atenolol

Absorption: 50–60% absorbed after oral administration.

Distribution: Minimal penetration of CNS.

Metabolism/Excretion: 40–50% excreted unchanged by the kidneys; remainder excreted in feces as unabsorbed drug.

Half-Life: 6–9 hr.

Time/Action Profile ⬆ ⬇

(cardiovascular effects)

ROUTE	ONSET	PEAK	DURATION
PO	1 hr	2–4 hr	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Uncompensated HF;
Pulmonary edema;
Cardiogenic shock;
Bradycardia or heart block.

Use Cautiously in:

Renal impairment (dosage ↓ recommended if CCr ≤35 mL/min);
Hepatic impairment;
Pulmonary disease (including asthma; beta selectivity may be lost at higher doses);
Diabetes mellitus (may mask signs of hypoglycemia);
Thyrotoxicosis (may mask symptoms);
Patients with a history of severe allergic reactions (intensity of reactions may be ↑);
OB: Crosses the placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have sensitivity to beta blockers (initial dose recommended).

Adv. Reactions/Side Effects ⬆ ⬇

CV: BRADYCARDIA, HF, hypotension, peripheral vasoconstriction

Derm: rash

EENT: blurred vision, stuffy nose

Endo: hyperglycemia, hypoglycemia

GI: ↑liver enzymes, constipation, diarrhea, nausea, vomiting

GU: erectile dysfunction, ↓libido, urinary frequency

MS: arthralgia, back pain, joint pain

Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares

Resp: bronchospasm, PULMONARY EDEMA, wheezing

Misc: drug-induced lupus syndrome

Interactions ⬆ ⬇

Drug-drug:

General anesthesia, phenytoin, and verapamil may cause additive myocardial depression.
Additive bradycardia may occur with clonidine, digoxin, diltiazem, ivabradine, and verapamil.
Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.
Concurrent use with amphetamine, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
Concurrent thyroid administration may ↓ effectiveness.
May alter the effectiveness of insulins or oral hypoglycemic agents (dosage adjustments may be necessary).
May ↓ the effectiveness of theophylline.
May ↓ the beneficial beta₁-cardiovascular effects of dopamine or dobutamine.
Use cautiously within 14 days of MAO inhibitor therapy; may result in hypertension.

Route/Dosage ⬆ ⬇

PO (Adults ): Antianginal: 50 mg once daily; may be ↑ after 1 wk to 100 mg/day (up to 200 mg/day). Antihypertensive: 25–50 mg once daily; may be ↑ after 2 wk to 50–100 mg once daily. MI: 50 mg, then 50 mg 12 hr later, then 100 mg/day as a single dose or in 2 divided doses for 6–9 days or until hospital discharge.

Renal Impairment

PO (Adults ): CCr 15–35 mL/min: dosage should not exceed 50 mg/day; CCr <15 mL/min: dosage should not exceed 50 mg every other day.

Availability ⬆ ⬇

(Generic available)

Tablets: 25 mg; 50 mg; 100 mg
In combination with: chlorthalidone (Tenoretic). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Monitor BP, ECG, and pulse frequently during dose adjustment period and periodically throughout therapy.
Monitor intake and output ratios and daily weights. Assess routinely for HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).
Monitor frequency of prescription refills to determine adherence.
Angina: Assess frequency and characteristics of angina periodically during therapy.

Lab Test Considerations:

May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
- May cause ↑ ANA titers.
- May cause ↑ in blood glucose levels.

Toxicity and Overdose:

Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures). Notify health care professional immediately if these signs occur.

Implementation ⬆ ⬇

PO: Take apical pulse before administering drug. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take atenolol as directed at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may cause life-threatening arrhythmias, hypertension, or myocardial ischemia.
Advise patient to make sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
Teach patient and family how to check pulse and BP. Instruct them to check pulse daily and BP biweekly and to report significant changes.
May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
Advise patients to change positions slowly to minimize orthostatic hypotension.
Caution patient that atenolol may increase sensitivity to cold.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken, to avoid alcohol, and to consult health care professional before taking any new medications, especially cold preparations.
Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block sweating as a sign of hypoglycemia.
Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
Instruct patient to inform health care professional of medication regimen before treatment or surgery.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Advise patient to carry identification describing disease process and medication regimen at all times.
Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