All are true about starting of B-Blocker therapy in a case of heart disease except
|A||They should be started with optimum doses|
|B|| They should be gradually increased over weeks. |
|C|| Special precautions should be taken in cases of NYHA class III and IV|
|D||Carvedilol and Metoprolol are the preferred drugs.|
(Ref: BG Katzung, Basic & Clinical Pharmacology’ 11th Edition’ 2010; pp-160)
a. Beta blockers have long been used to treat a variety of conditions related to heart and blood pressure.
b. Beta blockers have traditionally been contraindicated in heart failure.
c. Since the publication of an hypothesis in 2000 that pulses of norepinephrine can lead to cardiac arrhythmias leading to death, it has been realized that low dose of beta blockers should be used.
d. In recent years, it has been shown that three beta-blockers, e.g., metoprolol, bisoprolol or carvedelol have reduced mortality in chronic heart failure.
However, American college of clinical cardiology and American heart association issued guidelines in 2003 that
a. Low dose of beta blockers should be used
b. They should be used only in NYHAI and NYHA II (i.e. in mild and moderate cases)
c. Carvedilol or metoprolol can be used
d. Carvedilol is preferred due to its antioxidant activity
e. No beta blocker is used to treat severe CHF