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Metoprolol Nursing Considerations and Patient Teaching [Drug Guide]

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By Gil Wayne BSN, R.N.

As a nurse, it is important to have a solid understanding of metoprolol and how it should be administered to patients. This article will provide a comprehensive guide to metoprolol nursing considerations and cover everything from its uses to administration and side effects.

Table of Contents

What is Metoprolol?

Metoprolol is a prescription medication used to treat conditions like high blood pressure (hypertension), angina, and heart failure. It is a beta-blocker, a type of drug that works by blocking the effects of adrenaline and reducing the workload on the heart. This medication is available in different forms including tablets, extended-release tablets, and oral solutions. In this article, we will delve into the various uses, benefits, and potential side effects of Metoprolol.

Generic Name

  • metoprolol tartrate (Lopressor)
  • metoprolol succinate (Toprol-XL)

Brand Names

Metoprolol is available under various brand names including:

  • Lopresor
  • Lopresor SR
  • Lopressor
  • Toprol-XL
  • Betaloc
  • Kapspargo Sprinkle
  • Beloc
  • Seloken

Drug Classification of Metoprolol

The drug classification of metoprolol is:

Therapeutic

Pharmacologic

Indications and Therapeutic Effects

Metoprolol is used to treat a variety of medical conditions. Some of the most common uses of this medication include:

  • High blood pressure. Metoprolol is often prescribed to lower high blood pressure. This medication works by reducing the amount of work the heart has to do and relaxing the blood vessels, which in turn reduces the pressure in the vessels.
  • Angina pectoris. Angina is a type of chest pain that is caused by reduced blood flow to the heart. Metoprolol is used to treat angina by reducing the workload on the heart and improving blood flow.
  • Heart failure. Heart failure occurs when the heart is unable to pump enough blood to meet the body’s needs. Metoprolol is used to treat heart failure by reducing the workload on the heart and improving blood flow.
  • Atrial fibrillation. Atrial fibrillation is a type of irregular heartbeat that can cause palpitations and shortness of breath. Metoprolol is used to treat atrial fibrillation by slowing the heart rate and reducing the risk of blood clots.
  • Myocardial infarction prevention. Metoprolol is typically prescribed to people who have a history of heart diseases, such as heart attacks, angina (chest pain), or heart failure, to help prevent further episodes of myocardial infarction.

Unlabeled Use:

  • Tachycardia. Metoprolol appears to be an effective and safe drug in the treatment of supraventricular tachycardia. It is typically prescribed to people who have been diagnosed with tachycardia and are experiencing symptoms such as rapid or irregular heartbeat, chest pain, shortness of breath, lightheadedness, or dizziness.
  • Migraine prophylaxis. Metoprolol works by blocking the effects of adrenaline and other stress hormones on the body. This can help to reduce the frequency and severity of migraines, as stress is a common trigger for these headaches.
  • Tremors. Metoprolol is typically prescribed to people who have moderate to severe tremors that are affecting their quality of life. It may be used alone or in combination with other medications for tremor control.
  • Aggressive behavior. Aggressive behavior can be a complex and challenging issue, often stemming from underlying mental health conditions or neurological disorders. In some cases, beta-blocker medications like metoprolol may be used as part of a comprehensive treatment plan to help manage aggressive behavior. It can help reduce the frequency and severity of aggressive behavior, as stress can sometimes trigger this type of behavior.
  • Anxiety. Metoprolol can help to reduce feelings of anxiety, as stress and anxiety are often interconnected. While there are many effective treatments available, some people may find that beta-blocker medications like metoprolol can help to reduce symptoms of anxiety.

Mechanism of Action

The metoprolol mechanism of action is a complex process that involves several different steps. To understand how metoprolol works, it is important to understand the role of adrenaline and noradrenaline in the body. These hormones are produced by the adrenal glands and are responsible for increasing the heart rate and blood pressure in response to stress or physical activity.

