Pangasinan State University

INSTITUTE OF NURSING
Bayambang Campus
Bayambang, Pangasinan

Written Report about

Drugs Affecting the Body System

Peripheral Nervous System

Group 8
De Guzman, Laren
Jimenez, Jordan
Manzano, Raven
Tan, Angeleia

BSN II-1
(A.Y. 2023-2024)

QUENNY ANNE Q. APIL, MAN

Instructor
I. Introduction to the system

The Peripheral Nervous System (PNS) is a crucial part of the nervous system in the
human body. Its primary function is to connect the central nervous system (CNS), which
includes the brain and spinal cord, to the rest of the body, allowing for communication
between the CNS and various organs, muscles, and tissues.

The PNS is divided into two main components:

1. Somatic Nervous System (SNS):

- The SNS controls voluntary movements and sensory perception. It includes motor
neurons that transmit signals from the CNS to skeletal muscles, allowing us to
perform actions like walking, talking, and reaching.
- It also comprises sensory neurons that relay information from sensory receptors in
the skin, muscles, and joints to the CNS, enabling us to perceive sensations such as
touch, pain, and temperature.

2. Autonomic Nervous System (ANS):

- The ANS regulates involuntary bodily functions, including processes like heart rate,
digestion, and respiratory rate. It operates automatically, without conscious control.

2 Branches: the sympathetic and parasympathetic nervous systems. These two branches
work in opposition to maintain homeostasis in the body.

The sympathetic system is responsible for the "fight or flight" response, increasing heart
rate and preparing the body for action.

Parasympathetic system promotes relaxation and helps conserve energy. Its primary
function is to promote the body’s “rest and digest” response.

The PNS serves as a bridge between the CNS and the rest of the body, facilitating both
voluntary and involuntary bodily functions. The SNS governs voluntary muscle movements
and sensory perception, while the ANS oversees automatic bodily processes, with its
sympathetic and parasympathetic branches working together to maintain balance.
Anatomy of Peripheral Nervous System

II. Drugs affecting the Peripheral Nervous System

III. CHOLINERGIC DRUGS
Cholinergic drugs are agents that influence the activity of cholinergic receptors. Most of
these drugs act directly at cholinergic receptors, where they either mimic or block the
actions of acetylcholine.
2 subdivision of cholinergic receptors:
1. Muscarinic receptor – Responsive against Muscarine.
Muscarine – A plant alkaloid found in mushrooms and is considered poisonous
2. Nicotinic receptor- Responsive against Nicotine.

Types of Cholinergic drugs according to their action:

Direct acting – Cholinergic drugs that directly binds to receptors to either stimulate or block
the action of acetylcholine.
Indirect acting – Cholinergic drugs that blocks the action of acetylcholinesterase to open
up space for the action of acetylcholine.

Categories of Cholinergic Drugs

1. Muscarinic Agonists
2. Muscarinic Antagonist
3. Ganglionic stimulating agents
4. Ganglionic Blocking agents
5. Neuromuscular blocking agents
6. Cholinesterase Inhibitors
 Acetylcholine- Are excitatory neurotransmitter that wakes up or excites nerve cells to send
off signals

IV. MUSCARINIC AGONIST AND ANTAGONISTS

Muscarinic agonists bind to muscarinic receptors and thereby cause receptor activation

Classifications:
a. Urecholine, Duvoid (Bethanechol)
Indications
Bethanechol is indicated for the treatment of acute, functional postpartum and
postoperative urinary retention. It is also indicated for the treatment of
neurogenic atony of the bladder with retention.
Pharmacokinetics
Bethanechol is available for oral administration. Effects begin in 30 to 60
minutes and persist for about 1 hour. Because bethanechol is a quaternary
ammonium compound (Fig. 14.1), the drug crosses membranes poorly. As a
result, only a small fraction of each dose is absorbed..
Adverse Effects
CNS: headache, malaise, seizures. CV: bradycardia, profound hypotension
with reflexive tachycardia, flushing. EENT: lacrimation, miosis. GI:
abdominal cramps, diarrhea, excessive salivation, nausea, belching,
borborygmus. GU: urinary urgency. Respiratory: bronchoconstriction, asthma
attack. Skin: diaphoresis.
Nursing Considerations
• Adverse effects are rare with oral use.
• Monitor vital signs frequently, especially respirations. Always have atropine
injection available and be prepared to give 0.6 mg subcut or by slow IV push.
Provide respiratory support, if needed.
• Monitor patient for orthostatic hypotension.
• Watch closely for adverse reactions that may indicate drug toxicity.

