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CONTINUING PROFESSIONAL DEVELOPMENT
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1. Beta-blockers act to:
a) Depress sinus node function and
shorten atrial refractory periods.
b) Increase demand of myocardial oxygen
c) Shorten the diastolic component of the
d) Lower heart rate and improve
2. Lipophilic beta-blockers:
a) Are incompletely absorbed by the
b) Have long elimination half-lives.
c) Are less likely to cause central
d) Have low oral bioavailability.
3. Hydrophillic beta-blockers:
a) Are completely absorbed by the
b) Are more likely to cause central
c) Have high renal clearance.
d) Include agents such as pindolol and
4. Which of the following statementsis
a) Is likely to cause vivid dreams.
b) Is a selective beta-blocker.
c) Is unlikely to cause bronchoconstriction.
d) Is unlikely to mask the effects of
5. Which of the following is MOST
appropriate for a patient with liver
have excellent asthma control prior
to initiating therapy.
In addition, the
patient should be monitored by a doctor
after their first dose; a reduction in peak
expiratory flow (PEF) of more than 20%
may warrant treatment discontinuation.
If ongoing beta-blocker therapy is
prescribed, asthma patients should have
regular clinical reviews.
KEY LEARNING POINTS
Beta-blockers are a diverse group of
medicines, and each agent within the
group has specific factors which affect
therapeutic choice. It is essential that
healthcare professionals are aware of the
pharmacokinetic and pharmacodynamic
similarities and differences between
specific beta-blockers. Most importantly,
the patient’s comorbidities and current
medicines will determine the most
appropriate beta-blocker to use, or
whether these agents are contraindicated.
You are concerned that Mr Allonso
has poorly controlled asthma, and
has been prescribed a beta-blocker
(metoprolol). You contact Mr Allonso’s
doctor (Dr Finlay) to relay your concerns
and suggest an alternative treatment
option for his newly diagnosed angina.
Dr Finlay is pleased that you have
contacted him on this occasion and asks
for your advice regarding alternative
treatment options for Mr Allonso.
You inform Dr Finlay that calcium channel
blockers are also considered first line
treatment options in the prevention
of stable angina, and they are often
prescribed for patients who have a
contraindication to beta-blockers.
suggest that diltiazem controlled release
– initially 180 mg once daily; increase as
required up to 360 mg once daily – is an
alternative option for Mr Allonso. Dr Finlay
is happy to take your advice, and will
provide Mr Allonso with a prescription for
diltiazem. He will also address Mr Allonso’s
poorly controlled asthma at his next
consultation. Dr Finlay thanks you for
being so thorough in this case.
1. Cardiovascular Expert Group. Therapeutic guidelines:
cardiovascular. Version 6. Melbourne: Therapeutic
Guidelines Ltd; 2012.
2. Tarkin J, Kaski J. Pharmacological treatment of chronic
stable angina pectoris. Clin Med. 2013;13(1):63−70.
3. Davies S. Clinical presentation and diagnosis of coronary
artery disease: stable angina. British Med Bull. 2001;59:17−27.
4. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2014. At: www.amh.net.
5. Brenner G, Stevens C. Pharmacology 4th ed. Philadelphia:
6. Jallion P. Relevance of intrinsic sympathomimetic activity
for beta-blockers. Am J Cardiol. 1990;66:21c−21c.
7. Arboe B, Ulrick C. Beta-blockers: friend or foe in asthma?
Int J Gen Med. 2013;6:549−55 .
8. Borchard U. Pharmacological properties of β-adrenoceptor
blocking drugs. J Clin Bas Cardiol. 1998;1(1):5−9.
9. Lopez-Sendon J, Swedberg K, McMurray J, Tamargo J,
Maggioni A, Dargie H, et al. Expert consenus document on
β-adrenergic receptor blockers. Eur Heart J. 2004;25:1341−62.
10. Salpeter S, Ormiston T, Salpeter E, Wood-Baker R.
Cardioselective beta-blockers for reversible airways disease
(review). Cochrane Database of Systematic Reviews 2002;
Issue 4. Art. No.: DOI: 10.1002/14651858.CD002992.
11. Self T, Wallace J, Soberman J. Cardioselective beta-blocker
treatment of hypertension in patients with asthma: when
do benefits outweigh risks? J Asthma. 2012;49(9):947−51.
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