The study was presented as part of the Hospital training of the 5th stage, Al-Yarmouk University college/ department of Pharmacy 11th. April 2015

1. Agent Adrenergic
Receptor
Blocking
Activity
Lipid
Solubility
Protein
Bound
(%)
Half-
Life
(h)
Bioavail-
ability
(%)
Primary
(Secondary)
Route of
Elimination
Indications Usual
Dosage
Acebutolol
(Sectral®)
beta1 Low 15-25 3-4 40
7-fold1
Hepatic
(renal)
Hypertension, arrhythmias P.O.: 400-
1200 mg/d
Atenolol
(Tenormin®)
beta1 Low <5-10 6-92 50-60
4-fold1
Renal
(hepatic)
Hypertension, angina
pectoris, acute MI
P.O.: 50-200
mg/d
I.V.: 5 mg x
2 doses
Betaxolol
(Kerlone®)
beta1 Low 50-55 14-22 84-94 Hepatic
(renal)
Hypertension P.O.: 10-20
mg/d
Bisoprolol
(Zeneca®)
beta1 Low 26-33 9-12 80 Renal
(hepatic)
Hypertension, heart failure P.O.: 2.5-5
mg
Carteolol
(Cartrol®)
beta1
beta2
Low 20-30 6 80-85 Renal Hypertension P.O.: 2.5-10
mg/d
Carvedilol
(Coreg®)
beta1
beta2
alpha1
ND 98 7-10 25-35 Bile into feces Hypertension, heart failure
(mild to severe)
P.O.: 6.25
mg twice
daily
Esmolol
(Brevibloc®)
beta1 Low 55 0.15 NA
5-fold1
Red blood cell Supraventricular
tachycardia, sinus
tachycardia
I.V.
infusion: 25-
300
mcg/kg/min
Labetalol
(Normodyne®
, Trandate®)
alpha1
beta1
beta2
Moderate 50 5.5-8 18-30
10-fold1
Renal
(hepatic)
Hypertension P.O.: 200-
2400 mg/d
I.V.: 20-80
mg at 10-
min
intervals up

2. to a
maximum of
300 mg or
continuous
infusion of 2
mg/min
Metoprolol
(Lopressor®,
Toprol-XL®)
beta1 Moderate 10-12 3-7 50
10-fold1
(Toprol
XL®: 77)
Hepatic/renal Hypertension, angina
pectoris, acute MI, heart
failure (mild to moderate;
XL formulation only)
P.O.: 100-
450 mg/d
I.V.: Post-
MI 15 mg
Angina: 15
mg then 2-5
mg/hour
Arrhythmias
: 0.2 mg/kg
Nadolol
(Corgard®)
beta1
beta2
Low 25-30 20-24 30
5- to 8-
fold1
Renal Hypertension, angina
pectoris
P.O.: 40-320
mg/d
Penbutolol
(Levatol®)
beta1
beta2
High 80-98 5 100 Hepatic
(renal)
Hypertension P.O.: 20-80
mg/d
Pindolol beta1
beta2
Moderate 57 3-42 90
4-fold1
Hepatic
(renal)
Hypertension P.O.: 20-60
mg/d
Propranolol
(Inderal®,
various)
beta1
beta2
High 90 3-52 30
20-fold1
Hepatic Hypertension, angina
pectoris, arrhythmias
P.O.: 40-480
mg/d
I.V.: Reflex
tachycardia
1-10 mg
Propranolol
long-acting
beta1
beta2
High 90 9-18 20- to 30-
fold1
Hepatic Hypertrophic subaortic
stenosis, prophylaxis (post-
P.O.: 180-
240 mg/d

3. (Inderal-
LA®)
MI)
Sotalol
(Betapace®,
Betapace
AF®,
Sorine®)
beta1
beta2
Low 0 12 90-100 Renal Ventricular arrhythmias/
tachyarrhythmia
P.O. 160-
320 mg/d
Timolol
(Blocadren®)
beta1
beta2
Low to
moderate
<10 4 75
7-fold1
Hepatic
(renal)
Hypertension, prophylaxis
(post-MI)
P.O.: 20-60
mg/d
P.O.: 20
mg/d
Dosage is based on 70 kg adult with normal hepatic and renal function.
Note: All beta1-selective agents will inhibit beta2 receptors at higher doses.
1Interpatient variations in plasma levels.
2Half-life increased to 16-27 hours in creatinine clearance of 15-35 mL/minute and >27 hours in creatinine clearance <15 mL/minute.

