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NURS 133 Atenolol and Propranolol

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jasmine's version from 2016-06-03 02:05

Section 1

Question Answer
Atenolol (Norvasc) Anti-anginals; Anti-hypertensives; Beta blockers; Pregnancy category D; Management of hypertension; Management of angina pectoris; Prevention of MI
Atenolol actions Blocks stimulation of beta1 (myocardial)-adrenergic receptors; Does not usually affect beta2 (pulmonary, vascular, uterine)-receptor sites
Atenolol therapeutic uses Decrease BP and heart rate; Decreased frequency of attacks of angina pectoris; Prevention of MI
Elimination/Excretion of Atenolol 40-50 percent excreted unchanged by the kidneys; remainder excreted in feces as unabsorbed drug
Adverse/Side Effects of Atenolol
Contraindications of Atenolol Uncompensated HG; Pulmonary edema; Cardiogenic shock; Bradycardia or heart block
Use Atenolol cautiously in Renal impairment; Hepatic impairment; Geriatric patients; Pulmonary disease (including asthma; beta selectivity may be lost at higher doses); Diabetes mellitus (may mask signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); Patient with history of severe allergic reactions (intensity of reactions may be increased); OB: Crosses the placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression; Lactation, Pedi: Safety not established
Drug/Food interactions of Atenolol Fatigue, weakness,; bradycardia, HF, Pulmonary edema; Erectile dysfunction
Medication administration of Atenolol PO
Nursing interventions of Atenolol Monitor BP, ECG, and pulse frequently during dosage adjustment period and periodically throughout therapy; Monitor intake and output ratios and daily weights. Assess routinely for HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention); Monitor frequency of prescription refills to determine adherence; Angina: Assess frequency and characteristics of angina periodically throughout therapy; Lab test considerations: May cause increase BUN, serum lipoprotein, potassium, triglyceride, uric acid levels, ANA titers, and blood glucose levels; Toxicity and overdose: monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures), and notify health care professional immediately if these signs occur
Client education of Atenolol Instruct patient to take atenolol as directed at he same time each day, even if feeling better; Instruct to take any missed doses as soon as possible up to 8 hours before next dose-Abrupt withdrawal may cause 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 patient to check pulse daily and BP bi-weekly and to report significant changes; Caution patient to avoid driving or other activities requiring alertness until response to the drug is known; Advise patients to change positions slowly to minimize orthostatic hypotension; Caution patient that atenolol may increase sensitivity to cold; Instruct patient to avoid alcohol, and to consult health care professional before taking any new medications, especially cold preparations; Patient with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs; *Medication does not block sweating as a sign of hypoglycemia; Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs; Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding; 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 yet does not cure hypertension
Evaluation/Desired outcomes of Atenolol Decrease in BP; Reduction in frequency of angina; Increase in activity tolerance; Prevention of MI
Potential nursing diagnoses of Atenolol decreased cardiac output (side effects); Noncompliance (patient/family teaching)
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Section 2

