Sympatholytics

Question 1

• lol

Answer 1

• PO & IV

Medication:

• Propranolol
• Metoprolol
• Atenolol
• Carvedilol
• Labetalol
• Category Class: Beta-blocker (sleepy chicken)

MOA:

• Decreased HR (negative chronotrope) –> dec O2 demand
• Decreased excitability (negative dromotrope) –> dec dysrhythmia
• Decrease BP (preload & afterload) –> dec workload & O2 demand

Indication:
- Angina/MI, dysrhythmia, HTN, HF

Off Label Use:
- Glaucoma, migraine

Contraindication:

• Bradycardia, hypotension
• Call provider & hold for HR <60 or SBP <90
• Asthma, COPD

Side effects, Adverse reactions:

• Even selective beta-blockers may become nonselective at high dose (blocking beta 2 & bronchospasm)
• Monitor breath sounds (for worsening or new wheezing)
• Bradycardia, hypotension, dysrhythmia (FALL)
• Monitor trend of HR, BP, cardiac rhythm
• Postural hypotension and FALL (lie down if feeling dizzy, avoid sudden changes of position)
• Impotence, decreased libido (build rapport and discuss factors that may affect adherence)

Nursing Interventions (monitoring):
- Masks hypoglycemia symptoms (palpitation)- monitor DM patients BG for asymptomatic hypoglycemia

Patient Education:

• Avoid stopping abruptly, wean off over 1-2 weeks
• At home keep a log HR/BP and associated s/s

Question 2

Methyldopa & Clonidine

Answer 2

• Methyldopa, Clonidine
• Category Class: Alpha-2 Agonist (sleepy chicken)

Mechanism of Action:
- Decrease sympathetic stimulation
- Decrease HR & CO, vasodilated (decrease peripheral
resistance)

Indication:
- Hypertension

Off Label Use:
- Clonidine: CA pain, ADHD, opioid withdrawal,
migraine, menopause flushing
- Eye drops for glaucoma: brimonidine, apraclonidine

Contraindication:

• Pregnancy
• Lactation

Side effects, Adverse reactions:

• Na/water retention (use with diuretics & monitor daily weight & edema)
• Bradycardia
• Orthostatic hypotension, dizziness, FALL
• Impotence, decreased libido

“Clowns Can’t Always Make Oscar Mad”

Question 3

Hypertension Categories

Answer 3

• Normal BP: <120/80
• Elevated BP: SBP between 120-129 & DBP < 80
• HTN Stage 1: SBP between 130-139 or DBP between 80-89
• HTN Stage 2: SBP >/= 140 or DBP >/= 90
• HTN Urgency: 180/120 without S/S of end-organ damage
• HTN Emergency: HTN with S/S of end-organ damage