Beta-adrenoceptor blocking drugs Flashcards
Which organs/structures do do beta-blockers block the beta-adrenoceptors in? (5)
Heart Peripheral vasculature Bronchi Pancreas Liver
What does it mean if a beta-blocker has intrinsic sympathomimetic activity (ISA)?
Partial agonist activity: represents the capacity of beta-blockers to stimulate as well as to block adrenergic receptor
They cause less bradycardia and coldness of extremities than other beta-blockers
Beta-blockers with intrinsic sympathomimetic activity (ISA):
- Celiprolol hydrochloride
- Pindolol
- Acebutolol
- Oxprenolol hydrochloride
Name 4 beta-blockers which have intrinsic sympathomimetic activity (ISA)?
- Celiprolol hydrochloride
- Pindolol
- Acebutolol
- Oxprenolol hydrochloride
ISA = Partial agonist activity: represents the capacity of beta-blockers to stimulate as well as to block adrenergic receptor
They cause less bradycardia and coldness of extremities than other beta-blockers
What is the benefit of prescribing beta-blockers with intrinsic sympathomimetic activity (ISA)?
Cause less bradycardia and coldness of extremities than other beta-blockers
ISA = Partial agonist activity: represents the capacity of beta-blockers to stimulate as well as to block adrenergic receptor
Beta-blockers with intrinsic sympathomimetic activity (ISA):
- Celiprolol hydrochloride
- Pindolol
- Acebutolol
- Oxprenolol hydrochloride
What is the one indication to use celiprolol hydrochloride?
Mild to moderate hypertension
- Oral: 200 mg once daily, increased to 400 mg once daily if necessary
What are 12 contraindications to the use of beta-blockers?
- Asthma
- Cardiogenic shock
- Hypotension
- Marked bradycardia
- Metabolic acidosis
- Phaechromocytoma (except with alpha-blocker)
- Prinzmetal’s angina
- Second degree AV block
- Third-degree AV block
- Sick sinus syndrome
- Uncontrolled heart failure
- Peripheral arterial disease
Which AV blocks are contraindications to beta-blockers?
Second- and third-degree AV block
First-degree AV block is a caution to give beta-blockers
When an elderly patient is taking a beta-blocker in which conditions should consider may be potentially inappropriate (STOPP criteria)?
- In combination with verapamil or diltiazem
- With bradycardia (HR < 50), type II heart block, or complete heart block
- In diabetes mellitus patients with frequent hypoglycaemic episodes
- If prescribed a non-selective beta-blocker in a history of asthma requiring treatment
What is the risk of combining a beta-blocker with verapamil or diltiazem?
Risk of heart block
What is the risk of giving beta-blockers to a patient with either bradycardia (HR < 50), type II heart block or complete heart block?
Risk of complete heart block and asystole
What is the risk of giving a beta-blocker to patients with diabetes mellitus?
Risk of suppressing hypoglycaemic symptoms
Diabetes is a caution NOT a contraindications
BUT in elderly patients with frequent hypoglycaemic episodes the beta-blocker may be inappropriate
What is the risk of giving a beta-blocker (including cardioselective beta-blockers) to patient with a history of asthma, bronchospasm or obstructive airways disease?
Bronchospasms
BUT if there are no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision
Beta blockers can mask symptoms of which two conditions?
Hypoglycaemia
Thyrotoxicosis
Which drink greatly decreases the exposure to the beta blocker celiprolol?
Orange juice
What are the common side effects of beta-blockers? (21)
- Abdominal discomfort
- Bradycardia
- Confusion
- Depression
- Diarrhoea
- Dizziness
- Dry eye (reversible on discontinuation)
- Dyspnoea
- Erectile dysfunction
- Fatigue
- Headache
- Heart failure
- Nausea
- Paraesthesia
- Peripheral coldness
- Peripheral vascular disease
- Rash
- Sleep disorders (nightmares)
- Syncope
- Visual impairment
- Vomiting
If excessive bradycardia occurs following IV injection of beta-blocker, which drug can be used to counter the effects?