4. # Chief
complia
nt
Past
medical
Hx.
Past
surg.
Hx.
Social Hx.
(tobacco)
(alcohol)
Lab.investigation Final
Dx.
Tx. Clinical
outcome
Blood
sugar
Blood
urea
Serum
electrolyt
es
Lipid
profile
both
TG &
cholest
erol
Serum
troponin
PCV
ESR
1 Chest
pain
-ve Penfort
al DV
+ve
(heavy
smoker),
-ve alc
normal normal normal MI Metoprol
ol 50mg
Still in
hospital
2 Chest
pain
- ve -ve -ve, -ve normal high normal
ESR
Unstable
angina
Metoprol
ol 50 mg
Still in
hospital
3 Chest
pain
Hyperte
nsion on
capoten
tab25
-ve +ve
(heavy
smoker, -
ve alc.
normal normal high +ve normal
PCV &
ESR
IHD
Acute
coronar
y synd.
Metoprol
ol 25 mg
improve
4 Chest
pain
IHD -ve +ve
(heavy
smoker, -
ve alc.
normal
+ve
low
ESR
Acute
coronar
y synd.
STEMI
Metoprol
ol 50 mg
improve
5 Chest
pain
Hyperte
nsion on
lovasc
2.5
-ve -ve, -ve
alc.
normal MI Metoprol
ol 50 mg
improve
6 Shortnes
s of
breath
Hyperte
nsion on
Inderal
Hrenio
rrhaph
y &
-ve, -ve normal Low
PCV
AF Propranol
ol 40 mg
improve

5. 40 catarac
t
7 Chest
pain
Hyperte
nsion on
amlodipi
n|+ IHD
on
isordil
-ve -ve, -ve normal normal -ve normal
PCV
Pulmon
ary
oedema
Atenolol
50 mg
Still in
hospital
8 Epigastr
ic pain
-ve -ve -ve, -ve high +ve high
ESR
antiSTE
MI
cardioge
nic
shock
Metoprol
ol 50 mg
dead
9 Chest
pain
hyperte
nsion
-ve -ve, -ve normal normal -ve Low
PCV
Unstable
angina
Metoprol
ol 50 mg
improve
10 Chest
pain
Hyperte
nsion
5years
& DM
on
insulin
-ve +ve
(heavy
smoker), -
ve
high +ve low
ESR
angina Metoprol
ol 50 mg
improve
11 epigastri
a pain
DM on
oral
hypogly
cemic
agent
-ve -ve, -ve normal normal low normal ectopic
SVT
Metoprol
ol 50 mg
improve
12 unconsci
ous
hyperte
nsion
when he
tonsil
surger
y
-ve, +ve
alc
high Na
normal K
alc.
intoxific
ation &
Atenolol
(p.m.hx)
Still in
hospital

6. was 31
year
drug
poison -
ing
13 CVA left
side for
CT of
brain
CVA left
side,
hyperte
nsion on
Tenormi
n
-ve -ve, -ve normal low Na
low K
low
PCV
Atenolol
(p.m.hx)
Still in
hospital
14 leg pain,
CRF
hyperte
nsion on
Tenormi
n, DM
on
metform
in
-ve -ve, -ve normal high Na
high K
CRF Atenolol
(p.m.hx)
Still in
hospital
15 anorexia
&
abd.pain
CRF,
hyperte
nsion
renal
transpl
antatio
n
-ve, -ve normal high low Na
normal K
anorexia Timolol
(p.m.hx)
Still in
hospital
16 vomiting DM on
glibencl
amide,
rheumat
ism,
hyperte
nsion on
Tenormi
n
-ve -ve, -ve high Atenolol
(p.m.hx)
Still in
hospital

7. 17 disturbe
d
concentr
ation
CRF &
hyperte
nsion on
furosemi
de &
Tenormi
n
nephro
ctomy,
pertoni
al
dialysis
-ve, -ve normal normal normal
Na
high K
Atenolol
(p.m.hx)
Still in
hospital
18 chest
pain
hyperte
nsion on
tenormi
n-1year
-ve -ve, -ve high normal normal
Na
low K
high normal
PCV
angina Atenolol
(p.m.hx)
Still in
hospital
19 vomiting
&
diarrhea
hyperte
nsion on
Tenormi
n
-ve -ve, -ve Atenolol
(p.m.hx)
Still in
hospital
20 right
upper
abdomin
al pain
hyperte
nsion at
2006,
psoriasis
-ve -ve, -ve normal normal gall
bladder
stone
Bisoprolol
(p.m.hx)
Still in
hospital
21 loss of
consciou
s
MI since
5years
ago
herniac
tomy
&
vascula
r surg.
-ve, -ve metoprolo
l 20 mg
improve
22 hematoe
mesis
-ve -ve, -ve low jaundice
,
enlarged
spleen
propranol
ol 40 mg
improve