Nadolol

INTRODUCTION

Indications

Management of hypertension. Management of angina pectoris. Unlabeled Use: Arrhythmias. Migraine prophylaxis. Tremors (essential, lithium-induced, parkinsonian). Aggressive behavior. Antipsychotic-associated akathisia. Situational anxiety. Esophageal varices. Reduction of intraocular pressure.

Action

Blocks stimulation of beta₁ (myocardial) and beta₂ (pulmonary, vascular, and uterine) receptor sites. Therapeutic Effects: Decreased heart rate and blood pressure.

Adverse Reactions/Side Effects

CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nightmares. EENT: blurred vision, dry eyes, nasal stuffiness. Resp: bronchospasm, wheezing. CV: ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA, orthostatic hypotension, peripheral vasoconstriction. GI: constipation, diarrhea, nausea. GU: erectile dysfunction, decreased libido. Derm: itching, rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back pain, muscle cramps. Neuro: paresthesia. Misc: drug-induced lupus syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Watch for signs of CHF and pulmonary edema, including dyspnea, rales/crackles, weight gain, peripheral edema, and jugular venous distention. Report any new or increased signs of heart failure, but also determine if drug therapy is effective in reducing these symptoms in patients with preexisting heart failure.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Also assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

• 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.

• 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.

• Monitor excessive fatigue or weakness. Beta blockers often cause some degree of fatigue and weakness, but any sudden or severe change in muscle strength ...