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Clinical Case 6
 A 70-Year-old man is seen in follow-up at your
office after he has been hospitalized for a
myocardial infarction. He underwent successful
angioplasty and is currently asymptomatic. Prior to
his MI, he was not on medications. He is not a
smoker and is not diabetic. During his
hospitalization, he was noted to have persistently
elevated blood pressure readings. He had asthma as
a child, but has not had any recent wheezing
episodes . While in the hospital, he was started on
oral metoprolol.
Questions
1. Metoprolol is selective for which adrenoceptor?
2. What effects do agents such as metoprolol have
on the cardiovascular system?
3. In which organ is metoprolol primarily
metabolized?
4. Why must beta adrenergic antagonists be used
with caution in asthmatics?
Summary
 A 70-year-old hypertensive man with a
childhood history of asthma had a recent
myocardial infarction and is prescribed
metoprolol
Adrenoceptor selectively
antagonized by metaprolol
Beta 1
Effect of beta adrenoceptor antagonists
on the cardiovascular system
 Reduction of sympathetic-stimulated increases
in heart rate, contractility and cardiac output
 Lower BP as a result of effects on heart, renin-
angiotensin system, and CNS
 Increased atrioventricular (AV) conduction
time and refractoriness.
Organ in which metoprolol is
metabolized
Liver
Reason for caution in use in
asthhmatics
 Blockade of beta 2 adrenoceptor in bronchial
smooth muscle may cause increased airway
resistance and bronchospasm

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Clinical Case 6

  • 2.  A 70-Year-old man is seen in follow-up at your office after he has been hospitalized for a myocardial infarction. He underwent successful angioplasty and is currently asymptomatic. Prior to his MI, he was not on medications. He is not a smoker and is not diabetic. During his hospitalization, he was noted to have persistently elevated blood pressure readings. He had asthma as a child, but has not had any recent wheezing episodes . While in the hospital, he was started on oral metoprolol.
  • 3. Questions 1. Metoprolol is selective for which adrenoceptor? 2. What effects do agents such as metoprolol have on the cardiovascular system? 3. In which organ is metoprolol primarily metabolized? 4. Why must beta adrenergic antagonists be used with caution in asthmatics?
  • 4. Summary  A 70-year-old hypertensive man with a childhood history of asthma had a recent myocardial infarction and is prescribed metoprolol
  • 6. Effect of beta adrenoceptor antagonists on the cardiovascular system  Reduction of sympathetic-stimulated increases in heart rate, contractility and cardiac output  Lower BP as a result of effects on heart, renin- angiotensin system, and CNS  Increased atrioventricular (AV) conduction time and refractoriness.
  • 7. Organ in which metoprolol is metabolized Liver
  • 8. Reason for caution in use in asthhmatics  Blockade of beta 2 adrenoceptor in bronchial smooth muscle may cause increased airway resistance and bronchospasm