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Core Drug Summaries > Beta Blockers > Flashcards

Beta Blockers Flashcards

1
Q

What are the cardioselective beta blockers?

A

Acebutol, atenolol, betaxolol, celiprolol, esmolol, metoprolol, nebivolol

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2
Q

Name some non-cardioselective beta blockers.

A

Carvedilol, propranolol, sotalol, pindolol, labetalol, nadolol

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3
Q

Which beta blockers are classified as water-soluble?

A

Atenolol, celiprolol, nadolol, sotalol

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4
Q

What is a key characteristic of water-soluble beta-blockers?

A

Less likely to cross the BBB, therefore less likely to cause sleep disturbances and nightmares

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5
Q

Which beta blockers are lipid-soluble?

A

Labetalol, metoprolol, pindolol, propranolol

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6
Q

What is the mechanism of action of beta-blockers?

A

Antagonise the effects of sympathetic nerve stimulation or circulating catecholamines on beta-adrenoceptors

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7
Q

What is the effect of beta-blockers on the heart?

A

Decrease heart rate and reduce the force of blood pumped

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8
Q

What effect do beta-blockers have on blood vessels?

A

Cause vasodilation and lower blood pressure

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9
Q

What are the main types of beta-adrenoceptors affected by beta-blockers?

A

Beta1 (heart & kidney), Beta2 (smooth muscle, i.e., blood vessels & bronchi)

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10
Q

What is a common indication for beta-blockers?

A

Angina

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11
Q

What is the effect of beta-blockers on myocardial O2 demand?

A

Decreases myocardial O2 demand, decreases chest pain caused by narrowing of arteries

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12
Q

What is the first-line treatment for stable angina?

A

A beta blocker (BB) or a calcium channel blocker (CCB)

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13
Q

If a patient cannot tolerate a beta blocker or calcium channel blocker, what should be considered?

A

Switching to the other option (CCB or BB)

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14
Q

If symptoms are not controlled on either beta blocker or calcium channel blocker, what is the next step?

A

Consider using a combination of the two

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15
Q

Fill in the blank: Beta-blockers block the ________ in the heart.

A

B-adrenoceptors

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16
Q

True or False: Lipid-soluble beta-blockers are more likely to cause sleep disturbances.

A

True

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17
Q

What type of calcium channel blocker should be used in combination with a beta-blocker?

A

A dihydropyridine calcium channel blocker (e.g., nifedipine, amlodipine, felodipine)

Avoid co-prescribing with rate-limiting calcium channel blockers (verapamil or diltiazem) due to increased risk of cardiodepression.

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18
Q

When should a beta-blocker be offered after a myocardial infarction?

A

As soon as possible after an MI when the person is haemodynamically stable

It is part of the secondary prevention regimen alongside an ACE inhibitor, a statin, and dual antiplatelet therapy.

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19
Q

For how long should a beta-blocker be continued after a myocardial infarction in patients without reduced LVEF?

A

12 months

In patients with reduced LVEF, consider continuing a beta-blocker indefinitely.

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20
Q

What is the primary role of beta-blockers in heart failure management?

A

Decreases workload on the heart, preventing cardiac remodelling

It slows heart contractility and RAAS activation.

21
Q

What should be done when introducing a beta-blocker for heart failure?

A

Start low, go slow

This approach helps avoid exacerbation of acute heart failure symptoms.

22
Q

What effect do beta-blockers have on blood vessels in hypertension treatment?

A

Relaxes blood vessels leading to vasodilation

This decreases blood pressure.

23
Q

When can beta-blockers be offered in the treatment of resistant hypertension?

A

As a fourth antihypertensive agent in step 4 of treatment

It is not offered as a first-line treatment.

24
Q

In patients with potassium levels above 4.5mmol/L, which is preferred in step 4 for resistant hypertension?

A

A beta-blocker

It is preferred over spironolactone due to the risk of hyperkalaemia, especially in patients with reduced eGFR.

25
Q

What is the mechanism of action of beta-blockers in arrhythmias?

A

Block sympathetic stimulation of beta1-adrenoceptors

This leads to conduction delay and suppression of triggered activity.

