Alhusain
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54 yo COPD patent just, having MI ,you decided to give him a beta blocker ,which one will be your choice and why ?
a-metoprolol
b-esmolol
c-propranolol
d-nadolol
e-atenolol
f-timol ol
g-acetabutol
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| study499
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esmolol..............short acting B1 selective.
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| maoudoody
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esmolol
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| Karime
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Esmolol is better indicated for arrhytmias, like SVT, I think.
I would go with atenolol or metoprolol for a long term therapy after MI to dec. mortality
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| a3112
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metoprolol
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| power_doppler
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atenolol! or
metoprolol? 
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| littledoc
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Metoprolol
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| tompat
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i would say esmolol IV. it is particularly useful in pt. having reactive airways and PVD. it's half life is 8 min which allow us to stop the drug in case adverse effects show up. it has antiarrythmic properties too.
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| tompat
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scroll down to read about esmolol and metoprolol.
http://emedicine.medscape.com/article/155919-treatment
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| power_doppler
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thanks tompat. nice article
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| arlete
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B1 selective betablockers = AMEBA
Acebutolol
Metoprolol
Esmolol
Bisoprolol
Atenolol
There are others, but these are the most used of them.
I used Metoprolol for MI, esmolol for arrhythmias. From what I read, if the COPD is severe, esmolol is a better choice. Nice article!
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| power_doppler
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tnkx arlete
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| arlete
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| maoudoody
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also esmolol IV for aortic dissection
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| arlete
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 Good point, maoudoody!
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| Alhusain
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study499 wrote:
esmolol..............short acting B1 selective.
the right answer is B ( esmolol ) ...why ? 2 reasons :
1-among all cardioselecive ones(A,B,E&F) , Esmolol has a rapid onset, very short duration of action, and no significant intrinsic sympathomimetic or membrane stabilizing activity at therapeutic dosages.
2-Its elimination half-life after intravenous infusion is approximately 9 minutes. Esmolol inhibits the beta1 receptors located chiefly in cardiac muscle,but clinically this preferential effect is not absolute and at higher doses it begins to inhibit beta2 receptors located chiefly in the bronchial and vascular musculature.
so,its beta 1 blocker (cardioselective) ,has rapid onset,shortest duration of action and the least or no intrinsic sympathetice activity.furthermore rapidly metabolized by hydrolysis of the ester linkage, chiefly by the esterases in the cytosol of red blood cells and not by plasma cholinesterases or red cell membrane acetylchoIinesterase. Total body clearance in man was found to be about 20 L/kg/hr, which is greater than cardiac output; thus the metabolism of Esmolol is not limited by the rate of blood flow to metabolizing tissues such as the liver or affected by hepatic or renal blood flow. Esmolol has a rapid distribution half-life of about 2 minutes and an elimination half-life of about 9 minutes.
PS : I discussed this point with my attending physician friend ,he said thats true but esmolol only found as I.V and not available in all hospitals .so ,for the exam purposes this is the best answer (esmolol) ,if not among the options then pick metoprolol .
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| icarus
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I would go for a drug that has no ISA in it ... especially that the patient is having an MI .... so my answer would be Atenolol ... What do you think ?
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| icarus
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I mean you wouldn't want a drug with Intrinsic sympathetic activity ... the way you guys discussed this question is far for professional than a (basic science) perspective ... I believe that the trick of the question is : 1- to know that you shouldnt exacerbate the COPD, and the way to do that is to pick a B1 selective drug ---> you immediately eliminate Nadolol, Propranolol, and Timolol
2- You read in the stem that the context is a myocardial infarction, so - in my opinion - you wouldn't want a drug with ISA ... so you pick the onyl non-ISA drug which is Atenolol ...
Please help me, because i am getting nervous, and i want to know why my reasoning ( as for step 1, and not a cardiologist ) is wrong ...
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| NNL
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COPD patient Any long acting beta blocker would worsen his clincal picture so go for the most short acting cardio protector.
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| icarus
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But Atenolol is selective for B1, and if you didnt give it in a high dose, it would never affect the b2 !!! right ?
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