b受體阻滯劑（B receptor blocker）

1、b受體阻滯劑（B receptor blocker）1. can coronary artery intervention (PCI) be used after Betaloc?Answer: there is no special research to emphasize the use of Betaloc after PCI. But if patients receive PCI because of unstable angina or acute myocardial infarction, long-term treatment with betaloc is believe

2、d to be most beneficial.2. times Betaloc can be used as a first-line drug for angina pectoris?A: in October 2002, the revised ACC/AHA guidelines for the treatment of stable angina pectoris indicated that, without contraindications, beta blockers were the first choice for anti colic drugs.3. times wh

3、at Betaloc can be used for the treatment of arrhythmias?Answer: room early, room earlyAtrial fibrillation and atrial flutterSupraventricular tachycardiaMultifocal atrial tachycardiaQT extension syndromeArrhythmia caused by digitalis poisoningSudden cardiac death after myocardial infarction4., Chines

4、e are particularly sensitive to beta blockers, so is it unsafe for patients to use 25mg every day to use 100mg and 200mg?A: beta blockers vary in individual metabolism, and even in Western populations, the same dose can produce a difference of 20 times the serum concentration. But there is no large-

5、scale study showing racial differences, and CCS-2 research is being conducted in a large scale in the Chinese population. From the known safety data (27000 cases), 86% of the patients were well tolerated by oral 200mg betaloc.Can 5. times Betaloc be used in patients with cardiovascular disease assoc

6、iated with diabetes?Answer: the main body is B2 receptor to regulate blood sugar and Betaloc on the B1 receptor of B2 receptor is very small, so it can be used for patients with diabetes, and non selective B receptor blockers is not recommended. UKPDS studies and other large-scale pooled analyses ha

7、ve demonstrated that selective B1 blockers may benefit more patients at high risk.A multicenter cohort study assessed in patients with acute myocardial infarction beta blocker on diabetic survival effect (Kjekshus J, et al. European heart journal.1990; 11 (1): 43-50.). The results show that did not

8、receive beta blocker therapy in patients with a mortality rate of 1 years after hospital discharge was 23%. While the treatment group was only 10%. Multiple regression analysis showed that the use of beta blockers was an independent predictor of cardiovascular mortality in all patients with acute my

9、ocardial infarction with diabetes after 1 years of discharge.A subgroup of MERIT-HF of Betaloc sustained-release tablets on the efficacy and safety of diabetic patients with heart failure (Deedwania PC, et al. American heart journal. 2005; 149 (1): 159-167.). The results show that the use of metopro

10、lol sustained-release tablets in the treatment of the same can save the lives of patients and reduce the the risk of hospitalization for worsening heart failure. At the same time, metoprolol sustained release tablets are also well tolerated in patients with heart failure associated with type 2 diabe

11、tes mellitus. The incidence of hyperglycemia, hypoglycemia, and diabetic ulcers was similar in the two groups. The average dose used in diabetic patients with heart failure of metoprolol sustained-release tablets for 162mg without diabetes in patients with heart failure medication dose is 156mg, fur

12、ther explains the diabetic heart failure patients with application of metoprolol sustained-release tablets has good tolerance.Does 6. times Betaloc fail to treat patients with cardiovascular disease, diabetes or hyperlipidemia?Answer: the human body is mainly beta 2 receptor regulation of blood suga

13、r and blood lipid metabolism, Betaloc role in beta 1 receptor, beta 2 receptor function is very small, so it can be used in patients with diabetes or hyperlipidemia, rather than selective. UKPDS studies and other large-scale pooled analyses have shown that selective beta 1 receptor blockers offer mo

14、re benefit for high-risk patients.How many times does 7. times Betaloc apply to cardiovascular disease?Answer: hypertension, arrhythmia (including supraventricular and ventricular), heart failure, coronary heart disease (including myocardial infarction, angina), myocardial ischemia, migraine, hypert

15、rophic cardiomyopathy, mitral valve prolapse, dissecting aneurysm, digitalis poisoning, long QT syndrome and two tricuspid stenosis.What is the cause of sudden cardiac death by 8. times Betaloc?Answer: Betaloc is a lipophilic beta blocker, can inhibit lipid barrier through the brain beta 1 receptor,

16、 which increase vagal tone, sympathetic nerve tension is lowered, thereby reducing the incidence of ventricular fibrillation, reduce sudden cardiac death.Whats the significance of 9. times the lipophilicity of his music?Answer: lipophilic beta blockers are largely metabolized by liver metabolism, wi

