Names and pronunciation
(a-ten′oh-lole) Tenormin, Tenorectic
PDF page 116
Loading InternPractice…
Drug reference
(a-ten′oh-lole) Tenormin, Tenorectic
PDF page 116
Func. class.: Antihypertensive, antianginal
PDF page 116
Chem. class.: β-Blocker, β1-, β2- blocker (high doses)
PDF page 116
Do not confuse: atenolol/albuterol Tenormin/thiamine/Imuran
PDF page 116
ACTION: Competitively blocks stimu- lation of β-adrenergic receptor within vascular smooth muscle; produces nega- tive chronotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, negative inotropic activity decreases O2 consumption in myocardium; decreases action of renin- aldosterone-angiotensin system at high doses, inhibits β2 receptors in bronchial system at higher doses
PDF page 116
USES: Hypertension, angina pectoris; suspected or known MI (IV use); MI prophylaxis
PDF page 116
Unlabeled uses: Migraine prophylaxis, supraventricular tachycardia prophylaxis (PSVT), unstable angina, alcohol with- drawal, lithium-induced tremor
PDF page 116
CONTRAINDICATIONS: Preg- nancy, hypersensitivity to β-blockers, car- diogenic shock, second- or third-degree heart block, sinus bradycardia, cardiac failure Precautions: Breastfeeding, major surgery, diabetes mellitus, thyroid/ renal disease, HF, COPD, asthma, well- compensated heart failure, dialysis, myasthenia gravis, Raynaud’s disease, pulmonary edema
PDF pages 116, 117
Black Box Warning: Abrupt discontinu- ation Black Box Warning: Taper gradually, do not discontinue abruptly, may precipitate angina, MI • If pregnancy is planned or suspected; do not use in pregnancy, breastfeeding Black Box Warning: Not to discontinue product abruptly, taper over 2 wk (an- gina); to take at same time each day as directed • Not to use OTC products unless di- rected by prescriber • To report bradycardia, dizziness, con- fusion, depression, fever • To take pulse at home; advise when to notify prescriber (heart rate <50 bpm) • To limit alcohol, smoking, sodium intake • To comply with weight control, dietary adjustments, modified exercise program • To carry emergency ID to identify prod- uct, allergies, conditions being treated • To avoid hazardous activities if dizzi- ness is present • To change position slowly to limit or- thostatic hypotension • That product may mask symptoms of hypoglycemia in diabetic patients • Pregnancy/breastfeeding: if preg- nancy is planned or suspected; do not use in pregnancy, breastfeeding; to use con- traception while taking this product; to avoid breastfeeding
PDF pages 117, 118
SIDE EFFECTS CNS: Insomnia, fatigue, dizziness, mental changes, memory loss, depres- sion, lethargy, drowsiness, strange dreams CV: Profound hypotension, bradycardia, HF ENDO: Hypo- and hyperglycemia GI: Nausea, diarrhea, vomiting, constipation GU: Impotence, decreased libido, uri- nary frequency INTEG: Rash RESP: Bronchospasm, dyspnea, wheez- ing, pulmonary edema
PDF page 117
INTERACTIONS • Mutual inhibition: sympathomimetics (cough, cold preparations) Increase: hypotension, bradycardia— reserpine, hydrALAZINE, methyldopa, pra- zosin, anticholinergics, digoxin, diltiaZEM, verapamil, cardiac glycosides, calcium channel blockers, antihypertensives; mon- itor and adjust dose if needed Increase: hypoglycemia—insulins, oral antidiabetics Increase: hypertension—amphetamines, ePHEDrine, pseudoephedrine Increase: toxicity risk—dolasetron; lido- caine (IV) Decrease: atenolol effect—salicylates, rifamycins, penicillins, NSAIDs, calcium carbonate, aluminum antacids Drug/Herb Increase: atenolol effect—hawthorn Decrease: atenolol effect—ephedra (ma huang) Drug/Lab Test Increase: BUN, potassium, triglycerides, uric acid, ANA titer, platelets, alkaline phosphatase, creatinine, LDH, AST/ALT Decrease: glucose
