Cardiovascular Medications in Pregnancy
Afshan B. Hameed, Diana S. Wolfe in Cardio-Obstetrics, 2020
Beta blockers are an additional option for BP control. Although literature notes that fetal exposure to beta blockers may be associated with low birthweight, labetalol is a pregnancy class-C alpha- and beta-adrenergic antagonist that has traditionally been a first-line agent against hypertensive disorders in pregnancy. Labetalol has been shown to effectively reduce maternal BP and decrease both maternal and fetal morbidity and mortality in mild to moderate hypertension [18]. Metoprolol succinate is a beta-selective adrenergic antagonist in pregnancy class C. An open controlled trial for its use in moderate hypertension in pregnancy showed significantly better BP control than placebo without increases in preterm labor or maternal and fetal complications [19]. Carvedilol is dependent on renal elimination, which can lead to greater amounts of drug excretion and thus higher doses during pregnancy given increases in GFR. Atenolol is a pregnancy class-D beta-adrenergic antagonist, which should be avoided in pregnancy, especially in the first trimester [20,21].
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Anton C. de Groot in Monographs in Contact Allergy, 2021
Metoprolol is a cardioselective competitive β1-adrenergic receptor antagonist with antihypertensive properties. This agent antagonizes β1-adrenergic receptors in the myocardium, thereby reducing the rate and force of myocardial contraction, leading to a reduction in cardiac output. Metoprolol is indicated for the treatment of angina, heart failure, myocardial infarction, atrial fibrillation, atrial flutter and hypertension. Off-label uses of metoprolol include supraventricular tachycardia and thyroid storm. In pharmaceutical products, metoprolol is most often employed as metoprolol succinate (CAS number 98418-47-4, EC number not available, molecular formula C34H56N2O10) or as metoprolol tartrate (CAS number 56392-17-7, EC number 260-148-9, molecular formula C34H56N2O12) (1).
Acute pain management in the emergency department
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
Beta-blockers may have a place in selected patients who do not achieve control of chest pain with the above agents. The rationale for their use is that they reduce myocardial oxygen demand by reducing heart rate and contractility. The reduction in heart rate also results in a greater proportion of diastole in the cardiac cycle, thus theoretically allowing more coronary perfusion time. Cohort studies of esmolol and metoprolol infusions have reported reduction in pain intensity and frequency.80[II], 81[III], 82[IV] When compared to titrated i.v. morphine, both treatments resulted in significant reductions in pain, but morphine was effective faster.80[II] Indicative doses of esmolol are 2–24 mg/minute titrated to reduce the heart rate and systolic blood pressure product by 20–25 percent. Indicative doses of metoprolol are 2.5–5 mg every five to ten minutes as intermittent boluses or 3 mg/minute as an infusion titrated to heart rate, blood pressure, and effect. Beta-blockage is contraindicated in patients with bradycardia, advanced atrioventricular block, hypotension, significant pulmonary congestion, or severe chronic obstructive airways disease.
A case of immunotactoid glomerulopathy in a patient with monoclonal gammopathy of renal significance
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Victoria Campdesuner, Yeshanew Teklie, Natalia Lattanzio, Christian Lorenzo, Stephen Bell, Yorlenis Rodriguez, Ashok Sastry
Three months later, he complained of worsening fatigue and had undergone a cardiac catheterization with his cardiologist, which revealed no significant obstructive coronary artery disease. This led to a diagnosis of nonischemic cardiomyopathy with a depressed left ventricular function with an ejection fraction (EF) of 35–40%. Metoprolol succinate 25 mg daily and isosorbide dinitrate 30 mg daily were initiated. Physical exam was notable for stable, pitting edema of the lower extremities and diminished breath sounds in the right lower lung. Creatinine rose to 2.37 mg/dL with a protein/creatinine ratio of 10039.0 mg/G. Urinalysis revealed proteinuria, hematuria, and trace amounts of leukocyte esterase. Microscopic evaluation of the urine showed 1–3 hyaline casts, 75–100 red blood cells, and >100 white blood cells. Blood pressure remained stable at 132/84 mm Hg. Subsequent serum immunofixation revealed a monoclonal immunoglobulin G (IgG) lambda protein measuring 0.71 g/dL. Urine immunofixation electrophoresis confirmed the presence of a monoclonal IgG lambda protein measuring 18.7 mg/dL. The patient was scheduled for computed tomography (CT)-guided left kidney biopsy. Pathology revealed immunotactoid glomerulonephritis with IgG1-lambda deposits.
Current pharmacotherapeutic strategies for cardiac arrhythmias in heart failure
Published in Expert Opinion on Pharmacotherapy, 2020
Ashish Correa, Yogita Rochlani, Wilbert S. Aronow
For AF with a rapid ventricular response, initial intravenous therapy may be used, but ultimately patients should be bridged to oral beta-blocker therapy (see Table 1 for details regarding the route of administration and dosing). Metoprolol and esmolol are usually used as intravenous agents for ventricular rate control. Intravenous metoprolol may be given as 2.5 to 5 mg bolus over 2 min, with the dose repeated every 5 min until adequate rate control is achieved, but to a maximum of 15 mg. After this point, the therapy should be switched to an oral regimen. Esmolol is often used as a trial of beta-blocker therapy, especially in patients in whom there is concern regarding starting beta-blockers. This is because esmolol as a very rapid onset of action, and due to its rapid metabolism in the blood, it has a short duration of action [33]; thus, when an esmolol infusion is discontinued, its effects are short-lasting. For acute rate control, esmolol may be given as an intravenous bolus, followed by an infusion until oral medications can be started (see Table 1 for details).
Metoprolol in the treatment of cardiovascular disease: a critical reappraisal
Published in Current Medical Research and Opinion, 2018
A bulk of clinical experience on the use of metoprolol has been gathered throughout the years. Metoprolol succinate has indications for hypertension, angina pectoris, symptomatic mild-to-severe chronic heart failure as an adjunct to other heart failure therapy, disturbances of cardiac rhythm, including, in particular, supraventricular tachycardia, maintenance treatment after myocardial infarction, functional heart disorders with palpitations, and migraine prophylaxis1.
Related Knowledge Centers
- Angina
- Beta Blocker
- Cyp2D6
- Fatigue
- Myocardial Infarction
- Syncope
- Tachycardia
- Hypertension
- Migraine
- Oral Administration