Which three of the following are common adverse effects of beta-blockers?

A. Bronchospasm: Non-selective beta-blockers inhibit beta-2 receptors located in the bronchial smooth muscle, leading to unintended constriction of the airways. This physiological response significantly increases airway resistance and can trigger acute respiratory distress in patients with underlying asthma or COPD. Clinicians must exercise extreme caution when prescribing these agents to individuals with reactive airway diseases. B. Bradycardia: Beta-adrenoceptor antagonists decrease the firing rate of the sinoatrial node and slow conduction through the atrioventricular node. This negative chronotropic effect results in a reduced heart rate, which is a primary pharmacological action of the drug class. Excessive blockade can lead to symptomatic bradycardia, requiring a dose adjustment or discontinuation to maintain adequate cardiac output. C. Hyperglycemia: Beta-blockers do not typically cause an elevation in blood glucose levels as a primary adverse effect. Instead, they are known to mask the sympathetic symptoms of hypoglycemia, such as tachycardia and tremors, which can be dangerous for diabetic patients. They may also slightly impair insulin release, but they are not categorized as hyper-glycemic agents. D. Fatigue: The reduction in cardiac output and the blockade of peripheral beta-receptors often lead to a profound sense of lethargy or exercise intolerance. Patients frequently report feeling tired because the heart cannot increase its rate sufficiently to meet increased metabolic demands during physical activity. This is one of the most common reasons for patient non-compliance with beta-blocker therapy.