Metoprolol Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Metoprolol

Brand Name: Apo-Metoprolol (CAN), Betaloc (CAN), Lopresor (CAN), Lopressor, Novometoprol (CAN), Nu-Metop (CAN), Toprol-XL

Pregnancy Category C

Drug classes: Beta1-selective adrenergic blocker, Antihypertensive

Therapeutic actions

Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.

Indications

· Hypertension, alone or with other drugs, especially diuretics

· Prevention of reinfarction in MI patients who are hemodynamically stable or within 3–10 days of the acute MI (immediate-release tablets and injection)

· Treatment of angina pectoris

· Treatment of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin (Toprol-XL only)

Contraindications

· Contraindicated with sinus bradycardia (HR <> 0.24 sec), cardiogenic shock, CHF, systolic BP <>

Adverse effects

Pharyngitis, erythematous rash, fever, sore throat, laryngospasm

Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech

CHF, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension

Rash, pruritus, sweating, dry skin

Eye irritation, dry eyes, conjunctivitis, blurred vision

Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis

Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination

Drug Interactions:

· Increased effects of metoprolol with verapamil, cimetidine, methimazole, propylthiouracil

· Increased effects of both drugs if metoprolol is taken with hydralazine

· Increased serum levels and toxicity of IV lidocaine, if given concurrently

· Increased risk of orthostatic hypotension with prazosin

· Decreased antihypertensive effects if taken with NSAIDs, clonidine, rifampin

· Decreased therapeutic effects with barbiturates

· Hypertension followed by severe bradycardia if given concurrently with epinephrine

Nursing considerations

· Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring.

· Ensure that patient swallows the ER tablets whole; do not cut, crush, or chew.

· Consult physician about withdrawing drug if patient is to undergo surgery (controversial).

· Give oral drug with food to facilitate absorption.

· Provide continual cardiac monitoring for patients receiving IV metoprolol.