Nonselective Alpha & Beta Blockers

• These are non-selective drugs.
• competitively block norepinephrine at alpha & beta receptors
• called sympatholytic drugs b/c they lyse or block SNS effects to prevent S&S associated w/ sympathetic stress reaction
•       ↓ HR & ↓ BP
•       ↑ renal perfusion & ↓ renin levels

Indications

• primarily used to treat cardiac conditions i.e essential HTN (usually adjunct w/ diuretics)

Contraindications

• brady or heart block
• shock or CHF
• pregnancy & lactation

Cautions

• bronchospasm & resp distress
•        (due to loss of NE bronchodilation effects)

Adverse Effects

• arrhythmia, hypotension, CHF
• pulm edema, bronchospasm, dyspnea
• dizziness, vertigo
• insomnia, fatigue
• N/V, gastric pain

Kinetics

• Well absorbed
• Metabolized in the liver and excreted in the urine & feces

Drugs
1. Amiodarone (Cordarone)

• antiarrhythmic agent 
• reserved for emergency use

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2. Carvedilol (Coreg)

• indicated for HF, MI, HTN, left ventricle dysfunction

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3. Labetalol (Normodyne)

• indicated for HTN
• control of BP in pheochromocytoma 
• used for clonidine withdrawal HTN

Nursing Mgmt for All A&B Agonists

• monitor diabetic pt closely: these drugs also mask S&S hypoglycemic & hyperglycemia
•        priority for diabetic pt is to monitor glucose over pulse; priority for most pt on adrenergic blockers is to monitor pulse 
• monitor vitals + blood glucose + liver/kidney function
• educate pt about AE, re-educate diabetics about glucose monitoring
• find out pt herbal drug use:
•        Ginseng = ↑ anti-HTN effects (risk hypotension, CNS effects)
•        Xuan shen, nightshade = ↓ HR (risk severe brady, reflex tachy)
•        Celery, Xuan shen, coriander = ↓ glucose (inc risk hypoglycemia)
•        Saw palmetto = ↑ risk urinary tract complications