Beta-Blockers

Question 1

Give 5 examples of cardioselective beta blockers?

Answer 1

• Atenolol
• Bisoprolol
• Celiprolol
• Metoprolol
• Acebutolol

Question 2

Give 5 examples of non-cardioselective beta-blockers?

Answer 2

• Nadolol
• Oxprenolol
• Propanolol
• Sotalol
• Timolol

Question 3

What is meant by a cardioselective beta-blocker?

Answer 3

They primarily target beta-adrenoceptors in the heart

Question 4

What is the advantage of cardioselective beta blockers?

Answer 4

They cause fewer effects on end organs outside the heart

Question 5

What do non-cardioselective beta blockers target?

Answer 5

Beta-adrenoceptors in the heart and other end organs

Question 6

What is the mechanism of action of beta blockers?

Answer 6

They inhibit stimulation of beta-adrenoceptors in the heart (if selective) and in vascular smooth muscle, bronchi, and other organs, e.g. liver and pancreas (if not selective)

Question 7

What does the beta blockade in the heart result in?

Answer 7

Reduction in heart rate and force of contraction

Question 8

What does beta blockade outside of the heart result in?

Answer 8

Vasoconstriction and bronchoconstriction

Question 9

What are the routes of delivery of beta blockers?

Answer 9

• PO
• IV
• Topical

Question 10

Give an example of when beta-blockers may be used IV?

Answer 10

IV metoprolol in atrial fibrillation

Question 11

Give an example of when beta blockers may be used topically?

Answer 11

In treatment of glaucoma

Question 12

What are the indications for beta-blockers?

Answer 12

• Hypertension
• Chronic heart failure
• Ischaemic heart disease, especially post-MI prophylaxis and treatment of angina
• AF, atrial flutter, and SVT
• Anxiety
• Migraine
• Thyrotoxicosis
• Primary open angle glaucoma

Question 13

What beta blocker is used for hypertension in pregnancy?

Answer 13

Labetalol

Question 14

Why should beta blockers not be used in acute heart failure?

Answer 14

Risk of deterioration

Question 15

What beta blocker is used in anxiety?

Answer 15

Propanolol

Question 16

What are the contraindications to beta-blockers?

Answer 16

• Asthma
• 2nd or 3rd degree heart block
• Sick sinus syndrome
• Uncontrolled heart failure
• Bradycardia and hypotension
• Metabolic acidosis
• Severe peripheral arterial disease

Question 17

Who should beta-blockers be used with caution in?

Answer 17

• History of obstructive airway disease
• Diabetic patients
• Hyperkalaemia

Question 18

What should be done if beta-blockers are used in patients with history of obstructive airway disease?

Answer 18

Use cardioselective type under close supervision

Question 19

What should diabetic patients on beta-blockers be warned about?

Answer 19

Beta blockers may mask signs of hypoglycaemic attack

Question 20

What might beta blockers interact with?

Answer 20

• Other anti-hypertensive drugs

- Verapamil

Question 21

What might happen if beta-blockers are given with other anti-hypertensive drugs?

Answer 21

May cause hypotension

Question 22

What might happen if beta-blockers are given with verapamil?

Answer 22

Complete heart block or significant blood pressure drop can occur

Question 23

What monitoring is required with beta blockers?

Answer 23

Monitor lung function of patients with obstructive airway disease who are taking beta blockers

Question 24

What are the common side effects of beta blockers?

Answer 24

• Fatigue
• Headache
• Dizziness
• Erectile dysfunction
• Sleep disturbance and nightmares
• Cold peripheries

Question 25

What are the less common side effects of beta blockers?

Answer 25

May worsen Raynaud’s disease

Question 26

Why do beta-blockers have slightly different adverse effect profiles?

Answer 26

Because they vary in their lipid or water solubility, which results in a slightly different adverse effect profile

Question 27

Give 3 examples of beta blockers that are more soluble in water

Answer 27

• Atenolol
• Nadolol
• Sotalol

Question 28

What is the result of beta blockers being more soluble in water?

Answer 28

Less likely to cross blood-brain barrier and cause less disturbance to sleep

Question 29

What patient counselling is required with beta blockers?

Answer 29

• Side-effects
• Risk of breathing problems in asthmatics and patients with COPD
• Risk of hypoglycaemia in diabetics
• Compliance
• Withdrawal
• Overdose

Question 30

What advice should be given to patients with asthma/COPD on beta-blockers?

Answer 30

They should call an ambulance if having breathing difficulties

kinda irrelevant cut shouldn’t be on them anyway

Question 31

What needs to be discussed regarding compliance with beta blockers?

Answer 31

Emphasise should not stop taking their beta blocker unless advised by their doctor

Question 32

Why is it important that the patient does not stop taking their beta blocker unless advised by doctor?

Answer 32

Likely that their body is used to the drug, and when they stop taking it may suffer from ‘rebound’ symptoms such as worsening chest pain or arrhythmias

Question 33

How is withdrawal avoided with beta blockers?

Answer 33

If needs to be stopped, normally dose reduction is undertaken over 7-14 days and is important that withdrawal is supervised

Question 34

What should be discussed regarding overdose with beta-blockers?

Answer 34

The adverse effects of a beta blocker overdose are unpredictable, and can be dangerous, hence medical help should be sought immediately