Like all β-blockers, these medications have generic names ending with the suffix “-olol”. However, it is important to note that selective β-blockers begin with a letter from A-M, as opposed to nonselective β-blockers which begin with a letter from N-Z. Two notable exceptions are the nonselective β-blockers carvedilol and labetalol.
These medications are selective for blocking β1-adrenergic receptors. They decrease heart rate, contractility and renin release.
Atenolol is a β1-blocker that does not cross the blood brain barrier. It is typically indicated for arrhythmias, angina, MI and hypertension (though it is not first-line for hypertension).
Esmolol is a very short-acting drug with rapid onset. It is typically given via IV in certain operating room scenarios to treat tachycardia and supraventricular tachycardia (SVT). It is also the drug of choice in aortic dissection.
Metoprolol is a β1-blocker which is typically used for rate control, angina, MI and CHF. Because it crosses the blood-brain barrier, it can be used for migraine prophylaxis. It has off label use for anxiety disorders as well.
Some β1-selective blockers also act as partial β-agonists at high doses. This means that they have some intrinsic sympathomimetic activity along with their β-blocking activities, like the medication acebutolol.
Acebutolol is a β1-blocker with partial β-agonist activity at high doses. It is typically indicated for arrhythmias and hypertension.
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