Muscarinic antagonists competitively block the actions of acetylcholine at muscarinic

receptors.

Classifications:

a. Atropine [Atropine, others]

Indications:

The intravenous, intramuscular, subcutaneous, intraosseous, and endotracheal

use of atropine is indicated for the temporary blockade of severe or life-
threatening muscarinic effects. The intramuscular use of atropine in the form
of a pen injector is indicated for the treatment of poisoning by susceptible
organophosphorus nerve agents having cholinesterase activity as well as
organophosphorus or carbamate insecticides in adult and pediatric patients.
The ophthalmic use of atropine is indicated for mydriasis, cycloplegia, and
penalization of the healthy eye in the treatment of amblyopia. In combination
 with difenoximide or diphenoxylate (tablets for oral use), atropine is indicated
as adjunctive therapy in the management of acute nonspecific diarrhea.

Pharmacokinetics

Atropine may be administered topically (to the eye) and parenterally (IM, IV,
and subcutaneous). The drug is rapidly absorbed following administration and
distributes. to all tissues, including the CNS. Elimination is by a combination
of hepatic metabolism and urinary excretion. Atropine has a half-life of
approximately 3 hours.

Adverse Effects

Severity and frequency of adverse reactions are dose related. CNS: headache,
restlessness, insomnia, dizziness, ataxia, disorientation, hallucinations,
delirium, excitement, agitation, confusion, fever. CV: bradycardia,
palpitations, tachycardia, atrial and ventricular arrhythmias. EENT: blurred
vision, mydriasis, photophobia, cycloplegia, increased IOP. GI: dry mouth,
constipation, thirst, nausea, vomiting. GU: urine retention, erectile
dysfunction. Hematologic: leukocytosis. Metabolic: hyperglycemia,
hypoglycemia, hyponatremia, hypokalemia. Skin: rash. Other: anaphylaxis.

Nursing Considerations

• Doses less than 0.5 mg in adults and less than 0.1 mg in children may increase
risk of paradoxical bradycardia. Alert: Watch for tachycardia in cardiac patients
because it may lead to ventricular fibrillation.
• Monitor fluid intake and urine output. Drug causes urine retention and urinary
hesitancy.
V. CHOLINESTERASE INHIBITORS
Cholinesterase inhibitors are drugs that prevent the degradation of acetylcholine by
acetylcholinesterase (also known simply as cholinesterase). Cholinesterase inhibitors are
also known as anticholinesterase drugs.
Classifications:
a. Bloxiverz (Neostigmine)
Indications
Neostigmine is used for the symptomatic treatment of myasthenia gravis by
improving muscle tone.
Pharmacokinetics
Neostigmine may be administered IM, IV, or by subcutaneous injection.
Because neostigmine carries a positive charge, the drug is poorly absorbed
following oral administration. Consequently, oral formulations have been
discontinued in the United States although they remain available in Canada and
some other countries. Once absorbed, neostigmine can reach sites of action at
the NMJ and peripheral muscarinic receptors but cannot cross the blood-brain
barrier to affect the CNS. Duration of action is 2 to 4 hours. Neostigmine is
eliminated by enzymatic degradation by cholinesterase.

