Beta blockers used in all except (Kerala 2007 repeat)
Ans) a (Peripheral vascular disease) Ref Goodman & Gilman 11th edition, KDT 7th ed, Katzung 11th edEvery kerala exam there will be 3-5 questions concerning the beta and alpha selectivity and action beta antagonists, its uses and contraindication.Thesame question was asked in 2007 kerala examThe use of beta blockers will cause worsening of peripheral vascular disease.USES1) Hypertension -They are one of the first choice drugs used in treatment of hypertension.2) Angina pectoris- Beta-blockers reduce the frequency of anginal episodes and improve exercise toler- ance in many patients with angina3) Cardiac arrhythmias- Beta antagonists are often effective in the treatment of both supraventricular and ventricular arrhythmias.4) Myocardial infarction- Beta antagonists are strongly indicated in the acute phase of a myocardial infarction. In this setting, relative contraindications include brady cardia, hypotension, moderate or severe left ventricular failure, shock, heart block, and active airways disease.5) Congestive heart failure6) Dissecting aortic aneurysm7) Pheochromocytoma8) Thyrotoxicosis -controls the sympathetic symptoms without affecting thyroid status.9) Migraine -Propranolol is the most effective drug for prophylaxis of migraine10) Anxiety11) Essential tremor12) Glaucoma13) Hypertrophic obstructive cardiomyopathy14) Beta-receptor antagonists have been found to diminish portal vein pressure in patients with cirrhosis and prevent variceal bleedingAdverse effects1) Central nervous system effects include sedation, sleep disturbances, and depression. Rarely, psychotic reactions may occur.2) Worsens pre existing asthma and COPD3) Worsening of peripheral vascular disease4) Beta-receptor blockade depresses myocardial contractility and excitability., caution must be exercised in starting a beta receptor antagonist in patients with compensated heart failure5) Beta blockers may interact with the calcium antagonist verapamil causing severe hypotension, bradycardia, heart failure, and cardiac conduction abnormalities.6) Exacerbates variant(prinzmetars) angina.7) The incidence of hypoglycemic episodes in diabetics that are exacerbated.They also can cause impaired carbohydrate tolerance.8) Plasma lipid profile is altered.Total triglycerides and LDL cholesterol tend to increase while HDL cholesterol decreases.ENFUVIRTIDEEnfuvirtide is a synthetic 36-amino-acid peptide fusion inhibitor that blocks entry HIV genome into the cell.Enfuvirtide, binds to the gp41 subunit of the viral envelope glycoprotein, preventing the conformational changes required for the fusion of the viral and cellular membranes. It has no activity against HIV-2. Enfuvirtide must be administered by subcutaneous injection. Metabolism appears to be by proteolytic hydrolysis without involvement of the CYP450 system. Elimination half-life is 3.8 hours.Classification of antiretroviral drugs 1.Nucleoside reverse transcriptase inhibitor 4. Protease inhibitors* Zidovudine* Didanosine* Zalcitabine* Stavudine* Lamivudine* Emtricitabine* Abacavir* Saquinavir* Ritonavir* Indinavir* Nelfinavir* Amprenavir* Atazanavir* Lopinavir2. Non nucleoside reverse transcriptase inhibitors* Efavirenz* Nevirapine* Delavirdine* Etravirine5.Fusion inhibitors* Enfuvirtide* Maraviroc6. Integrase inhibitor* Raltegravir3.Nucleotide analogues* Tenofovir* Adefovir
Peripheral vascular disease
Angina
Hypertension
Anxiety
A.N.S.