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PHARMACOLOGY 💊
Beta blockers are medications that help decrease blood pressure, slow down the
heart rate, and treat dysrhythmias. This review will discuss the mechanism of
action of beta blockers, what conditions they treat, nursing implications, side
effects, and patient education.
Beta blockers block the BETA receptors sites in the body so norepinephrine and
epinephrine can NOT bind to the receptor site and elicit a sympathetic nervous
system response.
Sympathetic nervous system: it’s the “fight or flight system”it works to save your life
from danger.
When BETA receptors sites are stimulated by the SNS and have norepinephrine and
epinephrine bind to them, the person can experience (note these are just some of the
responses created by the sympathetic nervous system):
Beta 1 receptors are mainly located in the HEART (remember you have one heart) and
in the kidneys (specifically the juxtaglomerular cells that release renin).
Beta 2 receptors are located in the bronchioles of the LUNGS (remember you have two
lungs), GI system, vascular smooth muscle and skeletal muscle, and ciliary body of the
eye.
It’s important to remember what patient populations cannot take the nonselective beta
blockers and side effects they may cause for exams.
● Propranolol, Sotalol, Timolol etc.
Mechanism of Action of Beta Blockers (how they affect the body)
● Slow heart rate (both selective and nonselective)
Beta receptors (mainly beta 1) are in the cardiac nodal tissue and conduction system of
the heart. These areas control our heart rate. Beta blockers slow down how they work,
so they’re helpful with dysrhythmias like supraventricular tachycardia.
Monitor for AV blocks like 2 or 3 degree and severe bradycardia (contraindicated)
Mask tachycardia during hypoglycemic episodes in diabetics because these
medications keep the heart rate from increasing (remember they slow down the heart
rate).
Decrease the strength of contractions (both selective and nonselective)
Beta receptors (mainly beta 1) are in the cardiac myocytes that control the strength of
the heart’s contractions. Beta blockers cause a negative inotropic effect because they
make the contractions weaker. This helps ease the workload on the heart and decrease
oxygen consumption by the myocardium (great for treating stable angina due to
coronary artery disease).
Watch for the development or worsening of heart failure…not to be used in patient with
uncompensated heart failure or cardiogenic shock.
The ciliary body of the eye has beta 2 receptors. The ciliary body of the eye is
responsible for the production of aqueous humor. In patients with glaucoma, the high
eye pressure is high due to a high amount of aqueous humor collecting in the eye.
Nonselective beta blockers (example eye drops like Timolol) will decrease the
production of aqueous humor and help decrease intraocular pressure.
Bronchoconstriction (only nonselective)
Nonselective affect beta 2 receptors which are found in the bronchioles of the lungs.
These medications should NOT be used in patients with asthma or COPD due to the
risk of bronchoconstriction.
Avoid in patients with peripheral vascular disease. These medications may cause cold
feet and hands and erectile dysfunction.
Used For?
Hypertension, stable angina (CAD), dysrhythmias (example SVT), compensated
heart failure, migraines, glaucoma (example: Timolol), tremors, anxiety
Asthma & COPD patients can’t have nonselective beta blockers due to
bronchoconstriction… Propranolol, Sotalol, Timolol etc.
Blood glucose is monitored closely in diabetes (TEACH). They need to monitor for
hypo/hyperglycemic AND the masking of hypoglycemia due to NO TACHYcardia
experienced with blood glucose drops.
Know overdose signs and symptoms: Bradycardia, heart blocks, low blood pressure,
mental status changes: very lethargic or fainting, difficulty breathing due to
bronchospasm, heart block… TEACH patients to monitor for these as well.