Beta-Adrenergic Receptor Antagonists (Blockers)

Available PO and IV.

Prescribed long term for stable angina, systolic CHF, MI (secondary prevention), Htn, and AFIB (for control of heart rate). No longer considered first-line Rx for essential Htn, especially in elderly pts.

Long-term Rx must be continued periop (Class I ACC/AHA recommendation).

Risk-benefit balance of periop (prophylactic) beta-blocker Rx is unclear.

Periop Rx prevents MI after surgery, but increases risks of CVA and hypotension.

Periop Rx may be reasonable for selected pts with ischemia on cardiac stress testing or three or more risk factors on the Revised Cardiac Risk Index (Class IIb ACC/AHA recommendation).

Increases risks of hypotension, bradycardia, and CVA. Risks may be further elevated in the presence of anemia, nonselective beta-blockers, or short duration of preop medication (<5 d).

Periop beta-blockade should be avoided in pts with CVD.

Contraindicated in pts with asthma. Nonselective beta-blockers may precipitate bronchospasm in COPD with significant reversible airway obstruction.

May worsen or precipitate CHF in pts with decreased LV function.

May cause hypotension and CVA, especially in the presence of anemia or nonselective beta-blockers.

May worsen underlying systolic cardiac dysfunction.

Can precipitate bronchospasm, especially with nonspecific beta-blockers and COPD with known reversible airway obstruction.