Propranolol / Inderal

Question 1

Cost

Answer 1

$4 up to $108 for Inderal LA

Question 2

Drug Class

Answer 2

Pharmacologic: Non-specific B-adrenoceptor blocker
Therapeutic: Antihypertensive, antiarrhythmic, primary and secondary prevention of MI, anti-anginal

Question 3

Pharmacodynamics

Answer 3

Binds directly to B1 receptors and B2 receptors, leading to lower BP via several mechanisms (less CO, less RAAS); recent evidence suggests less effective in preventing strokes than other drugs

Question 4

Pharmacokinetics

Answer 4

Available po or iv, variable oral F, onset 1-2 hours, duration 12-24 h, can be given once per day, cleared by hepatic metabolism (shorter half life)

Question 5

Toxicity

Answer 5

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

Question 6

Interactions

Answer 6

Additive effects with most other antihypertensives, additive AV block with CEB’s

Question 7

Special Considerations

Answer 7

May be especially useful in HTN patients with exertional angina, MI, Afib; watch out for abrupt withdrawl; no longer first line drug for essential HTN unless recent data suggests; note metoprolol needs to be taken several times per day

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