Mindanao State University – Iligan Institute of Technology Student: SALIMBAGAT, CHRISTINE.

P Section: 262

PHARMACOLOGY DRUG STUDY

Brand Name: Inderal Generic Name: Propranolol Drug Classification: Beta blockers

Dosage, Route & Frequency Drug-Drug &

Pres Side Effects
Drug Action Drug-Food Indications Contraindications Adverse Reactions (By System)
Recommended cribe (By System)
Interactions
d
Hypertension Nonselective Drug: PHENOTHI Management Greater than first-degree CNS: fatigue, weakness, Body as a Whole: Fever; pharyngitis; respiratory
Adult: PO 40 mg beta-blocker of AZINES have of cardiac heart block; CHF, right anxiety, dizziness, distress, weight gain, LE-like reaction, cold
b.i.d., usually need both cardiac additive arrhythmias, ventricular failure secondary drowsiness, insomnia, extremities, leg fatigue,
160–480 mg/d in and bronchial hypotensive myocardial to pulmonary hypertension; memory loss, mental arthralgia, anaphylactic/anaphylactoid
divided adrenoreceptor effects. BETA- infarction, ventricular dysfunction; sinus depression, mental reactions.
doses; InnoPran s which ADRENERGIC tachyarrhyth bradycardia, cardiogenic status changes, Urogenital: Impotence or decreased libido.
XL dose 80 mg q hs, competes with AGONISTS (e.g., a mias shock, significant aortic or nervousness, Skin: Erythematous, psoriasis-like eruptions;
may increase to 120 epinephrine and lbuterol) associated mitral valvular disease; nightmares. pruritus, Stevens-Johnson syndrome, toxic
mg hs norepinephrine antagonize with digitalis bronchial asthma or EENT: blurred vision, epidermal necrolysis, erythema
Child: PO 1 mg/kg/d for available effects. Atropine intoxication, bronchospasm, severe COPD, dry eyes, nasal multiforme, exfoliative dermatitis, urticaria.
in 2 divided doses (1– beta-receptor and TRICYCLIC anesthesia, pulmonary edema, allergic stuffiness. Resp: Reversible alopecia, hyperkeratoses of scalp,
5 mg/kg/d) sites. In higher ANTIDEPRESSAN and rhinitis during pollen season; bronchospasm, palms, feet; nail changes, dry skin.
Neonate: PO 0.25 doses, exerts TS block thyrotoxicosi concurrent use with wheezing. CNS: Drug-induced psychosis, sleep disturbances,
mg/kg q6–8h (max: 5 direct quinidine- bradycardia. DIU s, adrenergic-augmenting CV: ARRHYTHMIAS, depression, confusion, agitation, giddiness, light-
mg/kg/d) IV 0.01 like effects, RETICS and hypertrophic psychotropic drugs or within 2 BRADYCARDIA, HF, headedness, fatigue, vertigo, syncope,
mg/kg slow IV push which depresses other HYPOTENSI subaortic wk of MAO inhibition therapy; PULMONARY EDEMA, weakness, drowsiness, insomnia, vivid dreams,
over 10 min q6–8h cardiac function VE stenosis, abrupt discontinuation; major orthostatic visual hallucinations, delusions, reversible
prn (max: 0.15 mg/kg including AGENTS increase angina depression; peripheral hypotension, organic brain syndrome.
q6–8h) contractility and hypotension. pectoris due vascular disease, Raynaud's peripheral CV: Palpitation, profound bradycardia, AV heart
Angina arrhythmias. High doses to coronary disease; pregnancy (category vasoconstriction. GI: block, cardiac standstill, hypotension, angina
Adult: PO 10–20 mg Lowers both of tubocurarine atheroscleros C). constipation, diarrhea, pectoris, tachyarrhythmia, acute CHF, peripheral
b.i.d. or t.i.d., may supine and may potentiate is, Cautious Use nausea. GU: erectile arterial insufficiency resembling Raynaud's
need 160–320 mg/d standing blood neuromuscular pheochromo Peripheral arterial dysfunction,plibido. disease, myotonia, paresthesia of hands.
in divided doses pressures in blockade. Cimeti cytoma, insufficiency; history of Derm: ERYTHEMA Special Senses: Dry eyes (gritty sensation), visual
Arrhythmias hypertensive dine decreases hereditary systemic insect sting reaction; MULTIFORME, disturbances, conjunctivitis, tinnitus, hearing
Adult: PO 10–30 mg patients. clearance, essential patients prone to EXFOLIATIVE loss, nasal stuffiness.
t.i.d. or q.i.d. IV 0.5–3 Mechanism of increases tremor; also nonallergenic bronchospasm DERMATITIS, STEVENS- GI: Dry mouth, cheilostomatitis, nausea,
mg q4h prn antimigraine effects. ANTACID treatment of (e.g., chronic bronchitis, JOHNSON SYNDROME, vomiting, heartburn, diarrhea, constipation,
Child: PO 1–4 action unknown S may decrease hypertension emphysema); major surgery; TOXIC EPIDERMAL flatulence, abdominal cramps, mesenteric
mg/kg/d in 4 divided but thought to absorption. alone, but cerebrovascular disease, NECROLYSIS, itching, arterial thrombosis, ischemic colitis,