17、th a short half-life, no accumulation of kidney function, and safe use of renal insufficiency. Lipophilic decided Betaloc can penetrate the blood brain shield in the cerebrospinal fluid content, inhibit brain beta 1 receptor, thereby reducing sudden cardiac death.What is the mechanism and function o

18、f 10. times Betaloc?Answer: Betaloc has good selectivity, less side effects, safe and reliable; antihypertensive effect significantly, and reduce the incidence of complications and mortality of hypertension; reduce the onset of angina pectoris, improve exercise tolerance; protect the heart, reduce t

19、he incidence of myocardial infarction, reduce the reinfarction rate and mortality after myocardial infarction, and prevent atherosclerosis to reduce the occurrence of sudden cardiac death, characteristics.How does 11. times Betaloc affect heart rate and blood pressure?Answer: metoprolol selective ef

20、fects on cardiac beta 1 receptor, firstly, decreased heart rate, decreased myocardial contractility, slow heart conduction velocity, so that the reduction in cardiac output, lower blood pressure; in addition, Betaloc dilation of blood vessels, reduce norepinephrine release, reduce renin secretion, r

21、educe sympathetic stimulation, thus lower blood pressure. For Betaloc, the maximum blood concentration was 1-2 days, and the heart rate dropped to a minimum of 1-2 days, and the blood pressure dropped to normal for 1-2 weeks. As long as the heart rate greater than 55 beats per minute, can continue t

22、o use. The maximum blood concentration was linear with heart rate, but not multiple; if withdrawal, the heart rate returned to normal rapidly, while blood pressure recovered slowly without BP rebound.12. times what dose Betaloc use in combination with antihypertensive drugs?A: Betaloc is used in com

23、bination with a variety of antihypertensive drugs, including calcium antagonists, diuretics, and alpha blockers.13. times Betaloc is suitable for those hypertensive patients with comorbidities?Answer: according to JNC-7, beta blockers are a strong indication of high risk patients with hypertension,

24、heart failure, angina pectoris, and myocardial infarction.14. why does Betaloc treat heart failure slowly from a small dose, while the treatment of acute myocardial infarction requires large doses and rapid administration?Answer: the treatment of chronic heart failure, to begin with a small dose, an

25、d then according to the patients condition slowly increase measurement, to minimize the adverse effects of negative inotropic effect of beta blockers brings to the patient, and in the short term to long-term play a beneficial treatment.Second, for patients with acute myocardial infarction time is li

26、fe, in order to reduce the oxygen consumption of heart, prevent myocardial infarction area expansion and ventricular fibrillation occurred, to block offensive nervous system immediately effective measure, after rapid intravenous injection to the order of priority and oral administration of large dos

27、e of betaloc.15. acute myocardial infarction is accompanied by third degree atrioventricular block. Is it possible to receive Betaloc after intravenous therapy?Answer: absolutely. In addition to heart rate, Betaloc may have an impact on blood pressure and metabolism and can not be directly measured

28、for metabolic effects. For example, for a pacemaker after fixed heart rate in patients with dilated cardiomyopathy, Betaloc is good although the installation is fixed frequency pacemakers, heart rate did not change after 6 months of treatment, the ejection fraction increased significantly,The benefi

29、t of beta blockers is at least partly modulated by other mechanisms, such as reduced renin and endothelin, and the modulation of inflammatory cytokines (e.g., TNF alpha).16. times Betaloc a (metoprolol) is best for those hypertensive patients?Answer: the European Society of Cardiology beta blockers

30、group consensus document pointed out that the high blood pressure in patients with myocardial infarction, ischemic heart disease, arrhythmia or heart failure, left ventricular function in asymptomatic insufficiency, diabetes or coronary heart disease risk in the past, alone or in combination with be

31、ta blockers is the preferred method of treatment (class I the level of evidence, grade a).Also pointed out that in Britains new guidelines for hypertension: beta blockers for young patients, especially for ACEI and ARB is not tolerated or contraindicated in patients with pregnancy and pregnancy, pla

32、n and high sympathetic activity, and in patients with hypertension complicated with angina pectoris and myocardial infarction of the important therapeutic drugs.Metoprolol is also an effective and safe combination therapy. In our country, the blood pressure control rate of hypertensive patients is v

33、ery low, only 6.1%, and ischemic heart disease is the most common form of target organ damage in hypertension. Hypertension patients often need more than 2 drugs combination treatment to effectively control blood pressure, and can effectively reduce the incidence of adverse reactions. Beta blockers

