Adrenergic antagonists

Adrenergic antagonists are also referred to as sympatholytics because they lyse, or block, the
effects of the sympathetic nervous system. They react with specific adrenergic receptor sites
without activating them, thus preventing the typical manifestations of SNS activation.
These drugs occupy the adrenergic receptor site so released norepinephrine can be prevented
from activating the receptor.
Adrenergic antagonists have varying degrees of specificity and are therefore classified into five:
nonselective adrenergic antagonists, nonselective alpha- and beta- adrenergic antagonists, and
selective alpha1– and beta-adrenergic antagonists.
Andrenergic Antagonists: Generic and Brand Names
Andrenergic Antagonists: Generic and Brand Names
Here is a table of commonly encountered adrenergic antagonists, their generic names, and brand
names:

Classification Generic Name Brand Name

amiodarone Cordarone
Nonselective Adrenergic
carvedilol Coreg
Blocking Agents
labetalol Normodyne, Trandate

Nonselective Alpha-
Adrenergic Blocking phentolamine Regitine
Agent

alfuzosin Uroxatral

doxazosin Cardura
Alpha1-Selective
Adrenergic Blocking prazosin Minipress
Agents
tamsulosin Flomax

terazosin Hytrin

Nonselective Beta- nebivolol Bystolic

Adrenergic Blocking
Agents nadolol Corgard

propranolol Inderal
 timolol Blocarden, Timoptic

bisoprolol Zebeta
Beta1-Selective
Adrenergic Blocking esmolol Brevibloc
Agents
metoprolol Lopressor, Toprol XL

Disease Spotlight: Cardiorespiratory-related conditions, Benign Prostatic Hypertrophy

Nonselective adrenergic antagonists are primarily used to treat cardiac-related conditions.
Completely opposite with sympathomimetics, these drugs are ideal for hypertension and heart
failure because they reduce the rate and conduction of the heart, relieving it from too much
workload.
Of all nonselective alpha adrenergic antagonists, only phentolamine (Regitine) is used. This drug
classification has its use limited because of more specific drugs.
Selective alpha1-receptor adrenergic antagonists can improve urine flow in male patients and are
used as treatment for benign prostatic hypertrophy (BPH). This is because they can block smooth
muscle receptors in the genitourinary tract which leads to relaxation of prostate and bladder.
Nonselective beta-adrenergic antagonists are used to treat CV problems and to prevent
reinfarction after MI.
Selective beta1-receptor adrenergic antagonists is more advantageous than nonselective beta-
blockers because they don’t block beta2-receptors, allowing bronchodilation. This class is
preferred for smokers and those with respiratory problems. They are also used for treating
hypertension, angina, and cardiac arrhythmias.
Nonselective Adrenergic Blocking Agents
Nonselective adrenergic blocking agents block all receptors (alpha- and beta-receptors). These
drugs are primarily used to treat cardiac-related conditions.
Popular example under this class include labetalol and carvedilol.
Therapeutic Action
The desired and beneficial actions of nonselective adrenergic antagonists are as follows:
Nonselective adrenergic antagonists competitively block the effects of norepinephrine at both
alpha and beta receptors throughout the SNS. This results in lower blood pressure, slower pulse
rate, and increased renal perfusion with decreased renin levels.
Indications
Nonselective adrenergic antagonists are indicated for the following medical conditions:
Most nonselective adrenergic antagonists  (e.g. labetalol, carvedilol, etc.) are indicated to treat
essential hypertension, alone or in combination with diuretics. Others (e.g. amiodarone) is for
emergency cases and is only used as an antiarrhythmic.
Here are some important aspects to remember for indication of adrenergic antagonists in
different age groups:
Children
They are at greater risk for complications related to use of these drugs, i.e. bradycardia, difficulty
breathing, and changes in glucose metabolism.
Safety of these drugs has not been established in children younger than 18. However, three drugs
have established pediatric dosage. Prazosin (for treatment of hypertension) and phentolamine
(used during surgery for pheochromocytoma) are two of these drugs.
Adults
Adults with diabetes should be monitored closely for fluctuations in glucose levels because
sympathetic reactions (e.g. sweating, feeling tense, increased heart rate, and rapid breathing) can
cause problems with glucose levels.
Adults with CNS complications may benefit from adrenergic antagonists which are not centrally-
acting.
Use of these drugs among pregnant and lactating women is justified when benefits clearly
outweigh the risks.
Older adults
Dose adjustment is needed as this age group is also more susceptible to drug side effects.
They are more likely to have toxic levels of the drug because of renal or hepatic impairments.
Bisoprolol is the drug of choice for older patients in treating hypertension because it is not
associated with as many problems and regular dosing profiles can be used.
Pharmacokinetics
Here are the characteristic interactions of nonselective adrenergic antagonists and the body in
terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral Varies 1-2 h 8-12 h

