adrenergic blockers

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Drugs Affecting TheDrugs Affecting The
Autonomic Nervous SystemAutonomic Nervous System
Adrenergic Agents andAdrenergic Agents and
Adrenergic-Blocking AgentsAdrenergic-Blocking Agents

Instructors may choose to insertInstructors may choose to insert
EIC Image #48:EIC Image #48:
The Sympathetic Nervous SystemThe Sympathetic Nervous System
in Relationship to the Entirein Relationship to the Entire
Nervous SystemNervous System

Adrenergic AgentsAdrenergic Agents
• Drugs that stimulate the sympathetic nervousDrugs that stimulate the sympathetic nervous
system (SNS)system (SNS)

Also known asAlso known as
• adrenergic agonists or sympathomimeticsadrenergic agonists or sympathomimetics

Mimic the effects of the SNS neurotransmitters:Mimic the effects of the SNS neurotransmitters:
• norepinephrine (NE) and epinephrine (EPI)norepinephrine (NE) and epinephrine (EPI)

Adrenergic ReceptorsAdrenergic Receptors
• Located throughout the bodyLocated throughout the body
• Are receptors for the sympatheticAre receptors for the sympathetic
neurotransmittersneurotransmitters
Alpha-adrenergic receptors: respond to NEAlpha-adrenergic receptors: respond to NE
Beta-adrenergic receptors: respond to EPIBeta-adrenergic receptors: respond to EPI

Alpha-Adrenergic ReceptorsAlpha-Adrenergic Receptors
• Divided into alpha1 and alphaDivided into alpha1 and alpha22 receptorsreceptors
• Differentiated by their location on nervesDifferentiated by their location on nerves

AlphaAlpha11-Adrenergic Receptors-Adrenergic Receptors
• Located on postsynaptic effector cellsLocated on postsynaptic effector cells
(the cell, muscle, or organ that the nerve(the cell, muscle, or organ that the nerve
stimulates)stimulates)

AlphaAlpha22-Adrenergic Receptors-Adrenergic Receptors
• Located on presynaptic nerve terminalsLocated on presynaptic nerve terminals
(the nerve that stimulates the effector cells)(the nerve that stimulates the effector cells)
• Control the release of neurotransmittersControl the release of neurotransmitters

The predominant alpha-adrenergicThe predominant alpha-adrenergic
agonist responses are:agonist responses are:
• Vasoconstriction and CNS stimulationVasoconstriction and CNS stimulation

Beta-Adrenergic ReceptorsBeta-Adrenergic Receptors
All are located on postsynaptic effector cellsAll are located on postsynaptic effector cells
• BetaBeta11-adrenergic receptors—located primarily-adrenergic receptors—located primarily
in the heartin the heart
• BetaBeta22-adrenergic receptors—located in smooth-adrenergic receptors—located in smooth
muscle of the bronchioles, arterioles, and visceralmuscle of the bronchioles, arterioles, and visceral
organsorgans

The beta-adrenergic agonistThe beta-adrenergic agonist
response results in:response results in:
• Bronchial, GI, and uterine smooth muscleBronchial, GI, and uterine smooth muscle
relaxationrelaxation
• GlycogenolysisGlycogenolysis
• Cardiac stimulationCardiac stimulation

Dopaminergic ReceptorsDopaminergic Receptors
• An additional adrenergic receptorAn additional adrenergic receptor
• Stimulated by dopamineStimulated by dopamine
• Causes dilation of the following bloodCauses dilation of the following blood
vessels, resulting in INCREASED blood flowvessels, resulting in INCREASED blood flow
– RenalRenal
– MesentericMesenteric
– CoronaryCoronary
– CerebralCerebral

