Inotropes in the beta-blocker era pdf Culburra

inotropes in the beta-blocker era pdf

Inotropes and Vasopressors Circulation Acute Decompensated Heart Failure: Inpatient Management Collin Fischer, MD Cardiology Service Eisenhower Army Medical Center Augusta, GA

List of Inotropic agents Drugs.com

Chronic Inotropic Therapy in the Current Era Circulation. Role of Vasopressors and Inotropes in the Management of Shock At the point where patients are adequately resuscitated yet remain hypotensive the initiation of vasopressors may be required to achieve the desired MAP., Beta-blocker In patients with reduced EF not already receiving a beta-blocker, this treatment should be started as soon as possible after stabilization, blood pressure and heart rate permitting*..

Skeletal formula of propranolol, the first clinically successful beta blocker. Class identifiers; Synonyms: β-blockers, beta-adrenergic blocking agents, beta antagonists, beta-adrenergic antagonists, beta-adrenoreceptor antagonists, beta adrenergic receptor antagonists Beta-blockers: It was once believed that beta-blocker drugs, being negative inotropes, should not be used to treat HF but numerous large clinical trials have shown this class of drug increases survival, reduces hospitalisation and improves heart function in systolic HF.

thrombolytic era, specifically in patients who have substantial left-ventricular dysfunction, who might also have heart failure, and in whom ACE inhibitors will have been prescribed. We designed the Carvedilol Post- Infarct Survival Control in LV Dysfunction (CAPRICORN) study to test the hypothesis that the addition of carvedilol to standard modern management of acute myocardial infarction in beta-blocker use in Post MI patients reduces cV events by 23% in prospective studies and upto 40% in observational studies. 14,20 The benefits are greatest in patients at high risk 20

beta-blocker use in Post MI patients reduces cV events by 23% in prospective studies and upto 40% in observational studies. 14,20 The benefits are greatest in patients at high risk 20 may 1998:1336–40 combined inotropic and beta-blocker therapy in chf (until December 1, 1996, death or heart transplantation) was 20.9 6 3.9 months (range 0.6 to 82.5).

Despite their theoretic appeal, agents that increase cardiac contractility (positive inotropes) have consistently been shown to increase mortality when given chronically to patients with heart failure. The routine use of inotropes as heart failure therapy in either the acute or the chronic setting Inotropes in the beta‐blocker era However, although many subjects improve on beta blockade, others do not, and some may even deteriorate. Even when subjects improve on beta blockade, they may subsequently decompensate and need acute treatment with a positive inotropic agent.

Lowes BD, Simon MA, Tsvetkova TO, Bristow MR: Inotropes in the beta-blocker era. Clin Cardiol 2000, 23 ( Suppl 3 ):III11-III16. This text provides an excellent discussion of the use of inotropic therapy in combination with ß-blockers. Figure 3 Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration.

Inotropes in Children MICHAEL CLIFFORD, MB, BS, FJFICM, FANZCA Royal Children’s Hospital, Melbourne, Victoria Michael Clifford is a staff anaesthetist at the Royal Children’s Hospital, Melbourne. The traditional hemodynamic model suggests that heart failure is primarily a defect in cardiac contractility, and drugs that increase cardiac contractility (positive inotropes) have thus long been considered an attractive pharmacologic target.

Ephedrine is a mixed alpha and beta agonist - it actually is a direct and indirect sympathomimetic - releasing norad from nerve endings (prone to tachyphylaxis though). Patients with American College of Cardiology/American Heart Association stage D heart failure have limited options beyond standard medical therapy including home inotropes, heart transplantation, mechanical circulatory support, or palliative care/hospice.

Ephedrine is a mixed alpha and beta agonist - it actually is a direct and indirect sympathomimetic - releasing norad from nerve endings (prone to tachyphylaxis though). Beta-blockers: It was once believed that beta-blocker drugs, being negative inotropes, should not be used to treat HF but numerous large clinical trials have shown this class of drug increases survival, reduces hospitalisation and improves heart function in systolic HF.

