Adrenergic Antagonists

(Sympatholytics)

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

• Disease Spotlight: Cardiorespiratory-related conditions, Benign
Prostatic Hypertrophy
• Nonselective Adrenergic Blocking Agents
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
o Nursing Considerations
▪ Nursing Assessment
▪ Nursing Diagnoses
▪ Implementation with Rationale
▪ Evaluation
• Nonselective Alpha-Adrenergic Blocking Agents
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
 o Nursing Considerations
▪ Nursing Assessment
▪ Nursing Diagnoses
▪ Implementation with Rationale
▪ Evaluation
• Alpha1-Selective Adrenergic Blocking Agents
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
o Nursing Considerations
▪ Nursing Assessment
▪ Nursing Diagnoses
▪ Implementation with Rationale
▪ Evaluation
• Nonselective Beta-Adrenergic Blocking Agents
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
o Nursing Considerations
▪ Nursing Assessment
▪ Nursing Diagnoses
▪ Implementation with Rationale
▪ Evaluation
• Beta1-Selective Adrenergic Blocking Agents
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
o Nursing Considerations
▪ Nursing Assessment
▪ Nursing Diagnoses
▪ Implementation with Rationale
▪ Evaluation
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
Normodyne,
labetalol
Trandate

Nonselective Alpha-Adrenergic
phentolamine Regitine
Blocking Agent

alfuzosin Uroxatral

doxazosin Cardura

Alpha1-Selective Adrenergic
prazosin Minipress
Blocking Agents

tamsulosin Flomax

terazosin Hytrin

nebivolol Bystolic

nadolol Corgard
Nonselective Beta-Adrenergic
Blocking Agents propranolol Inderal

Blocarden,
timolol
Timoptic

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