Therapeutic: antiarrhythmics (class II), antihypertensives
Pharmacologic: beta blockers
Treatment of hypertension (single agent or with other antihypertensives). Treatment of ventricular tachyarrhythmias. Unlabeled Use: Prophylaxis of MI, treatment of angina pectoris, management of anxiety, tremors, thyrotoxicosis, mitral valve prolapse, idiopathic hypertrophic subaortic stenosis.
Blocks stimulation of beta1 (myocardial)–adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, or uterine) receptor sites. Mild intrinsic sympathomimetic activity (ISA). Therapeutic Effects: Decreased heart rate. Decreased AV conduction. Decreased blood pressure.
Adverse Reactions/Side Effects
CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, nervousness, nightmares. EENT: blurred vision, stuffy nose. Resp: bronchospasm, wheezing. CV: BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction. GI: constipation, diarrhea, nausea, vomiting. GU: erectile dysfunction, diminished libido, urinary frequency. Derm: rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, joint pain. Misc: drug-induced lupus syndrome.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendixes G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.
Assess routinely for signs of CHF and pulmonary edema such as dyspnea, rales/crackles, weight gain, peripheral edema, and jugular venous distention. Report these signs to the physician immediately.
Assess blood pressure periodically, and compare to normal values (see Appendix F) to help document antihypertensive effects.
Assess exercise tolerance and episodes of angina pectoris. Document improvements in these variables, but also report any decline in exercise tolerance or increased frequency/severity of anginal attacks.
Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest). Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K). Repeated or prolonged bronchoconstriction may require a change in dose or medication.
Monitor signs of peripheral vasoconstriction, such as extreme coldness in the hands and feet, cyanosis, and muscle cramping. Notify physician of severe or prolonged signs of vasoconstriction.
Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur. Patients with diabetes mellitus should check blood glucose levels frequently.
Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Assess any joint or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Monitor mood and personality changes, including depression, anxiety, nervousness, ...
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