 Welcome to Nursing School Explained and this video in the pharmacology playlist about beta blockers or as they are sometimes referred to, beta adrenergic blockers. And really what that means is the adrenergic response always pertains to the sympathetic nervous system and so these medications block that sympathetic response. The thing that's unique about beta blockers or that they all have in common is that they end in LOL and so they are pretty funny that way and that's the way we can remember this particular medication class. And the reason that it's important to remember medications by their class is because medications that belong to the same class like the beta adrenergic blockers here have typically the same mechanism of action, side effects, contraindications and nursing considerations. So it's always easier to kind of clump these medications together in the group rather than memorizing them medication by medication and because we know they end in LOL we know that these beta blockers have the same data available to us. So for beta blockers we have to distinguish between beta one and beta two receptors that are located in different parts of the body. And beta one receptors are typically cardio selective. So the way I like to remember this is we have one heart, beta one receptors. And so because they are mostly located in the heart they regulate the sympathetic response of the heart rate as well as the heart's ability to contract. They're also located in the kidneys where they release renin which is an important part of the RAS, the renin angiotensin end aldosterone system that helps us to regulate our blood pressure by regulating the volume that we have in our blood vessels. Examples of beta one cardio selective beta blockers are metoprolol, atenolol and propranolol. Now we also have beta two receptors which are non-selective and those are mostly located in the lungs. We have two lungs, beta two, that's the way again I like to remember it. And they produce bronchodilation but they're also located in vascular smooth muscle which then helps us to dilate our arteries and as we dilate arteries the blood pressure will naturally drop. Examples of non-selective beta two blockers are cavetilol and labedolol. Now the reason that it is important to distinguish between cardio-selective and non-selective beta blockers is because we want to make sure we keep our patient's safety first, that's always our number one concern and so if we now block the patient's response to bronchodilate if we give them a beta blocker then they have trouble. So if a patient has underlying lung conditions such as COPD or asthma where they're already leaning towards the sides of bronchospasm constricted less compliance of the lungs and we take their ability away to dilate then we're going to cause them possibly some respiratory issues maybe even leading up to respiratory failure. So beta one blockers are safer for patients with lung conditions because they only affect beta one so they only affect cardio-selective, heart and kidney receptors in those two locations. The other thing besides lung conditions so because beta two receptors control vasodilation in vascular smooth muscle we also want to administer them cautiously or not at all to patients with peripheral vascular disease because of arthrosclerosis such as peripheral arterial disease or venous disease where they have trouble regulating their blood pressure because of some valve issues. But both beta blocker types of beta one or two work the same way. They block beta receptors as our name already says which leads to a decrease in blood pressure and a decrease in heart rate and like I mentioned before to a decrease in sympathetic response which is the adrenergic the sympathetic nervous system that will typically respond to situations. So indications when do we use them clearly for hypertension but also for patients with angina as well as in the prevention and treatment of myocardial infarction and beta blockers are many times used or actually present in the protocols for advanced cardioglyph support because they take away that kind of sympathetic response that happens in a patient when they are experiencing an MI. The only medication that is a little bit different is propranolol. It also is used for treatment of anxiety as well as migraine headaches. Common side effects for beta blockers are fatigue, dizziness, drowsiness as well as nausea vomiting, bronchospasm, and erectile dysfunction. The more serious side effects, because now again we're blocking these beta receptors leading to a decrease in heart rate and blood pressure, it can produce significant bradycardia. It can also produce AV conduction abnormalities which typically lower the heart rate as well when the conduction is not transmitted the normal way through the conduction pathway, but it can also lead to congestive heart failure and pulmonary edema. So we have to be very careful here monitoring the patients for these signs and symptoms and we'll get to that in a little bit. Contraindications, so we cannot or should not use beta blockers if the patient already has bradycardia because if the heart rate is already low and now we're blocking their beta receptors we're going to drop their heart rate even further and that might make them symptomatic, they might pass out, it might drop their blood pressure, those kind of things. It's also contraindicated in patients with a heart block because we said it's going to possibly cause these AV conduction abnormalities and typically in heart blocks the heart rate is low less than 60 than the intrinsic rate of our SA node. And also as we talked about before contraindicated in asthma and COPD because of the beta 2 non-selective ones. So in select cases the patient might be prescribed the beta 1 cardioselective beta blocker if there is an indication for it, but of course that's always a discussion that is up to the patient's provider to discuss with the patient the risks and benefits of taking medications of such a class. And then for nursing considerations, so as always with any anti-hypertensives we want to check patient's heart rate and blood pressure before we administer them. Typically the medication gets held if the heart rate is less than 60, in some cases less than 50 depending on the orders and what the goal of treatment is. And also if the systolic blood pressure is less than 100 because with the administration of these beta blockers we're going to lower down blood pressure, we're not going to lower down heart rate. So if they're already having a heart rate of 48, then we're going to administer the medication. It might drop them down to a heart rate of 45 or 40 and then they are definitely going to be symptomatic. So but always check the particular orders of what the provider recommends when to hold the medication. Beta blockers might also cause orthostatic hypotension. So we want to make sure that we inform the patient of carefully getting up from a lying down position to sitting up to standing up with taking enough time in between so that they can regulate their blood pressure as they get up. For patients with diabetes it might lead to hypoglycemia because they also have an effect on the sympathetic response that we discussed but also on the production of cortisol. So they are at risk for hypoglycemia so we want to keep a close eye on patients' blood glucose levels. And very importantly the abrupt discontinuation of beta blockers might lead to life-threatening arrhythmias, hypertension or cardiac ischemia. So if a patient now is symptomatic with when they are taking a beta blocker, might that be because they are fatigued, they're dizzy, they're having some issues here. It's very important to tell them do not discontinue the medication without talking to your provider first because if you abruptly stop it you might experience some of these symptoms. So if it's really determined that the patient needs to come off this medication they will slowly taper the patient off to prevent these things from happening. And then nursing considerations because we also give these beta blockers in the IV. So certainly we want to have the patient on a telemetry monitoring to see their EKG and any conduction issues or our EKG arrhythmias that might arise. We want to check the blood pressure every 5 to 15 minutes with IV administration of cardio-active medications and then we want to monitor them for the serious side-effect of CHF and pulmonary edema so these signs and symptoms of heart failure by monitoring their eyes and nose and daily weight very closely. Thank you for watching this video on beta blockers. Please also check out the other videos in the pharmacology playlist that not only pertain to antihypertensors but to general medication classes. And again, if you remember the different classes and what they have in common, pharmacology will be much much easier for you. Please give me a thumbs up if you've enjoyed the video and I'll see you soon right here on Nursing School Explained. Thanks for watching.