Alpha Blockers: Option 3: Post an explanation of the properties...

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

·         Chalikonda, S. A. (2009). Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. AANA Journal, 77(2), 103–108. 
Retrieved from the Walden Library databases.

·         Frankenstein, L., Katus, H. A., Grundtvig, M., Hole, T., de Blois, J., Schellberg, D., ... Agewall, S. (2013). Association between spironolactone added to beta-blockers and ACE inhibition and survival in heart failure patients with reduced ejection fraction: A propensity score-matched cohort study. European Journal of Clinical Pharmacology, 69(10), 1747–1755. 
Retrieved from the Walden Library databases.

·         Hao, G., Wang, Z., Guo, R., Chen, Z., Wang, X., Zhang, L., & Li, W. (2014). Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled studies. BMC Cardiovascular Disorders, 14, 148. 
Retrieved from the Walden Library databases.

·         Levy, P. D., Laribi, S., & Mebazaa, A. (2014). Vasodilators in acute heart failure: Review of the latest studies. Current Emergency and Hospital Medicine Reports, 2(2), 126–132.

·         Shi, C. (2013). Blood pressure lowering efficacy of alpha blockers for primary hypertension. International Journal of Evidence-Based Healthcare, 11(3), 204–205.
Retrieved from the Walden Library databases.

·         Tocci, G., Battistoni, A., Passerini, J., Musumeci, M. B., Francia, P., Ferrucci, A., & Volpe, M. (2015). Calcium channel blockers and hypertension. Journal of Cardiovascular Pharmacology and Therapeutics, 20(2), 121–130. 
Retrieved from the Walden Library databases.

·         Toppen, W., Sareh, S., Satou, N., Shemin, R., Hunter, C., Buch, E., & Benharash, P. (2014). Do preoperative β-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines. American Surgeon, 80(10), 1018–1021. 
Retrieved from the Walden Library databases.

·         Wang, A. (2012). Efficacy of class III antiarrhythmics and magnesium combination therapy for atrial fibrillation. Pharmacy Practice, 10(2), 65–71.
Retrieved from the Walden Library databases.

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

1.       Alpha blockers

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by Day 3:

·         Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

·         Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

·         Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Labetalol is a beta blocker that is often given to treat hypertension during the perioperative period. Labetalol is preferred for treating hypertension associated with tachycardia (Broussard, 2016). As a PACU nurse, I have administered this medication both preoperatively and postoperatively, but more commonly after surgery.  Before treating hypertension, the patient's preoperative and baseline BP, as well as the home medication list and timing of last doses of antihypertensive medications are reviewed.  Typically, initial treatment is with small bolus doses 5 to 20 mg IV push over 2 minutes; may administer additional injections using double the dose (maximum dose: 80 mg/dose) at 10-minute intervals until target SBP is reached; total maximum dose of 300 mg (Drugs.com, 2017).

A 48-year-old African American male was received to the PACU status post inguinal hernia repair.  His BP was 187/101, heart rate 88 bpm.  He had a history of poorly controlled HTN and tobacco use.  His preoperative BP was 160/90. Current medications include Lisinopril-HCTZ 20mg/12.5mg po daily.  The patient admits to frequent noncompliance with medications.  The attending anesthesiologist ordered labetalol 10mg IV x 2 doses for SBP>180.  The two doses were given 10-15 minutes apart and the patient’s BP returned to baseline 154/87. Prior to discharge, he was counseled on the importance BP management including medication compliance, routine PCP visits, and lifestyle modification including smoking cessation. He was also educated on the adverse effects of uncontrolled HTN including stroke and heart attack.  In similar situations, I would choose a beta blocker to treat HTN if not contraindicated. 

References

Broussard, D. (2016).  Cardiovascular problems in the post anesthesia recovery unit.  Retrieved from https://www.uptodate.com/contents/cardiovascular-problems-in-the-post-anesthesia-care-unit-pacu?                          source=search_result&search=labetalol&selectedTitle=5~96.

Drugs.com (2017). Labetalol: Dosages.  Retrieved from https://www.drugs.com/dosage/labetalol.html