Beta blockers

و في الأرضِ آياتٌ للموقنينَ * و في أنفُسِكم أفلا تُبْصِرونَ * : 

و في الأرضِ آياتٌ للموقنينَ * و في أنفُسِكم أفلا تُبْصِرونَ * الذا ر يات 20 و 21

Hope despite the “Black” year in cardiology: 

Hope despite the “Black” year in cardiology Sayed Syleem, M.Sc. Cardiologist Kafr Saad central hospital 2010

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Alpha 1 Receptors Alpha 2 receptors Vasoconstriction (skin & mucous m.) Increase BP Pupil dilation Closure of urinary bladder sphincter Thickened salivary secretions Ejaculation Decrease NE release Decrease BP Decrease GI motility Beta 1 receptors Beta 2 receptors Increase HR Increase cardiac contraction increase cardiac conduction Lipolylis Bronchodilation Vasodilation (skeletal muscle) Relaxation of uterus Relaxation of GIT& ↓ GI secretions Relaxation of urinary bladder Increase blood sugar

Autonomic NS: 

Autonomic NS Parasympathomimetics Direct Choline esters Acetyle choline Cholinemimetic alkalo. Pilocarpine Indirect Anti-choline esterase Physiostigmine Parasympatholytics Muscarinic receptor (-) Natural belladonna alk. Atropine Synthetic atropine sups Ipratopium Drugs affect ganglia Stimulants Nicotine Blockers Tri-Metaphan Sympathomimetics Catecholamines Natural Dopamine- Adrenaline Synthetic Dobutamine Non-catecholamines  Ephidrine-Amphetam. Sympatholytics Adrenergic blockers Alpha Prazocin Beta    Next Alpha 2 stimulants  Alpha-Methyl dopa Ganglion blockers  Tri-Metaphan Neuron blockers  - NA release Bretylium  Deplete NA stores Reserpine

Members: 

Members B1>>>B2 Acebutolol Atenolol Betaxolol Bisoprolol Esmolol Nebivolol Metoprolol Beta blockers with intrinsic sympathomimetic activity (ISA) include: Acebutolol Carteolol Penbutolol Pindolol Beta blockers that also block alpha blockers include: Carvedilol Labetalol Beta blockers that are non-selective, do not have ISA, and do not block alpha receptors include: Levobunolol Metipranolol Nadolol Propranolol Sotalol Timolol

Uses of Beta blockers: 

Uses of Beta blockers Preventing migraine headaches Treating HTN Reducing the risk of future heart attacks and heart-related death in people who have had a heart attack Treating CHF Treating glaucoma Treating certain arrhythmias, such as AF and AFlut Treating angina Treating HOCM. Thyrotoxicosis Portal HTN

But in 2005: 

But in 2005 Conclusions: Nonselective BBs are ineffective in preventing varices in unselected patients with cirrhosis and portal HTN and are associated with ↑ number of adverse events. Groszmann, et al. (2005) Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. New England Journal of Medicine , 353 (21) , pp. 2254-2261.

Side effects of Beta Blockers: 

Side effects of Beta Blockers Bradycardia Hypotension Fatigue Cold hands and feet Bronchospasm Dizziness. + VLDL Sudden stop  Angina, MI, arrhythmia

Do Beta Blockers Cause Sexual Side Effects? : 

Do Beta Blockers Cause Sexual Side Effects? Decreased libido. Impotence (erectile dysfunction (ED)) Peyronie's disease

Is it true?: 

Is it true? It is important to understand that BB are frequently used in older and hypertensive individuals ( who are more likely to have sexual problems ). This makes it difficult to know if the sexual side effects are actually caused by the medication or other factors. Researchers found that people who knew that impotence was a side effect of BB were more likely to develop impotence. Their conclusion was that "the knowledge about side effects of BBs can produce anxiety that may cause erectile dysfunction.“ This study also found that a placebo (a "sugar pill" that does not contain any active ingredients) was just as effective as sildenafil for reversing impotence in these men taking a beta blocker.

