Beta-blockers contraindications

Beta-blocker AND ACE-I (ARB if ACE-I intolerant). Verapamil if beta-blockers contraindicated. If heart failure, see below... 

Committee on Safety of Medicines/Medicines Control Agency. Reminder Beta-blockers contraindicated in asthma. Current Problems (1996) 22,2. 

Drugs that may affect ergot alkaloids include beta blockers, CYB3A4 inhibitors (see Contraindications), nicotine, and sibutramine. 

Eor preventive treatments, the adverse effects of the beta blockers are classical for this class bradycardia, bronchospasm, hypotension, nightmares and depression. Indoramine induces neuropsychiatric effects (sedation, asthenia) and cardiovascular disorders (hypotension). Eluanarizine is strictly contraindicated in patients with Parkinsonism and depression. 

Contraindications Asthma, wheezing, or very low baseline pulmonary function tests concomitant useof beta-blockers hypersensitivity to the drug, because of the potential for severe bronchoconstriction... 

Contraindications Atrial fibrillation or flutter associated with accessory conduction pathways, cardiogenic shock, CHF, second- or third-degree heart block, severe hypotension, sinus bradycardia, ventricular tachycardia, within several hours of IV beta-blocker therapy... 

There are few absolute contraindications, but several points should be considered. Medications that produce changes in sinus node or AV nodal conduction may potentiate the cardiovascular adverse effects of the a2 agonists. This may be particularly relevant for concomitant administration of beta-blockers, which, similar to the agonists, have been used to treat aggression. 

The most common side effects are Raynaud s phenomenon with cold or even cyanotic distal extremities and digits, tiredness or weakness, bradycardia, and sexual impotence. Less common side effects are depression and dysphoria, bronchoconstriction, congestive heart failure, hallucinations, hypotension, vomiting or nausea, diarrhea, insomnia and nightmares, dizziness, and hypoglycemia. When due attention is paid to contraindications and the treatment is carefully monitored, the side effects of beta-blocker treatment are generally mild. 

Calcium channel blockers can also be given to treat stable angina, especially if beta blockers are not tolerated or are contraindicated in specific patients.13 These drugs decrease cardiac workload directly by limiting calcium entry into myocardial cells and indirectly by producing peripheral vasodilation, thus decreasing cardiac preload and afterload.47 Hence, cal-... 

In the past, beta blockers were considered detrimental in patients with heart failure.60 As indicated in Chapter 20, these drugs decrease heart rate and myocardial contraction force by blocking the effects of epinephrine and norepinephrine on the heart. Common sense dictated that a decrease in myocardial contractility would be counterproductive in heart failure, and beta blockers were therefore contraindicated in heart failure.60,69 It is now recognized that beta blockers are actually beneficial in people with heart failure because these drugs attenuate the excessive sympathetic activity associated with this disease.56,64 As indicated earlier,... 

Beta-blockers are an alternative to an ACE inhibitor when an ACE inhibitor is contraindicated or not tolerated (for example, in women of childbearing age or those with an increased sympathetic drive). 

A beta-blocker may be used in the treatment of primary open-angle glaucoma, but these drugs are contraindicated for use in persons with chronic obstructive pulmonary disease and heart block (see Chapter 10). A careful history should be taken before initiating therapy to avoid potentially fatal ramifications. It is advisable to monitor patients who are taking beta-blockers (e.g., pulse, blood pressure) and to inquire about side effects at periodic follow-up examinations. 

There is some anecdotal evidence that atrioventricular nodal blockade with verapamil or a beta-blocker can also be effective. However, in two cases the addition of a beta-blocker (either atenolol or metoprolol) to treatment with class I antidysrhythmic drugs (cibenzoline in one case and flecainide in the other) did not prevent the occurrence of atrial flutter with a 1 1 response (47). However, the author suggested that in these cases, although the beta-blockers had not suppressed the dysrhythmia, they had at least improved the patient s tolerance of it. In both cases the uses of class I antidysrhythmic drugs was contraindicated by virtue of structural damage, in the first case due to mitral valvular disease and in the second due to an ischemic cardiomyopathy. 

