Nonselective Beta Blockers

• competitively block beta receptors in SNS
• its therapeutic effects caused by beta-block in heart & juxtaglomerular apparatus 
•        (-) inotrope, (-) chronotrope, (-) dromotope 
•        this leads to ↓ arrhythmia, ↓ cardiac workload, ↓ O2 consumption
•        & dec BP b/c juxtaglomerular cells not stimulated to secrete renin
• drugs ending in -olol

Indications

• Tx cardiac conditions – HTN, angina, migraine headaches, preventing re-infarction after MI
• off label: anxiety/stage fright

Contraindications

• brady, heart block, shock, CHF
• COPD/asthma (blocks dilation)

Cautions

• diabetes (blocks normal S&S of hyper-/hypoglycemia)
• thyrotoxicosis (b/c blocking effects on thyroid gland)
• hepatic dysfunction

Adverse Effects

• brady, heart block, hypotension, arrhythmia, HF
• bronchospasm, cough
• fatigue, dizziness
• sleep disturbance, depression
• N/V, diarrhea
• ↓ labido, dysuria
• ↓ exercise tolerance / can no longer "get-up-and-go"

Kinetics

• Well absorbed from GI tract
• Metabolized in the liver

Drugs
1. Propranolol (Inderal)

• Patient teaching required:
•       teach pt to take pulse / take pulse before taking med
•       teach pt it blocks S&S hypoglycemia
•       teach about compliance &
•       teach that abrupt d/c can lead to withdrawal syndrome (tremors, sweating, headache, malaise, palpitation, rebound HTN, MI, life-threatening arrhythmia)
•       teach about postural hypotension 

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2. Sotalol (Betapace)

• indicated for life-threatening arrhythmia & maintenance of sinus rhythm w/ AF or a-fib pt

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Drug Interactions

• ↓ effectiveness w/ NSAIDs
• blood glucose changes w/ diabetic meds & insulin
• HTN may occur if given w/ clonidine

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Nursing Mgmt for Nonselective Beta Blockers

• if used LT, do not stop abruptly! (receptors become hypersensitive to catecholamines) – can cause rapid inc BP →  MI / stroke
•        should taper over 2wks
• labs: liver/kidney function, thyroid function, blood glucose