Atenolol / Tenormin

Question 1

Alternate Names

Answer 1

Metoprolol, Toprol XL class runs 4 vs 52 bucks for atenolol and 100 for Toprol XL

Question 2

Drug Class

Answer 2

Pharmacologic Class - specific Beta 1 adrenoceptor blocker

Therapeutic: Antihypertensive, antiarrhythmic, primary and secondary prevention of MI, anti-anginal

Question 3

Pharmacodynamics

Answer 3

Binds directly to Beta1 receptors, with a preference for beta 1 over beta 2, leading to lower blood pressure via several potential mechanisms; Less CO, less activation of RAAS -> Evidence suggests less effective in preventing strokes than other drugs

Question 4

Toxicity

Answer 4

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

Question 5

Interactions

Answer 5

Additive effects with most other anti-hypertensives; additive AV block with CEB’s

Question 6

Special Considerations

Answer 6

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 for essential HTN unless other indications exist (recent data); metoprolol needs to be taken several times per day and has more data for use in patients s/p MI

Question 7

Indications and dose / route

Answer 7

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

Question 8

Monitoring

Answer 8

BP, HR, exercise tolerance