Precautions with BB use: 

Precautions with BB use Heart failure Bradycardia Liver disease, such as liver failure, cirrhosis, or hepatitis Kidney disease, such as renal failure Diabetes Had a CVA or TIA Heart block Sick sinus syndrome Asthma COPD Hyperthyroidism An upcoming surgery Myasthenia gravis PAD Any allergies, including allergies to foods, dyes, or preservatives. Pregnant or thinking of becoming pregnant Breastfeeding.

An overdose with a beta blocker may cause the following problems:: 

An overdose with a beta blocker may cause the following problems: Bradycardia. Constriction of the airway. CHF Cardiac arrest Coma. Hypotension. Hypoglycemia. Treatment for a Beta Blocker Overdose Medications to increase the heart rate IV fluids and medications to increase blood pressure Asthma medications to reverse airway constriction IV glucose to reverse low blood sugar levels.

Pregnancy Category Ratings : 

Pregnancy Category Ratings The following beta blockers are Pregnancy Category B medications : Acebutolol Pindolol Sotalol The following beta blockers are Pregnancy Category C medications: Betaxolol Bisoprolol Carteolol Carvedilol Esmolol Labetalol Levobunolol Metipranolol Metoprolol Nadolol Nebivolol Penbutolol Propranolol Timolol The following beta blockers are Pregnancy Category D medications: Atenolol

Beta Blockers and Breast Milk : 

Beta Blockers and Breast Milk The following beta blockers pass through breast milk: Acebutolol Atenolol Betaxolol Levatol Metoprolol Nadolol Pindolol Propranolol Sotalol Timolol The medication could potentially pass through breast milk: Bisoprolol Carvedilol Carteolol Esmolol Levobunolol Metipranolol Nebivolol Penbutolol

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© National Portrait Gallery, London

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There are many thousands of us alive today thanks to the brilliant, pioneering work of James Whyte Black .

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He was born in 1924 in Uddingston, Lanarkshire. His father was a Scottish mining engineer. He was the 4 th son of 5 . Money was tight but he entered the St Andrews University exam by his maths teacher and, at the age of 15, won a residential scholarship there where he studied medicine.

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Black met Hilary Joan Vaughan (his age) at university in 1944. He completed his medical degree in 1946, he committed himself to physiological research. In 1946 he married the fellow student Hilary Vaughan . In 1947 they moved to Singapore, where he lectured at King Edward VII College of Medicine, University of Malaya.

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Returning to Britain in 1950, with what he said was "no home, no income of any kind and no prospects. But a chance meeting with an old colleague on Oxford Street led to a job (physiology lecturer) in the University of Glasgow Veterinary School , where he said he "slowly learned, like a primitive painter, how to be an effective experimenter.“ As he developed an interest in the way adrenaline affects the human heart, particularly in those suffering from angina. The couple had a daughter, Stephanie , born in 1951.

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He worked for ICI Pharmaceuticals from 1958 until 1964, during which time he developed propranolol to treat high blood pressure and heart disease, hailed as the greatest breakthrough in the treatment of that killer disease since the discovery of digitalis . Beta blockers, they became at one time the world's best-selling drug , slowing down the heart rate to treat and prevent heart attacks and angina pectoris and reduce high blood pressure.

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He was developing a similar method of treatment for stomach ulcers , but ICI did not wish to pursue the idea so Black resigned and joined Smith, Kline and French for whom he worked for 9 years. While there, he developed his second major drug, cimetidine which was launched under the brand name Tagamet in 1975. It outsold even his propranolol beta blocker to become the world's largest-selling prescription drug in 1988 and was the first prescription drug to sell over a billion dollars-worth. Ranitidine followed, using similar principles. Prior to these drugs surgery was the most common way to deal with stomach ulcers but this was often unsuccessful. http://hosted.ap.org/photos/C/ccc684f9-0f18-4835-baec-cd953f98aff5-bi ...