doses (max: 16 be related to generally stroke; renal or hepatic rash. pancreatitis.
mg/kg/d) IV 10–20 inhibition of with a disease; pheochromocytoma, Endo: hyperglycemia, Hematologic: Transient eosinophilia,
mcg/kg/min over 10 cerebral thiazide or vasospastic angina; older hypoglycemia (qin thrombocytopenic or nonthrombocytopenic
min vasodilation and other adults; diabetes mellitus; children). purpura, agranulocytosis.
Acute MI arteriolar antihyperten patients prone to MS: arthralgia, back Metabolic: Hypoglycemia, hyperglycemia,
Adult: PO 180–240 spasms. sives. hypoglycemia; pain, muscle cramps, hypocalcemia (patients with
mg/d in divided hyperthyroidism, myopathy. Neuro: hyperthyroidism). Respiratory: Dyspnea, laryngo
doses thyrotoxicosis; surgery; paresthesia. Misc: spasm, bronchospasm.
Migraine Prophylaxis myasthenia gravis; Wolff- ANAPHYLAXIS, drug-
Adult: PO 80 mg/d in Parkinson-White syndrome; induced lupus
divided doses, may lactation. syndrome.
need 160–240 mg/d
Responsibilities in the Nursing Process (ADPIE) Responsibilities in the Nursing Process (ADPIE)
A - ● Monitor BP and pulse frequently during dose adjustment P - ● To decrease BP. ● Control arrhythmias without appearance of detrimental side effects. ● Reduce frequency of anginal
period and periodically during therapy. ● Abrupt withdrawal of attacks. ●To increase activity tolerance. ● Prevent MI. ● Prevent vascular headaches. ● Management of thyrotoxicosis. ●
propranolol may precipitate life-threatening arrhythmias, Management of pheochromocytoma. ● To decrease tremors. ● Management of hypertrophic cardiomyopathy. ● To
hypertension, or myocardial ischemia● Pedi: Assess pediatric decrease symptoms associated with PTSD
patients for signs and symptoms of hypoglycemia, particularly when I - ● High Alert: IV vasoactive medications are inherently dangerous. Before administering intravenously, have second
oral foods and fluids are restricted. ● Patients receiving propranolol practitioner independently check the original order, dose calculations, and infusion pump settings. Also, patient harm or
IV must have continuous ECG monitoring and may have pulmonary fatalities have occurred when switching from oral to IV propranolol; oral and parenteral doses are not interchangeable. IV
capillary wedge pressure (PCWP) or central venous pressure (CVP) dose is 1/10 of the oral dose. Change to oral therapy as soon as possible. Do not confuse propranolol with pravachol. ● High
monitoring during and for several hours after administration. ● Alert: Do not confuse Inderal (propranolol) with Adderall (an amphetamine/dextroamphetamine combination drug). ● PO:
Monitor intake and output ratios and daily weight. Assess patient Take apical pulse prior to administering. If 50 bpm or if arrhythmia occurs, withhold medication and notify physician or other
routinely for evidence of fluid overload (peripheral edema, dyspnea, health care professional. ● Administer with meals or directly after eating to enhance absorption. ● Swallow extended
rales/crackles, fatigue, weight gain, jugular venous distention). ● release tablets whole; do not crush, break, or chew. Propranolol tablets may be crushed and mixed with food. ● Mix
Assess for rash periodically during therapy. May cause Stevens- propranolol oral solution with liquid or semisolid food (water, juices, applesauce, puddings). To ensure entire dose is taken,
Johnson syndrome. Discontinue therapy if severe or if accompanied rinse glass with more liquid or have patient consume all of the applesauce or pudding. Do not store after mixing● Inform
with fever, general malaise, fatigue, muscle or joint aches, blisters, patient that abrupt withdrawal can cause lifethreatening arrhythmias, hypertension, or myocardial ischemia
oral lesions, conjunctivitis, hepatitis and/or eosinophilia. ● Angina: E - ● Decrease in BP. ● Control of arrhythmias without appearance of detrimental side effects. ● Reduction in frequency of
Assess frequency and characteristics of anginal attacks● Vascular anginal attacks. ● Increase in activity tolerance. ● Prevention of MI. ● Prevention of vascular headaches. ● Management of
Headache Prophylaxis: Assess frequency, severity, characteristics, thyrotoxicosis. ● Management of pheochromocytoma. ● Decrease in tremors. ● Management of hypertrophic
and location of vascular headaches cardiomyopathy. ● Decrease in symptoms associated with PTSD.
D - ● Decreased cardiac output (Side Effects) ● Noncompliance
(Patient/Family Teaching)