When adrenaline and noradrenaline bind to beta receptors in the heart, they cause the heart to beat faster and increase blood pressure. Metoprolol works by blocking these beta receptors, preventing the hormones from binding to them and causing an increase in heart rate and blood pressure. As a result, the workload on the heart is reduced, and blood pressure is lowered, providing relief from symptoms of heart conditions and high blood pressure.

Precautions and Contraindications

While metoprolol is generally considered to be a safe and effective medication, there are some precautions and contraindications that should be considered before taking this medication. Some of the most important precautions and contraindications to be aware of include:

  • Allergic reactions. Metoprolol can cause an allergic reaction in some people, so it is important to be aware of any allergies or previous reactions to medications before taking metoprolol.
  • Heart conditions. Metoprolol is primarily used to treat heart conditions, but it should be used with caution in people with certain heart conditions, such as uncompensated heart failure or slow heartbeats.
  • Blood pressure. Metoprolol is used to treat high blood pressure, but it can cause low blood pressure in some people, especially when standing up suddenly.
  • Cardiogenic shock. Metoprolol is generally contraindicated in patients with cardiogenic shock, which is a serious condition where the heart is unable to pump enough blood to meet the body’s needs. Metoprolol is a beta-blocker, a type of medication that slows the heart rate and reduces the force of contraction of the heart, and in patients with cardiogenic shock, these effects can worsen the condition and further decrease the blood flow to the body.
  • Bradycardia, heart block, or sick sinus syndrome. Bradycardia, heart block, or sick sinus syndrome are conditions that can affect the normal functioning of the heart, and they can be contraindicated for metoprolol use. Metoprolol is a beta blocker that slows down the heart rate, which can be harmful to people with these conditions.
    • Bradycardia is a condition in which the heart beats too slowly, and it can lead to fatigue, dizziness, and fainting.
    • Heart block is a condition in which the electrical signals that regulate the heartbeat are disrupted, which can also lead to slow or irregular heartbeats.
    • Sick sinus syndrome is a condition in which the natural pacemaker of the heart, called the sinus node, doesn’t function properly, leading to slow or irregular heartbeats.
      • For people with these conditions, taking a beta blocker like metoprolol can worsen their symptoms and lead to serious complications. Therefore, people with bradycardia, heart block, or sick sinus syndrome should not take metoprolol and should seek alternative treatments that are safe and appropriate for their individual needs.
  • Kidney or liver disease. People with kidney or liver disease should use metoprolol with caution, as this medication can affect the functioning of these organs.
  • Pregnancy. Metoprolol is classified as a pregnancy category C medication, which means that it may be harmful to a developing fetus. Women who are pregnant or planning to become pregnant should discuss the potential risks and benefits of taking metoprolol with their healthcare provider.
  • Breastfeeding. Metoprolol can pass into breast milk and may be harmful to a nursing infant, so women who are breastfeeding should discuss the potential risks and benefits of taking metoprolol with their healthcare provider.

Drug Interactions

When administering metoprolol, the nurse should consider the following drug interactions:

Drug-Drug

It’s important to always inform the physician and healthcare team about all medications, supplements, and herbal products the patient is taking. This allows them to monitor for potential drug-drug interactions and make any necessary adjustments to the treatment plan.

  • Interactions with calcium channel blockers. Calcium channel blockers are medications that are commonly used to treat high blood pressure, angina, and heart failure. Taking metoprolol with calcium channel blockers such as verapamil and diltiazem can increase the risk of side effects, including low blood pressure and slow heartbeat. The physician may adjust dosages or choose a different treatment option if this interaction is a concern.
  • Interactions with blood thinners
    Blood thinners such as warfarin and heparin are used to prevent blood clots and strokes. Taking metoprolol with blood thinners can increase the risk of bleeding and bruising. The physician may adjust dosages or choose a different treatment option if this interaction is a concern.
  • Interactions with alcohol and nitrates
    Consuming alcohol while taking metoprolol can increase the risk of side effects, including dizziness and drowsiness. It’s best to limit alcohol consumption or avoid it entirely while taking metoprolol.
  • Interactions with sympathomimetic drugs. Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
  • Thyroid administration. Concurrent administration of thyroid administration may decrease effectiveness.
  • Insulins or oral hypoglycemic agents. May alter the effectiveness of insulins or oral hypoglycemic agents (dose adjustments may be necessary).
  • Theophylline. This may decrease the effectiveness of theophylline.
  • Dopamine or Dobutamine. May decrease the beneficial beta1-cardiovascular effects of dopamine or dobutamine.
  • MAO inhibitor. Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension).

