Propranolol

Question 1

Brand Name

Answer 1

Inderall

Question 2

Broad category

Answer 2

Antihypertensive / Antiarrythmic / sympatholytic

Question 3

Pharm Class

Answer 3

First gen nonselective beta-adrenergic antagonist

Question 4

MOA

Answer 4

Primary: nonselective, competitive antagonist that binds to and inhibits both Beta-1 and Beta-2 receptors
- prevents actions of catecholamines and NE –> decreases arterial BP by decreasing contractility, lowers HR, and diminshes renin release

Question 5

Indications / Clinical Uses

Answer 5

HTN
angina
acute MI
PHEOCHROMOCYTOMA
treat anxiety and panic attacks

Others:
Prophylaxis for migraines
Management of thyroid storm

Question 6

IV dose

Answer 6

0.5 - 1 mg over 1 minute

Question 7

Repeat dosing

Answer 7

0.5 mg q 3-5 mins

Question 8

MAX dosing

Answer 8

0.1 mg/kg MAX

Question 9

onset

Answer 9

2-3 mins

Question 10

Duration

Answer 10

4-6 hours

Question 11

CV effects

Answer 11

Decreased heart rate
decreased contractility
decreased CO
decreased systemic BP

Can precipitate acute CHF
may cause AV block

Question 12

Respiratory effects

Answer 12

bronchospasm (can be fatal)

Question 13

Metabolic effects?

Answer 13

Masks symptoms of hypoglycemia

Question 14

Other concerns?

Answer 14

Withdrawal syndrome if not titrated down d/t upregulation

Question 15

Contraindications (absolute)

Answer 15

Cardiogenic shock

Question 16

Precautions

Answer 16

Bronchospastic disease (CAREFUL)
AV block
bradycardia
PVD

Question 17

Metabolism

Answer 17

Hepatic: CYP 450
- CYP2D6
- CYP1A2
- CYP2C19

and conjugation

Question 18

Elimination

Answer 18

Primarily renal

Question 19

Elimination half-life

Answer 19

3-4 hours

Question 20

Vd considerations

Answer 20

Large Vd
- highly lipophilic
- extensive tissue distribution

Question 21

Clearance considerations

Answer 21

Reduced clearance with
- Hepatic impairment
- Low CO

• HIGH ER, flow dependent

Question 22

Protein binding

Answer 22

90-95% high