Autonomic Nervous System Regulation
4.13 Beta-1 Antagonists
Metoprolol is a selective Beta-1 antagonist.
Mechanism of Action: Metoprolol primarily blocks Beta-1 receptors in the heart, causing decreased heart rate and decreased blood pressure. However, higher doses can also block Beta-2 receptors in the lungs, causing bronchoconstriction.
Indications for Use: Metoprolol is commonly used to treat high blood pressure, chest pain due to poor blood flow to the heart, as an early intervention during a myocardial infarction (MI), and in several heart conditions involving an abnormally fast heart rate.
Nursing Considerations Across the Lifespan: Beta-1 antagonists can be given to pediatric and older adult clients, but doses should be individualized based on client response.
Do not crush extended-release (ER) formulations. Always check client’s apical pulse rate before giving drug. Withhold the drug and call the prescriber immediately if the heart rate is slower than 60 beats/minute, unless other parameters are provided. In diabetic clients, monitor glucose level closely because the drug masks common signs and symptoms of hypoglycemia. The most serious potential adverse effects are shortness of breath, bradycardia, and worsening heart failure. Other adverse effects include fatigue, dizziness, depression, insomnia, nightmares, gastrointestinal upset, erectile dysfunction, dyspnea, and wheezing.
Safety Warning: When stopping therapy, the dosage should be tapered over 1 to 2 weeks because abrupt discontinuation may cause chest pain or myocardial infarction (MI).
Patient Teaching & Education: Patients should be instructed to take the medication as prescribed. They should be advised that abrupt cessation of medication therapy may result in life-threatening cardiac arrhythmias. Patients should also be taught how to self-check pulse and blood pressure to assess the effectiveness of medication therapy. Additionally, they should be cautioned against sudden changes in position due to orthostatic blood pressure changes. Patients may experience increased sensitivity to cold and should be cautioned to avoid caffeinated substances.[1]
Metoprolol Medication Card
Now let’s take a closer look at the medication card for metoprolol.[2][3] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
Medication Card 4.13.1: Metoprolol
Class: Beta-1 Antagonist
Prototypes: Metoprolol
Therapeutic Effects
- Selective beta-1 blocker
- Decreases blood pressure or controls rapid heart rate
Administration
- IV and PO
- always assess apical HR prior to administration
Indications
- Angina: Long-term treatment of angina pectoris.
- Heart failure with reduced ejection fraction (ER oral formulation): Treatment of stable, symptomatic heart failure
- Hypertension: Management of hypertension.
- Myocardial infarction: Treatment of hemodynamically stable acute myocardial infarction to reduce cardiovascular mortality
Side Effects
- bradycardia
- hypotension
- worsening heart failure
- CNS: fatigue, dizziness, depression, insomnia, nightmares
- GI upset
- GU: erectile dysfunction
- Respiratory: dyspnea and wheezing
Nursing Considerations
- Always assess apical HR and if less than 60, do not administer and call the prescriber unless other parameters are provided
- Monitor blood sugar in diabetic patients because drug can mask symptoms of hypoglycemia
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain. ↵
- UpToDate (2021). Metoprolol. https://www.uptodate.com/contents/search ↵