Beta-1 Selective Blockers

• Do not usually block beta-2 receptor sites, including sympathetic bronchodilation 
• Preferred for patients who smoke or have asthma, obstructive pulmonary disease, or seasonal /  allergic rhinitis

Indications

• HTN
• angina
• some cardiac arrhythmias
• open-angle glaucoma

Contraindications

• brady, heart block
• shock, CHF, hypotension

Cautions

• COPD
• DM, thyroid disease

Adverse Effects

• CNS: Fatigue, dizziness, sleep disturbances
• CV: Bradycardia, heart block, CHF, hypotension
• Resp: Sx in resp tract (range from rhinitis to bronchospasm)
• GI: N/V, diarrhea
• ↓ libido and impotence

Kinetics

• absorbed from GI
• metabolized in liver and are excreted in the urine

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Drugs
Atenolol (Tenormin)

• Tx MI, angina 
• most used drug in its class for HTN

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Drug Interactions

• ↓ HTN effects w/ clonidine, NSAIDs, rifampin 
• ↑ toxicity IV lidocaine if given w/ these drugs
• ↑ risk orthostatic hypotension w/ prazosin

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Nursing Mgmt for All A&B Agonists

• Check apical pulse before PO admin, esp. in pt receiving digitalis (both drugs slow AV conduction)
•       If < 60 bpm, withhold dose & consult physician
• Monitor apical pulse, BP, respirations, & peripheral circulation throughout dosage adjustment period. Consult physician for acceptable parameters. 
• Sudden d/c of drug can exacerbate HTN, angina, & precipitate tachycardia or MI in pt w/ CAD, & thyroid storm in pt w/ hyperthyroidism – due to being hypersensitive to catecholamines