General High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Genetic Implications: Pronunciation: Trade Name(s) Ther. Class. antianginals antihypertensives Pharm. Class. beta blockers Unlabeled Use(s):
Action Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-adrenergic receptor sites. Therapeutic Effect(s):
PharmacokineticsAbsorption: Well absorbed after oral administration. Distribution: Crosses the blood-brain barrier, crosses the placenta; small amounts enter breast milk. Metabolism and Excretion: Mostly metabolized by the liver (primarily by CYP2D6; the CYP2D6 enzyme system exhibits genetic polymorphism); ~7% of population may be poor metabolizers and may have significantly ↑ metoprolol concentrations and an ↑ risk of adverse effects. Half-life: 3–7 hr. TIME/ACTION PROFILE (cardiovascular effects)
Contraindication/PrecautionsContraindicated in:
Use Cautiously in:
Adverse Reactions/Side EffectsCV: BRADYCARDIA, HF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction Derm: rash EENT: blurred vision, stuffy nose Endo: hyperglycemia, hypoglycemia GI: constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, ↑ liver enzymes, nausea, vomiting GU: erectile dysfunction, ↓ libido, urinary frequency MS: arthralgia, back pain, joint pain Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares Resp: bronchospasm, wheezing Misc: drug-induced lupus syndrome * CAPITALS indicate life-threatening. InteractionsDrug-Drug
Route/DosageWhen switching from immediate-release to extended-release product, the same total daily dose can be used PO (Adults): Hypertension/angina– 25–100 mg/day as a single dose initially or 2 divided doses; may be ↑ every 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). Extended-release products are given once daily. MI– 25–50 mg (starting 15 min after last IV dose) every 6 hr for 48 hr, then 100 mg twice daily. Heart failure– 12.5–25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day. Migraine prevention– 50–100 mg 2–4 times daily (unlabeled). IV (Adults): MI– 5 mg every 2 min for 3 doses, followed by oral dosing. PO (Children ≥6 yr): Hypertension– 1 mg/kg once daily (extended-release capsules); may be titrated, as needed (not to exceed 50 mg/day). Availability (generic available)Tablets (tartrate): 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg Cost: Generic: All strengths $7.18/100 Extended-release capsules (succinate; Kapspargo Sprinkle): 25 mg, 50 mg, 100 mg, 200 mg Extended-release tablets (succinate; Toprol XL): 25 mg, 50 mg, 100 mg, 200 mg Cost: Generic: 25 mg $35.68/100, 50 mg $41.93/100, 100 mg $53.95/100, 200 mg $84.54/100 Solution for injection: 1 mg/mL In Combination with: hydrochlorothiazide (Dutoprol, Lopressor HCT). See combination drugs. Assessment
Lab Test Considerations: May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
Implementation
IV Administration
Patient/Family Teaching
Evaluation/Desired Outcomes
metoprolol is a sample topic from the Davis's Drug Guide. To view other topics, please log in or purchase a subscription. Nursing Central is an award-winning, complete mobile solution for nurses and students. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Complete Product Information. What should the nurse assess before giving a beta blocker?Cardiovascular: It's imperative to assess baseline blood pressure and heart rate prior to giving beta blockers to clients. Those with bradycardia (HR < 60 bpm) or systolic blood pressure (SBP < 100 mmHg) should avoid using beta blockers.
Which of the following is a priority to assess before administering a beta blocker to a patient?Because beta blockers lower the heart rate and blood pressure, you will need to monitor your patient for bradycardia and hypotension, including orthostatic hypotension. With that said, always get a blood pressure and heart rate prior to giving the dose.
Which condition is an absolute contraindication to taking beta blockers?CONTRAINDICATIONS TO BETA BLOCKERS
Beta blockers should not be administered to patients with heart failure who have bradycardia, heart block or hemodynamic instability.
When administering a medication that stimulates the beta 1 adrenergic receptors in the heart which clinical manifestations does the nurse anticipate?The most common side effects are changes in heart rate and blood pressure. Selective binding to beta-1 receptors commonly causes tachycardia, palpitations, and hypertension.
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