Feb 25, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Paw paw paw paw paw paw paw from Eric. This was a text message I got. My son had borrowed his Mom's phone and I thought he was pretending to be our dog Sheldon. It turns out he just can't spell. He meant to say, Pew pew pew pew pew. Those are obviously the sounds a blaster makes in Star Wars. He was blasting me via text message. The telephone rings so infrequently in our house that Eric either ignores it, or picks up the receiver and starts singing, La la la la! because it is usually me calling from Winnipegosis, where I don't have cell coverage. He was shocked when one day he spent an hour in the pharmacy with me. The phone rings a lot here, doesn't it? Eric and I have completely different ideas about how people should communicate. Communication is key to parenting, I'm told. Too bad I'm failing at it.

What is my beta-blocker for? is a harder question for a pharmacist to answer than you would think. They have many, many different uses. Let's see if I can hone my communication skills and explain why. Well start with how important adrenaline is in your body. Pretend you lived 10,000 years ago. You raise your atlatl as you approach a small deer. Your spear thrower hits its mark on the ancient savannah. Suddenly, instead of getting Neolithic take-out to drag back to the family, there is a problem. A sabre-toothed tiger decides he is going to eat your deer and probably you for dessert. What do you do? Fight or flee?

This is what adrenaline what made for. That fight or flight reaction when presented with a sabre-toothed tiger. Adrenaline starts pumping and your heart beats faster, your blood pressure goes up, your lungs open up and blood goes to your muscles instead of your stomach. These are the perfect reactions for your body to have when fighting or running from the sabre-toothed tiger. However in our modern world, there aren't too many sabre-toothed tigers to run from. An overactive adrenaline system can actually harm the body over time.

We do have medications that can block the effects of adrenaline in the body. Adrenaline is made in the adrenal glands which sit on top of the kidneys. Beta-blockers stop adrenaline from reaching its receptors all over the body. As a pharmacist the thing I find the most fascinating about beta-blockers is that blocking these adrenaline receptors can be used to treat so many different conditions.

High blood pressure. Beta-blockers have been a popular and effective blood pressure pill for years. They do slow do the heart, but they probably decrease blood pressure by affecting the renin system.

Irregular heart beat. Because beta-blockers stop the adrenaline from reaching their receptors on the heart, they slow down the heart rate. This slowing of the heart rate also decreases the irregular heart beats.

Heart failure. When the heart is failing, the body produces a lot of adrenaline to deal with this stressful event. However the stimulation of the heart muscle by the adrenaline actually further weakens the heart muscle. When adrenaline is blocked, it leads to less stress on the heart muscle. The beta-blockade also may decrease the inflammatory mediators that the damaged heart releases and might affect cardiac remodeling.

Heart attack. After a heart attack, the heart muscle is damaged. Beta-blockers act like a governor on a golf cart engine. They don't let the heart beat too fast. This means the heart muscle needs less oxygen. This allows the heart muscle to recover better.

Migraine. Beta-blockers aren't helpful if you have a migraine right now, but they might prevent you from having your next one. They are a standard treatment for preventing migraines, but we aren't really certain how they work. We think they might affect adrenaline in the brain, but they also might affect other brain chemicals like serotonin.

Cheating at the Olympics and playing Carnegie Hall. Beta-blockers are banned in shooting sports. Because beta-blockade stops the effects of adrenaline, they stop the shaking of your hands if you are nervous during your Olympic archery or pistol competition. This is considered an unfair advantage, so they are banned. They don't drug test classical musicians, so some take beta-blockers to help with stage fright before big performances.

PTSD- Post Traumatic Stress Disorder. This is what soldiers can get after seeing horrible things in war or paramedics can get after seeing horrible things on the job. Here we are going into the more nebulous or experimental uses of beta-blockers. There are standard treatments for PTSD and they often involve antidepressants. Some researchers think beta-blockers might help to prevent PTSD. The idea is if you give beta-blockers to a soldier right after the horrible event, this will block the effect of adrenaline in the body. One of the effects of adrenaline is to make memories stick. Researchers think that blocking adrenaline might prevent normal memories from becoming PTSD memories.

Racism. This is the one I am most dubious about. Racism is a complicated series of thoughts and actions usually based on a life time of experience, parental teaching, peer groups, privilege and many other factors. But a researcher in England gave some test subjects a beta-blocker and others a placebo. Then she ran a test on them to reveal racial biases. The ones on the beta-blocker showed fewer racial biases. The researcher believes by blocking adrenaline, the beta-blocker group experienced less anxiety. She thinks that leads to fewer racial biases.

In the pharmacy, people always want to know what condition their medication is meant to treat. That can be a tricky question to answer with a beta-blocker. Beta-blocker treat many conditions and doctors don't tell pharmacists the patient's diagnosis. So pharmacists have to use their communication skills to find out what the patient knows about why they saw the doctor and what the doctor said the problem was to try to discern what the beta-blocker is being used for in each patients case. If only I could use those skills better outside the dispensary. My daughter Emily gave some serious, heart felt advice to our dog this morning, Stay happy Sheldon before he crushes your happiness! Apparently when I said, Emily take out the garbage, she heard, Emily do an unfair, meaningless, soul crushing piece of drudgery that will take hours to perform and will emotionally scar you for life. Oh well. I suck at communicating, but at least the garbage got to the curb.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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Atalatl video -

CBC article on Racism and Beta-blockers


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