PROPRANOLOL

 Propranolol, sold under the brand name Inderal among others, is a medication of the beta
blocker class. It is used to treat high blood pressure, a number of types of irregular heart rate,
thyrotoxicosis, capillary hemangiomas, performance anxiety, and essential tremors.

INDICATION
 The therapeutic benefits of propranolol for the treatment of hypertension and coronary heart
disease are well documented. For angina pectoris the dose must be determined cautiously for
every individual. The (proven) benefits of propranolol in the long-term prophylaxis following
myocardial infarction may be based on the drug's antiarrhythmic effects. This property can also
be used advantageously for catecholamine excess e.g. for pheochromocytoma or for atrial
fibrillation (combined with digitalis). The long-term results for hypertrophic obstructive
cardiomyopathy are disappointing.
 The treatment of thyrotoxicosis, propranolol not only has beneficial influence on the heart rate
but also on other symptoms (e.g. tremor). Propranolol reduces the risk of bleeding due to
esophageal varices during portal hypertension.
 The use of propranolol is also well documented for the interval treatment of migraine. The drug
can, furthermore, be useful for physical symptoms originating from anxiety states and for
essential (familial) tremor.

CONTRAIDICATION
1. Reversible airways diseases, particularly asthma or chronic obstructive pulmonary disease
(COPD)
 ASTHMA - is a common long-term inflammatory disease of the airways of the lungs.
 COPD - is a type of obstructive lung disease characterized by long-term breathing problems and
poor airflow.
2. Slow heart rate (bradycardia)
 BRADYCARDIA - is a condition typically defined wherein an individual has a resting heart rate of
under 60 beats per minute (BPM) in adults. Bradycardia typically does not cause symptoms until
the rate drops below 50 BPM. When symptomatic, it may cause fatigue, weakness, dizziness,
sweating, and at very low rates, fainting.
3. Sick sinus syndrome
 SICK SINUS SYNDROME - also called sinus dysfunction, or sinoatrial node disease (SND), is a
group of abnormal heart rhythms (arrhythmias) presumably caused by a malfunction of the
sinus node, the heart's primary pacemaker. Tachycardia-bradycardia syndrome is a variant of
sick sinus syndrome in which the arrhythmia alternates between slow and fast heart rates.
Tachycardia-bradycardia syndrome is often associated with ischemic heart disease and heart
valve disease.
4. Atrioventricular block (second- or third-degree)
 ATRIOVENTRICULAR BLOCK - is a type of heart block in which the conduction between the
atria and ventricles of the heart is impaired.
  Second-degree atrioventricular block (AV block) - is a disease of the electrical conduction
system of the heart. It is a conduction block between the atria and ventricles. The presence of
second-degree AV block is diagnosed when one or more (but not all) of the atrial impulses fail to
conduct to the ventricles due to impaired conduction. It is classified as a block of the AV node
and is categorized in between first-degree (slowed conduction) and third degree blocks
(complete block)
 Third-degree atrioventricular block (AV block) - also known as complete heart block, is a
medical condition in which the nerve impulse generated in the sinoatrial node (SA node) in the
atrium of the heart cannot propagate to the ventricles.
5. SHOCK
 Shock - is the state of not enough blood flow to the tissues of the body as a result of problems
with the circulatory system.
6. Severe low blood pressure
 Hypotension - is low blood pressure, especially in the arteries of the left sided systemic
circulation.
7. Cocaine toxicity
 Cocaine intoxication - refers to the immediate and deleterious effects of cocaine on the body.
Although cocaine intoxication and cocaine dependence can be present in the same individual,
these syndromes present with different symptoms.

NURSING RESPONSIBILITIES
1. Obtain careful medical history to rule out allergies, asthma, and obstructive pulmonary disease.
Propranolol can cause bronchiolar constriction even in normal subjects.
2. Monitor apical pulse, respiration, BP, and circulation to extremities closely throughout period of
dosage adjustment. Consult physician for acceptable parameters.
3. Evaluate adequate control or dosage interval for patients being treated for hypertension by
checking blood pressure near end of dosage interval or before administration of next dose.
4. Be aware that adverse reactions occur most frequently following IV administration soon after
therapy is initiated; however, incidence is also high following oral use in the older adult and in
patients with impaired kidney function. Reactions may or may not be dose related.
5. Lab tests: Obtain periodic hematologic, kidney, liver, and cardiac functions when propranolol is
given for prolonged periods.
6. Monitor I&O ratio and daily weight as significant indexes for detecting fluid retention and
developing heart failure.
7. Consult physician regarding allowable salt intake. Drug plasma volume may increase with
consequent risk of CHF if dietary sodium is not restricted in patients not receiving concomitant
diuretic therapy.
8. Fasting for more than 12 h may induce hypoglycemic effects fostered by propranolol.
9. If patient complains of cold, painful, or tender feet or hands, examine carefully for evidence of
impaired circulation. Peripheral pulses may still be present even though circulation is impaired.
Caution patient to avoid prolonged exposure of extremities to cold.