34、are the drug of choice for the treatment of ischemic heart disease, clinical evidence such as the HOT study also already confirmed that Tolol is one of the most important drug combination of antihypertensive therapy.17. can the hypertensive patients who are using Betaloc stop the withdrawal?Answer:

35、many patients taking beta blockers may suffer from coronary heart disease or occult coronary heart disease. Therefore, they must not be stopped at will. A sudden withdrawal, especially by a high dose of sudden withdrawal, may lead to rebound angina and lead to myocardial infarction.The British Hyper

36、tension Guidelines also point out that long-term treatment strategies should be taken into account in patients who are being treated with antihypertensive drugs containing beta blockers, without absolute replacement for other medications.Three. Receptor blocker related experiment answerDoes 1.ASCOT

37、confirm that the efficacy of antihypertensive drugs such as calcium antagonists is superior to those of older drugs such as the B receptor blocker?Answer: in fact, in the study of two end point events, although most of the amlodipine group especially the total mortality compared with atenolol group

38、decreased significantly, but the main end point events of the two treatment groups had no significant difference in the incidence, ASCOT-BPLA results can be regarded as neutral; this test is only the curative effect of two treatments comparison, comparison between drugs and drugs are not.The two gro

39、ups had different degrees of blood pressure reduction and some biochemical indexes, which was also one of the causes of the difference in end-point events. The improper drug selection, has confirmed the lack of cardiac protection benefits of atenolol.Therefore, it is not fair to think that beta bloc

40、kers are ineffective in treating hypertension and that beta blockers do not act as first-line antihypertensive drugs.2., the latest British hypertension guidelines do not recommend beta blockers as a first-line treatment for initial treatment. What is the basis for this?Answer: a recent study of dif

41、ferent types of antihypertensive drugs in clinical trials: a meta-analysis found that hypertensive patients using beta blocker therapy in hypertensive patients with the use of other drugs compared to the incidence of stroke increased by 16%. ASCOT study published a year ago that the amlodipine based

42、 therapy in hypertensive patients the overall mortality rate was significantly lower than in atenolol based therapy for patients. Although a meta-analysis and ASCOT application of beta blockers is mainly atenolol, but the British Hypertension Guidelines Writing Group believes that the exclusion of a

43、tenolol after other evidence for beta blockers is not recommended, as the first-line drugs for initial treatment for hypertension.3. poor cardiovascular protective effects of atenolol, metoprolol are the same?Answer: many studies have indicated that atenolol is effective in reducing,But it does not

44、reduce the major cardiovascular events in hypertensive patients. For example, the elderly MRC study showed that the antihypertensive efficacy of atenolol and diuretics are similar, but the major cardiovascular events but no difference with placebo. In spite of this, many clinical trials such as ASCO

45、T, LIFE is used as the control drug of atenolol, the result is not persuasive. From the perspective of pharmacology, atenolol is water soluble beta blocker metoprolol is fat soluble beta blockers, which can rapidly through the blood-brain barrier, while blocking the heart and central beta receptor,

46、effectively reduce the excitability of the sympathetic nervous system, clinical research has confirmed that metoprolol has definite protective effect on heart, chronic hypertension, heart failure after myocardial infarction, patients with sudden death risk significantly reduced. Therefore, the lack

47、of atenolol cardioprotective effect and can not be simply classified as class effects, and all of the beta blocker.What is the status of the 4. beta blockers in coronary heart disease?Answer: beta blockers as first-line treatment guidelines issued by domestic and foreign recommended, such as Europe

48、and the United States the authority of ESC, ACC and AHA were to strongly recommend beta blockers for the treatment of coronary heart disease, such as chronic stable angina ACC/AHA guidelines recommended stability angina patients should be a combination of drugs reduce symptoms, improve ischemia and

49、the prevention of myocardial infarction and death, two beta blockers also has the effect, therefore, beta blockers should be recommended as the initial treatment without contraindication in patients with angina pectoris, whether with myocardial infarction. Usually should be a beta blocker dose adjus

50、tment to the resting heart rate 55-60 times / min to achieve full effect. Guidelines for unstable angina and non ST segment elevation guidelines indicate that this should be used for long-term treatment in all patients without contraindications. For patients with ST segment elevation acute myocardia

51、l infarction, ACC/AHA and ESC recommend that all contraindicated patients should receive oral beta blockers and should be long-term (indefinitely) used to improve their long-term prognosis.The Chinese Journal of Cardiology and the Editorial Committee of the Chinese Journal of Cardiology published the latest diagnosis and treatment of chronic stabl