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Pharmacology · patient case question

Propranolol differs from atenolol in that it:

Patient case: Antihypertensive Review & Gingival Enlargement

demo: 60-year-old male

chief: “My gums have been growing over my front teeth.”

history: Hypertension, benign prostatic hyperplasia, angina.

meds: Nifedipine, prazosin, terazosin, atenolol

findings: Generalized fibrotic enlargement of the interdental papillae, most marked in the anterior maxilla. Plaque index moderate. No bone loss on bitewings.

  1. Blocks calcium channels in vascular smooth muscle
  2. Acts as a partial agonist at beta-1 receptors only
  3. Blocks both beta-1 and beta-2 receptors, allowing unopposed alpha-mediated peripheral vasoconstriction
  4. Is a selective beta-1 antagonist with no pulmonary effect
Show answer and explanation

Correct answer: C. Blocks both beta-1 and beta-2 receptors, allowing unopposed alpha-mediated peripheral vasoconstriction

  • A. Calcium channel blockade is verapamil, diltiazem, and the dihydropyridines.
  • B. Partial agonism describes agents with intrinsic sympathomimetic activity such as pindolol, not propranolol.
  • C. Correct. Propranolol is non-selective. Because beta-2 mediated vasodilation is blocked, epinephrine in local anesthetic can produce unopposed alpha vasoconstriction with a hypertensive response and reflex bradycardia. It also inhibits renin release.
  • D. That describes atenolol and metoprolol.

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