IV atropine sulfate
What are the risks of using a beta-blocker during pregnancy?
- Intra-uterine growth restriction
- Neonatal hypoglycaemia
- Bradycardia
The risk is greater in severe hypertension
Use of celiprolol hydrochloride in renal impairment:
(a) At which creatinine clearance should you reduce the dose of celiprolol?
(b) At which creatinine clearance should you avoid the use of celiprolol?
(a) half dose if creatinine clearance 15-40 mL/minute
(b) Avoid if creatinine clearance is < 15 mL/minute
Why should you avoid abrupt withdrawal of beta-blocker in ischaemic heart disease?
Rebound worsening of myocardial ischaemia
A gradual reduction of dose is preferable when beta-blockers are to be stopped
What are the indication for the use of the beta blocker pindolol? (2)
Hypertension
- Oral: Initially 5 mg 2–3 times a day, alternatively 15 mg once daily, doses to be increased as required at weekly intervals; maintenance 15–30 mg daily; maximum 45 mg per day.
Angina
- Oral: 2.5–5 mg up to 3 times a day.
What are the signs and symptoms of an overdose with beta-blockers?
- Light headedness
- Dizziness
- Bradycardia
- Hypotension
- Syncope (caused by bradycardia and hypotension)
- Heart failure may be precipitated or exacerbated
If beta-blocker was administered with IV injection, excessive bradycardia may be countered with IV atropine sulfate
What are the indications for the use of the beta-blocker acebutolol?
Hypertension
- Oral: Initially 400 mg daily for 2 weeks, alternatively initially 200 mg twice daily for 2 weeks, then increased if necessary to 400 mg twice daily; maximum 1.2 g per day.
Angina
- Oral: Initially 400 mg daily, alternatively initially 200 mg twice daily; maximum 1.2 g per day.
Arrhythmias
- Oral: 0.4–1.2 g daily in 2–3 divided doses.
Severe angina
- Oral: Initially 300 mg 3 times a day; maximum 1.2 g per day.
What is a common side effects of the beta-blocker acebutolol (in addition to the common side effects of all beta-blockers)?
Gastrointestinal disorder
Why is acebutolol not a good choice as a beta-blocker in mothers who are breastfeeding?
Present in breast milk in greater amounts than other beta-blockers
This is a problem with acebutolol and water-soluble beta-blockers
Why should acebutolol be used in caution in patients with severe renal impairment?
Risk of accumulation
Halve dose if eGFR 25-50 mL/minute/1.73m^2
Quarter dose if eGFR < 25 mL/minute/1.73m^2
DO NOT administer more than once daily
Which type of beta-blockers are MORE likely to enter the brain?
Lipid-soluble OR water-soluble
Lipid soluble beta-blockers
- labetalol
- metoprolol
- pindolol
- propranolol
Cause more sleep disturbance and nightmares
Which type of beta-blockers cause less sleep disturbance and nightmares?
Lipid soluble OR water soluble
Water-soluble beta-blockers
- Atenolol
- Celiprolol
- Hydrochloride
- Nadolol
- Sotaolol hydrochloride
Less likely to enter the brain
Which organ is responsible for the clearance of
(a) Lipid soluble beta-blockers?
(b) Water soluble beta-blockers?
(a) Lipid soluble beta-blockers are cleared via hepatic metabolism
(b) Water soluble are excreted by the kidneys
Lipid soluble beta-blockers
- labetalol
- metoprolol
- pindolol
- propranolol
Water-soluble beta-blockers
- Atenolol
- Celiprolol
- Hydrochloride
- Nadolol
- Sotaolol hydrochloride
Which beta-blockers have an intrinsically longer duration of action and need to be given only once? (4)
Atenolol
Bisoprolol fumarate
Celiprolol hydrochloride
Nadolol
Most beta-blockers have a relatively short duration of action and are required to be given 2-3 times daily.