26
Q

When can beta-blockers be used for atrial fibrillation?

A

As initial rate control monotherapy

They can also be combined with digoxin if monotherapy does not control symptoms.

27
Q

What should be avoided when treating arrhythmias with sotalol?

A

Avoid using sotalol due to the risk of aggravating existing arrhythmias

It may provoke new arrhythmias or cause torsades de pointes.

28
Q

What is a significant caution for beta-blocker use?

A

History of asthma, bronchospasm, or obstructive airways disease

Cardioselective beta-blockers can be given with caution if there is significant clinical need.

29
Q

Are cardioselective beta-blockers free from side effects related to bronchoconstriction?

A

No

Cardioselective beta-blockers have less effect on airways but are not free from side effects.

30
Q

What is a symptom of hypoglycaemia that may be masked by beta-blockers?

A

Increased heart rate

This masking could lead to significant complications in diabetic patients.

31
Q

Why should beta-blockers be avoided in elderly patients with diabetes mellitus?

A

Due to the risk of suppressing symptoms of hypoglycaemia

Suppressed symptoms could lead to complications such as seizures or coma.

32
Q

What is heart block?

A

Disruption in the conduction of electrical signals in the heart

It can be second-degree or third-degree heart block.

33
Q

What effect do beta-blockers have on heart rate and myocardium?

A

They slow the heart and can depress the myocardium

This increases the risk of complete heart block.

34
Q

What are the potential serious interactions when combining beta-blockers with verapamil or diltiazem?

A

Additive cardiac depressant effects

Serious effects can include bradycardia, asystole, and sinus arrest.

35
Q

What are common side effects of beta-blockers?

A

Sleep disorders, cold extremities, dizziness, fatigue, syncope

This list is not exhaustive; refer to the BF for specific drugs.

36
Q

What causes cold extremities in patients taking beta-blockers?

A

Peripheral vasoconstriction and decreased blood flow

More common in individuals with peripheral arterial disease.

37
Q

What monitoring is required for patients on beta-blockers?

A

Blood pressure & heart rate, lung function

Monitoring is crucial to ensure adequate clinical outcomes and to check for bronchospasm.

38
Q

Fill in the blank: Beta-blockers can lead to _______ due to reduction in cardiac output.

A

Dizziness, fatigue and syncope

This is linked to decreased organ perfusion.

39
Q

True or False: Beta-blockers have no central nervous system effects.

A

False

They can cause sleep disturbances and nightmares, especially lipid soluble beta-blockers.

40
Q

What is the primary indication for Atenolol tablets?

A

Relief of angina symptoms

Atenolol helps by slowing down the heart rate, making it easier for the heart to pump blood.

41
Q

What is the recommended dosage for Atenolol tablets?

A

1 tablet each morning

It is important to take the tablet at the same time every day.

42
Q

What should a patient do if they experience worsening symptoms during initiation or up-titration of Atenolol?

A

Expect improvement over 3-6 months

Initial worsening of symptoms may occur, but it should gradually improve.

43
Q

What are potential side effects of Atenolol tablets?

A

Weakness, tiredness, cold hands and feet, vivid dreams, sleeping disturbances

These symptoms should improve with time, but persistent or intolerable symptoms require contacting a GP.

44
Q

True or False: It is safe to suddenly stop taking Atenolol.

A

False

Sudden withdrawal can cause rebound symptoms.

45
Q

What routine appointments should patients on Atenolol attend?

A

Blood pressure and heart rate checks

Regular monitoring is essential for patients taking Atenolol.

46
Q

Fill in the blank: Atenolol may cause you to feel _______.

A

weak or tired

47
Q

What key question should be asked to initiate a consultation regarding Atenolol?

A

Do you know why you are taking these tablets for?

48
Q

What is a crucial counseling point regarding the use of Atenolol?

A

Do not stop taking them unless advised by your doctor

This is important to prevent rebound symptoms.

49
Q

What is the effect of Atenolol on heart rate?

A

Slows down heart rate

Core Drug Summaries (3 decks)

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