One of the next steps is often the use of a type of negative inotropic drug called a beta-blocker. Studies have shown that beta-blockers can benefit heart failure patients by improving their symptoms and heart function, and, in some cases, the chance of survival. Beta-blocker Use in Decompensated Heart Failure Alharethi and Hershberger 77 whom inotrope withdrawal will lead to imminent demise [30,31••,32••].

Other antidotes for beta blocker poisoning are salbutamol and isoprenaline. β-receptor antagonism Edit Stimulation of β 1 receptors by epinephrine and norepinephrine induces a positive chronotropic and inotropic effect on the heart and increases cardiac conduction velocity and automaticity. [47] Acute Decompensated Heart Failure: Inpatient Management Collin Fischer, MD Cardiology Service Eisenhower Army Medical Center Augusta, GA

Heart Failure Beta-blocker Use in Decompensated

inotropes in the beta-blocker era pdf

Beta-blocker use in decompensated heart failure SpringerLink. EDITORIAL COMMENT Beta-Blockers in Acute Heart Failure Do They Cause Harm?* Guillaume Jondeau, MD, PHD,yzx Olivier Milleron, MDyzx W ithin the last 40 years beta-blocker ther-, Inotropes – Angina and Heart Failure Management See online here The inotropic agent in the context of heart failure and angina is classified into positive and negative inotropic agent. The positive agent increases the contractility and will be discussed in detail in this article. A brief about the negative inotropic agent, which decreases the myocardial contractility, is mentioned. The.

Acute Decompensated Heart Failure Inpatient Management. (negative inotropic effects) and benefits (inhibiting the adverse effects of the sympathetic nervous system) of beta-blocker therapy has not been established in acute decompensation. The uncertainty has led to inconsistent management: some physicians discontinue these drugs until the patient is close to euvolemic status, some reduce dosage, and others continue the patient’s outpatient regimen., Beta-blocker Use in ST-segment Elevation Myocardial Infarction in the Reperfusion Era (GRACE) (IV) beta-blocker therapy for patients presenting with ST-segment elevation myocardial infarction. 11 . The objectives of the present observational study were to describe patterns of beta-blocker use during hospitalization (especially during the first 24 hours) in patients with ST-elevation.

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inotropes in the beta-blocker era pdf

Cardiac Failure in Children who.int. Beta Blocker Toxicity Version No 1;Last Reviewed August 2017 Page 3 of 3 Printed copies are uncontrolled 4 Disposition All cases of beta blocker poisoning should be discussed with the toxicology team and warrant a period of observation with telemetry. Toxicity if it will occur should manifest within 6 hours.4 Severe toxicity requiring inotropes or HIET will require ICU admission. 5 Additional 49 Hershberger RE, Nauman D, Walker TL, Dutton D, Burgess D. Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure..

inotropes in the beta-blocker era pdf

  • Selection of patients for heart transplantationin the
  • Effects of Beta-Blocker Withdrawal in Acute Decompensated
  • Rational use of inotropic therapy in heart failure

  • Lowes BD, Simon MA, Tsvetkova TO, Bristow MR: Inotropes in the beta-blocker era. Clin Cardiol 2000, 23 ( Suppl 3 ):III11-III16. This text provides an excellent discussion of the use of inotropic therapy in combination with ß-blockers. Figure 3 Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration.

    Several large clinical trials conducted over the past decade have shown that pharmacologic interventions can dramatically reduce the morbidity and mortality associated with heart failure. thrombolytic era, specifically in patients who have substantial left-ventricular dysfunction, who might also have heart failure, and in whom ACE inhibitors will have been prescribed. We designed the Carvedilol Post- Infarct Survival Control in LV Dysfunction (CAPRICORN) study to test the hypothesis that the addition of carvedilol to standard modern management of acute myocardial infarction in

    Inotropes in the beta‐blocker era However, although many subjects improve on beta blockade, others do not, and some may even deteriorate. Even when subjects improve on beta blockade, they may subsequently decompensate and need acute treatment with a positive inotropic agent. Patients discharged on a beta-blocker had an LVAD/transplantation-free cumulative survival of 71% during a follow-up of 2074 ± 201 days (confidence interval 1679–2470). Conclusion It takes time to put severely ill HF patients on beta-blockers and it may require bridging with inotropes which are independent of beta-adrenergic receptors.