Which beta-blockers lower peripheral resistance? (4)
Labetalol hydrochloride
Celiprolol hydrochloride
Carvedilol
Nebivolol
Mechanism: arteriolar vasodilating action
There is NO evidence that these drugs have important advantages over other beta-blockers in the treatment of hypertension.
How do the following beta-blocks lower peripheral resistance: labetalol hydrochloride, celiprolol hydrochloride, carvedilol, nebivolol?
Arteriolar vasodilating action
There is NO evidence that these drugs have important advantages over other beta-blockers in the treatment of hypertension.
Which beta-blockers are the most relatively cardioselective? (5)
Atenolol Bisprolol fumarate Metoprolol tartrate Nebivolol Acebutolol (to a lesser extent)
They have a lesser effect on B2 receptors and airways resistance but are NOT free of this side-effect
What are the indications for the use of the beta-blocker atenolol?
Hypertension
- Oral: 25–50 mg daily
Angina
- Oral: 100 mg daily in 1–2 divided doses.
Arrhythmias
- Oral: 50–100 mg daily.
- IV: 2.5 mg every 5 minutes if required, to be given at a rate of 1 mg/minute, treatment course may be repeated every 12 hours if required; maximum 10 mg per course.
- IV: 150 micrograms/kg every 12 hours if required, to be given over 20 minutes.
Migraine prophylaxis (unlicensed) - Oral: 50–200 mg daily in divided doses.
Early intervention within 12 hours of myocardial infarction
- IV: 5–10 mg, to be given at a rate of 1 mg/minute, followed by (by mouth) 50 mg after 15 minutes, then (by mouth) 50 mg after 12 hours, then (by mouth) 100 mg after 12 hours, then (by mouth) 100 mg once daily.
Which drug is atenolol commonly confused with?
Amlodipine
Care must be taken to ensure the correct drug is prescribed and dispensed
What is a common side effects of the beta-blocker atenolol (in addition to the common side effects of all beta-blockers)?
Gastrointestinal disorder
Which beta blockers are present in breast milk in greater amounts than other beta-blockers?
Water-soluble beta blockers
- Atenolol
- Nadolol
- Sotalol hydrochloride
AND
- Acebutolol
In which condition would you adjust the dose of water soluble beta blockers?
Renal impairment
Water-soluble beta-blockers
- Atenolol
- Celiprolol
- Hydrochloride
- Nadolol
- Sotaolol hydrochloride
What are the indications for the beta-blocker nadolol? (5)
Hypertension
- Oral: Initially 80 mg once daily, then increased in steps of up to 80 mg every week if required, doses higher than the maximum are rarely necessary; maximum 240 mg per day.
Angina
- Oral: Initially 40 mg once daily, then increased if necessary up to 160 mg daily, doses should be increased at weekly intervals, maximum dose rarely is used; maximum 240 mg per day.
Arrhythmias
- Oral: Initially 40 mg once daily, then increased if necessary up to 160 mg once daily, doses should be increased at weekly intervals; reduced to 40 mg daily if bradycardia occurs.
Migraine prophylaxis
- Oral: Initially 40 mg once daily, then increased in steps of 40 mg every week, adjusted according to response; maintenance 80–160 mg once daily.
Thyrotoxicosis (adjunct)
- Oral: 80–160 mg once daily.
What are the indications for the use of the beta-blocker sotalol hydrochloride?
