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With intrinsic sympathomimetic activity (ISA) • Pindolol • Acebutolol Mechanism of Action • ↓ Heart rate (negative chronotropy) • ↓ Myocardial contractility (negative inotropy) • ↓ AV nodal conduction • ↓ Renin release from kidneys ➡ Overall: reduced cardiac workload and blood pressure Indications Cardiovascular • Hypertension • Ischemic heart disease (angina) • Post-myocardial infarction • Heart failure (metoprolol, bisoprolol, carvedilol) • Arrhythmias (AF rate control, SVT) Non-cardiac • Thyrotoxicosis • Migraine prophylaxis • Essential tremor • Anxiety (performance anxiety) • Portal hypertension (variceal bleed prophylaxis) • Glaucoma (topical timolol) Adverse Effects • Bradycardia • Hypotension • Fatigue • Cold extremities • Sexual dysfunction • Sleep disturbances (esp
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