    Acute Decompensated Heart Failure: Inpatient Management Collin Fischer, MD Cardiology Service Eisenhower Army Medical Center Augusta, GA Use of inotropes & vasopressors To support the failing heart To support the failing peripheral vasculature To correct hypotension during anaesthesia (general or regional) 4.

    thrombolytic era, specifically in patients who have substantial left-ventricular dysfunction, who might also have heart failure, and in whom ACE inhibitors will have been prescribed. We designed the Carvedilol Post- Infarct Survival Control in LV Dysfunction (CAPRICORN) study to test the hypothesis that the addition of carvedilol to standard modern management of acute myocardial infarction in Figure 3 Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration.

    Other antidotes for beta blocker poisoning are salbutamol and isoprenaline. β-receptor antagonism Edit Stimulation of β 1 receptors by epinephrine and norepinephrine induces a positive chronotropic and inotropic effect on the heart and increases cardiac conduction velocity and automaticity. [47] Beta Blocker Toxicity Version No 1;Last Reviewed August 2017 Page 3 of 3 Printed copies are uncontrolled 4 Disposition All cases of beta blocker poisoning should be discussed with the toxicology team and warrant a period of observation with telemetry. Toxicity if it will occur should manifest within 6 hours.4 Severe toxicity requiring inotropes or HIET will require ICU admission. 5 Additional

    Catecholamines, inotropic medications, and vasopressor agents. In Chernow B. The pharmacologic approach to the critically ill patient. 1994. In Chernow B. The … beta-blocker use in Post MI patients reduces cV events by 23% in prospective studies and upto 40% in observational studies. 14,20 The benefits are greatest in patients at high risk 20

    When the combination of a PDEI and a beta-blocking agent is administered long-term in patients with HF, their respective benefits are additive and their adverse effects are counterbalanced [39 x [39] Lowes, B.D, Simon, M.A, Tsvetkova, T.O et al. Inotropes in the beta-blocker era. title = "Inotropes in the beta-blocker era", abstract = "Beta-adrenergic blocking agents are now standard treatment for mild to moderate chronic heart failure (CHF). However, although many subjects improve on beta blockade, others do not, and some may even deteriorate.

    Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration. Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration.

    Use of early beta-blocker therapy meant that the patient received some form of IV or oral beta-blocker therapy and was unable to account for dosage administered, brand, or its continued use. Despite their theoretic appeal, agents that increase cardiac contractility (positive inotropes) have consistently been shown to increase mortality when given chronically to patients with heart failure. The routine use of inotropes as heart failure therapy in either the acute or the chronic setting

    inotropes in the beta-blocker era pdf

    Beta-blocker Use in ST-segment Elevation Myocardial Infarction in the Reperfusion Era (GRACE) (IV) beta-blocker therapy for patients presenting with ST-segment elevation myocardial infarction. 11 . The objectives of the present observational study were to describe patterns of beta-blocker use during hospitalization (especially during the first 24 hours) in patients with ST-elevation Heart Transplantation Selection of Patients for Heart Transplantation in the Current Era of Heart Failure Therapy Javed Butler, MD, MPH, FACC,*†‡¶ Ghazanfar Khadim, MD,* Kimberly M. Paul, MD,§

    Measure #8 (NQF 0083) Heart Failure (HF) Beta-Blocker

    inotropes in the beta-blocker era pdf

    Inotropic therapy for heart failure An evidence-based. may 1998:1336–40 combined inotropic and beta-blocker therapy in chf (until December 1, 1996, death or heart transplantation) was 20.9 6 3.9 months (range 0.6 to 82.5)., Nevertheless, because inotropic state of the left ventricle is perceived as an important parameter in acute heart failure related to systolic dysfunction, pursuing beta-blocker therapy during the acute event may be suspected to be deleterious..