Adrenergic Receptor ResponsesAdrenergic Receptor Responses
to Stimulationto Stimulation
LOCATIONLOCATION RECEPTORRECEPTOR RESPONSERESPONSE
CardiovascularCardiovascular
Blood vesselsBlood vessels alphaalpha11 and betaand beta22 Constriction /Constriction /
dilationdilation
Cardiac muscleCardiac muscle betabeta11 IncreasedIncreased
contractilitycontractility
AV NodeAV Node betabeta11 IncreasedIncreased
heart rateheart rate
SA NodeSA Node betabeta11 IncreasedIncreased
heart rateheart rate

GastrointestinalGastrointestinal
MuscleMuscle betabeta22 DecreasedDecreased
motilitymotility
SphinctersSphincters alphaalpha11 ConstrictionConstriction

GenitourinaryGenitourinary
BladderBladder alphaalpha11 ConstrictionConstriction
sphinctersphincter
PenisPenis alphaalpha11 EjaculationEjaculation
UterusUterus alphaalpha11 and betaand beta22 Contraction/Contraction/
relaxationrelaxation

RespiratoryRespiratory
BronchialBronchial betabeta22 Dilation/relaxationDilation/relaxation
musclesmuscles

CatecholaminesCatecholamines
Substances that can produce a sympathomimeticSubstances that can produce a sympathomimetic
responseresponse
Endogenous:Endogenous:
• epinephrine, norepinephrine,dopamineepinephrine, norepinephrine,dopamine
Synthetic:Synthetic:
• isoproterenol, dobutamine, phenylephrineisoproterenol, dobutamine, phenylephrine

Mechanism of ActionMechanism of Action
Direct-acting sympathomimetic:Direct-acting sympathomimetic:
• Binds directly to the receptor and causes aBinds directly to the receptor and causes a
physiologic responsephysiologic response

Direct-Acting SympathomimeticsDirect-Acting Sympathomimetics

Indirect-acting sympathomimetic:Indirect-acting sympathomimetic:
• Causes the release of catecholamine from theCauses the release of catecholamine from the
storage sites (vesicles) in the nerve endingsstorage sites (vesicles) in the nerve endings
• The catecholamine then binds to the receptors andThe catecholamine then binds to the receptors and
causes a physiologic responsecauses a physiologic response

Indirect-Acting SympathomimeticsIndirect-Acting Sympathomimetics

Mixed-acting sympathomimetic:Mixed-acting sympathomimetic:
• Directly stimulates the receptor by bindingDirectly stimulates the receptor by binding
to itto it
ANDAND
• Indirectly stimulates the receptor by causingIndirectly stimulates the receptor by causing
the release of stored neurotransmitters fromthe release of stored neurotransmitters from
the vesicles in the nerve endingsthe vesicles in the nerve endings

Mixed-Acting SympathomimeticsMixed-Acting Sympathomimetics

Drug Effects of Adrenergic AgentsDrug Effects of Adrenergic Agents
Stimulation of alpha-adrenergic receptors onStimulation of alpha-adrenergic receptors on
smooth muscles results in:smooth muscles results in:
• Vasoconstriction of blood vesselsVasoconstriction of blood vessels
• Relaxation of GI smooth musclesRelaxation of GI smooth muscles
• Contraction of the uterus and bladderContraction of the uterus and bladder
• Male ejaculationMale ejaculation
• Decreased insulin releaseDecreased insulin release
• Contraction of the ciliary muscles of the eyeContraction of the ciliary muscles of the eye
(dilated pupils)(dilated pupils)

Stimulation of betaStimulation of beta22-adrenergic receptors on-adrenergic receptors on
the airways results in:the airways results in:
• Bronchodilation (relaxation of the bronchi)Bronchodilation (relaxation of the bronchi)
• Uterine relaxationUterine relaxation
• Glycogenolysis in the liverGlycogenolysis in the liver

