Step I Good Pharmacology Question

[bigfrank]

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A patient with a history of dysthymia has four consecutive B/P readings that average 150/85. It is thought that a medication to control her HTN should be initiated. Which of the following drugs is most likely to cause/exacerbate depression?
a. Nifedipine
b. Metoprolol
c. Triamterene
d. Lisinopril
e. Valsartan

 

[Idiopathic]

Metoprolol? Because of its anti-adrenergic action?

 

[daisygirl]

I've got a sneaking suspicion that metoprolol would exacerbate her depression. Beta-blocking drugs are known to cause sedation, sleep disturbances and sexual dysfunction- so anything that would worsen the way she feels could contribute to her depression.

I haven't gotten to review any of the psych disorders yet. I know what dysthymic disorder is, but I don't exactly remember what is believed to be the etiological basis of it.

 

[bigfrank]

I put B and I think it's right. It just "felt like" a question that could pop up on Step I/II.

- Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction.
AU - Ko DT; Hebert PR; Coffey CS; Sedrakyan A; Curtis JP; Krumholz HM
SO - JAMA 2002 Jul 17;288(3):351-7.

 

[starayamoskva]

I put B and I think it's right. It just "felt like" a question that could pop up on Step I/II.

- Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction.
AU - Ko DT; Hebert PR; Coffey CS; Sedrakyan A; Curtis JP; Krumholz HM
SO - JAMA 2002 Jul 17;288(3):351-7.

New onset, or exacerbation of existing depression is a side effect of metoprolol.

 

[mjl1717]

Id say answer b -because beta blockers have a negative chronotropic and ionotropic affect on the heart so its easy to say they depress the heart and interesting that they can cause mental depression. (I use the pneumonic MAAE for B1 selective) Big Frank thats a H.Y. q.

 

[Idiopathic]

I think it is best to know that the adrenergic blockers are the only drugs listed that might cause CNS depression, due to inhibition of the reticular activating system. All others exert a totally peripheral action.

Dont forget about Betaxolol in your mnemonic, I use ACE-BEAM

(ACEbutolol, Betaxolol, Esmolol, Atenolol, Metaprolol)

 

[bigfrank]

I'm not sure the exact mechanism is known, but I'm confident it is BBs. Thanks for all your help guys!!!

Yea, my FA had "A BEAM" of B1 Blockers!

And what are the only 2 BBs with instrinsic sympathomimetic effects, making them strict contraindications in patients with Angina? ..........

 

[stoic]

And what are the only 2 BBs with instrinsic sympathomimetic effects, making them strict contraindications in patients with Angina? ..........

Pindolol and Acebutolol.

 

[Idiopathic]

for some reason i thought it was pindolol and atenolol...

 

[bigfrank]

Pindolol and Acebutolol.

Yep! 👍

 

[mjl1717]

Just to complete Big Franks in service:
Beta blockers with alpha blocking activity would be:
*Labetalol and Carvedilol

And Butoxamine is a selective B2 antagonist but no current clinical use

 

[undecided05]

although not a B-blocker, I think Idio was talking about central actors causing depression. Methlydopa is notorius for its many side-effects; one of which is depression. Also a frequent answer on exams.

 

[mjl1717]

Ill also add that reserpine although old fashion for HTN can cause depression
and could be seen on an exam as a distractor!

 

[Mossjoh]

Does metoprolol cross the blood brain barrier?

Propranolol has the side effect of depression, because it crosses the BBB, but I thought it was the only B-blocker that did

Mossjoh

 

[daisygirl]

Does metoprolol cross the blood brain barrier?

Propranolol has the side effect of depression, because it crosses the BBB, but I thought it was the only B-blocker that did

Mossjoh

Propanolol is the b-blocker with the highest lipid solubility. Metoprolol has moderate lipid solubility according to my text, so it does cross the blood brain barrier with relative ease. Even though the drug isn't highly lipid soluble, the amount of drug that does cross the bbb has the potential of worsening the depression in an individual with dysthymic disorder.

The b-blockers have varying degrees of lipid solubility. According to baby Katzung (I can't believe that I opened up this book 😱 ), acebutolol and atenolol are the least lipid soluble of the b-blockers.

 

[bigfrank]

Wow, nice work guys/gals!