아테놀롤

베타-아드레날린 차단제

아테놀롤은 주로 소동물의 전신 고혈압 및 빈맥성 부정맥 관리에 사용되는 심장 선택성 베타 차단제입니다. 폐부종을 동반하지 않은 비대성 심근병증(HCM) 고양이에서 동적 유출로 폐쇄를 줄이고 이완기 충만을 개선하기 위해 자주 사용됩니다. **주요 특징:** * **심장 선택성:** 일반적인 용량에서 베타-2 활성이 최소화되어 프로프라놀롤과 같은 비선택적 베타 차단제보다 천식이나 기관지 경련 환자에게 비교적 안전하게 사용할 수 있습니다. * **음성 변력 작용:** 울혈성 심부전(CHF), 신부전 또는 동기능 부전 증후군 환자에게는 극도로 주의하여 사용해야 합니다. * **대사적 영향:** 고용량은 갑상선 기능 항진증이나 저혈당증의 임상 증상을 은폐할 수 있습니다. 또한 고혈당 또는 저혈당을 유발할 수 있으므로 혈당 변화가 심한 당뇨병 환자에게는 주의가 필요합니다. **임상 요점:** 프로프라놀롤과 달리 아테놀롤은 친수성이 매우 높습니다. 지용성이 낮아 혈액뇌장벽을 거의 통과하지 않으므로 중추신경계(CNS) 부작용(무기력 또는 우울증 등)이 현저히 적습니다. 주로 신장을 통해 변하지 않은 상태로 배설되므로 심각한 신기능 장애가 있는 환자의 경우 용량 조절이 필요할 수 있습니다.

작용 기전: Atenolol acts as a competitive, relatively specific antagonist at **β1-adrenergic receptors** located primarily in the myocardium. * **Pathway:** Blockade of β1-receptors → decreased intracellular cAMP → reduced intracellular calcium influx. * **Cardiovascular Effects:** This leads to negative chronotropic (decreased sinus heart rate) and negative inotropic (decreased contractility) effects. It slows AV conduction, diminishes cardiac output at rest and during exercise, and significantly decreases myocardial oxygen demand. * **Blood Pressure:** Reduces systemic blood pressure through decreased cardiac output and potentially decreased renin release from the kidneys. * **Selectivity Loss:** At higher dosages, β1 specificity may be lost, leading to **β2-receptor** blockade (which can cause bronchoconstriction and peripheral vasoconstriction). * Atenolol lacks intrinsic sympathomimetic activity (ISA) and membrane-stabilizing activity.

동물 종별 용량

Cats

Treatment of hypertension or cardiac conditions (e.g., hypertrophic cardiomyopathy) · 3 mg/kg PO q12h (or 6.25 -12.5 mg total dose) PO q12h · PO · q12h
Treatment of hypertension or cardiac conditions · 6.25-12.5 mg (total dose per cat) q12h · PO · q12h
Treatment of choice for hyperthyroid, hypertensive cats · 6.25-12.5 mg (total dose) PO q12-24h · PO · q12-24h · Beta-blockers are rarely sufficient alone to treat hypertension due to other causes.

Ferrets

Hypertrophic cardiomyopathy · 6.25 mg (total dose) PO once daily · PO · q24h
Hypertrophic cardiomyopathy · 3.13-6.25 mg (total dose) PO once daily · PO · q24h

Dogs

Cardiac arrhythmias, obstructive heart disease, hypertension, myocardial infarction, etc. · 0.3-0.6 mg/kg PO q12h · PO · q12h · For refractory VTach combine with mexiletine (5-8 mg/kg PO q8h)
Moderate to severe sub-valvular aortic stenosis (SAS) · 0.5-1 mg/kg PO twice a day · PO · q12h
To attempt to decrease syncopal episodes associated with pulmonic stenosis · 0.25-1 mg/kg PO twice a day · PO · q12h
Hypertension · 0.25-1 mg/kg PO q12h · PO · q12h

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Overt heart failure
Hypersensitivity to beta-blockers
Greater than first-degree heart block
Sinus bradycardia
Cats with hypertrophic cardiomyopathy with accompanying pulmonary edema

이상반응

Lethargy
Hypotension
Diarrhea
Bradycardia
Inappetence
Depression
Impaired AV conduction
Worsening of heart failure
Hypoglycemia
Syncope
Bronchoconstriction (rare at normal doses)

약물 상호작용

Anesthetics (myocardial depressants) · Additive myocardial depression may occur with concurrent use.
Calcium-Channel Blockers (e.g., diltiazem, verapamil, amlodipine) · Concurrent use should be done with caution due to additive negative inotropic effects, particularly in patients with preexisting cardiomyopathy or CHF.
Clonidine · Atenolol may exacerbate rebound hypertension after stopping clonidine therapy.
Furosemide, Hydralazine, or other hypotensive drugs · May increase the hypotensive effects of atenolol.
Phenothiazines · Concurrent use may exhibit enhanced hypotensive effects.
Reserpine · Potential for additive effects including hypotension and bradycardia.
Sympathomimetics (e.g., metaproterenol, terbutaline, epinephrine, phenylpropanolamine) · May have their actions blocked by atenolol, and they may in turn reduce the efficacy of atenolol.

모니터링

Cardiac function
Pulse rate
ECG (if necessary)
Blood pressure (if indicated)
Signs of toxicity (lethargy, hypotension, bradycardia)

과용량

Common clinical signs of overdose include lethargy and vomiting. Severe overdose represents extensions of the drug's pharmacologic effects: **hypotension, bradycardia, bronchospasm, cardiac failure, hypoglycemia, and hyperkalemia**. **Treatment:** * If recent oral ingestion: consider emptying the gut and administering activated charcoal. * **Monitor:** ECG, blood glucose, potassium, and blood pressure. * **Cardiovascular support:** Symptomatic treatment. Use fluids and pressor agents (dopamine or norepinephrine) for hypotension. * **Bradycardia:** Treat with atropine. If atropine fails, isoproterenol given cautiously is recommended. * **Metabolic:** Insulin and dextrose may be needed for hyperkalemia and hypoglycemia. * **Advanced support:** A transvenous pacemaker may be necessary. Cardiac failure can be treated with a digitalis glycoside, diuretics, and oxygen. * **Antidote:** Glucagon (5-10 mg IV; human dose) may increase heart rate and blood pressure and reduce the cardiodepressant effects of atenolol.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.