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Names of beta blockers
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Carvedilol (Coreg) (nonselective)labetalol (Trandate) (nonselective) propranolol (Inderal) (nonselective)metoprolol (Lopressor, Toporol XL) (Beta-1 selective)atenolol (Tenormin) (Beta-1 selective)
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Indications for use of beta blockers.
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HTN, MI, heart failure, dysrhythmias (afib particularly), angina, glaucoma, performance anxiety and stage fright (not FDA approved)
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Actions of beta blockers.
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Blocks beta adrenergic receptors in the heart, preventing adrenaline from stimulating these receptors.Slows impulse conduction through the heart, which slows heart rate and reduces contractility, both of which lower myocardial oxygen demand.Causes a reduction in blood pressure by reducing the force of the muscle contraction.
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Side effects of beta blockers.
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Most side effects are related to the negative chronotropic effects. Slower heart rate, hypotension, fatigue, nightmares, insomnia, dry mouth and eyes, dizziness, brochospasm, wheezing, claudication, worsening erectile dysfunction. Respiratory and peripheral symptoms can be worse with nonselective beta blockers.
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Contraindications for use of beta blockers.
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Do not use in pts with second or third degree heart block, sinus brady, sick sinus syndrome if no pacer is present, Wolfe-Parkinson-White syndrom, or uncompensated CHF.
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Pt education topics with beta blockers.
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Do not discontinue abruptly (can lead to angina, MI, ventricular arrythmias).Self regulate during exercise. Beta blockers will prevent heart rate increases with activity, which can lead to fatigue and dizziness during exercise.Monitor heart rate: contact physician if less than 60.Be aware of potential for dizziness with position changes: change positions slowly. Report excessive dizziness, light headedness or any syncopal episodes.
In diabetic pts, make sure they are aware that beta blockers can prevent some of the early signs of hypoglycemia: palpitations, diaphoresis, nervousness. |
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Nursing considerations for beta blockers.
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Always check BP and pulse. Monitor for dyspnea and respiratory distress. Use with caution in pts with asthma and bronchitis, impaired renal function, and those taking digitalis and diuretics.Beta blockers can block initial signs of hypoglycemia.
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Dose of metoprolol
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25mg, 50mg, 100mg po BID
25mg, 50mg, 100 mg, 200mg extended release Qday |
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Dose of propranolol
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10-80mg, Qday-QIDavailable in a sustained release
max dose is usually 320mg |
