Adrenergic antagonists: Beta blockers

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Adrenergic antagonists: Beta blockers

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A 67-year-old man is brought to the emergency department by his partner after being found down at home with several open pill bottles around him. According to the partner, “He has been so depressed recently, I hope he did not try to hurt himself.” Past medical history includes heart failure, hypertension, atrial fibrillation, diabetes, and major depressive disorder. Home medications include escitalopram, metoprolol, metformin, and digoxin. Temperature is 35.6°C (96.1°F), pulse is 32/min, respirations are 7/min, blood pressure is 72/40 mmHg, and oxygen saturation is 88% on room air. On physical examination, the patient is obtunded, and the extremities are pale and cool to touch. An electrocardiogram demonstrates sinus bradycardia. Which of the following treatments is the next best step in managing this patient’s clinical condition?  


Alpha blockers and beta blockers are two types of postsynaptic anti-adrenergic medications that prevent their respective receptors from being stimulated by catecholamines, like norepinephrine and epinephrine.

The nervous system is divided into the central nervous system, so the brain and spinal cord; and the peripheral nervous system, which includes all the nerves that connect the central nervous system to the muscles and organs.

The peripheral nervous system can be divided into the somatic nervous system, which controls voluntary movement of our skeletal muscles; and the autonomic nervous system, which controls the involuntary movement of the smooth muscles and glands of our organs; this system is then further divided into the sympathetic and parasympathetic nervous systems.

Now, the autonomic nervous system is made up of a relay that includes two neurons. We’ll focus on just the sympathetic nervous system.

Signals for the autonomic nervous system start in the hypothalamus, at the base of the brain. Hypothalamic neurons have really long axons that carry signals all the way down to the thoracic and lumbar spinal cord nuclei, where they synapse with preganglionic neuron cell bodies.

From there, the signal goes from the preganglionic neurons down its relatively short axon, exits the spinal cord, and reaches the nearby sympathetic ganglion, which is made up of lots of postganglionic neuron cell bodies.

The postganglionic neurons are also called adrenergic neurons, because they release the neurotransmitter norepinephrine, which is also called noradrenalin; and to a much lesser degree, epinephrine also known as adrenaline.


Adrenergic antagonists are a type of drug that blocks the action of adrenaline in the body. Adrenaline is a hormone that is released in response to stress or excitement, and it causes the heart rate to speed up and the blood vessels to narrow.

Beta-blockers are a type of adrenergic antagonist that blocks the sympathetic activation of Beta-adrenergic receptors. Beta-blockers work by blocking the action of adrenaline, which is responsible for the body's fight-or-flight response. This makes them ideal for treating conditions where the body's natural response to stress is harmful, such as high blood pressure and heart arrhythmia.


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