IM Immediate 5 min 5.5 h

T1/2: 6-8 h
Metabolism: liver
 Excretion: urine

Contraindications and Cautions

The following are contraindications and cautions for the use of nonselective adrenergic
antagonists:
Allergy to any component of the drug. To prevent hypersensitivity reaction
Bradycardia and heart blocks. Can be worsened by slowed heart rate and conduction.
Hepatic impairment. Can alter metabolism of drugs.
Asthma. Exacerbated by loss of norepinephrine’s effect of bronchodilation.
Shock or heart failure. Can become worse with loss of sympathetic reaction
Lactation. Potential effects on neonates.
Adverse Effects
Use of nonselective adrenergic antagonists may result to these adverse effects:
CNS: dizziness, paresthesias, insomnia, depression, fatigue, vertigo
CV: arrhythmias, hypotension, heart failure, pulmonary edema, CVA
Respiratory: bronchospasms, cough, rhinitis, bronchial obstruction
GI: nausea, vomiting, diarrhea, anorexia, flatulence
GU: decreased libido, impotence, dysuria, Peyronie disease.
Others: decreased exercise tolerance, hypoglycemia, rash
Carvedilol has been associated with hepatic failure related to its effects on the liver.
Abrupt withdrawal: MI, stroke, arrhythmias related to increased hypersensitivity to
catecholamines that develops when the receptor sites have been blocked.

Interactions
The following are drug-drug interactions involved in the use of nonselective adrenergic
antagonists:
Volatile liquid anesthetics (e.g. halothane, isoflurane). Increased risk of excessive hypotension.
Antidiabetics. Increased effects of antidiabetics so hypoglycemia should be watched out for.
Verapamil and diltiazem. Potentially dangerous conduction system disturbances if combined
with carvedilol.
Nursing Considerations
Here are important nursing considerations when administering nonselective adrenergic
antagonists:

Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking,
and examination:
Assess for contraindications or cautions (e.g. history of allergy to drug, heart blocks, asthma,
pregnancy or lactation status, etc.) to avoid adverse effects.
Establish baseline physical assessment to monitor for any potential adverse effects.
Assess the level of orientation and for any complaints of dizziness, paresthesias, or vertigo to
monitor CNS drug effects.
Assess vital signs, especially pulse and blood pressure to monitor for possible excess stimulation
of the cardiac system.
Note respiratory rate and auscultate lungs for adventitious sounds to evaluate effects on bronchi
and respirations.
Monitor laboratory test results (e.g. liver and renal function tests) to determine need for possible
dose adjustment, serum electrolyte levels to evaluate fluid loss and appropriateness of therapy,
and blood glucose to evaluate for hyper- or hypoglycemia.

Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Decreased cardiac output related to CV effects
Ineffective airway clearance related to lack of bronchodilating effects
Risk for injury related to CNS effects
Diarrhea related to increased parasympathetic activity

