Sympatholytics(BABs)-ATI pharm

Question 1

BAB’s

Answer 1

Beta Adrenergic Blockers

Question 2

Meds

Answer 2

Prototypes=
1-Cardioselective: Beta
-Metoprolol
-Atenolol
-Esmolol
2-Nonselective: beta1 and beta2(heart&lungs)
-Propranolol
-Nadolol
3-Alpha and Beta Blockers
-Carvedilol
-Labetalol

Question 3

Expected pharm action

Answer 3

1-cardiac conditions=result of beta1-adrenergic blockade in myocardium and in electrical conduction system of heart
2-decreased HR
3-decreased myocardial contractility;decreases CO
4-decreased rate of conduction through AV node
5-alpha blockade adds vasodilation in meds such as carvedilol and labetalol
6-reduces release of renin;decreases angiotensin II and causes vasodilation and promotes excretion of sodium/water

Question 4

Therapeutic uses

Answer 4

1-primary hypertension
2-angina,tachydysrhythmias, heart failure,MI
3-suppresses reflex tachycardia due to vasodilators
Other uses:
-hyperthyroidism,migraine,pheochromocytoma,glaucoma

Question 5

Complications:Beta1 Blockade(Metoprolol/propranolol)

Answer 5

1-bradycardia
2-decreased CO
3-AV block
4-orthostatic hypotension
5-rebound myocardium excitation

Question 6

Bradycardia

Answer 6

1-monitor pulse, if below 50/min hold med/notify provider

2-use cautiously in pts w/ diabetes,med can mask tachycardia,an early manifestation of low BG

Question 7

Decreased CO

Answer 7

1-use cautiously w/ pts who have heart failure

2-observe for manifestations of worsening heart failure

Question 8

AV block

Answer 8

Obtain baseline ECG and monitor

Question 9

Rebound myocardium excitation

Answer 9

1-myocardium becomes sensitized to catecholamines w/ long term use of beta-blockers
2-do not stop taking beta blockers abruptly, discontinue over 1-2 wks

Question 10

Complications: Beta2 Blockade(propranolol)

Answer 10

1-Bronchoconstriction=avoid in pts w/ asthma(give them beta1 selective agent)
2-Glycogenolysis is inhibited=pts who have diabetes rely on the breakdown of glycogen into glucose to manage low BG(can happen w/ insulin overdose)
3-decreased HR can mask low BG(pts w/ diabetes should receive a beta1 selective agent)

Question 11

Contraindications/precautions

Answer 11

-contraindicated with those who AV block and sinus bradycardia
Nonselective=contraindicated in those who have asthma,bronchospasm,&heart failure
Cardioselective=use cautiously in those who have asthma
In general, use cautiously in pts who have myasthenia gravis,hypotension,peripheral vascular disease,diabetes,depression,and older adults who have hx of severe allergies

Question 12

Interactions:Beta1(metoprolol,propranolol)

Answer 12

1-CCB verapamil/diltiazem intensify effects(decreased HR,myocardial contractility,rate of conduction through AV node)
2-antihypertensive meds=intensifies hypotensive effect of both meds;monitor for drop in BP

Question 13

Interactions:beta2(propranolol)

Answer 13

1-can mask hypoglycemic effect of insulin and prevent breakdown of fat in response to hypoglycemia;monitor BG levels

Question 14

Nursing admin

Answer 14

1-orally once or twice a day
2-can be IV=atenolol,metoprolol,labetalol,propranolol
3-do not crush or chew extended release tablets
4-teach pts to self monitor HR and BP at home daily
5-take w/ food to increase absorption

Question 15

Nursing Evaluation of med effectiveness

Answer 15

1-Absence of chest pain
2-Absence of cardiac dysrhythmias
3-Normotensive BP readings
4-Control of heart failure manifestations