Beta-blocker

Beta-blockers therapy should be considered in all patients with a significant cardiac history. 

Beta-blockers are medications that reduce the workload of the heart and lower blood pressure. They are commonly prescribed to relieve angina (a type of chest pain, pressure, or discomfort) or treat heart failure. They also are prescribed for people who have high blood pressure (hypertension). Several beta-blockers (metoprolol, propanolol, betaxolol, bisoprolol, and nadolol) have been detected in municipal sewage effluents up to the pg/L level (Temes 1998) and in groundwater samples (Sacher et al. 2001). 

Contaminants may reach the subsurface in a gaseous phase, dissolved in water, as an immiscible hquid, or as suspended particles. Contaminant partitioning in the subsurface is controlled by the physicochemical properties and the porosity of the earth materials, the composition of the subsurface water, as well as the properties of the contaminants themselves. While the physicochemical and mineralogical characteristics of the subsurface sohd phase define the retention capacity of contaminants, the porosity and aggregation stams determine the potential volume of liquid and air that are accessible for contaminant redistribution among the subsurface phases. Enviromnental factors, such as temperature and water content in the subsurface prior to contamination, also affect the pollution pattern. 

Under natural conditions, subsurface contaminants can be composed of single organic or inorganic compounds or mixtures thereof. These compounds have different properties, so they react differently, even if they reach the subsurface simultaneously. Therefore, knowledge of subsurface partitioning among individual components in a contaminant mixture is of major importance. 

Chapter 5 discusses contaminant adsorption on geosorbents and includes a short description of the surface properties of adsorbents and the methodology for quantifying adsorption. The chapter continues with a presentation of adsorption of various types of toxic chemicals on the subsurface solid phase. In addition to physicochemical adsorption, contaminants can be retained in the subsurface by precipitation, deposition, and trapping. These topics, as well as hysteresis phenomena and formation of bound residues, are discussed. 

Contaminant retention on geosorbents is controlled by tbeir physicochanical properties and their structural pattern, as well as by the properties of the contaminants themselves. The properties of these adsorbents control their capacity to retain and release contaminants in the subsurface enviromnent. 

Beta (/3)-blockers (e.g., propranolol, atenolol, oxyprenolol, pindolol) are used for treating hypertension, cardiac arrhythmias, angina pectoris, and myocardial infarction. These drugs have proven important in the management of alcohol withdrawal and hypothyroidism.56 -blockers also are used as prophylactics in 

HPI AV is a 62-year-old white man with a 6-year history of HTN. His current antihypertensive therapy consists of enalapril and hydrochlorothiazide, but AV s BP is still elevated at 165/94 mm Hg. PMH COPD, peptic ulcer disease (PUD), HTN, and chronic back pain. 

PE Vitals HR 85 beats/min, RR 14 breaths/min. Medications Omeprazole, enalapril, hydrochlorothiazide, acetaminophen. Metoprolol was initiated. 

Which beta-blockers provide alpha blockade as well  

Which beta-blocker is the most lipid soluble  

What are the advantages and disadvantages of having intrinsic sympathomimetic properties  

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Tran, C. D. Dotlich, M. Enantiomeric Separation of Beta-Blockers by High Performance Liquid Chromatography, ... 

This experiment introduces the use of a chiral column (a 3-cyclodextrin-bonded Cjg column) to separate the beta-blocker drugs Inderal LA (S-propranolol and... 

The success of quinine inspired the search for other antimalarials. The greatest impetus for the development of synthetic dmgs came this century when the two World Wars intermpted the supply of cinchona bark to the combatants. A stmcturally related 4-quinolinemethanol is mefloquine (65, Lariam [51773-92-3]) which now serves as an effective alternative agent for chloroquine-resistant P. falciparum. This is a potent substance that requires less than one-tenth the dose of quinine to effect cures. There are some untoward side effects associated with this dmg such as gastrointestinal upset and dizziness, but they tend to be transient. Mefloquine is not recommended for use by those using beta-blockers, those whose job requires fine coordination and spatial discrimination, or those with a history of epilepsy or psychiatric disorders. A combination of mefloquine with Fansidar (a mixture of pyrimethamine and sulfadoxine) is known as Fansimef but its use is not recommended. Resistance to mefloquine has been reported even though the compound has not been in wide use. 

Some of the side effects due to beta blockers such as the slowing of heart rate can be counteracted by administration of drugs which antagonize the alpha adrenergic receptors. The... 

