Pharmacological Action of

Effect Clinical Relevance

Beta Blockers
Decreases the rate of
Beneficial in tachycardia, atrial
Reduced Heart Rate spontaneous depolarization in
fibrillation, and other
(Negative Chronotropy) the SA node, slowing the heart
arrhythmias.
rate.
Reduces the force of
Decreased Contractility Useful in heart failure to reduce
contraction by inhibiting β₁
(Negative Inotropy) the workload of the heart.
receptors in the heart muscle.
Decreases both heart rate and
Helps manage heart failure and
Reduced Cardiac Output contractility, leading to lower
reduce oxygen demand.
cardiac output.
Decreases blood pressure by
Effective in treating
Lower Blood Pressure reducing cardiac output and
hypertension.
inhibiting renin release.
Lowers heart rate and
Decreased Myocardial Alleviates symptoms of angina
contractility, reducing the
Oxygen Demand and ischemic heart disease.
heart’s oxygen consumption.
Slows conduction through the
Used to prevent and treat
Prevention of Arrhythmias AV node and reduces abnormal
arrhythmias.
electrical activity.
Reduces oxygen demand and
Anti-ischemic Effects improves coronary blood flow Helps prevent and treat angina.
by reducing heart rate.
Initial Phase: Blockade of β₂
Initial Phase: Vasoconstriction
receptors in blood vessels,
and increased peripheral
leading to unopposed α₁
vascular resistance (PVR) due
receptor activation and
to α₁ activation.
Vascular Effects vasoconstriction.
Subsequent Phase: Decrease
(Propranolol) Subsequent Adaptation: With
in PVR and reduction in both
continuous administration,
systolic and diastolic blood
vascular resistance gradually
pressure after the blood vessels
decreases as the body adapts to
adapt.
decreased cardiac output (CO).
β₁ receptor blockade in the
Contributes to blood pressure
kidneys leads to a reduction in
Decreased Renin Release reduction, especially in
renin release from the
hypertensive patients.
juxtaglomerular cells.
Contraindicated in asthma
and COPD, especially with
nonselective β-blockers.
Blockade of β₂ receptors in Cardioselective β-blockers (e.g.,
Respiratory Effects bronchial smooth muscle can metoprolol) or those with
lead to bronchospasm. intrinsic sympathomimetic
activity (e.g., betaxolol,
celiprolol) are less likely to
cause bronchospasm.
Metabolic Effects Inhibition of Glycogenolysis: β- Increased risk of
blockers inhibit the breakdown of hypoglycemia: Particularly in
glycogen, delaying recovery from type 1 diabetes mellitus
hypoglycemia. patients.
Masking Hypoglycemia Symptoms: In diabetic patients with
β-blockers reduce normal warning frequent hypoglycemic
signs like tremors, tachycardia, and episodes, β-blockers should be
nervousness. used cautiously.
Skeletal Muscle Effects Tremor Inhibition: β-blockers Tremor Control: Useful in
inhibit catecholamine or stress- managing tremors in
induced tremors. conditions like essential
Reduced Exercise Capacity & tremor.
Fatigue: Blockage of β₂ receptors in Exercise Capacity & Fatigue:
skeletal muscles reduces blood flow, May limit physical
leading to decreased exercise capacity performance, especially in
and fatigue. physically active individuals.
Eye Effects Decreased Aqueous Humor Rarely Used for Glaucoma:
Formation & IOP: Propranolol, when Due to its local anesthetic
applied topically, decreases aqueous effect on the cornea and lesser
humor production and lowers potency compared to other
intraocular pressure (IOP). agents like timolol.
Adverse Effects Common Adverse Effects: Can be bothersome, especially
- Bradycardia in elderly or patients with
- Hypotension preexisting low heart rate or
- Fatigue hypotension.
- Dizziness
- Cold extremities
- Sexual dysfunction
Serious Adverse Effects: Severe Adverse Effects: Requires careful monitoring,
- Heart failure exacerbation (in especially in patients with
patients with preexisting heart asthma, COPD, or heart block.
failure)
- Bronchospasm (especially with
nonselective β-blockers)
- Severe hypotension
- Heart block (particularly in patients
with conduction disturbances)
Contraindications Contraindicated in: Use with caution or avoid in
Asthma and COPD (with these conditions, as β-blockers
nonselective β-blockers) due to can worsen symptoms.
risk of bronchospasm.
Severe bradycardia
Heart block (2nd or 3rd degree)
- Severe hypotension
- Cardiogenic shock
- Uncontrolled heart failure
Clinical Use Description Relevant β-blockers
β-blockers reduce cardiac Metoprolol, Atenolol,
Hypertension (High
output and lower systemic Bisoprolol, Carvedilol,
Blood Pressure)
vascular resistance. Labetalol
Reduce heart rate and
Carvedilol, Metoprolol,
Heart Failure contractility, easing the
Bisoprolol
workload on the heart.
Decrease myocardial
Angina Pectoris (Chest oxygen demand by Atenolol, Metoprolol,
Pain) reducing heart rate and Propranolol, Bisoprolol
contractility.
Slow conduction through
Metoprolol, Esmolol,
Arrhythmias the AV node and control
Propranolol
abnormal electrical activity.
Improve survival by
Post-Myocardial reducing the heart's Metoprolol, Carvedilol,
Infarction (MI) oxygen demand and Bisoprolol
preventing arrhythmias.
Control ventricular and
Tachycardia (Rapid Heart supraventricular Esmolol, Metoprolol,
Rate) tachycardia by slowing Propranolol
heart rate.
Reduce frequency and
Propranolol, Atenolol,
Migraine Prophylaxis severity of migraines by
Metoprolol
stabilizing vascular tone.
Decrease tremors by
Essential Tremor inhibiting β-adrenergic Propranolol, Atenolol
activity in skeletal muscles.
Reduce intraocular
Glaucoma (Ocular pressure by decreasing Timolol, Betaxolol,
Hypertension) aqueous humor Carteolol
production.
Alleviate physical
Anxiety symptoms of anxiety (e.g., Propranolol
tachycardia, tremors).
Control tachycardia and
Thyrotoxicosis
tremors caused by excess Propranolol, Atenolol
(Hyperthyroidism)
thyroid hormone.
Block catecholamine-
Pheochromocytoma induced symptoms,
Propranolol, Labetalol
(Pre-surgical treatment) including hypertension and
tachycardia.