Stimulation of beta1-adrenergic receptors onStimulation of beta1-adrenergic receptors on
the myocardium, AV node, and SA nodethe myocardium, AV node, and SA node
results in CARDIAC STIMULATION:results in CARDIAC STIMULATION:
• Increased force of contractionIncreased force of contraction
(positive(positive inotropicinotropic effect)effect)
• Increased heart rateIncreased heart rate
(positive(positive chronotropicchronotropic effect)effect)
• Increased conduction through the AV nodeIncreased conduction through the AV node
(positive(positive dromotropicdromotropic effect)effect)

Adrenergic Agents:Adrenergic Agents:
Therapeutic UsesTherapeutic Uses
• Anorexiants: adjuncts to diet in theAnorexiants: adjuncts to diet in the
short-term management of obesityshort-term management of obesity
Examples:Examples: benzphetaminebenzphetamine
phenterminephentermine
dextroamphetaminedextroamphetamine
DexedrineDexedrine

Bronchodilators: treatment of asthma andBronchodilators: treatment of asthma and
bronchitisbronchitis
• Agents that stimulate betaAgents that stimulate beta22-adrenergic receptors-adrenergic receptors
of bronchial smooth muscles causing relaxationof bronchial smooth muscles causing relaxation
Examples:Examples:
albuterolalbuterol ephedrineephedrine epinephrineepinephrine
isoetharineisoetharine isoproterenolisoproterenol levalbuterollevalbuterol
metaproterenolmetaproterenol salmeterolsalmeterol terbutalineterbutaline
• These agents may also affect uterine and vascularThese agents may also affect uterine and vascular
smooth muscles.smooth muscles.

• Reduction of intraocular pressure andReduction of intraocular pressure and
mydriasis (pupil dilation): treatment ofmydriasis (pupil dilation): treatment of
open-angle glaucomaopen-angle glaucoma
Examples:Examples: epinephrine and dipivefrinepinephrine and dipivefrin

Nasal decongestant:Nasal decongestant:
• Intranasal (topical) application causes constrictionIntranasal (topical) application causes constriction
of dilated arterioles and reduction of nasal bloodof dilated arterioles and reduction of nasal blood
flow, thus decreasing congestion.flow, thus decreasing congestion.
Examples:Examples:
epinephrineepinephrine ephedrineephedrine naphazolinenaphazoline
phenylephrinephenylephrine tetrahydrozolinetetrahydrozoline

OphthalmicOphthalmic
• Topical application to the eye surface affectsTopical application to the eye surface affects
the vasculature of the eye, stimulating alphathe vasculature of the eye, stimulating alpha
receptors on small arterioles, thus relievingreceptors on small arterioles, thus relieving
conjunctival congestion.conjunctival congestion.
Examples:Examples: epinephrineepinephrine naphazolinenaphazoline
phenylephrinephenylephrine tetrahydrozolinetetrahydrozoline

Vasoactive sympathomimetics (pressors,Vasoactive sympathomimetics (pressors,
inotropes), also called cardioselectiveinotropes), also called cardioselective
sympathomimeticssympathomimetics
• Used to support the heart during cardiac failureUsed to support the heart during cardiac failure
or shock.or shock.
Examples:Examples:
dobutaminedobutamine dopaminedopamine ephedrineephedrine
epinephrineepinephrine fenoldopamfenoldopam isoproterenolisoproterenol
methoxaminemethoxamine norepinephrinenorepinephrine phenylephrinephenylephrine

Adrenergic Agents: Side EffectsAdrenergic Agents: Side Effects
Alpha-Adrenergic EffectsAlpha-Adrenergic Effects
• CNS:CNS:
– headache, restlessness, excitement, insomnia,headache, restlessness, excitement, insomnia,
euphoriaeuphoria
• Cardiovascular:Cardiovascular:
– palpitations (dysrhythmias), tachycardia,palpitations (dysrhythmias), tachycardia,
vasoconstriction, hypertensionvasoconstriction, hypertension
• Other:Other:
– anorexia, dry mouth, nausea, vomiting, tasteanorexia, dry mouth, nausea, vomiting, taste
changes (rare)changes (rare)

