Beta blockers metoprolol

Beta-blockers are medications that reduce the workload of the heart and lower blood pressure. They are commonly prescribed to relieve angina (a type of chest pain, pressure, or discomfort) or treat heart failure. They also are prescribed for people who have high blood pressure (hypertension). Several beta-blockers (metoprolol, propanolol, betaxolol, bisoprolol, and nadolol) have been detected in municipal sewage effluents up to the pg/L level (Temes 1998) and in groundwater samples (Sacher et al. 2001). 

IMATINIB 1. ANTIARRHYTHMICS -flecainide, mexiletine, propafenone 2. ANTIDEPRESSANTS - fluoxetine, paroxetine, TCAs, trazodone, venlafaxine 3. ANTIPSYCHOTICS -clozapine, haloperidol, perphenazine, risperidone, thioridazine 4. BETA-BLOCKERS - metoprolol, propanolol, timolol 5. DONEPEZIL 6. METHAMPHETAMINE Imatinib may cause t plasma concentrations of these drugs, with a risk of toxic effects Inhibition of CYP2D6-mediated metabolism of these drugs Watch for early features of toxicity of these drugs... 

ARTEMETHER WITH LUMEFANTRINE BETA-BLOCKERS -METOPROLOL t risk of toxicity Uncertain Avoid co-administration... 

Okabe, K., Yamaguchi, H., and Kawa, Y. New lontophoretic transdermal administration of the beta-blocker metoprolol. J. Controlled Rel. 4 79, 1986. 

Drugs that are metabolized by the cytochrome P-450 (CYP) isoenzymes CYP2D6, CYP2C9, and CYP2C19 also exhibit genetic polymorphisms. An example of CYP2D6 metabolism is debrisoquine. In about 5-10 /o of Caucasians in North America and Europe and about 1% of Asians, 4-hydroxylation of debrisoquine is reduced, and such individuals are at increased risk for toxicity (orthostatic hypotension). Beta blockers (metoprolol and timolol), antiarrhythmic drugs (encainide and flecainide), tricyclic antidepressants... 

The effect of a beta-blocker (metoprolol 30-40 mg/day or bisoprolol 2.5-5.0 mg/day for 1 month) on the change in QT interval, QT dispersion, and transmural dispersion of repolarization caused by bepridil has been studied in 10 patients with paroxysmal atrial fibrillation resistant to various antidysrhythmic drugs (17). Bepridil significantly prolonged the QTc interval from 0.42 to 0.50 seconds, QT dispersion from 0.07 to 0.14 seconds, and transmural dispersion of repolarization from 0.10 to 0.16 seconds. The addition of a beta-blocker shortened the QTc interval from 0.50 to 0.47 seconds, QTc dispersion from 0.14 to... 

ANTICOAGULANTS - ORAL 5. ANTIDEPRESSANTS - mianserin, paroxetine 6. ANTIDIABETIC DRUGS - repaglinide, sulphonylureas 7. ANTIEMETICS - aprepi-tant 5-HT3-antagonists 8. ANTIFUN-GALS - fluconazole, itraconazole, ketoconazole, voriconazole 9. ANTIPSY-CHOTICS - apiprazole, chlorpromazine, haloperidol 10. BETA-BLOCKERS-metoprolol, propanolol, timolol... 

The client with essential hypertension is prescribed the beta blocker metoprolol (Lopressor). Which assessment data would make the nurse question administering this medication ... 

Nikolai LN, McClure EL, MacLeod SL, Wong CS (2006) Stereoisomer quantification of the Beta-blocker drugs atenolol, metoprolol, and propranolol in wastewaters by chiral high-performance liquid chromatography-tandem mass spectrometry. J Chromatogr A 1131 103-109... 

This is the drug Metoprolol, a beta-blocker). Obviously, a great many deductions have to be made to arrive at a structure from scratch in this way and whilst each one in this example is valid in its own right and they all fit together perfectly well with no obvious conflicts, structural verification via the HMQC/HMBC route would be advisable ... 

Beta Blockers. The beta blockers, which act by interfering with noradrenergic transmission, have been used to manage aggression and other behavioral disturbances in patients who have suffered brain injury due to trauma and stroke for over 25 years. Several beta blockers have been tested including propranolol (Inderal), pindolol (Visken), nadolol (Corgard), and metoprolol (Lopressor). Fat-soluble beta blockers such as propranolol and pindolol more readily cross the blood-brain barrier and are thus better suited to managing psychiatric symptoms such as behavioral lability. 

