Beta Blockers

turlough's version from 2017-10-30 18:31

Section 1

Question Answer
Is atenolol a cardioselective beta blocker? Yes
List 4 indications for atenolol Hypertension, angina pectoris, cardiac arrhythmias and myocardial infarction.
How does atenolol work? It relieves the symptoms of angina by reducing heart rate and contractility. Its mechanism in treating hypertension is unclear.
Mention one reason for reducing the dose of atenolol. Renal impairment
Does food affect the absorption of atenolol? Yes, food reduces atenolol absorption by 20%.

Section 2

Question Answer
8 contra-indications to the use of atenolol 1) Hypersensitivity. 2) 2nd or 3rd degree heart block. 3) Hypotension. 4) Bradycardia. 5) Uncontrolled heart failure. 6) Cardiogenic shock. 7) Sick sinus syndrome. 8) Metabolic acidosis.
What property of atenolol is responsible for it being contra-indicated in uncontrolled heart failure? Its negative inotropic effects
Is atenolol suitable in pregnancy? What about breastfeeding? No to both.
How might atenolol affect psoriasis? Atenolol may worsen psoriasis. Exercise extra caution when using atenolol in these patients.
What is the problem with using atenolol in a diabetic patient? Beta blockers can mask symptoms of hypoglycaemia, especially tachycardia.
What is the problem with using atenolol in asthmatics? While atenolol is cardioselective, there is still a risk of increased airway resistance particularly at higher doses.

Section 3

Question Answer
Discuss atenolol discontinuationPatients should come off atenolol gradually over 1-2 weeks due to the risk of rebound angina or hypertension.
5 interactions with atenolol 1) Anti-arrhythmic drugs. 2) Anti-diabetic drugs. 3) Calcium channel blockers. 4) Digoxin. 5) NSAIDs.
Explain the interaction between atenolol and anti-arrhythmic drugs Anti-arrhythmic drugs such as amiodarone have negative inotropic effects, like atenolol. This increases the risk of bradycardia and heart block. Avoid this combination in patients with AV block or sick sinus syndrome.
Explain the interaction between atenolol and calcium channel blockers. The combination of a beta-blocker with dihydropyridine-type CCBs increases the risk of hypotension. The combination of atenolol with non-DHP CCBs (diltiazem and verapamil) increases the risk of bradycardia and heart block because these drugs also have negative inotropic effects.
Explain the interaction between atenolol and digoxin. The combination of digoxin and a beta-blocker increases the risk of AV block.
Explain the interaction between atenolol and NSAIDsNSAIDs counteract atenolol's anti-hypertensive effect.

Section 4

Question Answer
5 common side effects of atenolol Bradycardia, cold extremities, dizziness, fatigue and GI upset.
How would you monitor the efficacy of atenolol if using it for hypertension? Determine reduction in blood pressure.
How would you monitor the efficacy of atenolol if using it for angina? Measure the reduction in chest pain, in the frequency of angina attacks and in the frequency with which the patient has to use their nitroglycerine pump spray.
3 counselling points for atenolol 1) Take on an empty stomach as food impairs absorption. 2) Avoid alcohol due to risk of hypotension and dizziness. 3) Don't stop taking suddenly due to risk of rebound hypertension, angina and even MI.
A specific counselling point for a diabetic patient starting atenolol Monitor blood sugar levels more closely as beta blockers make it more difficult for you to tell if you are having a hypo.

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Section 9

Section 10

Section 11