BETA BLOCKER

Question 1

BETA BLOCKER - examples

Answer 1

Bisoprolol
Atenolol 
Propranolol (non-cardioselective)
Metoprolol 
Carvedilol

Question 2

BETA BLOCKER - indications (5)

Answer 2

1. Ischaemic heart disease IHD
2. Chronic heart failure (carvedilol and bisoprolol)
3. Atrial fibrillation
4. Resistant Hypertension
5. Hypertension

Question 3

BETA BLOCKER - MOA - Atrial fibrillation and SVT

Answer 3

1) Acts on B1 receptors in the heart
2) Prolonging the refractory period of the AVN
3) Slow ventricular rate in atrial fibrillation and terminates SVT

Question 4

BETA BLOCKER - MOA - IHD

Answer 4

1) Acts on B1 receptors in the heart
2) Reduces FORCE and SPEED of myocardial contractility
3) Redcues cardiac workload AND oxygen demand = reduces ischaemia

Question 5

BETA BLOCKER - MOA - HTN

Answer 5

1) Acts on B1 receptors
2) Reduce renin secretion from kidney
3) Reduce blood pressure

Question 6

BETA BLOCKER - adverse effects (common)

Answer 6

• nausea
• Headache
• Fatigue
• Cold extremities
• Sleep disturbances and nightmares (less common with atenolol)
• IMPOTENCE IN MEN

Question 7

BETA BLOCKER - adverse effect important to mention to men

Answer 7

→ Impotence in men

Question 8

BETA BLOCKER - interactions

Answer 8

AVOID use with:
→ Non-dihydropyridine calcium channel blockers 
Examples:
Verapamil 
Diltiazem 

Why? Combination use of these drugs with beta blockers can cause heart failure, bradycardia and even asystole

Question 9

BETA BLOCKER - contraindications

Answer 9

→ In patients with asthma

→ In patients with heart block

Question 10

BETA BLOCKER - caution

Answer 10

1. Heart failure
   Why? Should be started at a very low dose and then gradually increased - as may initially impair cardiac function
2. Hepatic failure
   Why? Usually require dosage reduction

Question 11

BETA BLOCKER - what is the best beta blocker to give, if needed, to a patient who has COPD? And which should be avoided?

Answer 11

COPD patients but should opt for Cardioselective BB

Add cardioselective BBs

Question 12

BETA BLOCKER - a patient needs a beta blocker that causes less sleep disturbances and nightmares. Which beta blocker would you switch them to and why?

Answer 12

Atenolol

It is a water-soluble beta blocker and therefore less likely to cross the blood brain barrier and cause less sleep disturbances/nightmares

Question 13

BETA BLOCKER - what are examples of cardioselective beta blockers and what is meant by cardioselective beta blockers

Answer 13

cardioselective beta blockers have a higher affinity for the beta receptors in the heart

however, they are selective (NOT cardiospecific) which means they can still have some effect on the airways

examples:
- atenolol
- bisoprolol
- metoprolol