BB

Question 1

Side effects

Answer 1

• Fatigue
• brady
• bronchospasms
• coldness of extremities
• sleep disturbance (less common with water soluble)
• GI
• Mask symptoms of hypo

Question 2

Monitoring

Answer 2

• ECG (for bradycardia), Heart Rate (HR)
• Blood glucose levels in diabetics
• Lung function in patients with history of obstructive airway disease

Question 3

Withdrawal

Answer 3

Avoid abrupt

Question 4

CI

Answer 4

• 2nd or 3rd degree heart block
• Worsening UNSTABLE heart failure (but cautioned in stable heart failure)
• History of asthma/COPD or bronchospasm (because they precipitate bronchospasm)
• Avoid in frequent hypo
• Peripheral vascular disease

Question 5

Drug interactions

Answer 5

• Verapamil (and diltiazem) and Beta-blockers (high risk of hypotension and heart failure)
• AVOID combination
• Theophylline/Aminophylline -
  Increases risk of bronchospasms

Question 6

Which beta-blockers are likely to have less coldness of extremities and less bradycardia as a side-effect (have ISA)?

Answer 6

These have intrinsic sympathomimetic activity (ISA)
Celiprolol
Acebutolol
Pindolol
Oxprenolol
Accronymn: ISA-CAPO

Question 7

Water-soluble beta-blockers

Answer 7

• Celiprolol
• Atenolol
• Nadolol
• Sotalol

CANS

Question 8

What are the
characteristics of water soluble beta-blockers?

Answer 8

• less likely to enter the brain, therefore less sleep disturbances and nightmares
• Excreted by kidneys (dose reduction in renal impairment)

Question 9

Lipid soluble beta-blockers

Answer 9

• Propranolol
• Bisoprolol
• Carvedilol
• Labetalol
• Metoprolol
• timolol

Question 10

Cardioselective beta-blockers?

Answer 10

Beta-blockers that have a higher affinity for b1 receptors in the heart
They are SELECTIVE, but NOT specific - so they can still affect the airways to a lesser
extent
Examples:
- Bisoprolol
- Atenolol
- Metoprolol
- Nebivolol

Question 11

What are the common
NON-cardioselective beta-blocker?

Answer 11

Sotalol
Propranolol

Question 12

Which beta-blockers have an intrinsically longer duration of action?

Answer 12

Give OD
- Atenolol
- Bisoprolol
- Celiprolol
- Nadolol

Question 13

What type of beta-blocker is Atenolol (i.e. what are their characteristics?)

Answer 13

• Cardio-selective and water soluble

Question 14

Is Bisoprolol water soluble?

Answer 14

No, they are lipid soluble
Bisoprolol is cardioselective but NOT water-soluble so it
can cause sleep disturbances and vivid dreams

Question 15

Which beta-blockers can be used in asthmatics→

Answer 15

Atenolol, Bisoprolol and Celiprolol (cardioselective beta blockers)

Question 16

Which beta-blockers are associated with nightmares and which beta-blockers are advisable to lessen these symptoms

Answer 16

Lipophilic beta-blockers (Metoprolol, Propranolol and Carvedilol). Therefore hydrophilic beta-blockers are appropriate alternatives (Atenolol and Sotalol)