Beta Blockers

Question 1

Which beta-blockers are cardioselective? And what does this mean?

Answer 1

Atenolol, bisoprolol, celiprolol, esmolol, metoprolol.
B1 receptors block sympathetic stimulation of the heart and reduce systolic pressure, heart rate, cardiac contractility and output, which in turn decreases the demand by the heart for oxygen and increases exercise tolerance.

Cardioselective BBs block B1 preferentially over B2/
Blockade of B2 receptors located in the bronchial smooth muscle of the airways, which has the potential to cause bronchoconstriction.
NOTE: ONE heart and TWO lungs

Question 2

Beta blocker licensed in pregnancy?

Answer 2

Labetalol (100mg bd to start)

Question 3

Water soluble BBs

Answer 3

Atenolol, celoprolol, nadolol, sotalol are most water soluble (less likely to enter brain causing sleep disturbance.
These are more likely to be excreted by the kidneys so need dose reduction in impairment

Question 4

Side effects of BBs

Answer 4

fatigue
coldness of extremities
sleep disturbance
effect on carbohydrate metabolism causing hypo or hyperglycaemia
bronchospasm
abdominal discomfort
constipation
dry eye 
HF
ED
dyspnoea
rash
syncope

RARE = hallucination, exacerbation of psoriasis

Question 5

Role in angina

Answer 5

Improve exercise tolerance, relieve symptoms

Question 6

Contraindications for BB use

Answer 6

asthma, cardiogenic shock, bradycardia, prinzmetals angina, uncontrolled HF