Bisoprolol is a cardioselective beta blocker.
Let’s now talk about dos so there are six different size tablets available the smallest is 1.25 milligrams then we have a 2.5 milligram tablet there is a 3.75 milligram tablet a 5 milligram tablet a 7.5 milligram tablet and then a 10 milligram tablet 10 milligrams a day is the maximum dose of bizarre pulao and one point two five milligrams a day is the minimum
Dose of bizarre law all of these tablets are extremely small and very easy to take there’s offal always usually taken once daily usually in the morning the starting dose is usually 2 point 5 milligrams once a day however if you’ve got a very frail patients that say it’s an 80 year old a frail adored lady who’s got a very small body weight in that case you might
Start off as a more cautious dose of 1.25 milligrams if the starting dose isn’t achieving the desired effect then you increase the dose if you’ve started at a dose of 2.5 milligrams a day then you can usually increase the dose in size gaps of two point five milligrams you can go up then to five milligrams a day and if that’s not working you can go up to seven point
Five milligrams a day and if that’s not working you could go up to the maximum dose of ten milligrams a day if you started off with the more cautious dose of 1.25 milligrams and you want to increase the dose then you would increase it by one point two five milligrams rather than two point five milligrams to go from one point two five to two point five from 2.5 to 3
Point seven five from three point seven five to five milligrams at five milligrams if you’re dealing with a very frail patients you may want to consider not going any higher because you’ve probably blocked off a good deal of the sympathetic stimulation to their heart by now and it’s not achieving the desired effects you may want to consider using a different drug
To now treat whatever problem you’re trying to treat or adding in another drug alongside the bizarre prologue when you’re putting them on this drug of course you need to be monitoring while it’s doing their heart rate and their blood pressure to illustrate this let’s go through our five examples so if you’re using bizarre parole to treat high blood pressure then
Of course when you initiate the patient on it you’re going to be very interested in what it’s done to that blood pressure and you’re going to increase the dose until you’re happy but their blood pressure is under good control but whilst you’re doing that you need to be monitoring what it’s doing to their heart rate because it’s going to not only be bringing their
Blood pressure down but it’s going to be lowering their heart rate potentially and you don’t want their heart rate to go too low the slow of the heart rate is the longer is the time interval between successive beats of the heart this means that the gap between the systolic blood pressure and the diastolic blood pressure is going to get larger we call this the
Post pressure which is the difference between the systolic blood pressure and the diastolic blood pressure so this is shown quite nicely on this picture here so this is a graph and we’re plotting on the vertical axis here blood pressure and then on the horizontal axis we’re plotting time so here this is representing a heartbeat and you can see the blood pressure
Goes up to systolic blood pressure here and then between this and the next heartbeat the pressure is dropping down to diastolic blood pressure here then the heart beats again and it goes up to systolic blood pressure and then it drops down to diastolic blood pressure again now if you imagine making the heart go slower so here we are the heart beats and now it’s
Going to start eating slower so there’s going to be a much longer gap between this beat and the next beat and you can see that the blood pressure is going to fall it’s going to have much more opportunity to fall so it’s going to fall to a lower diastolic pressure so the difference between the systolic pressure and the diastolic pressure is going to increase the
Pulse pressure is going to increase when the heart rate is going slower now it might be the case that both the systolic blood pressure and the diastolic blood pressure are within normal ranges and i’ve written here the normal ranges for both of them so systolic blood pressure should usually be between 90 and 140 millimeters of mercury and diastolic blood pressure
Should usually be between 60 and 90 millimeters of mercury so it might be the case that this systolic blood pressure up here is let’s say a hundred and thirty five and this diastolic blood pressure down here is 65 so neither of them are hypotensive so he’s now the systolic hypertensive or diastolic hypertensive however if the gap between them if the pulse pressure
Is too high it can still lead to symptoms of low blood pressure it can lead to weakness floppiness feeling lightheaded potentially even passing out so having a too high post pressure is not good and this is the reason that you need to not just monitor what their systolic and diastolic blood pressure is doing but also what the heart rate is doing and look at what
Their pulse pressure is doing so overall to treat high blood pressure with bizarro though you are aiming to get the systolic blood pressure lower than 140 and the diastolic blood pressure lower than 90 and you’re going to increase the dose until you managed to achieve that provided that it doesn’t take the heart rate too low and the post pressure too high because that
Make them symptomatic of low blood pressure which can potentially be dangerous if they faint and injure themselves from falling onto the ground for sinus tachycardia and for the rate control of atrial fibrillation you’re going to increase the dose until you’ve got their heart rate under control and you’re aiming for it to be less than a hundred and you’re going to
Raise the dose as much as possible monitoring what their heart rate and their blood pressure is doing and of course you’re going to be very interested in what the blood pressure is doing you want to make sure that the drug isn’t making them hypotensive so as long as their blood pressure is okay you can continue to raise the dose until their heart rates under control
For the management of angina symptoms you’re going to raise the dose until you’ve got the symptoms as well controlled if you think you’re going to get them with this drug and again whilst you’re doing that you’re going to be monitoring what their heart rate and their blood pressure is doing making sure you’re not sending them hypertensive or bradycardic finally
For the prevention of cardiac remodeling ideally you want the individual to be on the highest dose of the drug that is possible that their heart rate in their blood pressure is going to tolerate so you’ll gradually raise the dose monitoring what it’s doing to the heart race in their blood pressure and make sure that they’re not going hypertensive or bradycardic
And as long as they’re not you can continue to raise those to protect them from cardiac remodelling so finally let’s end by talking about the side effects of the drug so the two main side effects of the drug are going to be hypotension and bradycardia we’ve already talked about those those aren’t really side effects they’re more effects of the dose being too high
So apart from those the two side effects that i do see most often are nausea and nightmares so some people take the drug and it makes them feel sick so they might be feeling mildly sick every single day of their life because they’re taking the drug every single day of their life usually this is a side effect that you only see when people are on larger doses so dose
Is greater than 5 milligrams so if someone’s on 10 milligrams of bazoft with all day and then they’re complaining of just sort of feeling sick on a daily basis it might be the case that i think about quit it be the bizarre for all that’s causing this sensation and really all you need to do is think about can the dose be lowered because usually as i say if you go
To a dose 5 milligrams or lower usually those doses don’t cause this problem finally the side effect of nightmares this is a famous side effect of bisoprolol that it can give you very vivid terrifying dreams other beta-blockers can cause this as well but bizarro is particularly bad so if it’s a big problem for the individual it’s very important for them to be on
This beta blocker what we can do is we can change it to a different cardio selective eater blocker that is less bad for causing nightmares and in the uk the one that we tend to change it to is atenolol which is another cardio selected beta blocker and it has boarded so three different tablet sizes 25 milligrams 50 milligrams and 100 milligrams and it usually is
Taken once daily as well like bizarre though and the dosing is nicely analogous to bizarre so two point five milligrams of this off the law can be converted to 25 milligrams of a terrible five milligrams of bizarre part can be converted to 50 milligrams of atenolol 10 milligrams of bizarre for all to 100 milligrams of atenolol in the uk we don’t like atenolol as
Much as bizarre lopez or perl always our first line beta-blocker we love bizarre prologue however if it’s causing this problem and this is a big issue for the individual then we do change bizarre prologue to attend a law
Transcribed from video
Bisoprolol Part 4 By Elliot Nicholson