Metoprolol

Question 1

Brand Name

Answer 1

Lopressor

Question 2

Broad Category

Answer 2

Antihypertensive / Antiarrythmic / Antianginal

Question 3

Class

Answer 3

Selective Beta-1 adrenergic receptor antagonist

Question 4

MOA

Answer 4

selectively and competitively antagonizes Beta-1 receptors resulting in decreased contractility and HR
- dose-dependent selectivity

Question 5

Uses

Answer 5

Rapid HR and Contractility Control
Decreased CO thus decreases BP
Treatment for MI
Chronic heart failure (reduce mortality and improve survival)

Question 6

Dosing

Answer 6

1-5 mg IV q2-5 mins up to 15 mg

Question 7

Concentration

Answer 7

1 mg/mL

Question 8

CV effects

Answer 8

Decreased HR
Decreased Contractility
Decreased CO
- which decreases BP
decreased myocardial oxygen demand
increased coronary perfussion d/t prolonged diastole

Question 9

General SE

Answer 9

fatigue
depression
decreased exercise tolerance

Question 10

Metabolic effects

Answer 10

Masks hypoglycemia

Question 11

Contraindications (absolute)

Answer 11

Cardiogenic shock
pre-existing bradycardia
advanced heart block
uncompensated heart failure

Question 12

Precautions

Answer 12

Reactive Airway disease (COPD or Asthma)
CYP2D6 poor metabolizers

Question 13

Other Concerns

Answer 13

Withdrawal syndrome without titration due to upregulation

BP may tank with anesthetics

Question 14

Metabolism

Answer 14

Extensive Hepatic
- CYP2D6

Question 15

Excretion

Answer 15

Renal (metabolites)

< 10% excreted unchanged

Question 16

Elimination Half-life

Answer 16

3-4 hours

Question 17

Vd considerations

Answer 17

Large Vd
- highly lipophilic
- extensive tissue distribution

Question 18

Clearance considerations

Answer 18

Flow dependent (prolonged by hepatic disease or low flow states)

Question 19

Protein binding

Answer 19

Low