PDF page 117
TREATMENT OF OVERDOSE: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O2, diuretic for cardiac failure, hemodialysis HIGH ALERT
PDF page 118
DOSAGE AND ROUTES Hypertension • Adult: PO 25-50 mg/day, increasing q1-2wk to 100 mg/day; may increase to 200 mg/day for angina, up to 100 mg/ day for hypertension • Child: PO 0.8-1 mg/kg/dose initially; range, 0.8-1.5 mg/kg/day; max 2 mg/kg/ day; max 2mg/kg/day up to 100mg/day • Geriatric: PO 25 mg/day initially MI • Adult: PO 100 mg/day in 1-2 divided doses; may need for 1-3 yr after MI Renal disease • Adult: PO CCr 15-35 mL/min, max 50 mg/day; CCr <15 mL/min, max 25 mg/ day; hemodialysis 25-50 mg after dialy- sis PSVT prophylaxis (unlabeled) • Child: PO 0.3-1.3 mg/kg/day Cardiac risk reduction during sur- gery (unlabeled) • Adult: PO 50 mg, start before planned procedure, titrate to heart rate, continue 7-30 days after procedure Unstable angina (unlabeled) • Adult: PO 50-200 mg/day Ethanol withdrawal prevention (unlabeled) • Adult: PO 50-100 mg/day Migraine prophylaxis (unlabeled) • Adult: PO 50-150 mg/day, titrate to response Lithium-induced tremor (unlabeled) • Adult: PO 50 mg/day
PDF page 117
Available forms: Tablets 25, 50, 100 mg
PDF page 117
Administer: PO route • Before meals, at bedtime; tablet may be crushed, swallowed whole, same time of day • Reduced dosage with renal dysfunction A • Store protected from light, moisture; place in cool environment
PDF page 117
Assess: • I&O, weight daily; watch for HF (rales/ crackles, jugular vein distention, weight gain, edema) • Hypertension: B/P, pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes (<50 bpm); ECG • Hypoglycemia: may be masked in dia- betes mellitus (tachycardia, sweating)
PDF page 118
Evaluate: • Therapeutic response: decreased B/P after 1-2 wk, increased activity tolerance, decreased anginal pain
PDF page 118
CLINICAL CONSIDERATIONS
PDF page 118
Patient and caregiver information:
PDF page 118
PHARMACOKINETICS PO: Peak 2-4 hr; onset 1 hr; duration 24 hr; half-life 6-7 hr; excreted unchanged in urine, feces (50%); protein binding 5%-15%
PDF page 117
• Adult: PO 25-50 mg/day, increasing q1-2wk to 100 mg/day; may increase to 200 mg/day for angina, up to 100 mg/ day for hypertension
PDF page 117
• Child: PO 0.8-1 mg/kg/dose initially; range, 0.8-1.5 mg/kg/day; max 2 mg/kg/ day; max 2mg/kg/day up to 100mg/day
PDF page 117
• Geriatric: PO 25 mg/day initially MI
PDF page 117
• Adult: PO 100 mg/day in 1-2 divided doses; may need for 1-3 yr after MI Renal disease
PDF page 117
• Adult: PO CCr 15-35 mL/min, max 50 mg/day; CCr <15 mL/min, max 25 mg/ day; hemodialysis 25-50 mg after dialy- sis PSVT prophylaxis (unlabeled)
PDF page 117
• Child: PO 0.3-1.3 mg/kg/day Cardiac risk reduction during sur- gery (unlabeled)
PDF page 117
• Adult: PO 50 mg, start before planned procedure, titrate to heart rate, continue 7-30 days after procedure Unstable angina (unlabeled)
PDF page 117
• Adult: PO 50-200 mg/day Ethanol withdrawal prevention (unlabeled)
PDF page 117
• Adult: PO 50-100 mg/day Migraine prophylaxis (unlabeled)
PDF page 117
• Adult: PO 50-150 mg/day, titrate to response Lithium-induced tremor (unlabeled)
PDF page 117
• Adult: PO 50 mg/day
PDF page 117