Beta Blockers Flashcards
What are the cardioselective beta blockers?
Acebutol, atenolol, betaxolol, celiprolol, esmolol, metoprolol, nebivolol
Name some non-cardioselective beta blockers.
Carvedilol, propranolol, sotalol, pindolol, labetalol, nadolol
Which beta blockers are classified as water-soluble?
Atenolol, celiprolol, nadolol, sotalol
What is a key characteristic of water-soluble beta-blockers?
Less likely to cross the BBB, therefore less likely to cause sleep disturbances and nightmares
Which beta blockers are lipid-soluble?
Labetalol, metoprolol, pindolol, propranolol
What is the mechanism of action of beta-blockers?
Antagonise the effects of sympathetic nerve stimulation or circulating catecholamines on beta-adrenoceptors
What is the effect of beta-blockers on the heart?
Decrease heart rate and reduce the force of blood pumped
What effect do beta-blockers have on blood vessels?
Cause vasodilation and lower blood pressure
What are the main types of beta-adrenoceptors affected by beta-blockers?
Beta1 (heart & kidney), Beta2 (smooth muscle, i.e., blood vessels & bronchi)
What is a common indication for beta-blockers?
Angina
What is the effect of beta-blockers on myocardial O2 demand?
Decreases myocardial O2 demand, decreases chest pain caused by narrowing of arteries
What is the first-line treatment for stable angina?
A beta blocker (BB) or a calcium channel blocker (CCB)
If a patient cannot tolerate a beta blocker or calcium channel blocker, what should be considered?
Switching to the other option (CCB or BB)
If symptoms are not controlled on either beta blocker or calcium channel blocker, what is the next step?
Consider using a combination of the two
Fill in the blank: Beta-blockers block the ________ in the heart.
B-adrenoceptors
True or False: Lipid-soluble beta-blockers are more likely to cause sleep disturbances.
True
What type of calcium channel blocker should be used in combination with a beta-blocker?
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.
When should a beta-blocker be offered after a myocardial infarction?
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.
For how long should a beta-blocker be continued after a myocardial infarction in patients without reduced LVEF?
12 months
In patients with reduced LVEF, consider continuing a beta-blocker indefinitely.
What is the primary role of beta-blockers in heart failure management?
Decreases workload on the heart, preventing cardiac remodelling
It slows heart contractility and RAAS activation.
What should be done when introducing a beta-blocker for heart failure?
Start low, go slow
This approach helps avoid exacerbation of acute heart failure symptoms.
What effect do beta-blockers have on blood vessels in hypertension treatment?
Relaxes blood vessels leading to vasodilation
This decreases blood pressure.
When can beta-blockers be offered in the treatment of resistant hypertension?
As a fourth antihypertensive agent in step 4 of treatment
It is not offered as a first-line treatment.
In patients with potassium levels above 4.5mmol/L, which is preferred in step 4 for resistant hypertension?
A beta-blocker
It is preferred over spironolactone due to the risk of hyperkalaemia, especially in patients with reduced eGFR.
What is the mechanism of action of beta-blockers in arrhythmias?
Block sympathetic stimulation of beta1-adrenoceptors
This leads to conduction delay and suppression of triggered activity.
When can beta-blockers be used for atrial fibrillation?
As initial rate control monotherapy
They can also be combined with digoxin if monotherapy does not control symptoms.
What should be avoided when treating arrhythmias with sotalol?
Avoid using sotalol due to the risk of aggravating existing arrhythmias
It may provoke new arrhythmias or cause torsades de pointes.
What is a significant caution for beta-blocker use?
History of asthma, bronchospasm, or obstructive airways disease
Cardioselective beta-blockers can be given with caution if there is significant clinical need.
Are cardioselective beta-blockers free from side effects related to bronchoconstriction?
No
Cardioselective beta-blockers have less effect on airways but are not free from side effects.
What is a symptom of hypoglycaemia that may be masked by beta-blockers?
Increased heart rate
This masking could lead to significant complications in diabetic patients.
Why should beta-blockers be avoided in elderly patients with diabetes mellitus?
Due to the risk of suppressing symptoms of hypoglycaemia
Suppressed symptoms could lead to complications such as seizures or coma.
What is heart block?
Disruption in the conduction of electrical signals in the heart
It can be second-degree or third-degree heart block.
What effect do beta-blockers have on heart rate and myocardium?
They slow the heart and can depress the myocardium
This increases the risk of complete heart block.
What are the potential serious interactions when combining beta-blockers with verapamil or diltiazem?
Additive cardiac depressant effects
Serious effects can include bradycardia, asystole, and sinus arrest.
What are common side effects of beta-blockers?
Sleep disorders, cold extremities, dizziness, fatigue, syncope
This list is not exhaustive; refer to the BF for specific drugs.
What causes cold extremities in patients taking beta-blockers?
Peripheral vasoconstriction and decreased blood flow
More common in individuals with peripheral arterial disease.
What monitoring is required for patients on beta-blockers?
Blood pressure & heart rate, lung function
Monitoring is crucial to ensure adequate clinical outcomes and to check for bronchospasm.
Fill in the blank: Beta-blockers can lead to _______ due to reduction in cardiac output.
Dizziness, fatigue and syncope
This is linked to decreased organ perfusion.
True or False: Beta-blockers have no central nervous system effects.
False
They can cause sleep disturbances and nightmares, especially lipid soluble beta-blockers.
What is the primary indication for Atenolol tablets?
Relief of angina symptoms
Atenolol helps by slowing down the heart rate, making it easier for the heart to pump blood.
What is the recommended dosage for Atenolol tablets?
1 tablet each morning
It is important to take the tablet at the same time every day.
What should a patient do if they experience worsening symptoms during initiation or up-titration of Atenolol?
Expect improvement over 3-6 months
Initial worsening of symptoms may occur, but it should gradually improve.
What are potential side effects of Atenolol tablets?
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.
True or False: It is safe to suddenly stop taking Atenolol.
False
Sudden withdrawal can cause rebound symptoms.
What routine appointments should patients on Atenolol attend?
Blood pressure and heart rate checks
Regular monitoring is essential for patients taking Atenolol.
Fill in the blank: Atenolol may cause you to feel _______.
weak or tired
What key question should be asked to initiate a consultation regarding Atenolol?
Do you know why you are taking these tablets for?
What is a crucial counseling point regarding the use of Atenolol?
Do not stop taking them unless advised by your doctor
This is important to prevent rebound symptoms.
What is the effect of Atenolol on heart rate?
Slows down heart rate