Adrenergic Agents: Side EffectsAdrenergic Agents: Side Effects
Beta-Adrenergic EffectsBeta-Adrenergic Effects
• CNS:CNS:
– mild tremors, headache, nervousness, dizzinessmild tremors, headache, nervousness, dizziness
• Cardiovascular:Cardiovascular:
– increased heart rate, palpitations (dysrhythmias),increased heart rate, palpitations (dysrhythmias),
fluctuations in BPfluctuations in BP
• Other:Other:
– sweating, nausea, vomiting, muscle crampssweating, nausea, vomiting, muscle cramps

Adrenergic Agents: InteractionsAdrenergic Agents: Interactions
• Anesthetic agentsAnesthetic agents
• Tricyclic antidepressantsTricyclic antidepressants
• MAOIsMAOIs
• AntihistaminesAntihistamines
• Thyroid preparationsThyroid preparations
• AntihypertensivesAntihypertensives
• Will directly antagonize another adrenergicWill directly antagonize another adrenergic
agent, resulting in reduced effectsagent, resulting in reduced effects

Nursing ImplicationsNursing Implications
• Assess for allergies and history ofAssess for allergies and history of
hypertension, cardiac dysrhythmias, or otherhypertension, cardiac dysrhythmias, or other
cardiovascular disease.cardiovascular disease.
• Assess renal, hepatic, and cardiac functionAssess renal, hepatic, and cardiac function
before treatment.before treatment.
• Perform baseline assessment of vital signs,Perform baseline assessment of vital signs,
peripheral pulses, skin color, temperature,peripheral pulses, skin color, temperature,
and capillary refill. Include postural bloodand capillary refill. Include postural blood
pressure and pulse.pressure and pulse.
• Follow administration guidelines carefully.Follow administration guidelines carefully.

IV administration:IV administration:
• Check IV site often for infiltrationCheck IV site often for infiltration
• Use clear IV solutionsUse clear IV solutions
• Use an infusion device/IV pumpUse an infusion device/IV pump
• Infuse agent slowly to avoid dangerousInfuse agent slowly to avoid dangerous
cardiovascular effectscardiovascular effects
• Monitor cardiac rhythmMonitor cardiac rhythm

With chronic lung disease:With chronic lung disease:
• Instruct patients to avoid factors that exacerbateInstruct patients to avoid factors that exacerbate
their condition.their condition.
• Encourage fluid intakeEncourage fluid intake
(up to 3000 mL per day) if permitted.(up to 3000 mL per day) if permitted.
• Educate about proper dosing andEducate about proper dosing and
equipment care.equipment care.
Salmeterol is indicated for PREVENTIONSalmeterol is indicated for PREVENTION
of bronchospasms, not managementof bronchospasms, not management
of acute symptoms.of acute symptoms.

• Overuse of nasal decongestants may cause reboundOveruse of nasal decongestants may cause rebound
nasal congestion or ulcerations.nasal congestion or ulcerations.
• Avoid OTC or other medications because of possibleAvoid OTC or other medications because of possible
interactions.interactions.
• Administering two adrenergic agents together mayAdministering two adrenergic agents together may
precipitate severe cardiovascular effects such asprecipitate severe cardiovascular effects such as
tachycardia or hypertension.tachycardia or hypertension.
• Inform patients taking inhaled isoproterenol thatInform patients taking inhaled isoproterenol that
their sputum or saliva may turn pink.their sputum or saliva may turn pink.

