Adrenergic-Blocking Drugs Flashcards
Atenolol
Chemical Classification
Beta-Blocker, Beta1-, Beta2-blocker (high doses)
Atenolol
Mechanism of Action
Competitively blocks stimulation of Beta-adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, negative inotropic activity decreases O2 consumption in myocardium; decreases action of renin-aldosterone-angiotensin system at high doses, inhibits Beta2 receptors in bronchial system at higher doses
Atenolol
Uses
Mild to moderate hypertension, prophylaxis of angina pectoris; suspected or known MI (IV use); MI prophylaxis
Atenolol
Contraindications
Pregnancy (D), hypersensitivity to Beta-Blockers, cardiogenic shock, 2nd- or 3rd degree heart block, sinus bradycardia, cardiac failure, Raynaud’s disease, pulmonary edema
Atenolol
Side Effects
CNS: Insomnia, Fatigue, Dizziness, Mental Changes, memory loss, hallucinations, depression, lethargy, drowsiness, strange dreams, catatonia
CV: PROFOUND HYPOTENSION, BRADYCARDIA, CHF, Cold Extremities, Postural Hypotension, 2nd or 3rd-Degree Heart Block
EENT: sore throat; dry, burning eyes; blurred vision; stuffy nose
ENDO: increased hypoglycemic response to insulin
GI: Nausea, Diarrhea, vomiting, MESENTERIC ARTERIAL THROMBOSIS, ISCHEMIC COLITIS
GU: impotence, decreased libido
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA PURPURA
INTEG: rash, fever, alopecia
RESP: BRONCHOSPASM, dyspnea, wheezing, pulmonary edema
Atenolol
Nursing Considerations
ASSESS:
- I&O, weight daily; watch for CHF (rales/crackles, jugular vein distention, weight gain, edema)
- Hypertension: BP, pulse q4hr; note rate, rhythm, quality; apical/radical pulse before administration; notify prescriber of any significant changes (<50bpm); ECG
- Baselines in renal/hepatic studies
Atenolol
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O2, diuretic for cardiac failure, hemodialysis
Esmolol
Functional Classification
Beta-Adrenergic Blocker (Antidysrhytmic II)
Esmolol
Mechanism of Action
Competitively blocks stimulation of Beta1-adrenergic receptors in the myocardium; produces negative chronotropic, inotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, decreases O2 consumption in myocardium; also decreases renin-aldosterone-angiotensin system at high doses; inhibits Beta2-receptors in bronchial system at higher doses
Esmolol
Uses
Supraventricular tachycardia, noncompensatory sinus tachycardia, hypertensive crisis, intraoperative and postoperative tachycardia and hypertension
Esmolol
Contraindications
2nd or 3rd-degree heart block; cardiogenic shock, CHF, cardiac failure, hypersensitivity, severe bradycardia
Esmolol
Side Effects
CNS: confusion, lightheadedness, paresthesia, somnolence, fever, dizziness, fatigue, headache, depression, anxiety, SEIZURES
CV: hypotension, bradycardia, chest pain, peripheral ischemia,
SOB, CHF, conduction disturbances, 1st-,2nd-,3rd-degree heart block
GI: Nausea, vomiting, anorexia, gastric pain, flatulence, constipation, heartburn, bloating
GU: urinary retention, impotence, dysuria
INTEG: Induration, Inflammation at Site, discoloration, edema, erythema, burning pallor, flushing, rash, pruritus, dry skin, alopecia
RESP: BRONCHOSPASM, dyspnea, cough, wheeziness, nasal stuffiness, PULMONARY EDEMA
Esmolol
Nursing Considerations
ASSESS:
- CHF: I&O ratio, weight daily, jugular venous distention, weight gain, crackles, edema
- DYSRHYTHMIAS: BP, pulse q4hr; note rate, rhythm, quality; rapid changes can cause shock; if systolic <60, notify prescriber before giving product; ECG continuously during inf, hypotension common
- Baselines in renal/hepatic studies, blood glucose before therapy begins
- BRONCHOSPASM: breath sounds, respiratory pattern
Esmolol
Overdose Treatment