- Symptomatic non-sustained ventricular tachyarrhythmias
- Prophylaxis of paroxysmal atrial tachycardia or fibrillation, paroxysmal AV re-entrant tachycardias, and paroxysmal supraventricular tachycardia after cardiac surgery
- Maintenance of sinus rhythm following cardioversion of atrial fibrillation or flutter
- Oral: Initially 80 mg daily in 1–2 divided doses, then increased to 160–320 mg daily in 2 divided doses, dose to be increased gradually at intervals of 2–3 days. - Life-threatening arrhythmias including ventricular tachyarrhythmias
- Oral: Initially 80 mg daily in 1–2 divided doses, then increased to 160–320 mg daily in 2 divided doses, dose to be increased gradually at intervals of 2–3 days, higher doses of 480–640 mg daily may be required for life-threatening ventricular arrhythmias (under specialist supervision).
Which beta-blocker may prolong the QT interval?
Sotalol hydrochloride
Important: manufacturer advises particular care is required to avoid HYPOKALAEMIA in patients taking sotalol—electrolyte disturbances, particularly hypokalaemia and hypomagnesaemia should be corrected before sotalol started and during use
In addition to the contraindications for all beta-blockers, what are two addition contraindications for the use of sotalol hydrochloride?
Long QT syndrome (congenital or acquired)
Torsafe de pointes
What is a common side effects of the beta-blocker sotalol (in addition to the common side effects of all beta-blockers)? (14)
- Anxiety
- Arrhythmia
- Chest pain
- Dyspepsia
- Fever
- Flatulence
- Hearing impairment
- Mood altered
- Muscle spasms
- Oedema
- Palpitations
- Sexual dysfunction
- Taste altered
- Torsade de pointes
What monitoring is required in patients taking sotalol hydrochloride? (3)
Corrected QT interval
ECG
Electrolytes (hypokalaemia, hypomagnesaemia, and others)
Which electrolyte disturbances should be corrected before starting and using the beta-blocker sotalol hydrochloride? (2)
Hypokalaemia
Hypomagnesaemia
What are the indications for the use of the beta-blocker bisoprolol fumarate?
- Hypertension
- Angina
- Oral: 5–10 mg once daily; maximum 20 mg per day. - Adjunct in heart failure
- Oral: Initially 1.25 mg once daily for 1 week, dose to be taken in the morning, then increased if tolerated to 2.5 mg once daily for 1 week, then increased if tolerated to 3.75 mg once daily for 1 week, then increased if tolerated to 5 mg once daily for 4 weeks, then increased if tolerated to 7.5 mg once daily for 4 weeks, then increased if tolerated to 10 mg once daily; maximum 10 mg per day.
In addition to the contraindications for all beta-blockers, what are two additional contraindications for the use of bisoprolol fumarate?
Acute or decompensated heart failure requiring IV inotropes
Sino-atrial block
What must you ensure before increasing the dose of bisoprolol fumarate?
That heart failure is not worsening
What is a common side effects of the beta-blocker bisoprolol fumarate (in addition to the common side effects of all beta-blockers)?
Constipation
For a patient taking bisoprolol fumarate, which conditions would you adjust the dose?
Hepatic impairment
Renal impairment
What are the indications for the use of the beta-blocker carvedilol?
- Hypertension
- Oral: Initially 12.5 mg once daily for 2 days, then increased to 25 mg once daily (if necessary up to 50 mg daily)
- Oral: in elderly 12.5 mg daily - Angina
- oral: Initially 12.5 mg twice daily for 2 days, then increased to 25 mg twice daily. - Adjunct to diuretics, digoxin or ACE inhibitors in symptomatic chronic heart failure
- Oral: Initially 3.125 mg twice daily, dose to be taken with food, then increased to 6.25 mg twice daily, then increased to 12.5 mg twice daily, then increased to 25 mg twice daily, dose should be increased at intervals of at least 2 weeks up to the highest tolerated dose, max. 25 mg twice daily in patients with severe heart failure or body-weight less than 85 kg; max. 50 mg twice daily in patients over 85 kg.
In addition to the contraindications for all beta-blockers, what is additional contraindications for the use of bisoprolol fumarate?
