Autonomic Nervous System Regulation
4.15 Beta-2 Antagonists
Propranolol is a Beta-2 antagonist.
Mechanism of Action: Propranolol is a nonselective beta-blocker because of its inhibition of both Beta-1 and Beta-2 receptors.
Indications for Use: Propranolol is used to treat high blood pressure, angina, various heart dysrhythmias (to lower the heart rate), and essential tremors. It is also used after a myocardial infarction to reduce mortality by decreasing heart workload, and in migraine prevention.
Nursing Considerations Across the Lifespan: Nonselective beta blockers must be used cautiously with clients who have co-existing asthma or chronic obstructive pulmonary disease (COPD) because of the effects on Beta-2 receptors that could potentially cause bronchoconstriction. It can also mask symptoms of hypoglycemia in diabetics. Use with caution in clients with impaired hepatic or renal function. Give immediate-release (IR) formulations on an empty stomach. Do not crush extended-release (ER) formulations. Propranolol ER is not considered a simple milligram-for-milligram substitute for conventional propranolol. Check blood pressure and apical pulse before giving drug; withhold and notify prescriber if apical pulse is less than 60 beats per minute or systolic blood pressure is less than 100 mm Hg, unless other parameters are provided. During IV administration, monitor blood pressure, ECG, and heart rate frequently. The most serious adverse effects include bronchoconstriction, hypotension, bradycardia, and signs of worsening heart failure. Other adverse effects are similar to selective beta blockers like metoprolol.
Propranolol is safe to give to pediatric clients, with dose adjustments made according to response to medication. No dose adjustments are needed for renal or liver dysfunction.
Safety Warning: Abrupt withdrawal of this drug may cause exacerbation of angina or a myocardial infarction. To discontinue this drug, gradually reduce dosage over 1 to 2 weeks.
Patient Teaching & Education: Clients should be instructed to follow the medication dosing regimen. Stopping medication therapy abruptly may cause life-threatening arrhythmias. Clients should be instructed on how to self-assess pulse and blood pressure to evaluate medication effectiveness. The medication may cause increased susceptibility to orthostatic blood pressure changes and increased sensitivity to cold.[1]
Propranolol Medication Card
Now let’s take a closer look at the medication Card for propranolol.[2] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
Medication Card 4.15.1: Propranolol
Class: Beta-2 Antagonist
Prototypes: Propranolol
Therapeutic Effects
- Decrease blood pressure and heart rate
- Prevent migraines
- Manage tremors
Administration
- Give immediate release formulations on an empty stomach
- Do not crush ER formulations
- Contraindicated in patients with asthma, COPD, or bradycardia
- Use cautiously in patients who have diabetes mellitus because drug masks some symptoms of hypoglycemia
- Use with caution in patients with impaired hepatic or renal function
- During IV administration, monitor blood pressure, ECG, and heart rate frequently
Indications
- Angina, chronic stable: To decrease angina frequency and increase exercise tolerance in patients with angina pectoris.
- Cardiac arrhythmias: Control of supraventricular arrhythmias (eg, atrial fibrillation and flutter, atrioventricular nodal reentrant tachycardia) and ventricular tachycardias
- Essential tremor: Management of familial or hereditary essential tremor.
- Hypertension: Management of hypertension.
- Migraine headache prophylaxis
- Myocardial infarction, early treatment and secondary prevention.
Side Effects
- Bronchoconstriction
- Hypotension
- Bradycardia
- Worsening heart failure
- Other adverse effects similar to metoprolol
Nursing Considerations
- Check BP and apical pulse before giving drug; withhold and notify prescriber if apical pulse is less than 60 or systolic blood pressure is less than 100 unless other parameters are provided
- Monitor BP, HR frequently
- Abrupt withdrawal of drug may cause exacerbation of angina or myocardial infarction. To discontinue drug, gradually reduce dosage over 1 to 2 weeks
- 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. ↵