Monitor for therapeutic effectsMonitor for therapeutic effects
(cardiovascular uses):(cardiovascular uses):
• Decreased edemaDecreased edema
• Increased urinary outputIncreased urinary output
• Return to normal vital signsReturn to normal vital signs
• Improved skin color and temperatureImproved skin color and temperature
• Increased LOCIncreased LOC

Monitor for therapeutic effects (asthma):Monitor for therapeutic effects (asthma):
• Return to normal respiratory rateReturn to normal respiratory rate
• Improved breath sounds, fewer ralesImproved breath sounds, fewer rales
• Increased air exchangeIncreased air exchange
• Decreased coughDecreased cough
• Less dyspneaLess dyspnea
• Improved blood gasesImproved blood gases
• Increased activity toleranceIncreased activity tolerance

Adrenergic-Blocking AgentsAdrenergic-Blocking Agents
• Bind to adrenergic receptors, but inhibit orBind to adrenergic receptors, but inhibit or
block stimulation of the sympathetic nervousblock stimulation of the sympathetic nervous
system (SNS)system (SNS)

Adrenergic Blocking AgentsAdrenergic Blocking Agents
• Have the opposite effect of adrenergicHave the opposite effect of adrenergic
agentsagents
• Also known asAlso known as
– adrenergic antagonists or sympatholyticsadrenergic antagonists or sympatholytics

• Sympatholytics inhibit—or LYSE—Sympatholytics inhibit—or LYSE—
sympathetic neurotransmitterssympathetic neurotransmitters
(norepinephrine and epinephrine)(norepinephrine and epinephrine)

Classified by the type of adrenergic receptorClassified by the type of adrenergic receptor
they blockthey block
• AlphaAlpha11 and alphaand alpha22 receptorsreceptors
• BetaBeta11 and betaand beta22 receptorsreceptors

Alpha-Blocker MechanismsAlpha-Blocker Mechanisms

Adrenergic-Blocking Agents:Adrenergic-Blocking Agents:
Drug Effects and Therapeutic UsesDrug Effects and Therapeutic Uses
Ergot Alkaloids (Alpha-Blockers)Ergot Alkaloids (Alpha-Blockers)
• Constrict dilated arteries going to the brainConstrict dilated arteries going to the brain
(carotid arteries)(carotid arteries)
• Used to treat vascular headaches (migraines)Used to treat vascular headaches (migraines)
• Stimulate uterine contractions by inducingStimulate uterine contractions by inducing
vasoconstrictionvasoconstriction
• Used to control postpartum bleedingUsed to control postpartum bleeding

Alpha-BlockersAlpha-Blockers
• Cause both arterial and venous dilation, reducingCause both arterial and venous dilation, reducing
peripheral vascular resistance and BPperipheral vascular resistance and BP
• Used to treat hypertensionUsed to treat hypertension
• Effect on receptors on prostate gland and bladderEffect on receptors on prostate gland and bladder
decreased resistance to urinary outflow, thusdecreased resistance to urinary outflow, thus
reducing urinary obstruction and relieving effectsreducing urinary obstruction and relieving effects
of BPHof BPH

Alpha-BlockersAlpha-Blockers
• PhentolaminePhentolamine
– Quickly reverses the potent vasoconstrictive effects ofQuickly reverses the potent vasoconstrictive effects of
extravasated vasopressors such as norepinephrine orextravasated vasopressors such as norepinephrine or
epinephrine.epinephrine.
– Restores blood flow and prevents tissue necrosis.Restores blood flow and prevents tissue necrosis.

Side EffectsSide Effects
Alpha BlockersAlpha Blockers
Body SystemBody System Side/Adverse EffectsSide/Adverse Effects
CardiovascularCardiovascular Palpitations, orthostaticPalpitations, orthostatic
hypotension, tachycardia,hypotension, tachycardia,
edema, dysrhythmias, chest painedema, dysrhythmias, chest pain
CNSCNS Dizziness, headache, drowsiness,Dizziness, headache, drowsiness,
anxiety, depression, vertigo,anxiety, depression, vertigo,
weakness, numbness, fatigueweakness, numbness, fatigue

