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Generic Name

Metoprolol

Brand Name

Lopressor

Classification

Antianginals, Antihypertensives, Beta blockers

Action

Blocks stimulation of beta 1 (myocardial)-adrenergic receptors. Does not

Dosage

usually affect beta 2 (pulmonary, vascular, uterine) - adrenergic receptor sites.

100 mg 1 tab OD

Indication

Hypertension. Angina pectoris. Prevention of MI and decreased mortality in

patients with recent MI. Management of stable, symptomatic (class II or III)
heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be

Contraindication

used with ACE inhibitors, diuretics and/or digoxin; Toprol XL only).

Contraindicated in: Uncompensated HF; Pulmonary edema; Cardiogenic
shock; Bradycardia, heart block, or sick sinus syndrome (in absence of a
pacemaker).

Use Cautiously in: Renal impairment; Hepatic impairment; Geri:

sensitivity to beta blockers; initial dose reduction recommended;
Pulmonary disease (including asthma; beta1 selectivity may be lost at
higher doses); Diabetes mellitus (may mask signs of hypoglycemia);
Thyrotoxicosis (may mask symptoms); Patients with a history of severe
allergic reactions (intensity of reactions may be increased); Untreated

Side Effects

pheochromocytoma (initiate only after alpha blocker therapy started)

CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness,
insomnia, memory loss, mental status changes, nervousness, nightmares.

EENT: blurred vision, stuffy nose.

Resp: bronchospasm, wheezing.

CV: Bradycardia, HF, Pulmonary Edema, hypotension, peripheral

vasoconstriction.

GI: constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence,

gastric pain, heartburn, liver enzymes, nausea, vomiting.

Drug Interactions

GU: erectile dysfunction, libido, urinary frequency.

Derm: rashes.

Endo: hyperglycemia, hypoglycemia.

MS: arthralgia, back pain, joint pain.

Misc: drug-induced lupus syndrome.

Risk of bradycardia when used with digoxin, verapamil, diltiazem, or
clonidine.

Hypotension may occur with other antihypertensives, acute ingestion of

alcohol, or nitrates.

May alter the effectiveness of insulins or oral hypoglycemic agents (dose

adjustments may be necessary).

1. Instruct patient to take medication as directed, at the same time each day,
Nursing
Responsibilities

even if feeling well; do not skip or double up on missed doses. Take

missed doses as soon as possible up to 8 hr before next dose. Abrupt
withdrawal may precipitate life-threatening arrhythmias, hypertension, or
myocardial ischemia.
2. Check pulse and BP daily to report significant changes to health care
professional.
3. May cause drowsiness. Caution patient to avoid driving or other activities
that require alertness until response to the drug is known.
4. Advise patient to change positions slowly to minimize orthostatic
hypotension.
5. Caution patient that this medication may increase sensitivity to cold.
6. Patients on antihypertensive therapy should also avoid excessive amounts
of coffee, tea, and cola.
7. Diabetics should closely monitor blood glucose, especially if weakness,
malaise, irritability, or fatigue occurs. Medication does not block sweating
as a sign of hypoglycemia.
8. Advise patient to notify health care professional if slow pulse, difficulty
breathing, wheezing, cold hands and feet, dizziness, light-headedness,
confusion, depression, rash, fever, sore throat, unusual bleeding, or
bruising occurs.
9. Hypertension: Reinforce the need to continue additional therapies for
hypertension (weight loss, sodium restriction, stress reduction, regular

exercise, moderation of alcohol consumption, and smoking cessation).

Medication controls but does not cure hypertension.
10. Consider the 10 rights in giving medication to patient: (1) Right Patient,
(2) Right medication, (3) Right dosage, (4) Right route, (5) Right time, (6)
Right documentation, (7) Right education, (8) Right to refuse, (9) Right
Source

assessment and (10) Right evaluation.

Davis's Drug Guide for Nurses, 14th Edition