Acute or decompensated heart failure requiring IV inotropes
What is a common side effects of the beta-blocker carvedilol (in addition to the common side effects of all beta-blockers)? (15)
- Anaemia
- Asthma
- Dyspepsia
- Eye irritation
- Fluid imbalance
- Genital oedema
- Hypercholesterolaemia
- Hyperglycaemia + hypoglycaemia
- Increased risk of infection
- Oedema
- Postural hypotension
- Pulmonary oedema
- Renal impairment
- Urinary disorders
- Weight increased
Beta-blockers may increase sensitivity to…
Allergens
Result in more serious hypersenstivity response
What effect do beta-blockers have to adrenaline (epinephrine)?
Beta-blockers may reduce the response to adrenaline (epinephrine)
If carvedilol is used during pregnancy close to delivery and/or when the mother is breastfeeding, what should infants be monitored for?
Signs of alpha-blockade and beta-blockade
What should be monitored in patients taking carvedilol?
Renal function during dose titration in patients with heart failure AND renal impairement, low BP, ischaemic heart disease, or diffuse vascular disease
In patients with a history of obstructive airway disease taking any beta-blocker, what should you monitor?
Lung function
What are the indications for the use of the beta-blocker nebivolol?
Essential hypertension
- Oral: 5 mg daily
Hypertension in patients with renal impairment
- Oral: Initially 2.5 mg once daily, then increased if necessary to 5 mg once daily.
Adjunct in stable mild to moderate heart failure
- Oral (adults 70 years and over): Initially 1.25 mg once daily for 1–2 weeks, then increased if tolerated to 2.5 mg once daily for 1–2 weeks, then increased if tolerated to 5 mg once daily for 1–2 weeks, then increased if tolerated to 10 mg once daily.
In addition to the contraindications for all beta-blockers, what is additional contraindications for the use of nebivolol?
Acute or decompensated heart failure requiring IV inotropes
What is a common side effects of the beta-blocker nebivolol (in addition to the common side effects of all beta-blockers)? (3)
- Constipation
- Oedema
- Postural hypertension
What are the indications for the use of the beta-blocker metoprolol tartrate? (7)
Hypertension
- Oral: Initially 100 mg daily, increased if necessary to 200 mg daily in 1–2 divided doses, high doses are rarely required; maximum 400 mg per day.
Angina
- Oral: 50–100 mg 2–3 times a day.
Arrhythmias
- Oral: Usual dose 50 mg 2–3 times a day, then increased if necessary up to 300 mg daily in divided doses.
Migraine prophylaxis
- Oral: 100–200 mg daily in divided doses.
Hyperthyroidism (adjunct)
- Oral: 50 mg 4 times a day.
In surgery
- Slow IV: Initially 2–4 mg, given at induction or to control arrhythmias developing during anaesthesia, then 2 mg, repeated if necessary; maximum 10 mg per course.
Early intervention within 12 hours of infarction
- IV: Initially 5 mg every 2 minutes, to a max. of 15 mg, followed by (by mouth) 50 mg every 6 hours for 48 hours, to be taken 15 minutes after intravenous injection; (by mouth) maintenance 200 mg daily in divided doses.
All oral doses are for the immediate-release medicine, please see BNF metoprolol tartrate page for doses of modified-release medicines
What is a common side effects of the beta-blocker metoprolol tartrate (in addition to the common side effects of all beta-blockers)? (3)
- Constipation
- Palpitations
- Postural disorders
What are the indications for the use of the beta-blocker propranolol hydrochloride? (13)
- Thyrotoxicosis (adjunct)
- Thyrotoxic crisis
- Hypertension
- Prophylaxis of variceal bleeding in portal hypertension
- Phaeochromocytoma (only with an alpha-blocker) in preparation for surgery
- Angina
- Hypertrophic cardiomyopathy
- Anxiety tachycardia
- Anxiety with symptoms such as palpitation, sweating and tremor
- Prophylaxis after myocardial infarction
- Essential tremor
- Migraine prophylaxis
- Arrhythmias
Which drug can propranolol be confused with?