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He was elected a Fellow of the Royal Society in 1976 and the same year he was awarded the Lasker award . In 1979, he was awarded the Artois-Baillet Latour Health Prize . He was made a Knight Bachelor on 10 February 1981 for services to medical research, receiving the honour from the Queen at Buckingham Palace , In 1982 Black was awarded the Wolf Prize in Medicine . In 1984 he became Professor of Analytical Pharmacology at the Rayne Institute of the King's College London medical school , where he remained until 1992.

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Hilary died in 1986, aged 62. He established the James Black Foundation in 1988 with funding from Johnson and Johnson and led a team of 25 scientists in drugs research, including gastrin inhibitors which may prevent some stomach cancers. He was awarded the 1988 Nobel Prize in Medicine . On 26 May 2000 he was appointed to the Order of Merit , of which there are only 24 members at any one time, by Queen Elizabeth II .

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Served as chancellor of the University of Dundee , Scotland, from 1992 to 2006. In 1994 he received the Ellison-Cliffe Medal from the Royal Society of Medicine . In 1994, he married Rona MacKie who survives him, as does Stephanie , the daughter of his first marriage. in 2004 was awarded the society's Royal Medal . During this time, he pioneered a method of research of intelligent drug design , now the foundation of the development of most new developments in the world-wide pharmaceutical industry.

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His invention of propranolol is considered to be one of the most important contributions to clinical medicine and pharmacology of the 20th century. It is estimated that medicines developed along the methodologies established by Black represent 20% of the $825 billion annual turnover of the world's top-selling drugs. The success of beta blockers was a major contributor to reducing the mortality rate from heart disease in the last few decades. In the UK alone 255 of every 100,000 men died from coronary heart disease in 1978. By 2007 that figure had plummeted to 65 per 100,000. They have prolonged the lives of millions of people and improved the quality of their lives as well.

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Black was such a very private man who was averse to publicity that he was horrified to discover he had won the Nobel Prize! He later remarked dryly that when he was told he had won the Nobel Prize he had commented "I wish I had had my beta blockers handy to slow down my heart rate!"

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أوضحت دراسة لباحثين في جامعة تكساس، نشرت في مجلة نيوانجلاند الطبية، أن إعطاء جرعات كبيرة من عقار "بروبرانولول" تعجل في الاستشفاء من الحروق و ت قلل من تلف العضلات الذي يصاحب عادة الإصابة بالحروق الشديدة. يذكر أن فترة النقاهة التي تلي التعرض للحروق الشديدة تشهد ميلا سلبيا للجسم يتمثل في محاولته التخلص من البروتين وبالتالي ضمور وضعف العضلات. وتتبع رئيس الفريق العلمي الدكتور ديفيد هيرندون أحوال 25 طفلا من ضحايا الحروق، تناول نصفهم تقريباً عقار بروبرانولول، وتم قياس هزال العضلات فيهم ، فوجدوا أن مستويات بروتين العضلات انخفضت بنسبة 27 في المئة بين الاطفال الذين لم يتناولوا هذا العقار، في حين زادت بنسبة 82 في المئة بين الاطفال الذين تناولوه. www. bbc .co.uk/doctorwho/dw

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In March,22, 2010 after a long illness, Sir James died on Monday aged 86.

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In the days following the announcement of his death, researchers revealed that beta blockers had been found to be a potential treatment for breast cancer, following trials which showed that the drug produced significant falls in both cancer spread and local recurrence.

November 2006: 

November 2006 USA study in Ohaio state university  nore-adrenaline + tumor growth and spread “Ronald Glasser et al.”

March 2010: 

March 2010 Germany-England study found that patients with cancer who were taking BBs  decreased the risk of dying

March 2010: 

March 2010 Des Powe et al. (Nottingham university) (Queen’s medical center) (UK) The study looked at data on 466 patients over ten years. Three groups were examined: those being treated for hypertension by BBs , those whose HTN was treated by other medications , and those who did not suffer from hypertension and were therefore not taking any medication. 43 of the 466 patients were already taking BBs and, in this group, there were significant falls in both cancer spread and local recurrence. They also had a 71 % lower risk of dying from breast cancer compared with the other groups.

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