Beta Blockers

Beta Blockers Nursing Pharmacology and Care Plans

Beta Blockers NCLEX Review Care Plans

Nursing Pharmacology Study Guide: Beta Blockers

Beta-adrenergic blocking agents, commonly known as beta blockers, are medications used to reduce blood pressure and are often prescribed to treat cardiac problems.

They work by blocking the effects of adrenaline, also called epinephrine, which is “the fight or flight” hormone. Beta blockers may affect the heart and blood vessels.

They reduce the blood pressure by slowing down the heart rate and contractility, as well as by improving blood flow by dilating veins and arteries.

Beta blockers provide various clinical benefits but may also pose a risk for adverse effects if not properly monitored.

Beta blockers are classified into three categories: non-selective, cardio-selective, and third-generation.

They can be administered orally, intravenously, or intramuscular route, they are also available in ophthalmic form.

Several factors are taken into consideration prior to prescribing which type of beta blockers will be used for a patient.

These factors include the type of condition currently being treated, potential side effects, and other conditions or medications that the patient is already taking.

Glucagon is the antidote in case of beta blocker toxicity.

Indications for Beta Blockers

Beta blockers are used in conjunction with other medications to reduce blood pressure.

Although they are used for the treatment of cardiovascular diseases, they are not recommended as first line treatment for hypertension alone and are often prescribed when other medications like diuretics are ineffective.

The effectiveness of beta blockers may be affected by age as they may not be as effective for older people, especially when used as a single agent.

Beta blockers are indicated for the treatment of arrhythmia because of their ability to slow down the heart rate.

They are also used to reduce mortality for patients who have recovered from heart attacks and congestive heart failure.

Beta blockers are also indicated to treat symptoms of cardiac-related conditions such as angina, postural tachycardia syndrome, coronary artery disease, portal hypertension, and aortic dissection.

They may also be used to treat other conditions such as migraine, glaucoma, and certain types of tremors.

Actions of Beta blockers

Beta blockers block the effect of beta-adrenergic stimuli of epinephrine and norepinephrine by binding to beta-adrenoceptors that found in the cardiac nodal tissue and inhibiting their normal sympathetic effects.

Beta-adrenoceptors are related to GS-proteins, which increase heart rate and contractility by increasing calcium absorption into the cells.

Beta blockers antagonize their effects, preventing the binding of epinephrine and norepinephrine to these receptors.

The first-generation beta blockers block both beta-1 and beta-2 receptors, as compared to the second-generation beta blockers, which block only beta-1 adrenoceptors.

The third generation of beta blockers blocks alpha-adrenoceptors, thereby producing vasodilation effects.

Side Effects and Adverse Reactions of Beta blockers

Although beta blockers are relatively safe and effective, they can still produce some side effects, just like most medications.

Due to the presence of baroreceptors all throughout the body, physiologic side effects can be very broad.  

The frequent side effects of beta blockers are fatigue, dizziness, poor circulation which is due to low blood pressure that is triggered by a decrease in heart rate.

They may also cause gastrointestinal problems such as stomach upset, constipation and diarrhea. Other side effects of taking beta blockers include sexual dysfunction weight gain, and cold extremities.

Beta blockers commonly cause bradycardia and hypotension as a result of their cardiac mechanism.

The side effects that are less common include depression, shortness of breath and disturbances in sleeping pattern.

The adverse effects of beta blockers may consist of bronchospasm, increased insulin resistance, prolonged QT intervals and an increased risk of heart block.

Contraindications and Cautions for Beta Blockers

Beta blockers have a US FDA Category of C, and should be used with caution during pregnancy.

However, they are effective for treating tachycardia and arrhythmias in mother and fetus.

Beta blockers are generally contraindicated in patients with asthma and chronic obstructive pulmonary disease (COPD) because they can cause bronchospasm.

They should be avoided in patients with Raynaud’s disease due to the risk of exacerbation.

Because beta blockers reduce heart rate and exercise capacity, they are also contraindicated for patients with sinus bradycardia, partial and high degree AV block. 

It is necessary for people with diabetes to monitor blood sugar levels when taking beta blockers because they can hinder signs of hypoglycemia.

These medications may also cause a slight elevation of triglycerides, so they are important to monitor cholesterol and triglycerides levels.

