Propranolol
Brand names: Inderal
Class: ❤️ Beta-Blockers
For the FNP boards, propranolol is the non-selective beta-blocker that shows up far outside cardiology questions. It blocks beta-1 and beta-2 receptors and is used for hypertension and angina but more commonly on boards for migraine prophylaxis, essential tremor, thyrotoxicosis and thyroid storm (rapid symptom control), performance anxiety, and portal hypertension/variceal bleed prophylaxis (along with nadolol). The non-selectivity makes it dangerous in asthma — bronchospasm — and a poor choice in COPD, where cardioselective metoprolol is safer. Propranolol crosses the blood-brain barrier and can cause vivid dreams and depression. Combine cautiously with insulin in diabetes: it masks adrenergic hypoglycemia warnings.
✅ Indications
HTN, angina, migraine prophylaxis, essential tremor, thyrotoxicosis/thyroid storm, performance anxiety.
⚙️ Mechanism of Action
Non-selective β-blocker.
📏 Dosing
Migraine prophylaxis: 40–160 mg/day divided. Tremor: 40–80 mg/day.
🚫 Contraindications
Asthma, decompensated HF, severe bradycardia, 2nd/3rd degree AV block.
⚠️ Adverse Effects
Bronchospasm, bradycardia, hypoglycemia masking, nightmares/depression.
🔬 Monitoring
HR, BP.
💎 Board Pearls
- 🤝 ONLY beta-blocker FDA-approved for migraine prophylaxis + essential tremor.
- 🔥 Thyroid storm: propranolol also blocks peripheral T4→T3 conversion at high doses.
Related Drugs in This Class
- Metoprolol — Lopressor (tartrate), Toprol-XL (succinate)
- Carvedilol — Coreg
- Labetalol — Trandate, Normodyne
Sources
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