Adverse Effects

Metoprolol is a prescription medication commonly used to treat high blood pressure and heart conditions. While it can be effective in managing these conditions, it’s important to understand the potential side effects of the medication so that nurses can take steps to minimize the harmful impact of the drug on patients’ health and well-being.

  • Common Side Effects. Common side effects of metoprolol include fatigue, dizziness, headache, constipation, diarrhea, dry mouth, flatulence, gastric pain, heartburn, increased liver enzymes, nausea, and vomiting. These side effects usually go away on their own after a few days of taking the medication.
  • Serious Side Effects. In rare cases, metoprolol can cause serious side effects, including hyperglycemia, hypoglycemia, slow or irregular heartbeat, worsening chest pain, bronchospasm, wheezing, and difficulty breathing.
  • Allergic Reactions. Allergic reactions to metoprolol are rare, but they can be serious. Symptoms of an allergic reaction can include itching, rash, hives, and difficulty breathing.
  • Others. Erectile dysfunction, decreased libido, urinary frequency, drug-induced hepatitis, and drug-induced lupus syndrome.

Administration Considerations

Available Forms

Metoprolol is available in the following forms:

  • Tablets (tartrate): 25 mg, 50 mg, 100 mg.
  • Extended-release tablets (succinate; Toprol XL): 25 mg, 50 mg, 100 mg, 200 mg.
  • Solution for injection: 1 mg/mL.
  • In combination with: hydrochlorothiazide (Dutoprol, Lopressor HCT).

Dosage for Adults

  • PO (Adults):
    • Antihypertensive/antianginal. 25 – 100 mg/day as a single dose initially or 2 divided doses; may be increased q 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). Extended-release products are given once daily.
    • MI. 25 – 50 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mg twice daily.
    • Heart failure. 12.5 – 25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day.
    • Migraine prevention. 50 – 100 mg 2 – 4 times daily (unlabeled).
  • IV (Adults):
    • MI. 5 mg q 2 min for 3 doses, followed by oral dosing.

Pharmacokinetics

The pharmacokinetics of metoprolol, including how it is absorbed, distributed, metabolized, and excreted, are important factors in determining its effectiveness and potential side effects.

  • Absorption. Metoprolol is usually taken orally, and it is absorbed into the bloodstream through the digestive system. The rate at which it is absorbed can be affected by various factors, such as the presence of food in the stomach and the individual’s metabolism.
  • Distribution. Once absorbed into the bloodstream, metoprolol is distributed throughout the body and reaches its target tissues, such as the heart. The distribution of metoprolol can be influenced by factors such as body weight, age, and liver function.
  • Metabolism and Excretion. Metoprolol is metabolized, or broken down, by the liver. The rate at which it is metabolized can vary from person to person, and it can be influenced by factors such as liver function, age, and the presence of other medications in the body. The remnants of metoprolol are excreted from the body through urine. The rate at which metoprolol is excreted can be influenced by factors such as liver function and kidney function.
  • Half-life. 3 – 7 hr.

Nursing Considerations for Metoprolol

As a nurse, it’s important to be aware of the special considerations that come with administering metoprolol to patients.