Implementation with Rationale

These are vital nursing interventions done in patients who are taking nonselective adrenergic
antagonists:
Do not discontinue abruptly after chronic therapy because hypersensitivity to catecholamines
may develop and patient could have severe reaction; taper drug slowly over two weeks,
monitoring the patient.
Educate patient about positive lifestyle changes (e.g. diet, exercise, smoking cessation) to aid in
lowering blood pressure.
Assess heart rate for changes that might suggest arrhythmia. Obtain blood pressure in various
positions to assess for orthostatic hypotension.
Monitor GI function and need for increased access to bathroom facilities and need for increased
fluid intake related to diarrhea.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance knowledge
about drug therapy and promote compliance.
Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Monitor patient response to therapy (improvement in blood pressure and heart failure).
Monitor for adverse effects (e.g. CV changes, headache, GI upset, liver failure).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
Monitor patient compliance to drug therapy.
Nonselective Alpha-Adrenergic Blocking Agents
Nonselective alpha-adrenergic blocking agents are drugs with specific affinity for alpha-receptor
sites. Their use has somewhat limited because of development of more specific and safer drugs.
Of all drugs, only phentolamine is still used.
Therapeutic Action
The desired and beneficial actions of nonselective alpha-adrenergic antagonists are as follows:
Phentolamine blocks the alpha1-adrenergic receptors, decreasing sympathetic tone in the
vasculature and causing vasodilation, which leads to lowering of blood pressure.
It also blocks the alpha2-receptors, preventing the feedback control of norepinephrine release.
The result is an increase in reflex tachycardia that occurs when blood pressure is lowered.
Indications
Nonselective alpha-adrenergic antagonists are indicated for the following medical conditions:
Phentolamine is most frequently used to prevent cell death and tissue sloughing after
extravasation of intravenous norepinephrine or dopamine, causing a local vasodilation and a
return of blood flow to the area.
For treatment of severe hypertension reactions caused by manipulation of pheochromocytoma
before and during surgery
For diagnosis of pheochromocytoma
Pharmacokinetics
Here are the characteristic interactions of nonselective alpha-adrenergic antagonists and the body
in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

IM Rapid 20 min 30-45 min

IV Immediate 2 min 15-30 min

T1/2: Unknown
Metabolism: Unknown
Excretion: Unknown

Contraindications and Cautions

The following are contraindications and cautions for the use of nonselective alpha-adrenergic
antagonists:
Allergy to any component of the drug. To prevent hypersensitivity reaction
Coronary artery disease or MI. Potential exacerbation of these conditions.
Pregnancy and lactation. Potential effects to  fetus or neonates.

Adverse Effects
Use of nonselective alpha-adrenergic antagonists may result to these adverse effects:
CNS: headache, weakness, dizziness
CV: hypotension, orthostatic hypotension, angina, MI, cerebrovascular accident, flushing,
tachycardia, arrhythmia
GI: nausea, vomiting, diarrhea
Interactions
The following are drug-drug interactions involved in the use of nonselective alpha-adrenergic
antagonists:
Ephedrine and epinephrine. Decreased hypertensive and vasoconstrictive effects
Alcohol. Increased hypotension
Nursing Considerations
Here are important nursing considerations when administering nonselective alpha-adrenergic
antagonists:
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking,
and examination:
Assess for contraindications or cautions (e.g. history of allergy to drug, CV diseases, pregnancy
or lactation status, etc.) to avoid adverse effects.
Establish baseline physical assessment to monitor for any potential adverse effects.
Assess orientation, affect, and reflexes to monitor for CNS changes related to drug therapy.
Monitor CV status (blood pressure, pulse rate, peripheral perfusion) to determine changes in
function.
Monitor urine output which will reflect perfusion of the kidney as another assessment of cardiac
function.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Decreased cardiac output related to blood pressure changes, arrhythmias, and vasodilation
Risk for injury related to CNS and CV effects
Implementation with Rationale
These are vital nursing interventions done in patients who are taking nonselective alpha-
adrenergic antagonists:
Monitor heart rate and blood pressure closely and frequently for changes to anticipate the need to
discontinue the drug if adverse reactions are severe.
Inject phentolamine directly into area of extravasation of epinephrine or dopamine to prevent
local cell death.
Institute safety measures to prevent injury if the patient experiences weakness, dizziness, or
orthostatic hypotension.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance knowledge
about drug therapy and promote compliance.
Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Monitor patient response to therapy (improvement in signs and symptoms of
pheochromocytoma, improvement in tissue condition after extravasation).
Monitor for adverse effects (e.g. orthostatic hypotension, arrhythmias, CNS effects).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
Monitor patient compliance to drug therapy.
Alpha1-Selective Adrenergic Blocking Agents
Alpha1-selective adrenergic blocking agents are drugs that have a specific affinity for alpha1-
receptors.
Common drug examples include prazosin, tamsulosin, and doxazosin.
Therapeutic Action
The desired and beneficial actions of alpha1-selective adrenergic blocking agents are as follows:
Blocking the postsynaptic alpha1-receptor sites. This causes a decrease in vascular tone and
vasodilation, which leads to a fall in blood pressure. A reflex tachycardia that accompanies a fall
in blood pressure does not occur because they do not block presynaptic alpha2-receptor sites.
Reducing total peripheral resistance through alpha blockade; it does not affect heart rate or
cardiac output.
Increasing high-density lipoproteins while lowering total cholesterol level.
Blocking smooth muscle receptors in prostate, prostatic capsule, prostatic urethra, and urinary
bladder neck leading to relaxation of bladder and prostate and improved flow of urine in male
patients.
Indications
Alpha1-selective adrenergic blocking agents are indicated for the following medical conditions:
For treatment of benign prostatic hypertrophy (BPH)
For treatment of mild to moderate hypertension as monotherapy or in combination with other
antihypertensives.
Pharmacokinetics
Here are the characteristic interactions of alpha1-selective adrenergic blocking agents and the
body in terms of absorption, distribution, metabolism, and excretion:
 Route Onset Peak Duration

