Beta Blockers

Question 1

Atenolol dose?

Answer 1

Initially, 25-50mg once daily. Increased to 100mg daily if needed.

Question 2

Atenolol and metoprolol both have a max maintenance dose of..?

Answer 2

100mg

Question 3

Bisoprolol has the lowest dose of the beta blockers. What is its starting dose, then maximum dose?

Answer 3

Starting = 1.25mg daily.

Slowly increased over weeks up to 10mg

Question 4

Carvedilol initial and maintenance dose?

Answer 4

12.5mg daily, increased to 50mg maximum.

Question 5

MOA of beta blockers?

Answer 5

Reduces HR, BP and contractility by blocking beta receptors. Reduces sympathetic activity

Question 6

Of atenolol, metoprolol, bisoprolol and carvedilol, which is non-selective?

Answer 6

Carvedilol. The rest are B1 selective

Question 7

ADRs of beta blockers?

Answer 7

Bradycardia, hypotension, orthostatic hypotension, nausea, diarrhoea

Question 8

Precaution with beta blockers and diabetes?

Answer 8

They may mask signs of hypoglycaemia, so diabetics should check their blood glucose more often

Question 9

Which beta blocker is excreted renally and therefore less concerned with hepatic impairment?

Answer 9

Atenolol

Question 10

Which beta blocker is least likely to cause nightmares and also should not be used while breastfeeding?

Answer 10

Atenolol. Because it is more hydrophilic

Question 11

Why aren’t beta blockers first line for hypertension?

Answer 11

Because they are less protective against stroke compared to other anti-hypertensives like ace inhibitors, especially important for elderly.

Question 12

Why is label 9 needed.

Answer 12

Because your body makes more beta receptors to compensate. If you suddenly stop, HR would rapidly increase and you could get angina, rebound HT, etc

Question 13

Which beta blocker shouldn’t be used in asthma?

Answer 13

Carvedilol

Question 14

Why is carvedilol more likely to cause orthostatic hypotension than the other BBs?

Answer 14

Because it is non selective and also antagonises the alpha receptor.