Adverse Effects
 Allergic: Allergic reactions and anaphylaxis. Neurologic: Dizziness,
convulsions, loss of consciousness, drowsiness, headache, dysarthria, miosis
and visual changes. Cardiovascular: Cardiac arrhythmias (including
bradycardia, tachycardia, A-V block and nodal rhythm) and nonspecific EKG
changes have been reported, as well as cardiac arrest, syncope and
hypotension. These have been predominantly noted following the use of the
injectable form of Prostigmin (neostigmine). Respiratory: Increased oral,
pharyngeal and bronchial secretions, and dyspnea. Respiratory depression,
respiratory arrest and bronchospasm have been reported following the use of
the injectable form of Prostigmin (neostigmine). Dermatologic: Rash and
urticaria. Gastrointestinal: Nausea, emesis, flatulence and increased peristalsis.
Genitourinary: Urinary frequency. Musculoskeletal: Muscle cramps and
spasms, arthralgia. Miscellaneous: Diaphoresis, flushing and weakness.
Nursing Considerations
Should be used with caution in patients with epilepsy, bronchial asthma,
bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac
arrhythmias or peptic ulcer. As a rule, 15 mg of neostigmine bromide orally is
equivalent to 0.5 mg of neostigmine methyl sulfate parenterally, due to poor
absorption of the tablet from the intestinal tract. Large doses should be avoided
in situations where there might be an increased absorption rate from the
intestinal tract. It should be used with caution when co-administered with
anticholinergic drugs, in order to avoid reduction of intestinal motility.
b. Physostigmine
Indications
Smaller doses may be required in patients with renal disease. Adjust dosage to
achieve desired effect. Antidote for nondepolarizing neuromuscular blockers
Adults: 0.1 to 0.25 mg/kg IV. Immediately before or with dose, also give
atropine sulfate 0.6 to 1.2 mg IV or an equipotent dose of glycopyrrolate.
Myasthenia gravis Adults: 60 to 120 mg immediate-release PO every 3 or 4
hours. Average dosage is 600 mg daily, but dosages up to 1,500 mg daily may
be needed. Dosage must be adjusted for each patient, based on response and
tolerance. Or, 180 to 540 mg extended-release tablets PO daily or b.i.d., with
at least 6 hours between doses.
Pharmacokinetics
Had a very rapid plasma elimination with a plasma clearance ranging from 47
to 163 l/h with a mean +/- s.d. of 92.5 +/- 37.7 l/h. The volume of distribution
was 46.5 +/- 19.2 l, while distribution and plasma elimination half-lives were
2.3 and 22 min, respectively. A fraction of the dose was probably hydrolyzed
in blood since its blood elimination half-life in vitro was approximately 190
min. After both intramuscular and subcutaneous administration, the systemic
availability was almost complete, the plasma terminal half-lives only being
somewhat longer than after intravenous administration. Plasma clearance,
volume of distribution and elimination half-life of physostigmine were not
correlated to age or body weight of the patients. The rapid plasma clearance of
physostigmine resulted in a short duration of ant sedative effect. After
administration of 1 mg physostigmine salicylate i.v., drug-induced sedation
was rapidly reversed with a duration of 30-60 min. The duration of action was
similar after intramuscular injection, but onset was delayed by 20-30 min.
 Adverse Effects
CNS: headache with high doses, weakness, syncope. CV: bradycardia, cardiac
arrest, hypotension, thrombophlebitis. EENT: miosis, rhinorrhea. GI: nausea,
vomiting, abdominal cramps, diarrhea, excessive salivation, increased
peristalsis. GU: urinary frequency, urinary urgency. Musculoskeletal: muscle
cramps, muscle fasciculations, muscle weakness, tingling in extremities.
Respiratory: bronchospasm, bronchoconstriction, increased bronchial
secretions. Skin: rash, diaphoresis.
Nursing Considerations
• Stop all other cholinergic before giving this drug.
• Monitor and document patients response after each dose. Optimum dosage is
difficult to judge. Alert: Regonol contains benzyl alcohol preservative, which
may cause toxicity in neonates.
• Mestinon syrup contains 5% alcohol.
• Look alike–sound alike: Dont confuse pyridostigmine with physostigmine.
Dont confuse Regonol with Reglan or Renagel.

