Atenolol

Question 1

Alternate Names

Answer 1

Propranolol, Inderal, Inderal LA, metoprolol, Toprol XL many others: COst 4-52$, up to 108$ for Inderal LA

Question 2

Drug Class

Answer 2

Pharm: Beta adrenoceptor blocker (beta 1 specificity)
Therapeutic: antihypertensive, antiarrhthmic, primary and secondary prevention of MI, anti-anginal

Question 3

Pharmacodynamics

Answer 3

Binds directly to beta-receptors, with a preference for Beta1 over beta2 receptors, leading to lower BP via several potential mechanisms (less CO, less RAAS); recent evidence suggests less effective in preventing strokes than other drugs, hence no longer used as initial monotherapy in most patients

Question 4

Pharmacokinetics

Answer 4

Available po or IV, variable oral F; onset 1-2 hours h, duration 12-24 hours, can be given once per day; renally excreted (longer half life)

Question 5

Toxicity

Answer 5

Excessive hypotension; bradycardia; heart block can worsen severe CHF (but indicated for mild to moderate CHF) worsen bronchospasm in severe asthmatics

Question 6

Interactions

Answer 6

Additive effects with most other antihypertensives, additive AV block with CEBs

Question 7

Special Considerations

Answer 7

May be especially useful in HTN patients with exertional angina, MI, atrial fibrillation, watch out for abrupt withdrawal; may no longer be first line drug unless other indications exist

Question 8

Indications and Dose / Route

Answer 8

For treatment of hypertension, 25-100 mg per day, in one or two doses

Question 9

Monitoring

Answer 9

BP, HR, exercise tolerance