Compounds which act as antagonists at the receptors for beta sympathetic transmitters (beta blockers) have gained very wide acceptance as antihypertensive agents. It was found subsequent to their introduction that there are two populations of beta receptors the beta-1 receptors are richest in the cardiovascular system whereas beta-2 receptors are mostly found in the bronchi. Lack of receptor-type specificity led to bronchial spasm in some asthmatic individuals on ingestion of the earlier beta blockers. Much of the work outlined below had as its goal the preparation of agents which showed selectivity for beta-1 receptors. 

T. Hyotylainen, T. Andersson and M. E. Riekkola, Eiquid cliromatographic sample cleanup coupled on-line with gas chromatography in the analysis of beta-blockers in human serum and urine , 7. Chromatogr. Sci. 35 280-286 (1997). 

Figure 15.4 Separation of mixtures of beta-blockers by using micellar HPLC, employing the following mobile phases (a) 0.12M SDS, 5% propanol, 0.5% tiiethylamine (b) 0.06 M SDS, 15% propanol (c) 0.1 IM SDS, 8% propanol. Adapted from Journal of Chromatographic Science, 37, S. Carda-Broch et al., Analysis of urine samples containing cardiovascular drugs by micellor liquid chromatography with fluorimetric detection , pp. 93-102, 1999, with permission from Preston Publications, a division of Preston Industries, Inc.

ACE inhibitors - AT antagonists - Alpha blockers - Beta blockers Isolated syslolic hypertension (older patienls) - Diuretics preferred (generally Thiazides) - Long-acting dihydropyridine calcium channel blocker... 

Diuretics - Beta blockers (non-ISA) - ACE inhibitors (with systolic dysfunction)... 

Cytochrome P450 2D6, also termed debrisoquine-sparteine hydroxylase, is a mixed-function oxidase localized in the endoplasmic reticulum which is responsible for the biotransformation of several tricyclic antidepressants, antipsychotics, beta-blockers, opioids, and many other drugs. 

Until recently, the cardiotonics and a diuretic were the treatment of choice for HE However, other dragp such as the angiotensin-converting enzyme (ACE) inhibitors, and beta blockers have become the treatment of choice during the last several years. See Figure 39-1 for an example of a method of determining treatment for left ventricular systolic dysfunction. See Chapters 23, 42, and 46 for more information on the beta blockers, ACE inhibitors, and diuretics, respectively. 

Propranolol may increase procainamide plasma levels. Additive cholinergic effects may occur when procainamide is administered with other drugp with anticholinergic effects. There is the potential of additive cardiodepressant effects when procainamide is administered with lidocaine. When a beta blocker, such as Inderal, is administered with lidocaine, there is an increased risk of lidocaine toxicity. 

Control of blood pressure in perioperative hypertension and in immediate postoperative period, CHF associated with acute Ml, angina pectoris unresponsive to recommended doses of nitrates or beta blockers... 

The effects of warfarin may increase when administered with acetaminophen, NSAIDs, beta blockers, disulfiram, isoniazid, chloral hydrate, loop diuretics, aminoglycosides, cimetidine, tetracyclines, and cephalosporins. Oral contraceptives, ascorbic acid, barbiturates, diuretics, and vitamin K decrease the effects of warfarin. Because die effects of warfarin are influenced by many drugp, die patient must notify die nurse or die primary healdi care provider when taking a new drug or discontinuing... 

Nikolai LN, McClure EL, MacLeod SL, Wong CS (2006) Stereoisomer quantification of the Beta-blocker drugs atenolol, metoprolol, and propranolol in wastewaters by chiral high-performance liquid chromatography-tandem mass spectrometry. J Chromatogr A 1131 103-109... 

Among pharmacenticals, EE2 has been the snbject of particular recent attention becanse of its ability to canse endocrine disrnption in fish, as has been described in Chapter 15. Low levels of mixtnres of beta blockers, such as propranolol, metoprol, and nadolol have been detected in snrface waters, and there have been investigations of their possible effects on aqnatic invertebrates (Huggett et al. 2002). Veterinary medicines, too, have come nnder scrntiny for example, the dramatic effects of diclofenac on vnltnres, which will be discnssed shortly. Many questions remain to be answered abont the possible ecological effects of complex mixtures of pharmaceuticals and veterinary medicines. 

Hnggett, D.B., Brooks, B.W., and Peterson, B. et al. (2002). Toxicity of select beta adrenergic receptor blocking pharmaceuticals (beta blockers) on aqnatic organisms. Archives Environmental Contamination and Toxicology 41, 229-235. 

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