VI. COMPETITIVE NEUROMUSCULAR BLOCKERS

Definition:

Competitive neuromuscular blocking agents are drugs that compete with acetylcholine
for binding to nicotinic M receptors. These drugs are also known as nondepolarizing
neuromuscular blockers, because they do not depolarize the motor end-plate.

It is divided into two types: Nondepolarizing and Depolarizing neuromuscular

blockers.

I. Nondepolarizing Neuromuscular Blockers

Pharmacokinetic

With the competitive neuromuscular blockers in use today, paralysis develops within
minutes of IV injection. Peak effects persist 20 to 45 minutes and then decline.
Complete recovery takes about 1 hour.

Adverse effects

Respiratory Arrest. Paralysis of respiratory muscles can produce respiratory arrest.

Because of this risk, facilities for artificial ventilation must be immediately available.
Patients must be monitored closely and continuously.

Hypotension. One competitive agent—atracurium—can Release significant amounts

of histamine. Hypotension can result.

Nursing Consideration/Implecations

Myasthenia Gravis. Neuromuscular blocking agents must be used with special care in
patients with myasthenia gravis. Doses that would have a minimal effect on other
patients can produce complete paralysis in patients with myasthenia gravis.
 Electrolyte Disturbances. Responses to neuromuscular Blockers can be altered by
electrolyte abnormalities. For example, low potassium levels can enhance paralysis,
whereas high potassium levels can reduce paralysis.

Classifications:

a. Pavulon (Pancuronium)

Indications

Adjunct to anesthesia to relax skeletal muscle, facilitate intubation, and assist with
Mechanical ventilation .

Pharmacokinetics

The elimination half-life of pancuronium has been reported to range between 89–161
minutes. The volume of distribution ranges from 241–280 mL/kg; and plasma
clearance is approximately 1.1–1.9 mL/minute/kg.

Adverse Effects

CV: tachycardia, increased BP, flushing. EENT: excessive salivation. Musculoskeletal:

residual muscle weakness. Respiratory: prolonged respiratory insufficiency or apnea.
Skin: transient rashes. Other: allergic or idiosyncratic hypersensitivity reactions.

Nursing Consideration/Implication

Dosage depends on anesthetic used, individual needs, and response. Dosages are
representative and must not be adjusted.

Monitor baseline electrolyte determinations (electrolyte imbalance can potentiate

Neuromuscular effects) and vital signs, especially respirations and HR

Drug doesnt cause histamine release or hypotension, but it may raise HR and BP

Monitor respirations closely until patient recovers fully from neuromuscular blockade,
as indicated by tests of muscle strength (hand grip, head lift, and ability to cough).

Give analgesics for pain

b. Tracrium (Atracurium)

Indications

Adjunct to general anesthesia to facilitate ET intubation and relax skeletal muscles

during surgery or mechanical ventilation.

Pharmacokinetics

Atracurium has an onset of action of approximately 2 minutes when an intubating dose

is given. Classified as an intermediate-acting non-depolarizing muscle relaxant with a
duration of action of approximately 40 to 45 minutes. The elimination half-life is
approximately 20 minutes.

Adverse Effects
 CV; Arrhythmia. RESP: prolong apnea, bronchospasm, cyanosis, respiratory
depression. EENT: Increased secretions, Increased intraocular pressure. HEMA:
Myoglobulinemia.

Nursing Consideration/Implication

Assess Vital Signs (VS) every 15 minutes, assess for electrolyte imbalances and
monitor input and output.

II. Depolarizing Neuromuscular Blocker

a. Succinylcholine (Anectin)

Indication

Adjunct to anesthesia to facilitate tracheal intubation; to provide skeletal muscle

relaxation during surgery or mechanical ventilation

Pharmacokinetics

Succinylcholine has an extremely short duration of action. Paralysis peaks about 1

minute after IV injection and fades completely 4 to 10 minutes later.

Adverse Effects:

CV: arrhythmias, bradycardia, cardiac arrest, tachycardia, HTN, hypotension, flushing.