Oral Varies 2-3 h Not known

T1/2: 22 hours
Metabolism: liver
Excretion: bile, feces, urine

Contraindications and Cautions

The following are contraindications and cautions for the use of alpha1-selective adrenergic
blocking agents:
Allergy to any component of the drug. To prevent hypersensitivity reaction
Lactation. Drugs cross into breast milk
Heart or renal failure. Can be exacerbated by blood pressure-lowering effects of the drug
Hepatic impairment. Can alter drug metabolism.
Pregnancy. Potential adverse effects to the fetus.
Adverse Effects
Use of alpha1-selective adrenergic blocking agents may result to these adverse effects:
CNS: headache, weakness, dizziness, fatigue, drowsiness, depression
CV: arrhythmia, hypotension, edema, HF, angina
GI: nausea, vomiting, diarrhea, abdominal pain
Vasodilation drug effect: flushing, rhinitis, reddened eyes, nasal congestion, priapism
Interactions
The following are drug-drug interactions involved in the use of alpha1-selective adrenergic
blocking agents:
Nitrates, calcium-channel blockers, angiotensin-converting-enzyme inhibitors. Increased
hypotensive effects.
Nursing Considerations
Here are important nursing considerations when administering alpha1-selective adrenergic
blocking agents:
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking,
and examination:
Assess for contraindications or cautions (e.g. history of allergy to drug, heart or renal failure,
pregnancy or lactation status, etc.) to avoid adverse effects.
Establish baseline physical assessment to monitor for any potential adverse effects.
Assess orientation, affect, and reflexes to monitor for CNS changes related to drug therapy.
Monitor CV status (blood pressure, pulse rate, peripheral perfusion) to determine changes in
function.
Assess renal function, including urinary output, to evaluate effects on the renal system and assess
benign prostatic hypertrophy and its effects on urinary output.
Monitor renal and hepatic function tests to evaluate potential need for dose adjustment.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Acute pain related to headache, GI upset, flushing, nasal congestion
Decreased cardiac output related to blood pressure changes, arrhythmias, vasodilation
Risk for injury related to CNS or CV effects of the drug

Implementation with Rationale

These are vital nursing interventions done in patients who are taking alpha1-selective adrenergic
blocking agents:
Monitor blood pressure, pulse, rhythm, and cardiac output regularly to evaluate for changes that
may indicate a need to adjust dose or discontinue the drug if CV effects are severe.
Establish safety precautions if CNS effects or orthostatic hypotension occurs to prevent patient
injury.
Arrange for small, frequent meals if GI upset is severe to relieve discomfort and maintain
nutrition.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance knowledge
about drug therapy and promote compliance.

Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Monitor patient response to therapy (lowering of blood pressure, improved urine flow with
BPH).
Monitor for adverse effects (e.g. GI upset, CNS, or CV changes).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
Monitor patient compliance to drug therapy.
Nonselective Beta-Adrenergic Blocking Agents
Nonselective beta-adrenergic blocking agents are drugs that block the beta-receptors within the
SNS. Nonselective blockade of all beta-receptors results in a loss of the reflex bronchodilation
that occurs with sympathetic stimulation.
Use of these drugs is limited in patients who smoke or have allergic or seasonal rhinitis, asthma,
or COPD.
Common drug examples include propranolol, nebivolol, and timolol.