Nursing Assessment

There are several important aspects of a nursing assessment for a patient taking metoprolol, including:

1. Monitor blood pressure, ECG, and pulse frequently during dose adjustment and periodically during therapy.
One of the primary nursing considerations when administering metoprolol is monitoring the patient’s ECG and vital signs, such as blood pressure, heart rate, and respiratory rate. This is important because metoprolol can affect these vital signs, and it’s essential to catch any adverse reactions or changes in a timely manner.

2. Assess hypersensitivity to metoprolol
Before administering metoprolol, it’s important to assess the patient for any allergies or sensitivities to the medication. Allergic reactions to metoprolol can be serious, and it’s crucial to identify them early on to prevent serious health consequences.

3. Monitor vital signs and ECG every 5 – 15 minutes during and for several hours after parenteral administration. If the heart rate is<40 bpm, especially if cardiac output is also decreased, administer atropine 0.25 – 0.5 mg IV.
Metoprolol, like all medications, has the potential to cause side effects. One of the most significant concerns with metoprolol is a decrease in heart rate, known as bradycardia. This decrease in heart rate can lead to decreased cardiac output, which can result in decreased blood flow to vital organs such as the brain and heart. To prevent these potentially life-threatening side effects, it is essential to monitor vital signs and ECG after administering metoprolol. If the heart rate of the patient is less than 40 beats per minute (bpm), especially if cardiac output is also decreased, it is recommended to administer atropine 0.25 to 0.5 mg intravenously (IV). Atropine works by increasing heart rate and improving cardiac output, thereby increasing blood flow to vital organs.

4. Monitor for side effects
Another important nursing consideration when administering metoprolol is monitoring the patient for any side effects or adverse reactions. Common side effects of metoprolol include fatigue, dizziness, headache, and diarrhea. If the patient experiences any of these symptoms or any other concerning symptoms, the nurse should notify the healthcare provider promptly.

5. Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of heart failure (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).
When administering metoprolol, it is crucial to monitor the patient’s fluid balance and heart function to ensure its safe and effective use. One of the side effects of metoprolol is heart failure, which can result in fluid buildup in the body and weight gain. Signs and symptoms include dyspnea (shortness of breath), rales/crackles in the lungs, weight gain, peripheral edema (swelling in the limbs), and jugular venous distension (swelling in the neck veins). To prevent these side effects and to ensure that the patient’s fluid balance is maintained, it is important to monitor the patient’s intake and output ratios and daily weights. This monitoring will allow healthcare providers to identify any potential fluid imbalances and take appropriate action to correct them.

6. Assess the frequency and characteristics of anginal attacks periodically during therapy.
Anginal attacks can be a side effect of metoprolol therapy, and it is important to monitor their frequency and characteristics to ensure the medication is working effectively. This monitoring will allow healthcare providers to determine if the medication is reducing the frequency and severity of anginal attacks, or if changes need to be made to the treatment plan.

7. Monitor laboratory values and results.
Metoprolol may cause increased levels of BUN, serum lipoprotein, potassium, triglyceride, and uric acid. It may also cause increased ANA titers, blood glucose levels, serum alkaline phosphatase, LDH, AST, and ALT levels. These changes can affect the patient’s overall health and well-being, and it is important to monitor them regularly during metoprolol therapy. Regular monitoring allows healthcare providers to identify any potential side effects early on and take action to prevent further health problems.

Nursing Diagnosis

Some common nursing diagnoses for a patient taking metoprolol, a beta-blocker medication, may include:

