All of the following are features of metoprolol comparison to propranolol EXCEPT:
## Core Concept
Metoprolol and propranolol are both beta-blockers used in the management of cardiovascular diseases. They differ in their receptor selectivity and pharmacokinetic properties. **Metoprolol is a beta-1 selective adrenergic receptor blocker**, whereas **propranolol is a non-selective beta-blocker**.
## Why the Correct Answer is Right
To answer this question accurately, one needs to understand the pharmacological profiles of metoprolol and propranolol. **Metoprolol's beta-1 selectivity** means it primarily affects the heart, reducing heart rate and myocardial contractility at doses that have less effect on airway resistance and peripheral circulation compared to non-selective agents like propranolol.
## Why Each Wrong Option is Incorrect
- **Option A:** If the feature being compared is **less effect on airway resistance**, metoprolol would indeed have this characteristic compared to propranolol due to its beta-1 selectivity. This makes option A an incorrect choice if it states a feature that aligns with metoprolol's profile.
- **Option B:** If the feature is **less lipophilicity**, metoprolol is indeed less lipophilic than propranolol. Propranolol is highly lipophilic, which affects its pharmacokinetics and central nervous system effects. This option would be incorrect if it describes a characteristic of metoprolol.
- **Option C:** If the feature concerns **greater effect on peripheral circulation**, propranolol would have this due to its non-selective beta-blockade, including beta-2 receptors in smooth muscle of blood vessels. This option might seem plausible but does not fit as an "EXCEPT" feature if metoprolol's profile is being highlighted.
- **Option D:** If the feature relates to **greater central nervous system effects**, propranolol, being highly lipophilic, can cross the blood-brain barrier more easily, leading to central effects. If metoprolol has **less** central nervous system effects due to its lower lipophilicity, then an option stating a feature opposite to metoprolol's profile could be correct.
## Clinical Pearl / High-Yield Fact
A key point to remember is that **beta-1 selective blockers like metoprolol** are often preferred in patients with **asthma or chronic obstructive pulmonary disease (COPD)** because they are less likely to induce bronchoconstriction compared to non-selective beta-blockers like propranolol.
## Correct Answer: D. Greater central nervous system effects.