Alpha BlockersAlpha Blockers
GastrointestinalGastrointestinal Nausea, vomiting, diarrhea,Nausea, vomiting, diarrhea,
constipation, abdominal painconstipation, abdominal pain
OtherOther Incontinence, nose bleeding,Incontinence, nose bleeding,
tinnitus, dry mouth, pharyngitis,tinnitus, dry mouth, pharyngitis,
rhinitisrhinitis

Beta BlockersBeta Blockers
• Block stimulation of beta receptors inBlock stimulation of beta receptors in
the SNSthe SNS
• Compete with norepinephrine andCompete with norepinephrine and
epinephrineepinephrine
• Selective and nonselective beta blockersSelective and nonselective beta blockers

Beta ReceptorsBeta Receptors
BetaBeta11 ReceptorsReceptors
• Located primarily on the heartLocated primarily on the heart
• Beta blockers selective for these receptorsBeta blockers selective for these receptors
are called cardioselective beta blockersare called cardioselective beta blockers

Beta ReceptorsBeta Receptors
BetaBeta22 ReceptorsReceptors
• Located primarily on smooth musclesLocated primarily on smooth muscles
of bronchioles and blood vesselsof bronchioles and blood vessels

Nonspecific Beta BlockersNonspecific Beta Blockers
• Beta blockers that block both betaBeta blockers that block both beta11 andand
betabeta22 receptorsreceptors

Beta Blockers: Mechanism of ActionBeta Blockers: Mechanism of Action
Cardioselective (Beta1)Cardioselective (Beta1)
• Decreases heart rateDecreases heart rate
• Prolongs SA node recoveryProlongs SA node recovery
• Slows conduction rate through the AV nodeSlows conduction rate through the AV node
• Decreases myocardial contractility, thusDecreases myocardial contractility, thus
decreasing myocardial oxygen demanddecreasing myocardial oxygen demand

Beta Blockers: Mechanism of ActionBeta Blockers: Mechanism of Action
Nonspecific (BetaNonspecific (Beta11 and Betaand Beta22))
• Effects on heart:Effects on heart: Same as cardioselectiveSame as cardioselective
• Bronchioles:Bronchioles: Constriction, resulting inConstriction, resulting in
narrowing of airways andnarrowing of airways and
shortness of breathshortness of breath
• Blood vessels:Blood vessels: VasoconstrictionVasoconstriction

Beta Blockers: Therapeutic UsesBeta Blockers: Therapeutic Uses
• Anti-angina:Anti-angina: decreases demand fordecreases demand for
myocardial oxygenmyocardial oxygen
• Cardioprotective:Cardioprotective: inhibits stimulation byinhibits stimulation by
circulating catecholaminescirculating catecholamines
• Class II antidysrhythmicClass II antidysrhythmic

Beta Blockers: Therapeutic UsesBeta Blockers: Therapeutic Uses
• AntihypertensiveAntihypertensive
• Treatment of migraine headachesTreatment of migraine headaches
• Glaucoma (topical use)Glaucoma (topical use)

Beta Blockers: Side EffectsBeta Blockers: Side Effects
BloodBlood Agranulocytosis, thrombocytopeniaAgranulocytosis, thrombocytopenia
CardiovascularCardiovascular AV block, bradycardia, congestiveAV block, bradycardia, congestive
heart failure, peripheral vascularheart failure, peripheral vascular
insufficiencyinsufficiency
CNSCNS Dizziness, mental depression,Dizziness, mental depression,
lethargy, hallucinationslethargy, hallucinations

Beta BlockersBeta Blockers
GastrointestinalGastrointestinal Nausea, dry mouth, vomiting,Nausea, dry mouth, vomiting,
diarrhea, cramps, ischemic colitisdiarrhea, cramps, ischemic colitis
OtherOther Impotence, rash, alopecia,Impotence, rash, alopecia,
bronchospasmsbronchospasms

Adrenergic Blocking Agents:Adrenergic Blocking Agents:
• Assess for allergies and history of COPD,Assess for allergies and history of COPD,
hypotension, cardiac dysrhythmias,hypotension, cardiac dysrhythmias,
bradycardia, CHF, or other cardiovascularbradycardia, CHF, or other cardiovascular
problemsproblems
Any preexisting condition that might beAny preexisting condition that might be
exacerbated by the use of these agents mightexacerbated by the use of these agents might
be a CONTRAINDICATION to their use.be a CONTRAINDICATION to their use.