  • Risk for decreased cardiac tissue perfusion. Beta-blockers can decrease heart rate and contractility, which can lead to decreased cardiac output and decreased oxygen and nutrient delivery to the tissues, potentially causing decreased cardiac tissue perfusion.
  • Impaired gas exchange related to bronchoconstriction. Beta-blockers can cause bronchoconstriction, which is a narrowing of the airways, leading to decreased airflow and impaired gas exchange. This can cause shortness of breath, wheezing, or coughing.
  • Decreased cardiac output related to negative inotropic effect. Beta-blockers can decrease heart rate and contractility, which can lead to decreased cardiac output and decreased oxygen and nutrient delivery to the tissues.
  • Risk for injury. Metoprolol can cause dizziness or hypotension, which can increase the risk of falls and other injuries.
  • Impaired physical mobility related to fatigue. Metoprolol can cause fatigue, which can impact the patient’s physical mobility.
  • Risk for impaired skin integrity. Metoprolol can decrease peripheral circulation, which can increase the risk of skin breakdown and pressure ulcers.
  • Deficient knowledge regarding medication regimen and potential side effects. The nurse should assess the patient’s understanding of the medication regimen, including the purpose of the medication, the proper dosage and administration, and potential side effects.

Metoprolol Nursing Interventions

Nursing interventions for a patient taking metoprolol, a beta-blocker medication, may include:

1. Ensure that the patient is taking the medication as prescribed, at the correct dose and frequency, and report any discrepancies to the healthcare provider.
Before administering intravenously, have a second practitioner independently check the original order and dose calculations.

2. Check the label of the medication.
Do not confuse Toprol-XL (metoprolol) with Topamax (topiramate). Do not confuse Lopressor with Lyrica. Do not confuse metoprolol tartrate with metoprolol succinate.

3. Promote physical activity.
Encourage the patient to engage in moderate physical activity, as tolerated, to maintain or improve physical function.

4. Take apical pulse before administering.
If <50 bpm or if arrhythmia occurs, withhold medication and notify healthcare professional.

5. Administer metoprolol with meals or directly after eating.
Metoprolol is typically taken with or directly after a meal to reduce the risk of gastrointestinal side effects, such as nausea or upset stomach.

6. Provide written materials.
Provide the patient with written materials, such as medication information sheets or brochures, to support their understanding of their medication regimen.

7. Extended-release metoprolol should be swallowed whole and should not be broken, crushed, or chewed.
Breaking, crushing, or chewing the tablet can cause the medication to be released too quickly into the body, which can increase the risk of side effects.

8. Intravenous Administration

Patient Education and Teaching

To ensure safe and effective treatment, it is important for patients to be properly educated about their medication and the steps they can take to prevent potential side effects. This is where the importance of metoprolol patient education and patient teaching comes into play.

1. Provide information about the medication.
Explain to the patient the purpose of metoprolol and why they have been prescribed this medication.

2. Educate patient regarding dosage and administration of the medication.
Explain the correct dose and frequency of metoprolol, and instruct the patient on how to take the medication correctly, including whether to take it with or after meals.

3. Discuss with patient the potential side effects of the medication.
Discuss the common side effects of metoprolol, such as fatigue, dizziness, or shortness of breath, and explain how to manage these symptoms.

4. Emphasize the importance of reporting any adverse reactions or changes in symptoms to the healthcare provider.
Like all medications, metoprolol can cause side effects. Shortness of breath can be a side effect of metoprolol and can be caused by the drug’s effect on the heart rate and blood pressure. Depression is a rare but possible side effect of metoprolol and can be caused by the drug’s effect on the brain.

5. Provide patient knowledge of the importance of monitoring vital signs.
Explain to the patient the importance of monitoring their blood pressure, heart rate, and respiratory rate and reporting any significant changes to the healthcare provider.

6. Instruct patient to take medication as directed.
Advise patient to take medication as directed, at the same time each day, even if feeling well. Tell patient not to skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before the next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.

7. Educate patient and family on how to check pulse daily and blood pressure biweekly and to report significant changes to healthcare professionals.
One of the primary nursing considerations when administering metoprolol is monitoring the patient’s vital signs, such as blood pressure, heart rate, and respiratory rate. This is important because metoprolol can affect these vital signs, and it’s essential to catch any adverse reactions or changes in a timely manner.

8. Caution patient to avoid driving or other activities that require alertness until response to the drug is known.
Metoprolol may cause drowsiness.

