instruction: hi doctor I am a senior year medical student in greece and I would like to ask you a question about my mother she had a history of hyper hypothyearoidism about 10 years ago but the last two years her thyearoid has been managed and she stopped taking to her cardiologist told her about 10 years ago to start taking inderal propranolol 20 my per day divided in a two time dose because she had palpitations and some arrhythmias she had an echo egg about a year ago and her heart was fine and her cardiologist suggested stopping inderal but being a very anxious person and having frequently anxiety tachycardia she did not stop it which brings me to the present having been diagnosed the past six months by her pulmonologist with allergic rhinitis asthma and having frequent wheezing episodes even though she takes antihistamines when the episodes occur shouldn she change her beta blocker to a cardio selective one she finds herself not being able to breathe while on inderal but the symptoms reappear when she takes it what would you recommend as a cardioselective beta blocker would it be safe to change from inderal to let us say atenolol if yes how would she do it
output: hello I have gone through the history you have described for your mother I really appreciate the way you have presented it with all details it is very important to know the reason to start tablet inderal at first point what kind of arrhythmia it was and all in order to evaluate does she really need to continue any beta blocker as your cardiologist year ago after cardiac evaluation did not find any reason to continue the medication as per your history as we see in a day to day practice patients with palpitations just due to anxiety or stress and without any cardiac issue non selective beta blockers would definitely aggravate her symptoms be you have mentioned in your description is wrong I guess as it appears to be 12 20 something might be a type error but looks normal to me for time being you can change the beta blocker to a selective beta blocker like metaprolol 12 my or nebivolol 5 my or atenelol 25 my on a very low dose get her evaluated again with her cardiac reports whenever possible and if not required better to slowly taper her beta blocker medication and stop as well because though cardioselective beta blockers has some or minimal effect on beta receptors as well even I would advise to start meditation and yoga to overcome her anxiety issue that will help her in controlling palpitations if they are related would like to review her all previous and recent cardiac records to further discuss and clarify management strategy