General Principals (Class) Beta adrenergic blocking agents prevent stimulation of the beta adrenergic receptors at the nerve endings of the sympathetic nervous system and therefore decrease the activity of the heart. They block sympathetic stimulation of the heart and reduce systolic pressure, heart rate, cardiac contractility and output, so decrease myocardial oxygen demand and increase exercise tolerance (agents, 2013) Indications Adrenergic blocking agents are used to treat angina, control abnormal heart rhythms and to reduce high blood pressure (agents, 2013).
They are also used to treat a variety of other conditions including benign prostatic hyperplasia and Reynaud’s disease (Blockers, 2013). Cautions Adrenergic blocking drugs are typically not used on people with asthma because they may trigger severe asthma attacks. Also with people who have diabetes, adrenergic blocking drugs may block signs of low blood sugar, such as rapid heartbeat (Blockers, 2013). Mechanism of Action •TO INTERRUPT THE STIMULATION OF THE SNS AT THE ALPHA 1- ADRENERGIC RECEPTORS.
•ALPHA BLOCKERS WORK TO BIND AND ANTAGONIZE RECEPTORS BY BLOCKING NOREPINEPHRINE making it non responsive called a competitive blockade. [Type text]
•A COVALENT BOND MAKES RECEPTORS LESS RESPONSIVE BUT RESPONSIVE IN A SMALL AMOUNT to norepinephrine called a noncompetitive blockade. Adverse Effects •SUDDEN DROP IN BLOOD PRESSURE AFTER THE FIRST DOSE CALLED THE FIRST-DOSE phenomenon, causing the patient to pass out.
•CARDIOVASCULAR PALPITATIONS, TACHYCARDIA, EDEMA AND ANGINA. •NAUSEA AND VOMITING, DIARRHEA, CONSTIPATION, DRY MOUTH AND ABDOMINAL Toxic Effects •IN THE CASE OF AN OVERDOSE, ACTIVATED CHARCOAL IS THE STANDARD CHOICE OF MED because after administered it binds to the drug and is removes it from the stomach and the circulation.
•SUPPORTIVE MEASURES INCLUDE VITALS, FLUIDS, AND ANTICONVULSANTS SUCH AS DIAZEPAM for the control of seizures. Route of Administration Alpha1 Blockers •MOSTLY ADMINISTERED ORALLY(PO) •EXCEPT FOR PHENTOLAMINE, ADMINISTRATION ROUTES ARE INTRAVENOUS(IV), intramuscular(IM), and subcutaneously(subcut)
•PHENTOLAMINE CAN BE USED FOR EXTRAVASATION OF VASOCONSTRICTING DRUGS(E. G. , norepinephrine, epinephrine, and dopamine) subcutaneously(subcut) in a circular fashion around the extravasation site to increase blood flow to the ischemic tissue and thus prevent permanent damage.
Beta Blockers Nonselective •MOSTLY ADMINISTERED PO
[Type text] •LABETALOL(NORMODYNE, TRANDATE) AND PROPRANOLOL(INDERAL) ARE administered PO and IV •TIMOLOL PO, IV, AND OPHTHALMIC FOR GLAUCOMA (SKIDMORE-ROTH, 2013) Cardioselective •MOSTLY ADMINISTERED PO •METOPROLOL (LOPRESSOR, TOPROL-XL), PO AND IV •ESMOLOL (BREVBLOC) IV ONLY (LILLY LANE, RAINFORTH COLLINS, & Snyder, 2014)
Common Drug Interactions Antacids (aluminum hydroxide type) ?Decrease absorption resulting in decreased beta blocker activity Antimuscarinics and Anticholinergics ?
Antagonism resulting in reduction of beta blocker effects Digoxin ?Additive effect, enhancing bradycardic effects of digoxin Diuretics, cardiovascular drugs, alcohol ?Additive effect resulting with additive hypotensive effects Neuromuscular blocking drugs ?Additive effect by prolonging neuromuscular blockade Oral hypoglycemic drugs and Insulin ?