Therapeutic Action
The desired and beneficial actions of nonselective beta-adrenergic blocking agents are as
follows:
Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus
Reduction of vascular tone in the CNS
Indications
Nonselective beta-adrenergic blocking agents are indicated for the following medical conditions:
These drugs are used for a wide range of conditions, including hypertension, stage fright
(situational anxiety), migraines, angina, and essential tremors.
Timolol and carteolol in ophthalmic form are used for reduction of intraocular pressure in
patients with open-angle glaucoma.
Pharmacokinetics
Here are the characteristic interactions of nonselective beta-adrenergic blocking agents and the
body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral 20-30 min 60-90 min 6-12 h

IV Immediate 1 min 4-6 h

 T1/2: 3-5 hours
Metabolism: liver
Excretion: urine

Contraindications and Cautions

The following are contraindications and cautions for the use of nonselective beta-adrenergic
blocking agents:
Allergy to any component of the drug. To prevent hypersensitivity reaction
Bradycardia, heart blocks, shock, HF. Can be exacerbated by the cardiac-suppressing effects of
these drugs
Bronchospasm, COPD, acute asthma. Can be worsen due to blocking of the sympathetic
bronchodilation
Pregnancy. Teratogenic effects have occurred in animal studies with all these drugs except
sotalol; neonatal apnea, bradycardia, and hypoglycemia can occur
Lactation. Potential effects to the neonate include slowed heart rate, hypotension, and
hypoglycemia
Diabetes, hypoglycemia. Drugs can block the normal signs and symptoms of hypo- and
hyperglycemia
Thyrotoxicosis. Adrenergic blocking effects on the thyroid gland
Renal or hepatic dysfunction. Can interfere with drug metabolism and excretion.
Adverse Effects
Use of nonselective beta-adrenergic blocking agents may result to these adverse effects:
CNS: headache, fatigue, dizziness, depression, paresthesia, sleep disturbances, memory loss,
disorientation
CV: bradycardia, heart block, HF, hypotension, peripheral vascular insufficiency
Respiratory: difficulty of breathing, coughing, bronchospasm, severe pulmonary edema, severe
bronchial obstruction
GI: GI upset, nausea, vomiting, diarrhea, gastric pain, colitis
GU: decreased libido, impotence, dysuria, Peyronie disease
Other: decreased exercise tolerance, hypo- or hyperglycemia, liver changes
Abrupt withdrawal: angina, MI, hypertension, stroke

Interactions
The following are drug-drug interactions involved in the use of nonselective beta-adrenergic
blocking agents:
Clonidine. Paradoxical hypertension can occur; increased rebound hypertension with clonidine
withdrawal.
NSAIDs. Decreased antihypertensive effect
Epinephrine. Initial hypertensive episode followed by bradycardia
Ergot alkaloids. Peripheral ischemia may occur
Insulin and other antidiabetic agents. Potential change in blood glucose levels

Nursing Considerations
Here are important nursing considerations when administering nonselective beta-adrenergic
blocking agents:
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking,
and examination:
Assess for contraindications or cautions (e.g. history of allergy to drug, heart failure, pregnancy
or lactation status, etc.) to avoid adverse effects.
Establish baseline physical assessment to monitor for any potential adverse effects.
Assess orientation, affect, and reflexes to monitor for CNS changes related to drug therapy.
Monitor CV status (blood pressure, pulse rate, peripheral perfusion) to determine changes in
function.
Assess abdomen, including auscultating bowel sounds to monitor GI effects.
Monitor renal and hepatic function tests to evaluate potential need for dose adjustment, as well as
electrolyte levels to monitor for risks for arrhythmias.

Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Acute pain related to CNS, GI, and systemic
Decreased cardiac output related to CV effects
Ineffective tissue perfusion related to CNS effects
Implementation with Rationale
These are vital nursing interventions done in patients who are taking nonselective beta-
adrenergic blocking agents:
Do not stop these drugs abruptly after chronic therapy, but taper gradually over 2 weeks because
long-term use of these drugs can sensitize the myocardium to catecholamines, and severe
reactions could occur.
Continuously monitor any patient receiving an intravenous form of these drugs to avert serious
complications caused by rapid sympathetic blockade.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance knowledge
about drug therapy and promote compliance.

Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Monitor patient response to therapy (lowering of blood pressure, decrease in angina episodes,
and improvement of condition being treated).
Monitor for adverse effects (e.g. GI upset, CNS, or CV changes).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
Monitor patient compliance to drug therapy.
Beta1-Selective Adrenergic Blocking Agents
Beta1-selective adrenergic blocking agents are drugs that do not block the beta1-receptors
responsible for bronchodilation. This gives them an advantage over nonselective beta-blockers.
These drugs are preferred for patients who smoke or who have asthma, any other obstructive
pulmonary disease, or seasonal or allergic rhinitis.
Popular examples under this class include atenolol, metoprolol, and esmolol.
Therapeutic Action
The desired and beneficial actions of beta1-selective adrenergic blocking agents are as follows:
Blocking the beta1-adrenergic receptors decreasing the excitability of the heart, cardiac output,
and oxygen consumption.
Decreasing renin release which lowers blood pressure.