Question Answer
Propranolol (Inderal) Anti-anginals; Anti-arrhythmics (class II); Anti-hypertensives; vascular headache suppressants; Beta blockers; Pregnancy category C; Management of hypertension, angina, arrhythamias, hypertrophic cardiomyopathy, thyrotoxicosis, essential tremors, pheochroocytoma; Also used in the prevention and management of MI, and the prevention of vascular headaches
Propranolol actions Blocks stimulation of beta1 (myocardial) and beta2 (pulmonary, vascular, and uterine)-adrenergic receptor sites
Propranolol therapeutic uses Decreased heart rate and BP; Suppression of arrhythmias; Prevention of MI
Elimination/Excretion of Propranolol Almost completely metabolized by the liver (primarily for CYP2D6 isoenzyme); CYP2D6 enzyme system exhibits genetic polymorphism: 7 percent of population may be poor metabolizers and may have significantly Increased propranolol concentrations and an increased risk of adverse effects
Adverse/Side Effects of Propranolol Fatigue, weakness; Arrhythmias, bradycardia, HF, pulmonary edema; Erectile dysfunction; Erythema multiforme, exfoliative dermatitis, stevens-johnson syndrome, toxic epidermal necrolysis; Anaphylaxis
Contraindications of Propranolol Uncompensated HF; Pulmonary edema; Cardiogenic shock; Bradycardia, sick sinus syndrome, or heart block (unless pace maker present)
Use Propranolol cautiously in Renal or hepatic impairment; Pulmonary disease (including asthma); diabetes mellitus (may mask signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); History of severe allergic reactions (may increase intensity of response); Skeletal muscle disease (may exacerbate myopathy); OB: Crosses the placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression; May also decrease blood supply to the placenta, increase the risk for premature birth or fetal death, and cause intrauterine growth retardation; May increase risk of cardiac and pulmonary complications in the infant during neonatal time frame; Lactation: Appears in breast milk; use formula if propranolol must be taken; Pedi: Increase risk of hypoglycemia, especially during periods of fasting such as before surgery, during prolonged exertion, or with coexisting renal insufficiency; Geri: Increase sensitivity to all beta blockers
Drug/Food interactions of Propranolol General anesthesia, IV phenytoin, and verapamil may cause additive myocardial depression; Additive bradycardia may occur with digoxin; Additive hypotension may occur with other anti-hypertensives, acute ingestion of alcohol or nitrates; Levels may be decrease with chronic alcohol use; Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia); Concurrent thyroid administration may decrease effectiveness; May alter the effectiveness of insulin or oral hypoglycemics (dose adjustments may be necessary); May decrease effectiveness of beta-adrenergic bronchodilators and theophylline; May decrease beneficial beta cardiovascular effects of dopamine or dobutamine; Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension); Cimetidine may increase blood levels and toxicity; Concurrent NSAIDs may decrease anti-hypertensive action; Smoking increase metabolism and decrease effects; Smoking cessation may increase effects; May increase levels of lidocaine and bupivacaine
Medication administration of Propranolol PO; IV
Nursing interventions of Propranolol Monitor BP and pulse frequently during dose adjustment period and periodically during therapy; Abrupt withdrawal of propranolol may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia (drug should be tampered over a 2 week period before discontinuation); Assess patient carefully during tapering and after medication and after medication is discontinued; Consider that patients thaking propranolol for non-cardiac indications may have diagnosed cardiac disease; Pedi: Assess pediatric patients for signs and symptoms of hypoglycemia, particularly when oral foods and fluids are restricted; Patients receiving propranolol IV must have continuous ECG monitoring and may have pulmonary capillary wedge pressure (PCWP) or central venous pressure (CVP) monitoring during and for several hours after administration; 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); Assess for rash periodically during therapy. May cause stevens-johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia; Angina: Assess frequency and characteristics of angina attacks periodically during therapy; vascular headache prophylaxis: Assess frequency, severity, characteristics, and location of vascular headaches periodically during therapy; PTSD: Assess frequency of symptoms (flashbacks, nightmares, efforts to avoid thoughts or activities that may trigger memories of the trauma, and hypervigilance) periodically throughout therapy; Lab test considerations: May cause increase BUN, serum lipoprotein, potassium, triglyceride, uric acid levels, ANA titers, and decrease or increase in blood glucose levels; In labile diabetic patients, hypoglycemia may be accompanied by precipitous increase of BP; Toxicity and overdose: Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures)-notify health care professional if occur; Hyoptension may be treated with modified Trendelenburg position and IV fluids unless contraindicated; Vasopressors (epinephrine, norepinephrine, dopamine, dobutamine) may also be used; **Hypotension does not respond to beta agonists; Glucagon has been used to treat bradycardia and hypotension
High alert of Propranolol IV vasoactive medications are inherently dangerous; Before administering intravenously, have second practitioner independently check the original order, dose calculations, and infusion pump settings. Also, patient harm or fatalities have occurred when switching from oral to IV propranolol; **Oral and parenteral doses are not interchangeable; IV dose is 1/10 of the oral dose; **Change to oral therapy as soon as possible; PO: **Take apical pulse prior to administration; If less than 50 bpm or if arrhythmia occurs, withhold medication and notify health care professional; Administer with meals or directly after eating to enhance absorption; Swallow extended release capsules whole; Do not crush, break, or chew; Propranolol tablets may be crushed and mixed with food; Mix propranolol oral solution with liquid or food (water, juices, applesauce, puddings); To ensure entire dose is taken, rinse glass with more liquid or have patient consume all of the applesauce or pudding-*Do not store after mixing
Client education of Propranolol Instruct patient to take medication as directed, at the same time each day, even if feeling well; Take missed doses up to 4 hours before next dose (8 hours for extended release propranolol); Inform patient that abrupt withdrawal can cause 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 daily and BP biweekly; Advise patient to hold dose and contact health care professional if pulse is less than 50 bpm or BP changes significantly; Caution patient to avoid driving or other activities requiring 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 increase; Caution patient that this medication may increase sensitivity to cold; Instruct patient to ask a health care professional before taking any OTC medications or herbal products, especially cold preparations, when taking this medication; Diabetic patients should closely monitor blood glucose, especially if weakness, malaise, irritability or fatigue occurs; May mask tachycardia and increased BP as signs of hypoglycemia, yet dizziness and sweating may still occur; Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs; 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 yet does not cure hypertension; Angina: Caution patient to avoid overexertion with decrease in chest pain; Vascular headache prophylaxis: Caution patient that sharing this medication may be dangerous; PTSD: Advise patient that medication may relieve distressing symptoms yet that psychotherapy is the primary treatment for the disorder-refer patient and family to a PTSD support group
Evaluation/Desired outcomes of Propranolol Decrease in BP; Control of arrhythmias without appearance of detrimental side effects; Reduction in frequency of angina attacks; Increase in activity tolerance; Prevention of MI; Prevention of vascular headaches; Management of thyrotoxicosis; Management of pheochromocytoma; Decrease in tremors; Management of hypertrophic cardiomyopathy; Decrease in symptoms associated with PTSD
Potential nursing diagnoses of Propranolol Decreased cardiac output (side effects); Noncompliance (patient/family teaching)
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