Prednisolone
Care must be taken to ensure the correct drug is prescribed and dispensed
For a patient taking propranolol, which conditions would you consider a dose reduction? (2)
Hepatic impairment
Renal impairment
What are the indications for use of the beta-blocker timolol maleate? (6)
- Hypertension
- Oral: Initially 10 mg daily in 1–2 divided doses, then increased if necessary up to 60 mg daily, doses to be increased gradually. Doses above 30 mg daily given in divided doses, usual maintenance 10–30 mg daily; maximum 60 mg per day. - Angina
- Oral: Initially 5 mg twice daily, then increased in steps of 10 mg daily (max. per dose 30 mg twice daily), to be increased every 3–4 days. - Prophylaxis after MI
- Oral: Initially 5 mg twice daily for 2 days, then increased if tolerated to 10 mg twice daily. - Migraine prophylaxis
- Oral: 10–20 mg daily in 1–2 divided doses. - Chronic open angle glaucoma
- Ocular hypertension
- To the eye: Apply twice daly
- Tiopex and Tomoptol-LA are applied once daily
When you apply beta-blockers topically to the eye should you consider the contraindications and cautions fro systemically administered beta-blockers?
YES
Systemic absorption can follow topical application to the eyes
What are the common side effects when timolol maleate is applied to the eye?
- Eye discomfort
- Eye disorders
- Eye inflammation
- Vision disorders
Which conditions would you consider reducing the dose of timolol maleate when taking orally?
Hepatic impairment
Renal impairment
What are the indications for the use of the beta-blocker esmolol hydrochloride?
- Short-term treatment of supraventricular arrhythmias (including atrial fibrillation, atrial flutter, sinus tachycardia)
- Tachycardia and hypertension in peri-operative period
- IV: 50–200 micrograms/kg/minute
What is a common side effects of the beta-blocker esmolol hydrochloride (in addition to the common side effects of all beta-blockers)? (5)
- Anxiety
- Appetite decreased
- Concentration impaired
- Drowsiness
- Hyperhidrosis
What are the indications for the use of the beta-blocker betaxolol? (2)
- Chronic open-angle glaucoma
- Ocular hypertension
- To the eye: Apply twice daily
What are the common side effects of betaxolol? (3)
- Eye discomfort
- Eye disorders
- Vision disorders
Mode of administration is topically to the eye
Systemic absorption can follow - side effects seen in all beta-blockers can occur
What are the indications for the use of the beta-blocker levobunolol hydrochloride? (2)
- Chronic open-angle glaucoma
- Ocular hypertension
- To the eye: Apply 1-2 times a day
What are the common side effects of levobunolol hydrochloride? (2)
- Eye discomfort
- Eye inflammation
Mode of administration is topically to the eye
Systemic absorption can follow - side effects seen in all beta-blockers can occur
Why do beta-blockers cause hypoglycaemia or hyperglycaemic in patients with or without diabetes?
They affect carbohydrate metabolism
How do beta-blockers mask the symptoms of hypoglycaemia (e.g. tachycardia)?
Interfere with metabolic and autonomic responses to hypoglycaemia
Which type of beta-blockers are preferred in patients with diabetes?
Cardioselective beta-blockers
- atenolol
- bisprolol fumarate
- metoprolol tartrate
- nebivolol
- acebutolol (to a lesser extent)
Avoid combining beta-blockers with (drug class?) for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes
Thiazide diuretics
Which beta-blockers are licensed for use in hypertension? (8)
Celiprolol hydrochloride (mild to moderate hypertension)
Pindolol
Atenolol
Nadolol
Nebivolol
Metoprolol tartrate
Propranolol
Timolol maleate
What happens if beta-blockers are used alone in a patient with phaeochromocytoma?