Codeine, dextromethorphan, haloperidol, thioridazine, perphenazine, nortriptyline, desipramine, fluoxetine, norfluoxetine, TCAs (hydroxylation), beta-blockers such as timolol and metoprolol, type 1C antiarrhythmics encainide, flecainide TCAs (desmethylation), triazolam, alprazolam, midazolam, carbamazepine, terfenadine, quinidine, lidocaine, erythromycin, cyclosporin... 

Antiarrhythmics encainide, flecainide, mexiletine Beta-blockers alprenolol, metoprolol, propranolol, timolol Opiates codeine, dextromethorphan, ethylmorphine... 

Drugs that may interact with hydralazine include beta blockers (eg, metoprolol, propranolol) and indomethacin. 

Drugs that affect all phosphodiesterase type 5 inhibitors include the following alcohol, amlodipine, angiotensin II receptor blockers, antacids, bendroflumethiazide, beta blockers, cimetidine, diuretics, enalaphl, metoprolol, nifedipine, rifampin, tacrolimus. 

Nitrates are required for symptomatic relief of chest pain they are not proven to improve hard outcomes such as MI or death. Nitrates should be given initially sublingually or by spray, followed by oral or transdermal routes if pain is relieved. Lack of pain relief mandates i.v. administration. Beta-blockers such as metoprolol are used and may reduce the risk of subsequent MI. Calcium channel blockers such as dilfiazem, verapamil, or long-acting di-hydropyridines can be added for symptom control if nitrates and beta-blockers do not suffice they do not improve outcomes. In fact, they may worsen outcomes in the presence of left ventricular dysfunction or CHF in acute coronary syndrome. 

In vitro, diphenhydramine inhibits CYP2D6 and therefore may interact with beta-blockers, some antidepressants such as desipramine, and antipsychotics such as promethazine. In a study by Hamelin et al. (2000), diphenhydramine was found to inhibit the metabolism of metoprolol in phenotypically extensive metabolizers, but not in poor metabolizers. The effects where observed clinically as well as pharma-cokinetically. 

Propranolol was the first blocker shown to be effective in hypertension and ischemic heart disease. Propranolol has now been largely replaced by cardioselective blockers such as metoprolol and atenolol. All B-adrenoceptor-blocking agents are useful for lowering blood pressure in mild to moderate hypertension. In severe hypertension, blockers are especially useful in preventing the reflex tachycardia that often results from treatment with direct vasodilators. Beta blockers have been shown to reduce mortality after a myocardial infarction and some also reduce mortality in patients with heart failure they are particularly advantageous for treating hypertension in patients with these conditions (see Chapter 13). 

Beta blockers without intrinsic sympathomimetic activity (eg, metoprolol, propranolol, atenolol) are effective therapeutic adjuncts in the management of thyrotoxicosis since many of these symptoms mimic those associated with sympathetic stimulation. Propranolol has been the 3 blocker most widely studied and used in the therapy of thyrotoxicosis. Beta blockers cause clinical improvement of hyperthyroid symptoms but do not typically alter thyroid hormone levels. Propranolol at doses greater than 160 mg/d may also reduce T3 levels approximately 20% by inhibiting the peripheral conversion of T4 to T3. 

Metoprolol (Lopressor, Toprol-XL). Metoprolol is considered a cardioselective beta blocker and has been approved for treating hypertension, preventing angina pectoris, and preventing myocardial reinfarction. As an antihypertensive and antianginal, metoprolol is usually administered orally. In the prevention of reinfarction, metoprolol is initiated by intravenous injection and then followed up by oral administration. 

Bauman JL, Talbert RL. Pharmacodynamics of beta-blockers in heart failure lessons from the carvedilol or metoprolol European trial. J Cardiovasc Pharmacol Ther. 2004 9 117-128. 

Beta blockers that bind to both beta-1 and beta-2 receptors (nonselective agents, see Table 20-2) may induce bronchoconstriction in patients with asthma or similar respiratory problems. These patients should be given one of the more cardioselective beta antagonists, such as atenolol (Tenormin) or metoprolol (Lopressor, others). Beta blockers may also produce excessive cardiac depression in individuals with certain types of cardiac disease. Beta blockers are generally well tolerated in most patients, however, and major problems are infrequent. 

Individual beta blockers are presented in Chapter 20. Beta blockers shown to be effective in treating arrhythmias include acebutolol, atenolol, esmolol, metoprolol, nadolol, propranolol, sotalol, and timolol (see Table 23-2). Choice of a specific beta blocker depends to a large extent on the exact type of arrhythmia present and the individual patient s response to the drug. 

Beta blockers -olol Metoprolol, propranolol Antihypertensive (21), antianginal (22), antiarrhythmic (23), congestive heart failure (24)... 

---