Mask signs of hypoglycemia and delay recovery from hypoglycemia (Lilly Lane, Rainforth Collins, & Snyder, 2014) Nursing implications for patients taking Adrenergic Blocking Drugs include: •PATIENT TEACHING (LILLY, COLLINS, SYNDER, 2014, PG 319-322) oWear a medical alert bracelet or necklace oCarrying around a list of medications and specific diagnosis around with them at all times oTake medication exactly as prescribed and never to stop the medication abruptly oAvoid caffeine and other CNS stimulants oAvoid consuming any alcohol oContact your doctor immediately if and when you experience any of the following:
Palpitations, chest pain, confusion, weight gain of 2 lbs in 24 hours or 5lbs in a week, dyspnea, nausea or vomiting. [Type text] oOn your next appointment with the doctor let them know if you have experience any of the following: Swelling in feet and ankles, shortness of breath, fatigue, dizziness, and syncope. oCaution while driving or engaging in activities and for the elderly:
These drugs can cause drowsiness, blurred vision, and dizziness oWhen changing positions, do it slowly, again these drugs can cause dizziness oAvoid hot weather, hot tubs, saunas, and tanning beds, hot hot baths and showers oAvoid excessive exercises oIncrease fluids and fiber consumptions, these medications can cause constipation oKeep a daily journal with your vital signs, feeling and wellness, any adverse effects Nursing Responsibilities include:
•ASSESSMENT (LILLY, COLLINS, SYNDER, 2014, PG 319-322) oPatient’s allergies such as food and medications oPast and present medical conditions: especially cardiac and pulmonary:
such as hyper and hypo tension, Bradycardia, emphysema, asthma, bronchitis, congestive heart failure oPast and present medications oBaseline vitals: oLung and Heart sounds and rhythms oBlood glucose levels oIntake and outtake oDaily weights •IMPLEMENTATION: (LILLY, COLLINS, SYNDER, 2014, PG 319-322) oIf experiencing dry mouth: give the patient water, oral care, sugarless candies and gum, mouth swabs oIf this drug is given IV:
Monitor ECG and heart [Type text] oObtain an apical pulse for one minute. If less than 60 beats a minute contact the doctor oObtain a standing and supine blood pressure: if systolic blood pressure is less than 100 mm Hg contact the doctor oReport the doctor if patient gains 2 lbs overnight or 5 lbs in one week oMonitor patient for swelling in the lower extremities, and any other adverse reactions oWean the patients off this drug in 1 to 2 weeks •ADVERSE EFFECTS: (PANCHMATIA, 2010, PG 227-233)
oBradycardia oHeart failure and heart attack oHypoglycemia oGastrointestinal disturbances oBronchospasms oArrhythmias oMigraines oAnxiety oFatigue oSleep disturbances oColdness of the extremities •THERAPEUTIC EFFECTS (LILLY, COLLINS, SYNDER, 2014, PG 319-322)
oWant the patient to be in normal range with their blood pressure at all times while taking this drug oWant the pulse to be in the normal range of 60-100 beats a minute oWant the patient to be free from injuries including any adverse reactions oWant the patient to follow the prescribe medication as follows to maintain safety and a therapeutic effect to help with the issue that they are having Common Adrenergic blocking drugs and their uses:
(Target Pharmacy on 29th and Maize road for the images of the pills made onto our poster board, and the most common drugs that they fill at their pharmacy) oAtenolol (Tenormin) (Cardioselective) oMetoprolol (Lopressor) (Cardioselective).
oPropranolol (Inderal) (Beta blockers, nonselective) oPhentolamine (Regitine) (Alpha blockers) oCarvedilol (Coreg, Coreg CR) [Type text] Adrenergic blocking drugs uses other than cardiac: (Panchmatia, 2010, Pg. 227-233) oMyocardial infarction: reduce mortality and prevent recurrence. Can be given within 6 hours of a heart attack. oAnxiety oGlaucoma oTremors oOpioid and alcohol withdrawal symptoms oMigraines [Type text] REFERENCES Agents, B. -a. b. (2013, October 7). drugs. com.
Retrieved November 1, 2013 Blockers, A. (2013, December 16). Mayo Clinic. Retrieved November 1, 2013 Collins, S. , Lilly, L. , Snyder, J.(2014), p. 313-314. Pharmacology and the Nursing Process. http://ehis. ebscohost. com. proxy. itt-tech. edu/eds/pdfviewer/pdfviewer? sid=la4ac5b7- 1178-44f2-b3b4-253e723609ee%40sessionmgr110&vid=3&hid=107 Lilly Lane, L. , Rainforth Collins, S. , & Snyder, J. (2014). Pharmacology and the Nursing Process. St Louis, Missouri: Elsevier Mosby. Lilley, L. L. , Collins, S. R. , Snyder, J. S. , (2014).
‘Adrenergic-Blocking Drugs In: (ed), Pharmacology and The Nursing Process . 7th ed. St. Louis: Elsevier Mosby . pp. 312-323. Panchmatia, S. (2010). Prescribing beta-adrenoceptor blocking drugs. Nurse Prescribing, 8(5), 227-233.