Alcohol consumption must be avoided during the course of treatment, because alcohol can lower the blood pressure, increase dizziness, and pose the risk for sudden hypotension.

Beta blockers should not be discontinued abruptly as doing so may increase the likelihood of a heart attack and other cardiac problems.

Drug Interactions with Beta blockers

Beta-blockers can interact with other medications commonly administered such as antihypertensive drugs, antianginals, insulin and other medications for diabetes, non-steroidal inflammatory drugs (NSAIDs) and certain antibiotics like rifampicin.

They may also have an interaction with other drugs such as anesthetics, anti-ulcer medications, antidepressants, anti-lipidemic, decongestants, and medications used to treat asthma, chronic obstructive pulmonary disease and Parkinson’s disease.

Nursing Care Plan for Patients on Beta Blockers

Possible Nursing Diagnoses:

Decreased Cardiac Output related to the mechanism of action of beta blockers

Risk for Bowel Incontinence related to side effect of beta blockers

Risk for Constipation related to side effect of beta blockers

Deficient knowledge related to beta blockers

Nursing Assessment

Nursing InterventionRationale
Assess the patient for signs and symptoms of hypertension, angina, arrhythmia, tachycardia, or other cardiac symptoms.To confirm the indication for administering beta blockers.
Assess if the patient has COPD, Raynaud’s disease, AV block, hypotension, or sinus bradycardia.Beta blockers are generally contraindicated in patients with asthma and chronic obstructive pulmonary disease (COPD) because they can cause bronchospasm. They should be avoided in patients with Raynaud’s disease due to the risk of exacerbation. Because beta blockers reduce heart rate and exercise capacity, they are also contraindicated for patients with sinus bradycardia, partial and high degree AV block.
Check the patient’s allergy status.Previous allergic reaction to beta blockers may render the patient unable to take them. Alternatives to beta blockers should therefore be considered in case of allergy.
Assess if the patient is pregnant or lactating.Beta blockers should be prescribed in caution to a pregnant woman as these drugs can potentially decrease placental perfusion.
Perform a focused physical assessment on the patient’s heart through and auscultation of heart sounds.To confirm the indication for administering beta blockers.  
Assess the patient’s mucous membranes and his/her ability to swallow.To check for any potential problems with administration, hydration, and absorption.
To ensure that the right form of beta blockers is given.
Collect bloods for triglycerides and blood glucose levels.Beta blockers should be used cautiously in patients with diabetes.

Nursing Planning and Intervention

Nursing InterventionRationale
Administer beta blockers ideally with meals and/or at bedtime.To ensure optimal absorption and therapeutic action by beta blockers, as well as reduce possible side effects.
Administer beta blockers about 1 hour before or 2 hours after administering other oral medications, as prescribed.Ideal spacing of beta blockers and other oral medications will ensure adequate absorption of the drugs administered.  
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking beta blockers. Instruct the patient on how to self-administer beta blockers.To inform the patient on the basics of beta blockers, as well as to empower him/her to safely self-administer the medication.
Monitor the patient’s input and output and commence stool chart.Beta blockers may cause diarrhea or constipation. Early detection of either side effect can help institute a bowel program and relieve them effectively.
Discourage intake of fish oil, grape juice, and orange juice with beta blockers.Fish oil can enhance hypotensive effect of beta blockers. Grape juice and orange juice can affect the potency of the drugs.
Encourage tobacco smoking sensation and reduction of alcohol consumption.Tobacco smoking and alcohol can reduce the benefits of beta blockers.
Encourage the patient to change position slowly.To prevent orthostatic hypotension.
Advise the patient not to break or crush the medications, unless it is safe to do so.Sustained release beta blocker tablets should not be broken or crushed as doing so may affect the potency of the drugs.

Nursing Evaluation

Nursing InterventionRationale
Ask the patient to repeat the information about beta blockers.To evaluate the effectiveness of health teaching on beta blockers.
Monitor the patient’s triglycerides and blood glucose levels.To ensure that the beta blockers did not cause any electrolyte imbalance of renal dysfunction.  
Monitor the patient’s response to beta blockers in terms of side effects, especially blood pressure and GI status.To check for any hypotension, bradycardia, or GI side effects, as well as to see if the beta blockers are effective or should be shifted to other medications due to an allergic reaction, severe side effects or adverse reactions.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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