EENT: Increased IOP. GI: excessive salivation. Metabolic: hyperkalemia.
Musculoskeletal: Postoperative muscle pain, muscle fasciculation, jaw rigidity,
rhabdomyolysis with acute renal failure. Respiratory: apnea, bronchoconstriction,
prolonged respiratory depression. Skin: rash. Other: allergic or idiosyncratic
hypersensitivity reactions, anaphylaxis, malignant hyperthermia

Nursing Consideration/Implication

All neuromuscular blockers can cause respiratory arrest. Facilities for intubation and
mechanical ventilation should be immediately available

Succinylcholine may cause muscle pain. Reassure the patient that this response,
although unpleasant, is not unusual.

Certain antibiotics, including aminoglycosides and tetracyclines, can intensify

neuromuscular blockade. Use them with caution. These drugs delay inactivation of
succinylcholine, thereby greatly prolonging paralysis. Accordingly, cholinesterase
inhibitors are contraindicated for patients receiving succinylcholine.

VII. ADRENERGIC DRUGS

i. ADRENERGIC AGONISTS

Definition:

Adrenergic agonists produce their effects by activating adrenergic receptors. Since the
sympathetic nervous system acts through these same receptors, responses to adrenergic agonists
and responses to stimulation of the sympathetic nervous system are very similar. These drugs
activate Alpha1, Alpha2, Beta1 and/or Beta2 receptors.
 The adrenergic agonists fall into two major chemical classes: catecholamines and
noncatecholamines. The catecholamines and noncatecholamines differ in three important
respects: (1) availability for oral use, (2) duration of action, and (3) ability to act in the CNS.

Catecholamines are so named because they contain a catechol group and an amine group.
Noncatecholamines have ethylamine in their structure, but do not contain the catechol moiety
that characterizes the catecholamines.

I. Cathecolamine
a. Adrenalin (Epinephrine hydrochloride)

Indications

Used for anaphylaxis, hypotension associated with septic shock, asthma and cardiac
resuscitation.

Pharmacokinetic effects

When administered parenterally, epinephrine has a rapid onset and short duration of
action. Following IV injection, epinephrine is rapidly cleared from the plasma with an
effective half-life of < 5 minutes. A pharmacokinetic steady state following continuous
intravenous infusion is achieved within 10-15 minutes.

Adverse effects

CNS: drowsiness, headache, nervousness, tremor, cerebral hemorrhage, stroke, vertigo,

pain, disorientation, agitation, anxiety, apprehensiveness, fear, restlessness, dizziness,
weakness, subarachnoid hemorrhage. CV: palpitations, ventricular fibrillation, shock,
widened pulse pressure, HTN, tachycardia, anginal pain, cardiac arrhythmias, altered
ECG (including decreased T-wave amplitude). GI: nausea, vomiting. Respiratory:
dyspnea, respiratory difficulties. Skin: Urticaria, hemorrhage at injection site, pallor,
sweating. Other: tissue necrosis.

Nursing Consideration/Implication

In patients with Parkinson disease, drug increases rigidity and tremor.b.

Norepinephrine bitartrate.

Drug interferes with tests for urinary catecholamines.

Epinephrine is drug of choice in emergency treatment of acute anaphylactic reactions

Observe patient closely for adverse reactions. Notify prescriber if adverse reactions
develop; adjusting dosage or stopping drug may be necessary Indications.

If BP increases sharply, give rapid-acting vasodilators, such as nitrates and alpha

blockers, to counteract the marked pressor effect of large doses.

II. Noncathecolamines
a. Akovaz (Ephedrine)

Indications

The FDA-approved primary indication for ephedrine is the treatment of clinically

significant hypotension perioperatively. Induction of general and ongoing anesthesia
 during operative cases results in vasodilatation and hypotension, requiring treatment
with vasopressors

Pharmacokinetic effects

The onset of action after intravenous administration is 3 to 5 minutes, and the duration
of pressor and cardiac responses to ephedrine is 10-15 minutes after intravenous
administration of 5 to 25 mg or intramuscular or subcutaneous administration of 25 to
50 mg.

