhttp://en.wikipedia.org/wiki/Penbutololhttp://en.wikipedia.org/wiki/Pindololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Acebutololhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Betaxololhttp://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Celiprololhttp://en.wikipedia.org/wiki/Esmololhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nebivolol


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2-#Selective agents

• uta2amine ('eak 6adrenergic agonist activity) 6 Fo common clinicalutility, used in e2perimental situations.

Adverse e1ects

• >o' lood ressure• Dlo' "eart -ate

• mpaired +irculation

• >oss of Dleep

• "eart


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o Febivolol

Indication di1erences

• Agents specically indicated for cardiac arrhythmia

o smolol, sotalol, landiolol

• Agents specically indicated for congestive heart failure

o isoprolol, carvedilol, sustained6release metoprolol, nebivolol

• Agents specically indicated for glaucoma

o eta2olol, carteolol, levobunolol, metipranolol, timolol

• Agents specically indicated for myocardial infarction

o Atenolol, metoprolol, propranolol

• Agents specically indicated for migraine prophyla2is

o Timolol, propranolol

ropranolol is the only agent indicated for control of tremor, portalhypertension and esophageal variceal bleeding, and used in con0unction 'ith6blocker therapy in phaeochromocytoma.[&]

See Also

• Alpha blockers

Alpha blocker

4 blockers or +adrenergic, 4#antagonists are pharmacological agents that act as antagonists of adrenergic receptors (6adrenoceptors).[1]

Classi6cation

• 1 blockers or antagonists act at 16adrenoceptors• & blockers or antagonists 6 act at &6adrenoceptors

/hen the term Jalpha blockerJ is used 'ithout further 3ualication, itsometimes refers to 1 blockers, and sometimes refers to agents that act atboth types of receptors.[citation needed]

Fon6selective 6adrenergic blockers include?

http://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Esmololhttp://en.wikipedia.org/wiki/Sotalolhttp://en.wikipedia.org/wiki/Landiololhttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nebivololhttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Betaxololhttp://en.wikipedia.org/wiki/Carteololhttp://en.wikipedia.org/wiki/Levobunololhttp://en.wikipedia.org/wiki/Metipranololhttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Phaeochromocytomahttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Rossi-1http://en.wikipedia.org/wiki/Alpha_blockershttp://en.wikipedia.org/wiki/Pharmacological_agenthttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/Adrenergic_receptor#.CE.B1_receptorshttp://en.wikipedia.org/wiki/Alpha_blocker#cite_note-0http://en.wikipedia.org/wiki/Alpha-1_blockerhttp://en.wikipedia.org/wiki/Alpha-1_blockerhttp://en.wikipedia.org/wiki/Alpha-1_blockerhttp://en.wikipedia.org/wiki/Alpha-1_adrenergic_receptorhttp://en.wikipedia.org/wiki/Alpha-1_adrenergic_receptorhttp://en.wikipedia.org/wiki/Alpha-1_adrenergic_receptorhttp://en.wikipedia.org/wiki/Alpha-2_blockerhttp://en.wikipedia.org/wiki/Alpha-2_blockerhttp://en.wikipedia.org/wiki/Alpha-2_blockerhttp://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptorhttp://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptorhttp://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptorhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Esmololhttp://en.wikipedia.org/wiki/Sotalolhttp://en.wikipedia.org/wiki/Landiololhttp://en.wikipedia.org/wiki/Congestive_heart_failurehttp://en.wikipedia.org/wiki/Bisoprololhttp://en.wikipedia.org/wiki/Carvedilolhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Nebivololhttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Betaxololhttp://en.wikipedia.org/wiki/Carteololhttp://en.wikipedia.org/wiki/Levobunololhttp://en.wikipedia.org/wiki/Metipranololhttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Atenololhttp://en.wikipedia.org/wiki/Metoprololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Timololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Propranololhttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Phaeochromocytomahttp://en.wikipedia.org/wiki/Beta_blocker#cite_note-Rossi-1http://en.wikipedia.org/wiki/Alpha_blockershttp://en.wikipedia.org/wiki/Pharmacological_agenthttp://en.wikipedia.org/wiki/Receptor_antagonisthttp://en.wikipedia.org/wiki/Adrenergic_receptor#.CE.B1_receptorshttp://en.wikipedia.org/wiki/Alpha_blocker#cite_note-0http://en.wikipedia.org/wiki/Alpha-1_blockerhttp://en.wikipedia.org/wiki/Alpha-1_adrenergic_receptorhttp://en.wikipedia.org/wiki/Alpha-2_blockerhttp://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptorhttp://en.wikipedia.org/wiki/Wikipedia:Citation_needed


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• heno2yben*amine• hentolamine

The agents carvedilol and labetalol are both 6 and S6blockers.

'ses blockers are used in the treatment of several conditions, such as-aynaud=s disease, hypertension, and scleroderma.

Adrenergic receptor

Adrenaline

Foradrenaline

The adrenergic receptors (or adrenoceptors) are a class of K protein6coupled receptors that are targets of the catecholamines, especially

noradrenaline (norepinephrine) and adrenaline (epinephrine). Althoughdopamine is a catecholamine, its receptors are in a dierent category.

Gany cells possess these receptors, and the binding of an agonist 'illgenerally cause a sympathetic response (i.e. the ght6or6@ight response).


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1.#.& & receptor

o 1.$ S receptors

1.$.1 S1 receptor

1.$.& S& receptor

1.$.# S# receptor

Subtypes

There are t'o main groups of adrenergic receptors, and S, 'ith severalsubtypes.

• receptors have the subtypes 1 (a K3 coupled receptor) and & (a Ki

coupled receptor). henylephrine is a selective agonist of the receptor.• S receptors have the subtypes S1, S& and S#. All three are linked to Ks

proteins (although S& also couples to Ki)[1], 'hich in turn are linked to

adenylate cyclase. Agonist binding thus causes a rise in theintracellular concentr

antihypertensive drug

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