BB Flashcards
Side effects
- Fatigue
- brady
- bronchospasms
- coldness of extremities
- sleep disturbance (less common with water soluble)
- GI
- Mask symptoms of hypo
Monitoring
- ECG (for bradycardia), Heart Rate (HR)
- Blood glucose levels in diabetics
- Lung function in patients with history of obstructive airway disease
Withdrawal
Avoid abrupt
CI
- 2nd or 3rd degree heart block
- Worsening UNSTABLE heart failure (but cautioned in stable heart failure)
- History of asthma/COPD or bronchospasm (because they precipitate bronchospasm)
- Avoid in frequent hypo
- Peripheral vascular disease
Drug interactions
- Verapamil (and diltiazem) and Beta-blockers (high risk of hypotension and heart failure)
- AVOID combination
- Theophylline/Aminophylline -
Increases risk of bronchospasms
Which beta-blockers are likely to have less coldness of extremities and less bradycardia as a side-effect (have ISA)?
These have intrinsic sympathomimetic activity (ISA)
Celiprolol
Acebutolol
Pindolol
Oxprenolol
Accronymn: ISA-CAPO
Water-soluble beta-blockers
- Celiprolol
- Atenolol
- Nadolol
- Sotalol
CANS
What are the
characteristics of water soluble beta-blockers?
- less likely to enter the brain, therefore less sleep disturbances and nightmares
- Excreted by kidneys (dose reduction in renal impairment)
Lipid soluble beta-blockers
- Propranolol
- Bisoprolol
- Carvedilol
- Labetalol
- Metoprolol
- timolol
Cardioselective beta-blockers?
Beta-blockers that have a higher affinity for b1 receptors in the heart
They are SELECTIVE, but NOT specific - so they can still affect the airways to a lesser
extent
Examples:
- Bisoprolol
- Atenolol
- Metoprolol
- Nebivolol
What are the common
NON-cardioselective beta-blocker?
Sotalol
Propranolol
Which beta-blockers have an intrinsically longer duration of action?
Give OD
- Atenolol
- Bisoprolol
- Celiprolol
- Nadolol
What type of beta-blocker is Atenolol (i.e. what are their characteristics?)
- Cardio-selective and water soluble
Is Bisoprolol water soluble?
No, they are lipid soluble
Bisoprolol is cardioselective but NOT water-soluble so it
can cause sleep disturbances and vivid dreams
Which beta-blockers can be used in asthmatics→
Atenolol, Bisoprolol and Celiprolol (cardioselective beta blockers)