PROPANOLOL (Inderal, Inderal – LA generic) - PowerPoint Presentation

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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:AntihypertensivesThiazide DiureticsBeta BlockersACE InhibitorsCalcium Channel blockersAngiotensin II Receptor BlockersAlpha 1 Blockers

Alpha

2

Agonists

What are Beta blockers?

Name and ClassificationDrug Name:PROPRANOLOL: generic Inderal; Inderal Long acting (LA) - Brand nameClassification:KEY Beta Blocker

Drug

PharmacodynamicsAll 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

S

upraventricular

conduction and cardiac output

Decrease Cardiac work

load and

oxygen consumption

Decrease the secretion of renin

.

Therapeutic

level -------

50-100mg/ml (better

effect)

PharmacokineticsLipid soluble (lipophilic)Excretion -------- Hepatic (Liver)Absorptions rate --- 90%Availability after first pass --- 30%Peak time of concentration ------1-1.5hrsHalf life ------

3-5

hrs

; 8-11hrs for long acting

Duration of action -----

11hrs

Protein bound --------

93%

Hepatic Metabolism -------

2D6 substrate

Indication/Recommended DosageHypertension: 120-240mg/day bid -tid; max dose 640mgAngina: 120-160 mg/day; max dose 320 mg Essential tumor: 120mg/day; max dose 320 mg

Off-label

use:

Migraine Prophylaxis

ContraindicationThe use of Propranolol is contraindicated in the following conditions: Sinus bradycardiaGreater than first degree heart blockCardiogenic shockPulmonary edemaSevere Asthma or COPDRaynaud’s diseasePregnancy (second and third trimesters)Uncompensated heart failureHypersensitivity

B-Blockers

Propranolol PrecautionsAvoid in patients with anaphylactic allergic reactionsMay mask signs and symptoms of hypoglycemiaCautiously use in patients with hepatic/ renal

impairment

Cautiously

use in patients with reactive airway

Review of LiteratureApproved 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 ConsiderationsDiuretics are the first line for African-Americans since Beta Blockers can be less predictableAsian American were less responsive to beta blockers than CaucasiansLanguage Barrier- Providing patient with information on the regimen in the appropriate language, or with the help of a translatorLanguage barriers and cultural barrier were are the top predictor of non adherence in elderly Chinese Americans

Implementation Plan: Age, EthnicityAge: The polypharmacy that accompanies increased comorbidities in age decreases compliance. Medication information in a larger fontReinforcing regimen at follow up visitsAsking patient to bring medication bottles to all appointmentRemember 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: AdherenceA 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 ConsiderationsPregnancy 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 GuidelinesThe 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.

ReferencesAlbert, 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 Health-System 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).

ReferencesHao, 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). 453-459Hsu, 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

, 1383-1393

.

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.