9. Advise patient to change positions slowly.
This is to minimize orthostatic hypotension.

10. Warn patient that this medication may increase sensitivity to cold.
One of the side effects of metoprolol is increased sensitivity to cold. This side effect is not experienced by everyone who takes metoprolol but experiencing it should be reported to the physician immediately.

11. Encourage the patient to engage in moderate physical activity, as tolerated.
This is to maintain or improve physical function, and explain how physical activity can impact the effectiveness of metoprolol.

12. Provide information about possible drug interactions.
Discuss any potential drug interactions with metoprolol, including over-the-counter medications, supplements, and herbal products, and explain the importance of reporting any new medications or changes in medications to the healthcare provider.

13. Stress the importance of compliance with medication.
Emphasize the importance of taking metoprolol as prescribed and of not missing doses or stopping the medication without consulting the healthcare provider.

14. Instruct proper storage of medication.
Explain the proper storage of metoprolol, including keeping it in a safe, secure place out of reach of children, and avoiding exposure to heat or moisture.

15. Encourage patient to give importance to follow-up checkups.
Explain the importance of regular follow-up appointments with the healthcare provider to monitor the effectiveness of the medication and the patient’s response to treatment.

16. If patient is diabetic, monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs.
This is because metoprolol can potentially affect blood sugar levels. It is always important for individuals with diabetes to closely monitor their blood sugar levels and to inform their healthcare provider of any changes or concerns.

17. Instruct patient to inform health care professional of medication regimen before treatment or surgery.
This is because some medications, including metoprolol, can affect the heart rate and blood pressure and may need to be adjusted before certain procedures. By informing the healthcare professional, the patient can ensure that the treatment is performed safely and with the best outcome possible.

18. Advise patient to carry identification describing disease process and medication regimen at all times.
It is advisable for patients taking metoprolol to carry identification that describes their disease process and medication regimen at all times. This is especially important in case of an emergency, as it helps healthcare providers quickly and accurately determine the patient’s medical history and current treatment. This information can be critical in providing appropriate and effective care in an emergency situation.

19. 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.

Evaluation and Desired Outcomes

The evaluation and desired outcomes of metoprolol treatment vary depending on the specific condition being treated. However, some common desired outcomes of metoprolol treatment include:

  • Lowering blood pressure. One of the primary uses of metoprolol is to treat high blood pressure. The desired outcome is to lower blood pressure to a healthy level.
  • Improvement of heart function. In patients with heart conditions, such as heart failure or angina, the desired outcome of metoprolol treatment is to improve heart function and reduce symptoms.
  • Improvement of blood flow. Metoprolol can improve blood flow by relaxing the blood vessels, which in turn helps to lower blood pressure and reduce the risk of heart attacks.
  • Slower heart rate. Metoprolol can slow the heart rate, which can help prevent palpitations and shortness of breath associated with atrial fibrillation.
  • Alleviating chest pain. Metoprolol can help reduce the frequency and severity of angina (chest pain) symptoms in patients with heart disease.
  • Reducing symptoms of anxiety. Metoprolol may have a calming effect and reduce symptoms of anxiety in some patients.
  • Decreasing tremors. Metoprolol can help reduce tremors in patients with tremors or tremors caused by other medical conditions.
  • Reduced risk of blood clots. By slowing the heart rate, Metoprolol can also reduce the risk of blood clots, which can be a serious problem for people with atrial fibrillation.

Metoprolol is a commonly used beta-blocker medication with specific considerations for administration and monitoring in patients. As a nurse, it is important to be aware of the potential adverse effects of metoprolol, as well as the recommended monitoring parameters. By following these metoprolol nursing considerations, we can help ensure optimal patient outcomes.

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Gil Wayne ignites the minds of future nurses through his work as a part-time nurse instructor, writer, and contributor for Nurseslabs, striving to inspire the next generation to reach their full potential and elevate the nursing profession.

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