Pharmacology · patient case question
Which statement best describes how carvedilol reduces cardiac workload?
Patient case: Chest Pain During the Appointment
Patient: 64-year-old female
Chief Complaint: “My mouth is hurting on the upper right.”
Background: Hyperlipidemia and hypertension, both reportedly well controlled. Non-smoker. No prior cardiac events.
Medications: Simvastatin 40 mg daily · Carvedilol 12.5 mg twice daily · Aspirin 81 mg daily
Vital Signs: On seating: BP 138/84 mmHg · HR 68 bpm · RR 16 · T 98.4°F
Findings: During the examination she develops crushing substernal chest pain radiating into the left arm, with diaphoresis. Emergency medical services are activated, oxygen is delivered, and a sublingual nitroglycerin tablet is administered. Her panoramic radiograph, taken earlier, incidentally shows diffusely narrowed pulp chambers and canals in multiple posterior teeth.
Show answer and explanation
Correct answer: C. It blocks beta-1, beta-2, and alpha-1 receptors, lowering heart rate, contractility, and afterload
- A. Incorrect. Selective beta-2 blockade has no therapeutic use and would provoke bronchospasm. Beta-2 agonism, not antagonism, is what albuterol does.
- B. Incorrect. Angiotensin II receptor blockade describes losartan and valsartan — the drugs with the -sartan suffix.
- C. Correct. Carvedilol is a third-generation, non-selective beta blocker with additional alpha-1 antagonism. Beta blockade lowers heart rate and contractility, reducing oxygen demand, while alpha-1 blockade produces peripheral vasodilation that lowers afterload.
- D. Incorrect. ACE inhibition describes lisinopril and enalapril — the drugs with the -pril suffix.
Note: Dental relevance of non-selective beta blockade: epinephrine in local anesthetic can produce unopposed alpha-mediated vasoconstriction with a rise in blood pressure and reflex bradycardia. Limit the dose, aspirate carefully, and monitor.