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9 Cards in this Set
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What is the best-known trade names for metoprolol?
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Lopressor and Toprol-XL
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Lopressor is metoprolol tartrate which is immediate-release whereas Toprol-XL is metoprolol succinate which is an extended-release formulation.
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What is the functional class of metoprolol?
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Class II antidysrhythmic (beta blocker).
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Other beta blockers include carvedilol (Coreg), labetalol (Normodyne, Trandate) and propranolol (Inderal). Most have generic names ending in "-lol".
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What is the mechanism of action of metoprolol?
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Selective inhibitor of beta-1 adrenergic receptors located on cardiac muscle. Completely blocks beta-1 receptors, with little or no effect on beta-2 receptors at doses less than 100mg. Reduces heart rate, cardiac output at rest and during exercise, and lowers BP.
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Lopressor can mask tachycardia associated with hypoglycemia.
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What are the listed indications for metoprolol?
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- Chest pain associated with AMI, ACS
- Angina pectoris - SVT |
Metoprolol is frequently prescribed for off-label use in anxiety disorders.
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What are the listed contraindications for metoprolol?
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- Hypersensitivity
- Sinus bradycardia - Heart block greater than 1st degree (except in patients with a functioning artificial pacemaker) - Cardiogenic shock (BP < 100mmHg) - Uncompensated cardiac failure - Pregnancy (2nd and 3rd trimesters) - Asthma - COPD |
Metoprolol is pregnancy category C in the US: "Risk can not be ruled out- Adequate, well-controlled human studies are lacking, and animal studies have shown a risk to the fetus or are lacking as well.
There is a chance of fetal harm if the drug is administered during pregnancy; but the potential benefits may outweigh the potential risk." |
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What are the listed precautions for metoprolol?
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- Impaired hepatic or renal function
- CHF controlled by digitalis or diuretics - Do not mix with IV calcium channel blockers |
AstraZeneca, the manufacturer of Toprol-XL, also lists hyperthyroidism and arteriosclerosis.
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What are the listed side effects for metoprolol?
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- Bronchospasm
- Bradycardia - Palpitations - Edema - CHF - Reduced peripheral circulation - Drowsiness - Insomnia |
Abrupt cessation of metoprolol therapy (or other beta blockers) may cause a thyroid storm
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What are the listed interactions for metoprolol?
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- Drugs which slow AV conduction such as digoxin as the effects may be cumulative with beta-blockers
- Glucagon: metoprolol may blunt the hyperglycemic action of glucagon - Verapamil or diltiazem may have synergistic pharmacological effects when taken concurrently with beta-blockers |
Drugs that inhibit CYP2D6 such as quinidine and fluoxetine may increase metoprolol plasma concentration, which can decrease its beta-1 selectivity.
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What is the dosage and route of metoprolol?
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5mg slow IVP (over 2-5 minutes) q5 minutes x3 (max of 15mg)
Acute MI: Maintain systolic BP>100 and heart rate >60/minute SVT: Maintain heart rate 90-100/minute |
Home PO dosages of metoprolol are in the range of 100-450mg/day
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