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Pregnancy Category: B
Pharmacologic: beta blockers
Pharmacologic: beta blockers
Management of hypertension.Management of angina pectoris.
Blocks stimulation of beta1 (myocardial) and beta2 (pulmonary, vascular, and uterine) -adrenergic receptor sites.
Has intrinsic sympathomimetic activity (ISA), which may produce less bradycardia.
Decreased heart rate and BP.
Absorption: Well absorbed following oral administration.
Distribution: Moderate CNS penetration. Crosses the placenta; enters breast milk.
Metabolism and Excretion: Partially metabolized by the liver; 50% excreted unchanged by the kidneys.
Half-life: 3–4 hr.
Time/action profile (cardiovascular effects)
|PO||7 days||2 wk||8–24 hr|
Contraindicated in: Uncompensated HF; Pulmonary edema; Cardiogenic shock; Bradycardia or heart block.
Use Cautiously in: Renal impairment; Hepatic impairment; Geriatric: May have ↑ sensitivity to beta blockers; initial dose reduction recommended); Pulmonary disease (including asthma); Diabetes mellitus (may mask signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); Patients with a history of severe allergic reactions (intensity of reactions may be increased); Obstetric / Lactation / Pediatric: Safety not established; may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression.
Adverse Reactions/Side Effects
Central nervous system
- fatigue (most frequent)
- weakness (most frequent)
- memory loss
- mental status changes
Ear, Eye, Nose, Throat
- blurred vision
- dry eyes
- nasal stuffiness
- arrhythmias (life-threatening)
- bradycardia (life-threatening)
- HF (life-threatening)
- pulmonary edema (life-threatening)
- orthostatic hypotension
- peripheral vasoconstriction
- erectile dysfunction (most frequent)
- ↓ libido
- back pain
- muscle cramps
- drug-induced lupus syndrome
Drug-Drug interactionGeneral anesthesia, IV phenytoin, and verapamil may cause additive myocardial depression.Additive bradycardia may occur with digoxin.Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).Concurrent thyroid preparations administration may ↓ effectiveness.May alter the effectiveness of insulin or oral hypoglycemic agents (dosage adjustments may be necessary).May ↓ the effectiveness of beta-adrenergic bronchodilators and theophylline.May ↓ the beneficial beta cardiovascular effects of dopamine ordobutamine.Use cautiously within 14 days of MAO inhibitors (may result in hypertension).Concurrent NSAIDs may ↓ antihypertensive action.
Oral (Adults) 5 mg twice daily initially; may be ↑ by 10 mg/day q 2–3 wk as needed (up to 45–60 mg/day).
Availability (generic available)
Tablets: 5 mg, 10 mg, 15 mg
- Monitor BP and pulse frequently during dose adjustment and periodically throughout therapy. Assess for orthostatic hypotension when assisting patient up from supine position.
- Monitor intake and output ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention).
- Angina: Assess frequency and characteristics of anginal attacks periodically throughout therapy.
- Lab Test Considerations: May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
- May cause ↑ ANA titers.
- May cause↑ blood glucose levels.
Potential Nursing DiagnosesDecreased cardiac output (Side Effects)
Noncompliance (Patient/Family Teaching)
- Oral: Take apical pulse prior to administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.
- May be administered with food or on an empty stomach.
- Instruct patient to take medication as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed dose as soon as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.
- Advise patient to make sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
- Teach patient and family how to check pulse and BP. Instruct them to check pulse daily and BP biweekly. Advise patient to hold dose and contact health care professional if pulse is <50 bpm or BP changes significantly.
- May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
- Advise patients to change positions slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased.
- Caution patient that this medication may increase sensitivity to cold.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially cough, cold, or allergy remedies.
- Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication may mask tachycardia and increased BP as signs of hypoglycemia, but dizziness and sweating may still occur.
- Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding or bruising occurs.
- Instruct patient to inform health care professional of medication regimen prior to treatment or surgery.
- Advise patient to carry identification describing disease process and medication regimen at all times.
- Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.
- Angina: Caution patient to avoid overexertion with decrease in chest pain.
- Decrease in BP.
- Reduction in frequency of anginal attacks.
- Increase in activity tolerance.