acebutolol – n. 醋丁洛尔 Sectral – n. 【奥】噻克洛尔
esmolol – n. 艾司洛尔 Brevibloc – n. 【奥】布里维洛克
propranolol – n. 普萘洛尔 Inderal – n. 心得安 注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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Class II Antiarrhythmics II类抗心律不齐药
The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. Several beta-adrenergic blockers, such as acebutolol (Sectral), esmolol (Brevibloc), and propranolol (Inderal), are used as antiarrhythmics.
The class II antiarrhythmics competitively block beta-receptor sites in the heart and kidneys. The result is a decrease in heart rate, cardiac excitability, and cardiac output, a slowing of conduction through the AV node, and a decrease in the release of renin. These effects stabilize excitable cardiac tissue and decrease blood pressure, which decreases the heart’s workload and may further stabilize hypoxic cardiac tissue. These drugs are indicated for the treatment of supraventricular tachycardias and PVCs.
Acebutolol is an oral drug. Esmolol is administered IV. Propranolol may be administered orally or IV. These drugs are absorbed from the GI tract or have an immediate effect when given IV and undergo hepatic metabolism. They are excreted in the urine. Food has been found to increase the bioavailability of propranolol, although this effect has not been found with other beta-adrenergic blocking agents.
The use of these drugs is contraindicated in the presence of sinus bradycardia (rate less than 45 beats/min) and AV block, which could be exacerbated by the effects of these drugs; with cardiogenic shock, HF, asthma, or respiratory depression, which could worsen due to blockage of beta-receptors; and with pregnancy and lactation because of the potential for adverse effects on the fetus or neonate.
Caution should be used in patients with diabetes and thyroid dysfunction, which could be altered by the blockade of the beta-receptors, and in patients with renal and hepatic dysfunction, which could alter the metabolism and excretion of these drugs.
1. Routine laboratory monitoring in clients taking ß blockers should include:
A. Sodium
B. Glucose
C. Thyrotropin
D. Creatine phosphokinase 2. Competitive antagonism of which of the following occurs at ß receptor sites?
A. Catecholamines
B. Adrenergic sites
C. Acetylcholine
D. Norepinephrine
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答案 Answers
1.B. Glucose Rationale: ß blockers influence glucose metabolism. Although A, C, and D are nice to have, there is no indication that routine assessment of thyrotropin, sodium, or creatine phosphokinase is needed. 2. A. Catecholamines Rationale: Catecholamine receptor sites are blocked by the action of ß-blocking agents. Adrenergic sites may be blocked, but the more appropriate response is catecholamine receptors. Acetylcholine is not affected by ß blockers. Norepinephrine is a catecholamine.
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