Atenolol

(ah - T E N -o h -l o hl )

CLASSIFICATION(S): Beta-adrenergic blocking agent PREGNANCY CATEGORY: C Rx: Tenormin. WRx: Apo-Atenol, Gen-Atenolol, Novo-Atenol, Nu-Atenol, PMS-Atenolol, Rhoxal-atenolol, ratio-Atenolol.
SEE ALSO BETA-ADRENERGIC BLOCKING AGENTS.

USES (1) Hypertension (either alone or with other antihypertensives such as thiazide diuretics). (2) Long-term treatment of angina pectoris due to coronary atherosclerosis. (3) Acute MI. Investigational: Prophylaxis of migraine, alcohol withdrawal syndrome, situational anxiety, ventricular arrhythmias, prophylactically to reduce incidence of supraventricular arrhythmias in coronary artery bypass graft surgery. ACTION/KINETICS Action Combines reversibly with beta-adrenergic receptors to block the response to sympathetic nerve impulses, circulating catecholamines, or adrenergic drugs. Predominantly beta-1 blocking activity. Has no membrane stabilizing activity or intrinsic sympathomimetic activity. Pharmacokinetics Low lipid solubility. Peak blood levels: 1 24 hr. t /2: 69 hr. 50% eliminated unchanged in the feces. Geriatric clients have a higher plasma level than younger clients and a total clearance value of about 50% less. SPECIAL CONCERNS Dosage not established in children. SIDE EFFECTS Most Common Dizziness, fatigue, nausea, bradycardia, hypotension, vertigo. See Beta-Adrenergic Blocking Agents for a complete list of possible side effects. HOW SUPPLIED Tablets: 25 mg, 50 mg, 100 mg.

DOSAGE TABLETS Hypertension. Initial: 50 mg/day, either alone or with diuretics; if response is inadequate, 100 mg/day. Doses higher than 100 mg/day will not produce further beneficial effects. Maximum effects usually seen within 12 weeks. Angina. Initial: 50 mg/day; if maximum response is not seen in 1 week, increase dose to 100 mg/day (some clients require 200 mg/day). Alcohol withdrawal syndrome. 50100 mg/day. Prophylaxis of migraine. 50100 mg/day. Ventricular arrhythmias. 50100 mg/day. Prior to coronary artery bypass graft surgery. 50 mg/day started 72 hr prior to surgery. NOTE: Adjust dosage in cases of renal failure to 50 mg/day if CCR is 1535 mL/min/1.73 m2 and to 50 mg every other day if CCR is less than 15 mL/min/1.73 m2.

NURSING CONSIDERATIONS
E Do not confuse atenolol with albuterol (sympathomimetic) or with timolol (beta-blocker). Do not confuse Tenormin with Tenoretic (atenolol plus chlorthalidone). ADMINISTRATION/STORAGE With hemodialysis, give 25 or 50 mg in the hospital after each dialysis. Give under supervision; significant decreases in BP may occur. ASSESSMENT 1. Identify reasons for therapy, type, onset of symptoms. 2. Note history of diabetes, pulmonary disease, or cardiac failure. 3. List drugs prescribed; ensure none interact. 4. Assess VS, EKG, and lung sounds. CLIENT/FAMILY TEACHING 1. Take at same time each day. May take with food if GI upset occurs. 2. May mask symptoms of low blood sugar in those with diabetes. Monitor
IV = Intravenous

C = see color insert

H = Herbal

E = sound alike drug

ATENOLOL
6. Sensitivity to cold may occur due to reduced blood flow to feet and hands. This may cause them to feel cold and make you more sensitive to the cold. Dress warmly in cold weather and use care when are out in the cold for long periods of time. 7. With initiation of therapy or change in dosage stress importance of F/U for evaluation of drug response. Keep log of HR and BP at different times during the day for provider review. 8. Practice reliable contraception and report if pregnancy suspected. OUTCOMES/EVALUATE BP; HR Frequency of anginal attacks Prevention of repeat infarction

FS closely; may need to alter insulin dose while taking drug. 3. A beta blocker drug lowers BP and heart rate, controls angina, and may decrease mortality from recurrent MI. Do not stop suddenly; sharp chest pain, irregular heartbeat, and sometimes heart attack may occur. 4. Report any difficulty breathing; swelling of extremities; irregular heart beat, altered mood, or depression. 5. Use caution while driving or performing tasks requiring mental alertness; may cause drowsiness. May cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase effects. Avoid sudden position changes to prevent sudden drop in BP.

Bold Italic = life threatening side effect

= black box warning

W = Available in Canada