    Rational use of inotropic therapy in heart failure

    Difference between Inotropic Chronotropic and Dromotropic. 49 Hershberger RE, Nauman D, Walker TL, Dutton D, Burgess D. Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure., Introduction of beta blocker (BB) therapy in DHF patients requiring inotrope support is discouraged due to the negative hemodynamic impact of acute BB therapy.2-5 On the other hand, reduction in heart rate by BB therapy results in decreased myocardial oxygen demand.

    Abstract. Beta-adrenergic blocking agents are now standard treatment for mild to moderate chronic heart failure (CHF). However, although many subjects improve on … Beta-blockers: It was once believed that beta-blocker drugs, being negative inotropes, should not be used to treat HF but numerous large clinical trials have shown this class of drug increases survival, reduces hospitalisation and improves heart function in systolic HF.

    Role of Vasopressors and Inotropes in the Management of Shock At the point where patients are adequately resuscitated yet remain hypotensive the initiation of vasopressors may be required to achieve the desired MAP. Acute Decompensated Heart Failure: Inpatient Management Collin Fischer, MD Cardiology Service Eisenhower Army Medical Center Augusta, GA

    First, patients Wunderlich C, Schoen SP, Rauwolf T, with cardiogenic shock were excluded from mely appropriate in the ‘beta-blocker era’. The Weinbrenner C, Strasser RH. Levosimendan is these studies. Secondly, the current literature superior to enoximone in refractory cardiogenic authors conclude that a 24-h levosimendan suggests that levosimendan can be used in shock complicating acute Acute Decompensated Heart Failure: Inpatient Management Collin Fischer, MD Cardiology Service Eisenhower Army Medical Center Augusta, GA

    This study examines the effects of phosphodiesterase type III (PDEIII) inhibition vs beta stimulation on global function of the left ventricle (LV) and systemic haemodynamics in a porcine model of acute coronary stenosis with beta blockade. thrombolytic era, specifically in patients who have substantial left-ventricular dysfunction, who might also have heart failure, and in whom ACE inhibitors will have been prescribed. We designed the Carvedilol Post- Infarct Survival Control in LV Dysfunction (CAPRICORN) study to test the hypothesis that the addition of carvedilol to standard modern management of acute myocardial infarction in

    in the heart and have a negative inotropic action, which lessens cardiac workload, as the force and rate of the heartbeat is reduced and undesirable remodelling of the heart is minimised. 9780620421645.indb 32 16/9/08 11:09:55. Beta-blockers in heart failure 33 Figure 1. Effects of the parasympathetic and sympathetic nervous systems. Parasympathetic Sympathetic Dilates pupil Inhibits flow of Lowes BD, Simon MA, Tsvetkova TO, Bristow MR: Inotropes in the beta-blocker era. Clin Cardiol 2000, 23 ( Suppl 3 ):III11-III16. This text provides an excellent discussion of the use of inotropic therapy in combination with ß-blockers.

    with a beta-blocker resulted in a significantly greater decrease in diastolic blood pressure (dbP) compared with the reduction achieved with an AcE inhibitor plus a beta-blocker. in the heart and have a negative inotropic action, which lessens cardiac workload, as the force and rate of the heartbeat is reduced and undesirable remodelling of the heart is minimised. 9780620421645.indb 32 16/9/08 11:09:55. Beta-blockers in heart failure 33 Figure 1. Effects of the parasympathetic and sympathetic nervous systems. Parasympathetic Sympathetic Dilates pupil Inhibits flow of

    We sought to assess the effects of combined oral positive inotropic and beta-blocker therapy in patients with severe heart failure. Background. Patients with severe, class IV heart failure who receive standard medical therapy exhibit a 1-year mortality rate >50%. Methods and results. This was a multinational, randomized, double‐blind, phase IV study in 60 patients; follow‐up was 1 month. There was a significant increase in cardiac index and a significant decrease in pulmonary capillary wedge pressure (PCWP) at 24 and 48 h for both dobutamine and levosimendan.

    negative inotropic agent Any agent, including beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem, verapamil), used to manage congestive heart failure caused by pure diastolic dysfunction, as such agents reduce cardiac contractility. Inotropic, Chronotropic and Dromotropic are different types of cardiac drugs. This classification is based on the way these drugs are used for the treatment of a particular condition. Inotropic drugs This classification is based on the way these drugs are used for the treatment of a particular condition.