Hypertensive crisis
Always use with an alpha-blocker (phenoxybenzamine hydrochloride)
Which drug should always be used with a beta-blocker in a patient with pheochromocytoma?
Alpha-blocker (phenoxybenzamine hydrochloride)
What is the risk if a patient taking a beta-blocker for angina suddenly stops taking the medication?
Exacerbation of angina
Therefore gradual reduction of dose is preferable when beta-blockers are to be stopped
There is a risk of precipitating heart failure when beta-blockers and (drug?) are used together in established ischaemic heart disease?
verapamil
What is the risk of using both a beta-blocker and verapamil in a patient with established ischaemic heart disease?
Precipitating heart failure
Which beta-blockers may reduce early mortality after IV and subsequent oral administration in the acute phase of a MI (first 24-48 hours)? (2)
Atenolol
Metoprolol tartrate
Which beta-blockers have a protective value when started in the early convalescent phase of an MI? (4)
Acebutolol
Metoprolol tartrate
Propranolol hydrochloride
Timolol maleate
How fo beta blockers function as anti-arrhythmic drugs?
By attenuating the effects of the sympathetic system of automaticity and conductivity within the heart
Beta blockers are useful in the management of which arrhythmias? (3)
Supraventricular tachycardias
Atrial fibrillation (especially in patients with thyrotoxicosis; in conjunction with digoxin)
Arrhythmias following MI
Esmolol hydrochloride is used for the (short-term or long-term?) treatment of supraventricular arrhythmias?
Short-term
Esmolol hydrochloride is a relatively cardioselective beta-blocker with a very short duration of action
Sotalol hydrochloride is a (?)selective beta-blocker with additional class III anti-arrhythmic activity
non-cardio
Sotalol hydrochloride is a non-cardioselective beta-blocker with additional class (?) anti-arrhythmic activity
class III
Sotalol hydrochloride is used for the prophylactic treatment of which arrhythmias?
Paroxysmal supraventricular arrhythmias
ALSO suppresses ventricular ectopic beats and non-sustained ventricular tachycardia
Which beta-blocker is more effective than lidocaine in the termination of spontaneous sustained ventricular tachycardia due to coronary disease or cardiomyopathy?
Sotalol hydrochloride
How do beta-blockers produce benefit in heart failure?
Block sympathetic activity
Which beta-blockers reduce mortality in any grade of stable heart failure?
Bisoprolol fumarate
Carvedilol
Nebivolol is licensed for stable mild to moderate heart failure in patients over 70 years
Which beta-blocker is licensed for use in stable mild to moderate heart failure in patients over 70 years?
Nebivolol
- Initially 1.25 mg once daily for 1–2 weeks, then increased if tolerated to 2.5 mg once daily for 1–2 weeks, then increased if tolerated to 5 mg once daily for 1–2 weeks, then increased if tolerated to 10 mg once daily.
Why are beta-blockers used in the pre-operative preparation for thyroidectomy?
The thyroid gland is rendered less vascular thus making surgery easier
How do beta-blockers help in the treatment of thyrotoxicosis?
Reverse clinical symptoms
BUT thyroid function tests remain increased
Do beta-blockers have any effect on the level of thyroid hormones in a patient with thyrotoxicosis?
NO
Administration of propranolol hydrochloride can reverse clinical symptoms of thyrotoxicosis within 4 days. Routine tests of increased thyroid function remain unaltered.
Within how many days of taking propranolol will you see a reverse in the clinical symptoms of thyrotoxicosis?
4 days
Which beta-blocker is most commonly used in the symptomatic treatment of thyrotoxicosis?
Propranolol hydrochloride
- oral: 10–40 mg 3–4 times a day.
Which patients with anxiety will respond best to a beta-blocker?
Those with palpitation, tremor and tachycardia
Which beta-blockers are used topically in the treatment of glaucoma?
Betaxolol
Levobunolol hydrochloride
Timolol maleate