Adverse effects

CNS: headache, anxiety. CV: bradycardia, severe HTN, arrhythmias, ischemic injury.
Respiratory: respiratory difficulties. Skin: irritation with extravasation, necrosis and
gangrene secondary to extravasation. Other: anaphylaxis.

Nursing Consideration/Implication

Drug isn’t a substitute for blood or fluid replacement therapy. If patient has volume
deficit, replace fluids before giving vasopressors

Keep emergency drugs on hand to reverse effects of drug: atropine for reflex
bradycardia, Phentolamine to decrease vasopressor effects, and propranolol for
arrhythmias.

Vasoactive medications can immediately affect blood pressure, heart rate, and pulse
oximetry. Continue monitoring vital signs, watching for possible severe drop in BP

Dont confuse ephedrine with epinephrine.

VIII. ADRENERGIC ANTAGONISTS

- Cause direct blockade of adrenergic receptors. With one exception, all of the adrenergic
antagonists produce reversible (competitive) blockage.
- Most are more selective unlike adrenergic agonists that act at alpha- and beta-adrenergic.

2 Major Groups:

1. Alpha-Adrenergic Blocking Agents

- Drugs that produce selective blockade of alpha-adrenergic receptors
2. Beta-Adrenergic Blocking Agents
- Drugs that produce selective blockade of beta receptors

Classifications:

Alpha-Adrenergic Antagonists:

I.
a. Minipress (Prazosin Hydrochloride)

Indications

Reduction of blood pressure in patients with essential hypertension.

Pharmacokinetics side effects

 It is administered orally and its effects peak in 1 to 3 hours and persist for 10 hours.
The drug undergoes extensive hepatic metabolism followed by excretion in the bile
wherein only 10% is eliminated in the urine. The half life is 2 to 3 hours.

Adverse effects

CV: orthostatic hypotension, reflex tachycardia, EENT: nasal congestion.

Nursing Coordination/Implication
Available in capsules (1,2, and 5 mg) for oral. The initial adult dosage for
hypertension is 1 mg 2- or 3-times a day. The maintenance dosage is 2 to 20 mg/day
taken in divided doses.
b. Hytrin (Terazosin)

Indications

Reduction of blood pressure in patients with essential hypertension and reduction

of symptoms in patients with BPH.

Pharmacokinetics

It is administered orally and the peak effects is after 1-2 hours. Its half-life is 9-12
hours. The drug undergoes extensive hepatic metabolism followed by excretion in
the bile and urine.

Adverse effects

CNS: headache. CV: orthostatic hypotension, reflex tachycardia. EENT: nasal

congestion.

Nursing Consideration/Implication

Available in tables (1, 2, 5, 10 mg) and capsules (1, 2, 5, 10 mg). 1–5 mg/day for
hypertension, 10 mg/day for BPH and maximum of 20 mg. Administer at the same
time each day. Give the first dose at bedtime to minimize first-dose effect.

II. Nonselective Agents

c. Ora Verse (Phentolamine)

Indications

Phentolamine has three approved applications: Diagnosis and treatment of

pheochromocytoma; prevention of tissue necrosis following extravasation of
drugs that produce alpha-mediated vasoconstriction; and reversal of soft tissue
anesthesia.

Pharmacokinetics

It is administered through IM, IV, local infiltration and its peak effects are 30-
45 minutes in IM and 1-2 minutes in IV. Its half life is unknown in IM and 20
minutes in IV. The drug undergoes extensive hepatic metabolism followed by
excretion through the urine.

Adverse Effects
 CV: orthostatic hypotension, reflex tachycardia. EENT: nasal congestion. GI:
inhibition of ejaculation.

Nursing Consideration/Implication

Available in IV solution (0.4 mg/1.7 mL) and is limited to reversal of

anesthetic following dental surgery. Infiltration post IV extravasation: 5–10 mg
diluted in 10 mL saline. To prevent hypertension during surgical excision of a
pheochromocytoma: 5 mg (IM or IV) given 1 to 2 hours before surgery.
Infiltration post IV extravasation: Inject drug into extravasated region.