    Heart Transplantation Selection of Patients for Heart Transplantation in the Current Era of Heart Failure Therapy Javed Butler, MD, MPH, FACC,*†‡¶ Ghazanfar Khadim, MD,* Kimberly M. Paul, MD,§ When the combination of a PDEI and a beta-blocking agent is administered long-term in patients with HF, their respective benefits are additive and their adverse effects are counterbalanced [39 x [39] Lowes, B.D, Simon, M.A, Tsvetkova, T.O et al. Inotropes in the beta-blocker era.

    Beta-blocker Use in Decompensated Heart Failure Alharethi and Hershberger 77 whom inotrope withdrawal will lead to imminent demise [30,31••,32••]. The excess mortality seen in the past with the oral inotropic agent vesnarinone trial was attributed solely to an increase in death occurring suddenly. 8 Ventricular tachyarrhythmias on inotropic therapy in the current era may have been successfully treated by antitachycardia pacing or defibrillation. Sudden death in advanced HF can also be caused by bradyarrhythmias, which in some cases may

    Pharmaceuticals in the aquatic environment β CORE. Despite concerns about the possibility of side-effects due to the negative inotropic effects of beta-blockade, tolerability in the major placebo-controlled beta-blocker trials was very good., Abstract. Beta-adrenergic blocking agents are now standard treatment for mild to moderate chronic heart failure (CHF). However, although many subjects improve on ….

    Inotropes – Angina and Heart Failure Management

    inotropes in the beta-blocker era pdf

    CHFpatients.com IV Heart Failure Drugs. may 1998:1336–40 combined inotropic and beta-blocker therapy in chf (until December 1, 1996, death or heart transplantation) was 20.9 6 3.9 months (range 0.6 to 82.5)., Beta-blocker Use in ST-segment Elevation Myocardial Infarction in the Reperfusion Era (GRACE) (IV) beta-blocker therapy for patients presenting with ST-segment elevation myocardial infarction. 11 . The objectives of the present observational study were to describe patterns of beta-blocker use during hospitalization (especially during the first 24 hours) in patients with ST-elevation.

    Beta-Blockers in Acute Heart Failure JACC Heart Failure

    inotropes in the beta-blocker era pdf

    Calcium channel antagonist and beta-blocker overdose. Beta-blocker In patients with reduced EF not already receiving a beta-blocker, this treatment should be started as soon as possible after stabilization, blood pressure and heart rate permitting*. Its major disadvantage is the pro-arrhythmic properties and the inevitable tachycardia, which explains why the studies frequently pair it up with a beta-blocker. Schmittinger et al (2008) found that the use of milrinone and metoprolol together is "feasible", but this was a retrospective analysis..

    inotropes in the beta-blocker era pdf


    The following textual and MeSH search terms were used in different combinations: heart failure, beta-blocker, beta-blockade, adrenergic beta antagonist, carvedilol, inotropic agent, and dobutamine. The search was designed to select original clinical trials assessing the use of BB in patients with severe HF being treated with dobutamine. Expected outcomes included information on the prognosis Introduction of beta blocker (BB) therapy in DHF patients requiring inotrope support is discouraged due to the negative hemodynamic impact of acute BB therapy.2-5 On the other hand, reduction in heart rate by BB therapy results in decreased myocardial oxygen demand

    Its major disadvantage is the pro-arrhythmic properties and the inevitable tachycardia, which explains why the studies frequently pair it up with a beta-blocker. Schmittinger et al (2008) found that the use of milrinone and metoprolol together is "feasible", but this was a retrospective analysis. Despite their theoretic appeal, agents that increase cardiac contractility (positive inotropes) have consistently been shown to increase mortality when given chronically to patients with heart failure. The routine use of inotropes as heart failure therapy in either the acute or the chronic setting

    Inotropic, Chronotropic and Dromotropic are different types of cardiac drugs. This classification is based on the way these drugs are used for the treatment of a particular condition. Inotropic drugs This classification is based on the way these drugs are used for the treatment of a particular condition. Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration.

