NAME 1.1 Substance Propranolol 1.2 Group Beta-blocker Beta-adrenergic receptor blocking agent Class II antiarrhythmic drug 1.3 Synonyms 1-isopropylamine-3-(1-naphtylhoxy)-2 propanol ġ-isopropylamine-3-(alpha naphthoxy)-2 propanol-hydrochloride ġ-isopropylamino-3-(1-naphthyloxy)propan-2-ol ġ-isopropylamino-3-(1-naphthyloxy)propan-2-olhydrochloride ġ.4 Identification numbers 1.4.1 CAS numberģ18-98-9 AY - 64043 ICI - 45520 NCS - 91523 RTECS: UB 7500000 propranolol base RTECS: UB 7525000 propranolol hydrochloride 1.5 Main brand names, main trade names Angilol (United Kingdom) Arcablock-Retard-Capsules International Programme on Chemical Safetyġ. AUTHOR(S), REVIEWER(S), DATE(S) (INCLUDING UPDATES), COMPLETE ADDRESS(ES) TOXICOLOGICAL ANALYSES AND BIOMEDICAL INVESTIGATIONSĨ.1.2 Storage of laboratory samples and specimensĨ.1.3 Transport of laboratory samples and specimensĨ.2 Toxicological analyses and their interpretationĨ.2.1 Tests on toxic ingredient(s) of materialĨ.2.1.2 Advanced qualitative confirmation test(s)Ĩ.2.2.2 Advanced qualitative confirmation test(s)Ĩ.2.3 Interpretation of toxicological analysesĨ.3 Biomedical investigations and their interpretationĨ.3.4 Interpretation of biomedical investigationsĨ.4 Other biomedical (diagnostic) investigations and their interpretationĨ.5 Overall Interpretation of all toxicological analyses and toxicological investigationsĩ.4 Systematic description of clinical effectsĩ.4.9 Eye, ear, nose, throat: local effectsĩ.4.12.2 Fluid and electrolyte disturbancesġ0.2 Life supportive procedures and symptomatic/specific treatmentġ4. NAMEĢ.4 First aid measures and management principlesĦ.3 Biological half-life by route of exposureĨ. In addition, propranolol (Inderal) is not cardioselective and blocks both beta-1 and beta-2 receptors.Propranolol (PIM 441) Propranolol 1. Answer E is incorrect because cardioselective beta blockers target Beta-1 receptors found in cardiac muscle whereas Beta-2 receptors are primarily located in the lungs. Metoprolol succinate (Toprol XL) and metoprolol tartrate (Lopressor) are both metabolized via CYP 2D6, making answer D correct as poor metabolizers may allow accumulation leading to toxicity. It is important to counsel patients with diabetes who take beta blockers that these symptoms of hypoglycemia may be masked, but sweating is not masked by beta blockers. Answer C is correct because beta blockers can mask tachycardia during a hypoglycemic episode. If used for HFrEF, the only three beta blockers recommended are metoprolol succinate (Toprol XL), bisoprolol (Ziac) and carvediol (Coreg). Beta blockers are considered a part of first-line treatment for patients with ischemic heart disease, such as our patient who has had a previous myocardial infarction, and in patients with heart failure with reduced ejection fraction (HFrEF). Answer B is incorrect because beta blockers are not first line treatment for uncomplicated hypertension due to worse outcomes compared to other first-line agents (increased risk of stroke). It is important to also note that during beta blocker toxicity, many other drugs are also used as part of treatment such as fluids to manage hypotension and even sometimes glucagon (Gvoke) which is considered an antidote for beta blocker toxicity. What instead would potentially be used is atropine (AtroPen), an anticholinergic agent that increases cardiac output and treats bradycardia. Answer A is incorrect because adenosine (Adenocard/Adenoscan) is a Class IV antiarrhythmic used for paroxysmal supraventricular tachycardia (PSVT) and would lower the patient's heart rate even further.
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