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  #1  
Old 06-19-2011
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Drug Giving beta blocker to an asthmatic!

A 26 year old female with a history of asthma and grave's disease comes to the emergency room with diaphoresis, hypertension, anxiety, tachycardia, and palpitations. The attending physician would like to give her a beta-blocker. Which beta-blocker do you recommend?
A - Timolol
B - Propanolol
C - Pindolol
D - Metoprorol
E - Nadolol
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from A to M => b1 (-olol)

Metoprolol

Last edited by bebix; 06-19-2011 at 08:45 AM. Reason: added "olol"
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Metoprolol...B1 selective
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Quote:
Originally Posted by bebix View Post
from A to M => b1

Metoprorol
Exceptions to this rule are Carvedilol and Labetalol, which are alpha and non-selective beta blockers

Notice that these two do not have the classic -olol ending though. That should help you remember that they are the exceptions
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Quote:
Originally Posted by apx85 View Post
Exceptions to this rule are Carvedilol and Labetalol, which are alpha and non-selective beta blockers

Notice that these two do not have the classic -olol ending though. That should help you remember that they are the exceptions
yup, the rule is for the -olol

and itīs Metroprolol...no "D - Metoprorol"
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Old 06-19-2011
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Its Pindolol.Clearly writtdn in katzung .
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I think it's D - Metoprolol
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Quote:
Originally Posted by earthpole View Post
A 26 year old female with a history of asthma and grave's disease comes to the emergency room with diaphoresis, hypertension, anxiety, tachycardia, and palpitations. The attending physician would like to give her a beta-blocker. Which beta-blocker do you recommend?
A - Timolol
B - Propanolol
C - Pindolol
D - Metoprorol
E - Nadolol
For me the answer is (Choice: D)
The BB of choice in Grave's is Propranolol
however, generally speaking, in asthamatic patients no BB can be considered safe and should be avoided as much as possible
if the clinical effect of BB is a must (Like this case) then the trend is to use low dose cardioselective BB (B1 selective) and the best here will be Metoprolol
Pindolol cannot be the answer as it has ISA (Instrinsic Sympathetic Activity)
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Partial agonist activity<intrinsic sympathomimetic activity> has an advantage in treating asthma because they are less likely to cause bronchospasm than ful antagonists such as propranolol.
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Its D .. METOPROLOL .. because its a B1 selective blocker ..
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Old 06-20-2011
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the correct answer is D
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Metoprolol is the only β1 selective antagonist in this list of beta blockers. Blocking β1 receptors generally reduces heart rate and sympathetic symptoms such as seen in thyroid storm. β2 blockade prevents bronchodialation increasing the risk for bronchospasm. As a general rule you should not use a beta blocker with β2 antagonist activity in a person with asthma because of possibility of inducing bronchospasms. Here is a simple rule that can be used to determine whether a beta-blocker is cardio selective (β1) or not: Beta blockers starting with A-M are cardio selective, and N-Z are not. But be careful, this rule will help you with most of the more common drugs but can’t being used for all beta blockers. Two common drugs to watch out for are carvedilol and labetelol which have mixed mixed beta/alpha agonist activity.
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Quote:
Originally Posted by kasimjaved View Post
Partial agonist activity<intrinsic sympathomimetic activity> has an advantage in treating asthma because they are less likely to cause bronchospasm than ful antagonists such as propranolol.
However ISA in this specfic case will hurt the grave's disease by increasing heart rate
Best wishes
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Quote:
Originally Posted by kasimjaved View Post
Partial agonist activity<intrinsic sympathomimetic activity> has an advantage in treating asthma because they are less likely to cause bronchospasm than ful antagonists such as propranolol.
It does have an advantage in asthma, but not in Graves.

Beta blockers without intrinsic sympathomimetic activity are effective therapeutic adjuncts in the management of thyrotoxicosis since many of these symptoms mimic those associated with sympathetic stimulation.
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