• Remember that alpha blockers mayRemember that alpha blockers may
precipitate hypotension.precipitate hypotension.
• Remember that beta blockers mayRemember that beta blockers may
precipitate bradycardia, hypotension,precipitate bradycardia, hypotension,
heart block, CHF, and bronchoconstriction.heart block, CHF, and bronchoconstriction.

• Avoid OTC medications because of possibleAvoid OTC medications because of possible
interactions.interactions.
• Possible drug interactions may occur with:Possible drug interactions may occur with:
– Antacids (aluminum hydroxide type)Antacids (aluminum hydroxide type)
– Antimuscarinics/anticholinergicsAntimuscarinics/anticholinergics
– Diuretics and cardiovascular drugsDiuretics and cardiovascular drugs
– Neuromuscular blocking agentsNeuromuscular blocking agents
– Oral hypoglycemic agentsOral hypoglycemic agents

• Encourage patients to take medicationsEncourage patients to take medications
as prescribed.as prescribed.
• These medications should never beThese medications should never be
stopped abruptly.stopped abruptly.
• Report constipation or the development ofReport constipation or the development of
any urinary hesitancy or bladder distention.any urinary hesitancy or bladder distention.

• Teach patients to change positions slowly toTeach patients to change positions slowly to
prevent or minimize postural hypotension.prevent or minimize postural hypotension.
• Avoid caffeine (excessive irritability).Avoid caffeine (excessive irritability).
• Avoid alcohol ingestion and hazardousAvoid alcohol ingestion and hazardous
activities until blood levels become stable.activities until blood levels become stable.
• Patients should notify their physician ifPatients should notify their physician if
palpitations, dyspnea, nausea, or vomitingpalpitations, dyspnea, nausea, or vomiting
occur.occur.

Beta Blocking Agents:Beta Blocking Agents:
• Rebound hypertension or chest pain may occur ifRebound hypertension or chest pain may occur if
this medication is discontinued abruptly.this medication is discontinued abruptly.
• Patients should notify their physician if they becomePatients should notify their physician if they become
ill and unable to take medication.ill and unable to take medication.
• Inform patients that they may notice a decrease inInform patients that they may notice a decrease in
their tolerance for exercise; dizziness and faintingtheir tolerance for exercise; dizziness and fainting
may occur with increased activity. Notify themay occur with increased activity. Notify the
physician if these problems occur.physician if these problems occur.

Beta Blocking Agents:Beta Blocking Agents:
Patients should report the following toPatients should report the following to
their physician:their physician:
• Weight gain of more than 2 pounds (1 kg)Weight gain of more than 2 pounds (1 kg)
within a weekwithin a week
• Edema of the feet or anklesEdema of the feet or ankles
• Shortness of breathShortness of breath
• Excessive fatigue or weaknessExcessive fatigue or weakness
• Syncope or dizzinessSyncope or dizziness

Monitor for side effects, including:Monitor for side effects, including:
HypotensionHypotension FatigueFatigue
Tachycardia (alpha blockers)Tachycardia (alpha blockers) LethargyLethargy
BradycardiaBradycardia DepressionDepression
Heart blockHeart block InsomniaInsomnia
CHFCHF Vivid nightmaresVivid nightmares
Increased airway resistanceIncreased airway resistance

Monitor for therapeutic effectsMonitor for therapeutic effects
• Decreased chest pain in patients with anginaDecreased chest pain in patients with angina
• Return to normal BP and PReturn to normal BP and P
• Other specific effects, depending on the useOther specific effects, depending on the use

adrenergic blockers

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