Pharmacological Class: Beta Blocker

✨ Indications ✨ * Hypertension * Angina pectoris * Prevention of MI and decreased mortality in patients with recent MI * Management of stable, symptomatic (class II or III) heart failure Unlabeled Use(s): * Ventricular arrhythmias/tachycardias * Tremors * Anxiety

➡️ Action ➡️ Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-adrenergic receptor sites.

Therapeutic Effect(s): * Decreased BP and heart rate. * Decreased frequency of attacks of angina pectoris. * Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure.

🚫Contraindication/Precautions ⚠️ Contraindicated in: * Uncompensated HF; * Pulmonary edema; * Cardiogenic shock; * Bradycardia, heart block, or sick sinus syndrome (in absence of a pacemaker). Use Cautiously in: * Renal impairment * Hepatic impairment * Pulmonary disease (including asthma -> blocks beta1) * Diabetes mellitus (may mask signs of hypoglycemia) 😵‍💫Adverse Reactions/Side Effects 🤢 CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, nervousness, CV: BRADYCARDIA, HF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction Endo: hyperglycemia, hypoglycemia GI: constipation, diarrhea, dry mouth, flatulence, gastric pain, heartburn, ↑ liver enzymes, nausea, vomiting MS: arthralgia, back pain, joint pain Resp: bronchospasm, wheezing

💊 Drug Interactions 💊 * ↑ risk of bradycardia when used with digoxin, verapamil, diltiazem, or  clonidine.25w

Other tips: ⭐️ Hold on the morning of a treadmill stress test. ⭐️ At higher doses can affect beta 2 receptors and induce wheezing especially on patients already with asthma or COPD. ⭐️ For patients with an MI or history of CAD we may tolerate a lower BP/HR so ask for parameters. ⭐️ Toprol XL is used for patients with Heart Failure with a reduced Ejection Fraction (HFrEF) (EF <40%). (Metoprolol tartrate is not an evidenced based beta blocker for HFrEF).