    Introduction of beta blocker (BB) therapy in DHF patients requiring inotrope support is discouraged due to the negative hemodynamic impact of acute BB therapy.2-5 On the other hand, reduction in heart rate by BB therapy results in decreased myocardial oxygen demand Inotropes – Angina and Heart Failure Management See online here The inotropic agent in the context of heart failure and angina is classified into positive and negative inotropic agent. The positive agent increases the contractility and will be discussed in detail in this article. A brief about the negative inotropic agent, which decreases the myocardial contractility, is mentioned. The

    Pheochromocytoma is a rare tumor that usually starts in the cells of one of your adrenal glands. Although they are usually benign, pheochromocytomas often cause the … Beta-blocker and positive inotropic therapies are currently viewed as alternative strategies for the management of severe heart failure patients. However, both the theoretical background and

    Introduction of beta blocker (BB) therapy in DHF patients requiring inotrope support is discouraged due to the negative hemodynamic impact of acute BB therapy.2-5 On the other hand, reduction in heart rate by BB therapy results in decreased myocardial oxygen demand Inotropes in Children MICHAEL CLIFFORD, MB, BS, FJFICM, FANZCA Royal Children’s Hospital, Melbourne, Victoria Michael Clifford is a staff anaesthetist at the Royal Children’s Hospital, Melbourne.

    Beta-blocker Use in Decompensated Heart Failure Alharethi and Hershberger 77 whom inotrope withdrawal will lead to imminent demise [30,31••,32••]. Figure 3 Concomitant use of beta blocker and milrinone causes inhibition of G inhibitory alpha protein which is an inhibitor of adenylyl cyclase and phosphodiesterase III enzyme, both results in increased cyclic adenosine monophosphate concentration.

    Ephedrine is a mixed alpha and beta agonist - it actually is a direct and indirect sympathomimetic - releasing norad from nerve endings (prone to tachyphylaxis though). Inotropes in Children MICHAEL CLIFFORD, MB, BS, FJFICM, FANZCA Royal Children’s Hospital, Melbourne, Victoria Michael Clifford is a staff anaesthetist at the Royal Children’s Hospital, Melbourne.

    Combination therapy with a positive inotrope and a beta-blocker appears to be useful in the treatment of severe, class IV heart failure. It may be used as a palliative measure when transplantation is not an option or as a bridge to heart transplantation. Further study of … Use of early beta-blocker therapy meant that the patient received some form of IV or oral beta-blocker therapy and was unable to account for dosage administered, brand, or its continued use.

    June, 2003 - Coreg is a non-selective beta-blocker: It blocks both beta-1 and beta-2 heart receptors. Toprol-XL is a selective beta-blocker : It blocks mostly beta-1 heart receptors. In a crossover study, Dr. Bert Andersson studied blood flow in 10 CHFers while they took IV dobutamine. Inotropes_____19 Other therapies _____19 options for children with cardiac failure, namely an ACE inhibitor and a beta‐blocker. In the case of ACE inhibitors, the two supported by the greatest paediatric data are captopril

    beta-blocker use in Post MI patients reduces cV events by 23% in prospective studies and upto 40% in observational studies. 14,20 The benefits are greatest in patients at high risk 20 Patients with American College of Cardiology/American Heart Association stage D heart failure have limited options beyond standard medical therapy including home inotropes, heart transplantation, mechanical circulatory support, or palliative care/hospice.

    Our Reading Guide for Then Again by Diane Keaton includes Book Club Discussion Questions, Book Reviews, Plot Summary-Synopsis and Author Bio. Then again diane keaton pdf Lockhart River The brilliance of “Then Again” is that Keaton doesn’t ignore these men and those movies. They are the reason we know her, and she’s grateful and tender and respectful of them. Also, honest. She didn’t want to love Beatty, she wanted to be him. She pushed Pacino to marry her, though she knew he never would. As for Woody Allen, she finds him quite the hunk — and those glasses are