Download PROPANOLOL A CARDIOVASCULAR BETA BLOCKER

PROPANOLOL (INDERAL, INDERAL – LA GENERIC)
A CARDIOVASCULAR BETA BLOCKER
TEAM 2 MEMBERS:
Stella O. Akpuaka
Bosede Adedire
Tamika Missouri
Amanda Rothenbecker
WHAT ARE CARDIOVASCULAR AGENTS?
Wide variety of drugs used for management and
treatment of several different conditions of the
heart and blood vessels.
 Classes:
 Antihypertensives
 Thiazide Diuretics
 Beta Blockers
 ACE Inhibitors
 Calcium Channel blockers
 Angiotensin II Receptor Blockers
 Alpha 1 Blockers
 Alpha2Agonists

WHAT ARE BETA BLOCKERS?
NAME AND CLASSIFICATION
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Drug Name:
 PROPRANOLOL: generic
 Inderal; Inderal Long acting (LA) - Brand
name
Classification:
 KEY Beta Blocker Drug
PHARMACODYNAMICS
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All Beta blockers have similar mechanisms of action
which is competitive blockade of Beta Adrenergic
receptor.
Effects of the Propranolol on the body includes:
 Highly selective to Beta 1 & Beta 2 receptors
 Decreasing heart rate
 Supraventricular conduction and cardiac output
 Decrease Cardiac work load and oxygen
consumption
 Decrease the secretion of renin.
Therapeutic level -------50-100mg/ml (better effect)
PHARMACOKINETICS
Lipid soluble (lipophilic)
 Excretion -------- Hepatic (Liver)
 Absorptions rate --- 90%
 Availability after first pass --- 30%
 Peak time of concentration ------1-1.5hrs
 Half life ------3-5 hrs; 8-11hrs for long acting
 Duration of action -----11hrs
 Protein bound --------93%
 Hepatic Metabolism -------2D6 substrate

INDICATION/RECOMMENDED DOSAGE
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Hypertension: 120-240mg/day bid -tid; max dose
640mg
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Angina: 120-160 mg/day; max dose 320 mg
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Essential tumor: 120mg/day; max dose 320 mg
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Off-label use: Migraine Prophylaxis
CONTRAINDICATION

The use of Propranolol is contraindicated in the
following conditions:
Sinus bradycardia
 Greater than first degree heart block
 Cardiogenic shock
 Pulmonary edema
 Severe Asthma or COPD
 Raynaud’s disease
 Pregnancy (second and third trimesters)
 Uncompensated heart failure
 Hypersensitivity

B-BLOCKERS
PROPRANOLOL PRECAUTIONS
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Avoid in patients with anaphylactic allergic
reactions
May mask signs and symptoms of hypoglycemia
Cautiously use in patients with hepatic/ renal
impairment
Cautiously use in patients with reactive airway
REVIEW OF LITERATURE
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Approved in 1967, Propranolol is one of the most
frequently prescribed beta-adrenergic blocking agents
to treat hypertension, angina, and arrhythmias.
Usually used in combination with other cardiac drugs,
for example: ACE inhibitors and diuretics to control
blood pressure.
Off-label uses include management of migraines,
tremors, and anxiety
IMPLEMENTATION PLAN: PRESCRIBING
AND CULTURAL CONSIDERATIONS

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Diuretics are the first line for African-Americans
since Beta Blockers can be less predictable
Asian American were less responsive to beta
blockers than Caucasians
Language Barrier- Providing patient with
information on the regimen in the appropriate
language, or with the help of a translator
 Language barriers and cultural barrier were are the
top predictor of non adherence in elderly Chinese
Americans

IMPLEMENTATION PLAN: AGE, ETHNICITY
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Age: The polypharmacy that accompanies increased
comorbidities in age decreases compliance.
 Medication information in a larger font
 Reinforcing regimen at follow up visits
 Asking patient to bring medication bottles to all
appointment
Remember that hypertension has increasing
morbidity in younger populations.
Beta Blockers should be avoided as first line in
youth due to delayed growth and lipid panel
abnormalities
IMPLEMENTATION PLAN: ADHERENCE
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A telephone follow-up to Medicare patients, by
pharmacists, has shown to increase patient
adherence with home antihypertensive medications
Frequent dosing and increased cost decreases
adherence
Patient’s are more likely to be adherent to a regimen
that is started during a hospital admission because
they relate the medication to the disease
SPECIAL CONSIDERATIONS
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Pregnancy and Lactation: Category C - Teratogenic
and embryo toxic effects have been demonstrated in
animals. Give drugs only if the potential benefit justifies
the potential risk to the fetus.
Pediatrics: Safety and effectiveness of beta blockers,
with the exception of propranolol, has not been
established in children.
Geriatrics: There is potential for drug accumulation in
the elderly, therefore, therapeutic doses must be small
and titrated slowly in the elderly.
Patients with liver impairments: Propranolol should
be administered with caution to patients with impaired
renal and hepatic function, half-life of propranolol may
be increased in these patients.
EVIDENCED BASED GUIDELINES
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The American Association of Cardiology (AAC) in
conjunction with American Heart Association (AHA)
emphasize education on risk reduction for coronary
arterial disease.
The AAC/AHA update recommend that all patient with
cardiac disease be seen by a cardiologist before initiating a
beta blocker.
Beta blocker therapy should be used in all patient with left
ventricular systolic dysfunction (ejection fraction <40%),
with heart failure or prior myocardial infarction unless
contraindicated.
Allow one to two months for a drug trial with beta blockers
to adjust dose and monitor for therapeutic response and
adverse reactions.
REFERENCES
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Albert, N. M. (2008). Improving medication adherence in
chronic cardiovascular disease. Critical Care Nurse, 28(5),
54-64.
Barner, J. C., Gabrillo, E. R., Godly, P. J., & Moczygemba,
L. R. (2008). Development and implementation of a
telephone medication therapy management program for
Medicare beneficiaries. American Journal of HealthSystem Pharmacy, 65(17), 1655-1660.
Edmunds, M. W. & Mayhew, M.S. (2013). Pharmacology
for the Primary Care Provider. (4th ed.). St. Louis, MO:
Mosby Elsevier.
Flynn, J. (2011). Management of hypertension in the
young: role of antihypertensive medications. Journal of
Cardiovascular Pharmacology, 58(2).
REFERENCES
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Hao, J., Yang, M. B., Liu, H. & Li, S. K. (2011).
Distribution of propranolol in periocular tissue: A
comparison of topical and systemic administration. Journal
of Ocular Pharmacology and therapeutics, 27 (5). 453-459
Hsu, Y., Mao, C., & Wey, M. (2010). Antihypertensive
medication adherence among elderly Chinese Americans.
Journal of Transcultural Nursing, 21(4), 297-305.
http://dx.doi.org/10.1177/1043659609360707
Johnson, J. (2008). Ethnic differences in cardiovascular
drug response. New Drugs and Technologies, 118, 13831393.
Shamliyan, T., Choi, J. Y., Ramakrishnan, R., Miller, J.,
Wang, S. Y., Taylor, F. & Kane R. (2013). Preventive
pharmacologic treatment for episodic migraine in adults.
Journal of General Internal Medicine, 28 (9), 1225-1237.