Beta-Adrenergic Antagonists:

I. First-Generation: Nonselective Beta Blockers

a. InnoPran XL (Propranolol)

Indications

Propranolol can reduce heart rate, decrease the force of ventricular contraction,
and suppress impulse conduction through the AV node. I other words it can
reduce the cardiac output. It can also suppress secretion of renin.

propranolol can produce three major effects: bronchoconstriction;

vasoconstriction; and reduced glycogenolysis.

Pharmacokinetics

It is administered orally and the peak effects is after 1-4 hours. The half-life of
the drug in adults is 3-5 hours. The drug undergoes hepatic metabolism
followed by excretion through the urine.

Adverse Effects

CNS: depression, insomnia, nightmares, hallucinations. CV: hypotension,

angina pectoris, cardiac dysrhythmias, myocardial infarction, rebound cardiac
excitation. Respiratory: bronchoconstriction. GI: inhibition of glycogenolysis.
Other: Effects in Neonates during pregnancy

Nursing Consideration/Implication

Propranolol hydrochloride is available in three oral formulations: IR tablets (10

to 80 mg) sold generically, ER capsules (60 to 160 mg) sold as Inderal LA and
InnoPran XL, and oral solution (4 and 8 mg/mL) sold generically. The drug is
also available in solution (1 mg/mL) for IV administration.

For treatment of hypertension, the initial dosage is 40 mg twice a day (using

IR tablets or oral solution) or 80 mg once a day (using ER capsules). Usual
maintenance dosages are 120 to 240 mg/day in three or four divided doses
(using IR tablets or oral solution) or 120 to 160 mg once a day (using ER
capsules).

For angina pectoris, the initial dosage is 80 mg once a day (using ER capsules).
The usual maintenance dosage is 160 mg once a day (using ER capsules) or 80
to 320 mg/day in two, three, or four divided doses (using IR tablets).
 Intravenous administration of propranolol is not routinely done except in
emergency situations or when a patient is under anesthesia. Dosing is 1 to 3
mg at a rate not exceeding 1 mg/min.

II. Second-Generation: Cardio-selective Beta Blockers

b. Lopressor (Metoprolol)

Indications

Metoprolol reduces heart rate, force of contraction, and conduction velocity

through the AV node and reduces secretion of renin by the kidney.

Pharmacokinetics

It is administered through IV and orally. The peak effects through IV is after

5-15 minutes and through oral is after 2-4 minutes. The half-life of the drug in
adults is 3-7 hours. The drug undergoes hepatic metabolism followed by
excretion in the urine.

Adverse Effects

CNS: migraine headache, situational anxiety, insomnia, depression. CV:

hypotension, angina pectoris, cardiac dysrhythmias, myocardial infarction,
heart failure, rebound cardiac excitation. Respiratory: bronchoconstriction. GI:
inhibition of glycogenolysis.

Nursing Consideration/Implication

Available in tables (25, 37, 5, 50, 75, 100 mg) and IV solution (1 mg/ml, 5 ml,
5 mg/5 ml In 5 ml). The dosage in tablets is 50 – 100 mg/day, Max 200 mg/day.
While in IV solution it is 1.25-5mg 2-4 times daily. It can be administered with
food and in IV labeling advises 5 mg boluses administered 2 min apart.

III. Third-Generation: Beta Blockers with Vasodilation Actions

c. Nebivolol

Indications

Nebivolol can dilate blood vessels and promotes synthesis and release of nitric
oxide from the vascular epithelium.

Pharmacokinetics

It is administered orally and the peak effects is after 1.5-4 hours. The half-life
of the drug in adults is 12-19 hours. The drug undergoes hepatic metabolism
followed by excretion through urine and feces.

Adverse Effects

CV: hypertension, heart failure

Nursing Consideration/Implication

Available in tablets (2.5, 5, 10, 20 mg) for oral. The dosage 5–20 mg/day and
a maximum of 40 mg/day. Administer with or without food.