Traditionally, beta-blockers have been contraindicated in patients with heart failure. However, there are some patients with systolic heart failure who benefit from a... 

Intermittent claudication has also been reported to be worsened by beta-adrenoceptor antagonists, but has been difficult to document because of the difficulty of study design in patients with advanced atherosclerosis. As early as 1975 it was reported from one small placebo-controlled study that propranolol did not exacerbate symptoms in patients with intermittent claudication (70). This has subsequently been supported by the results of several large placebo-controlled trials of beta-blockers in mild hypertension and reports of trials of the secondary prevention of myocardial infarction, in which intermittent claudication was not mentioned as an adverse effect, even though it was not a specific contraindication to inclusion (71). In addition, a comprehensive study of the effects of beta-adrenoceptor antagonists in patients with intermittent claudication did not show beta-blockade to be an independent risk factor for the disease (72). In men with chronic stable intermittent claudication, atenolol (50 mg bd) had no effect on walking distance or foot temperature (73). These findings have been confirmed in a recent meta-analysis of 11 randomized, controlled trials to determine whether beta-blockers exacerbate intermittent claudication (SEDA-17, 234). 

Second-degree or third-degree heart block is a contraindication to beta-adrenoceptor blockade. If it is considered necessary for the control of dysrhythmias, a beta-blocker can be given after the institution of pacing. 

B Because this patient has asthma and is wheezing, calcium channel blockers are the drug class of choice. Unlike beta-blockers and adenosine, they do not cause bronchospasm. Beta-blockers and adenosine should be used cautiously in patients with obstructive lung disease, and use should be avoided in patients with asthma. Digoxin is not contraindicated, but it is not the drug of choice due to its slow onset. Amiodarone is indicated for ventricular arrhythmias, but not PSVT. 

C Diltiazem. Quinidine can be used to maintain normal sinus rhythm (NSR) after cardioversion of atrial fibrillation. Metoprolol is commonly used to control ventricular rate before conversion to NSR. However, this patient has two contraindications (COPD and diabetes) for beta-blocker use. Unlike diltiazem, amlodipine and nimodipine do not block AV nodal conduction therefore, they would be ineffective at rate control. 

Adrenaline is contraindicated in cases of diabetes, hyperthyroidism, serious heart arrhythmias and coronary insufficiency or in combination with beta-blockers or monoamine oxidase (MAO) inhibitors. Lidocaine with adrenaline has a very rapid onset of action. Its duration of action is longer than that of lidocaine without adrenaline. However, inadvertent injection of a lidocaine-adrenaline solution into the vessels located near the nerve trunks increases the heart rate (immediate sinus tachycardia at over 130 beats per minute, spontaneously reversible in around 15 minutes) and increases ventricular excitability (risk of fibrillation). It can trigger angina attacks that may lead to a heart attack. It is therefore preferable not to use adrenaline before a full-face phenol peel. 

Beta-blocker therapy if no contraindication (Espec. if prior Ml or other indicationf... 

Beta-blocker (or calcium channel blocker if BB contraindicated) Statin... 

STEMI (17). This landmark trial revealed that the use of early beta-blocker therapy in STEMI reduces the risks of reinfarction and ventricular fibrillation. However, there was a small increase in frequency of cardiogenic shock in patients randomized to the beta-blocker group. Therefore, beta-blockers should be contraindicated in patients presenting with a cardiogenic shock or decompensated congestive heart failure (CHF). Other relative contraindications to beta-blockers include advanced heart block, bradyarrythmias, and active asthma. Unless these contraindications are present, the (ACC/AHA) guidelines list oral beta-blocker therapy within 24 hours as a class I indication in patients with ACS (18). In patients presenting with left ventricular dysfunction after MI as defined by an ejection fraction <40%, carvedilol has been shown to reduce reinfarction rate and mortality in the Carvedilol Post Infarction Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial when compared with placebo (19). 

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