Beta Blocker List: Example Medications and Drug Name Trick
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Example Case
A male patient presents with altered mental status. His wife states that his confusion began this morning. She did not notice any “stroke-like” symptoms such as facial droop, slurred speech, or weakness. He has had no recent head trauma.
The patient’s heart rate is 40 on arrival with a blood pressure of 81/47. The wife states he takes “several blood pressure medications”. Upon medication review, the patient takes carvedilol, lisinopril, and losartan. You try to recall whether carvedilol is selective vs non-selective.
Beta Blocker Medications
The drug list for beta blockers is extensive, making it challenging to remember the mechanism of action and pharmacology of each one.
Some beta blocker medications are selective for beta-1 receptors, while other beta blockers are non-selective for beta-1 and beta-2 receptors.
A third category also antagonizes both alpha and beta receptors.
What if there were an easy way to remember all of the beta blocker types?
Fortunately there is!
Every EZmed lecture provides you with simple memory tricks to remember the material.
Today you will learn an easy way to remember the different types of beta blockers.
If you want to improve your medical knowledge with minimal effort, then make sure to check out the other EZmed lectures that make medicine easy with countless mnemonics and tricks!
Other pharmacology tricks include the cephalosporin trick!
Beta Receptors
Beta receptors were discussed in a previous EZmed lecture where you learned memory tricks to remember the different types of beta receptors and their locations.
Beta receptors are a type of adrenergic receptor involved in the sympathetic nervous system.
The sympathetic nervous system is our “fight or flight” response, and is activated in situations of danger, fear, excitement, anxiety, nervousness, etc.
The sympathetic nervous system releases catecholamines, such as norepinephrine and epinephrine, onto adrenergic receptors.
These adrenergic receptors include alpha receptors and beta receptors.
When adrenergic receptors are activated, they produce a fight or flight sympathetic response.
For example, activation of beta-1 receptors in the heart will increase heart rate and cardiac contraction.
Increasing the heart rate and cardiac contraction will increase cardiac output and blood pressure during a fight or flight response.
If we block the beta-1 receptors in the heart using a beta blocker, then this can slow the heart rate or decrease blood pressure as a result.
This is why beta blockers can serve as an antiarrhythmic to treat rapid heart rates (tachycardia) or rhythms (tachyarrhythmia).
This is why beta blockers are also a type of antihypertensive medication, and can be used to treat high blood pressure.
To learn more about the different types of beta receptors, their location, and their function, check out the EZmed lecture on beta receptors.
Do you know everything you need to know about beta receptors? Not sure? Check out the EZmed lecture filled with easy tricks and more images like the one above!
Beta Blockers - “LOL”
Beta blocker drug names are easy to remember because they end in the suffix “LOL”.
The challenge, however, is remembering which beta receptor(s) the beta blocker targets.
We learned in our beta receptor lecture that there are 3 different types of beta receptors: Beta-1, Beta-2, and Beta-3.
Some beta blockers are selective for beta-1 receptors only.
Other beta blockers are non-selective for beta-1 and beta-2 receptors.
Finally, some beta blockers can antagonize both alpha and beta adrenergic receptors.
How can you remember them all?
Read on to find out!
A-N = Beta-1 Selective
As previously mentioned, some beta blockers are selective for beta-1 receptors.
These medications are also called “cardioselective” beta blockers, as the heart contains beta-1 receptors.
Beta-1 receptors are located on pacemaker cells of the cardiac conduction system.
When the beta-1 receptors of the conduction system are activated, SA node automaticity and AV node conduction velocity are increased which will increase heart rate.
Beta-1 receptors are also located on the contractile muscle cells of the heart.
When the beta-1 receptors on contractile muscle cells are activated, cardiac contraction will increase.
An increase in heart rate and cardiac contraction will in turn increase cardiac output and blood pressure.
Therefore, the activation of beta-1 receptors increases heart rate, cardiac contraction, cardiac output, and blood pressure.
Therefore, beta blockers can be used to treat tachyarrhythmias and hypertension as previously mentioned.
Of note, there are beta-1 receptors located in the kidneys as well.
Activation of beta-1 receptors in the kidneys stimulates renin release from the juxtaglomerular cells.
Renin is involved in activating the renin-angiotensin-aldosterone system (RAAS), which will increase blood pressure as well.
Although beta-1 receptors are located in the heart and kidneys, the beta blocker effects on the heart tend to be more clinically significant than those of the kidney.
Now for the memory trick!
Beta blockers that are selective for beta-1 receptors generally begin with the letters A-N.
Examples of selective beta receptors include atenolol, esmolol, and metoprolol.
One exception is nadolol, which is non-selective for beta-1 and beta-2.
However, nebivolol is cardioselective (particularly at low doses), which is why “N” is included in A-N.
O-Z = Non-Selective for Beta-1 and Beta-2
We already learned beta-1 receptors are primarily located in the heart and kidneys.
There are also beta-2 receptors located throughout the body.
Some beta blockers are non-selective and antagonize both beta-1 and beta-2 receptors.
Here is the memory trick for the non-selective beta blockers!
Beta blockers that are non-selective for beta-1 and beta-2 receptors generally begin with the letters O-Z.
Examples of non-selective beta blockers include propranolol and timolol.
One of the main locations for beta-2 receptors is the lungs.
When beta-2 receptors in the lungs are activated, bronchodilation occurs.
Therefore, blocking or antagonizing beta-2 receptors in the lungs can lead to bronchoconstriction.
For this reason, non-selective beta blockers are generally avoided (or used cautiously) in those with pulmonary disease such as COPD.
Beta blockers that are selective for beta-1 receptors may have less pulmonary adverse effects, but still should be used cautiously.
Alternate Ending = Alpha + Beta Blocker
We already know beta blockers block beta receptors.
In addition to blocking beta receptors, some beta blockers can block alpha receptors as well.
Remember alpha receptors are the other main type of adrenergic receptor.
Alpha receptors are found on blood vessels and cause vasoconstriction when activated.
Therefore, blocking alpha receptors will reduce vasoconstriction which can also help decrease blood pressure.
The selective and non-selective beta blockers we have discussed so far generally end in “olol”.
If you see an alternate ending from “olol”, then it could indicate an alpha and beta blocker.
Two common medications in this category include labetalol and carvedilol, in which labetalol ends in “alol” and carvedilol ends in “ilol”.
This is not a hard-and-fast rule as some medications ending in “olol” block both alpha and beta receptors.
However, it is a simple method to remember labetalol and carvedilol, which are 2 of the more common medications in this category.
Another exception is sotalol, which is a non-selective beta blocker (O-Z).
Although it has an alternate ending (“alol”), it does not have alpha antagonistic properties.
Of note, sotalol also possesses potassium channel blocking properties.
Summary
Hopefully this gave you a simple way to remember beta blockers and whether they are selective vs non-selective vs a combination alpha/beta blocker.
With a couple exceptions, most medications beginning with A-N are selective beta-1 blockers.
Most medications beginning with O-Z are non-selective beta-1 and beta-2 blockers.
Labetalol and carvedilol, which have alternate endings to the classic “olol”, antagonize both alpha and beta receptors.
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