Discontinue Product
Metoprolol (Lopressor)
Functional Classification
Antihypertensive, antianginal
Metoprolol (Lopressor)
Chemical Classification
Beta1-Blocker
Metoprolol (Lopressor)
Mechanism of Action
Lowers BP by Beta-Blocking effects; reduces elevated renin plasma levels; blocks Beta2-adrenergic receptors in bronchial vascular smooth muscle only at high doses; negative chronotropic effect
Metoprolol (Lopressor)
Uses
Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure
Metoprolol (Lopressor)
Contraindications
Hypersensitivity to beta-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome
Metoprolol (Lopressor)
Side Effects
CNS: Insomnia, Dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue
CV: Hypotension, BRADYCARDIA, CHF, Palpitations, dysrhythmias, CARDIAC ARREST, AV BLOCK, PULMONARY/PERIPHERAL EDEMA, CHEST PAIN
EENT: sore throat; dry, burning eyes
GI: Nausea, Vomiting, colitis, cramps, Diarrhea, constipation, flatulence, dry mouth, Hiccups
GU: impotence
HEMA: AGRANULOCYTOSIS, EOSINOPHILIA, THROMBOCYTOPENIA, PURPURA
INTEG: rash, purpura, alopecia, dry skin, urticaria, pruritus
RESP: BRONCHOSPASM, dyspnea, wheezing
Metoprolol (Lopressor)
Nursing Considerations
ASSESS:
- ECG directly when giving IV during initial treatment
- I&O, weight daily; check for CHF (weight gain, jugular venous distention, crackles, edema, dyspnea)
- BP during initial treatment, periodically thereafter; pulse q4hr; note rate, rhythm, quality
- Apical/radial pulse before administration; notify prescriber of any significant changes or pulse <50bpm
- Baselines of renal, hepatic studies before therapy begins
- Skin turgor, dryness of mucous membranes for hydration status
Metoprolol (Lopressor)
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor
Propranolol (Inderal)
Functional Classification
Antihypertensive, antianginal, antidysrhythmic (class II)
Propranolol (Inderal)
Chemical Classification
Beta-Adrenergic Blocker
Propranolol (Inderal)
Mechanism of Action
Nonselective Beta-Blocker with negative inotropic, chronotropic, dromotropic properties
Propranolol (Inderal)
Uses
Chronic stable angina pectoris, hypertension, supraventricular dysrhythmias, migraine prophylaxis, pheochromocytoma, cyanotic spells related to hypertrophic subaortic stenosis
Propranolol (Inderal)
Contraindication
Hypersensitivity to this product; cardiogenic shock, AV heart block; bronchospastic disease; sinus bradycardia; bronchospasm; asthma
Propranolol (Inderal)
Side Effects
CNS: depression, hallucinations, dizziness, Fatigue, lethargy, paresthesias, bizarre dreams, disorientation
CV: BRADYCARDIA, hypotension, CHF, palpitations, AV block, peripheral vascular insufficiency, vasodilation, cold extremities, PULMONARY EDEMA, DYSRHYTHMIAS
EENT: sore throat, LARYNGOSPASM, blurred vision, dry eyes
GI: nausea, vomiting, diarrhea, colitis, constipation, cramps, dry mouth, hepatomegaly, gastric pain, acute pancreatitis
GU: impotence, decreased libido, UTIs
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA
INTEG: rash, pruritus, fever
META: hyperglycemia, hypoglycemia
MISC: facial swelling, weight change, Raynaud’s phenomenon
MS: joint pain, arthralgia, muscle cramps, pain
RESP: dyspnea, respiratory dysfunction, Bronchospasm, cough
Propranolol (Inderal)
Nursing Considerations
ASSESS:
- ABRUPT WITHDRAWAL: taper over a few weeks, do not discontinue abruptly; dysrhythmias, angina, myocardial ischemia, or MI may occur, taper over 2 wk
- BP, pulse, respirations during beginning therapy; notify prescriber if pulse 5lb
- I&O ratio, CCR if kidney damage is diagnosed; fatigue, weight gain, jugular distention, dyspnea, peripheral edema, crackles
Atenolol
Functional Classification
Antihypertensive, antianginal
