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

Drug Name:

PROPRANOLOL:

generic
Inderal; Inderal Long acting (LA) - Brand name

Classification:
KEY

Beta Blocker Drug

PHARMACODYNAMICS

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

Hypertension: 120-240mg/day bid -tid; max dose

640mg

Angina: 120-160 mg/day; max dose 320 mg

Essential tumor: 120mg/day; max dose 320 mg

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
Raynauds disease
Pregnancy (second and third trimesters)
Uncompensated heart failure
Hypersensitivity

B-BLOCKERS

PROPRANOLOL PRECAUTIONS
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

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 CONSIDERATIONS

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
Johnson, J. (2008). Ethnic differences in cardiovascular drug response.
New
Drugs and Technologies, 118, 1383-1393.

IMPLEMENTATION PLAN
CULTURAL CONSIDERATIONS, AGE, ETHNICITY

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 (Hsu, Mao, & Wey, 2010).
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 (Joseph, 2011)

IMPLEMENTATION PLAN
ADHERENCE
A telephone follow-up to Medicare patients, by
pharmacists, has shown to increase patient
adherence with home antihypertensive medications
(Barner, Gabrillo, Godly, & Moczygema, 2008)
Frequent dosing and increased cost decreases
adherence (Albert, 2008)
Patients are more likely to be adherent to a
regimen that is started during a hospital admission
because they relate the medication to the disease
(Albert, 2008)

Special Consideration
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.

Evidence based Guidelines :

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

Edmunds, M. W. & Mayhew, M.S. (2013). Pharmacology

for the Primary Care Provider. (4th ed.). St. Louis, MO:
Mosby Elsevier.
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
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.