Indications
Nonselective beta-adrenergic blocking agents are indicated for the following medical conditions:
Treatment for cardiac arrhythmias, hypertension, and chronic angina
Prevention of reinfarction after an MI by decreasing cardiac workload and oxygen consumption
In oral form, used to decrease intraocular pressure and to treat open-angle glaucoma
Pharmacokinetics
Here are the characteristic interactions of beta1-selective adrenergic blocking agents and the
body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral Varies 2-4 h 24 h

IV Immediate 5 min 24 h

T1/2: 6-7 h
Metabolism: –
Excretion: bile, urine, feces

Contraindications and Cautions

The following are contraindications and cautions for the use of beta1-selective adrenergic
blocking agents:
Allergy to any component of the drug. To prevent hypersensitivity reaction
Bradycardia, heart blocks, cardiogenic shock, HF. Can be exacerbated by the cardiac-
suppressing effects of these drugs
Pregnancy and lactation. Potential effects to the fetus or neonate
Diabetes, thyrotoxicosis, COPD. Potential for adverse effects on these diseases with sympathetic
blockade
Adverse Effects
Use of beta1-selective adrenergic blocking agents may result to these adverse effects:
CNS: headache, fatigue, dizziness, depression, paresthesia, sleep disturbances, memory loss,
disorientation
CV: bradycardia, heart block, HF, hypotension, peripheral vascular insufficiency
Respiratory: rhinitis, bronchospasm, dyspnea
GI: GI upset, nausea, vomiting, diarrhea, gastric pain, colitis
GU: decreased libido, impotence, dysuria, Peyronie disease
Other: decreased exercise tolerance, hypo- or hyperglycemia, liver changes
Abrupt withdrawal: angina, MI, hypertension, stroke
Interactions
The following are drug-drug interactions involved in the use of beta1-selective adrenergic
blocking agents:
Clonidine, NSAIDs, rifampin, barbiturates. Decreased hypertensive effects
Epinephrine. Initial hypertensive episode followed by bradycardia
Lidocaine. Increased serum levels and toxicity of lidocaine
Prazosin. Increased risk for orthostatic hypotension
Verapamil, cimetidine, methimazole, propylthiouracil. Increased effects of selective beta1-
blockers
Nursing Considerations
Here are important nursing considerations when administering beta1-selective adrenergic
blocking agents:

Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking,
and examination:
Assess for contraindications or cautions (e.g. history of allergy to drug, bradycardia, pregnancy
or lactation status, etc.) to avoid adverse effects.
Establish baseline physical assessment to monitor for any potential adverse effects.
Assess orientation, affect, and reflexes to monitor for CNS changes related to drug therapy.
Monitor CV status (blood pressure, pulse rate, peripheral perfusion) to determine changes in
function.
Assess abdomen, including auscultating bowel sounds to monitor GI effects.
Monitor renal and hepatic function tests to evaluate potential need for dose adjustment, as well as
electrolyte levels to monitor for risks for arrhythmias.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Acute pain related to CNS, GI, and systemic
Decreased cardiac output related to CV effects
Ineffective tissue perfusion related to CNS effects

Implementation with Rationale

These are vital nursing interventions done in patients who are taking beta1-selective adrenergic
blocking agents:
Do not stop these drugs abruptly after chronic therapy, but taper gradually over 2 weeks because
long-term use of these drugs can sensitize the myocardium to catecholamines, and severe
reactions could occur.
Continuously monitor any patient receiving an intravenous form of these drugs to avert serious
complications caused by rapid sympathetic blockade.
Give oral forms of metoprolol with food to facilitate absorption.
Provide comfort measures to help patient cope with drug effects.
Provide patient education about drug effects and warning signs to report to enhance knowledge
about drug therapy and promote compliance.

Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Monitor patient response to therapy (lowered blood pressure, fewer angina episodes, lowered
intraocular pressure).
Monitor for adverse effects (e.g. GI upset, CNS, or CV changes).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
Monitor patient compliance to drug therapy.