Beta Blockers

[Kooky Korky]

What do you usually see as the pulse rate below which you hold a BB? What setting are you in?

Thanks!

[Weebee, LVN]

60 is my bottom line

[casi, ASN, RN]

Depends on the patient and how they react to the drug and it depends on what it is treating.

[General E. Speaking, RN, RN]

60 is my bottom line

yup, unless they have a pacemaker!

[General E. Speaking, RN, RN]

At my hospital we aren't allowed to use our own judgment and hold any medication. 90% of the time there is no parameters either. So we make a lot of phone calls.

Good grief, is this the trend nowadays?

[krimicrat]

Good grief, is this the trend nowadays?

My thoughts exactly. That is crazy.

[CCL RN, RN]

I hold where the parameters say to hold.

If no parameters are listed I will still give the med even if HR is below 60, if thats their baseline. Plenty of pts need their meds, especially cardiac meds. You can also look at their history here in the hospital to see what happened yesterday, the day prior, etc.

If the pt is having an unusually low hr or BP, then I'll toss a phone call towards the MD.

Also, I do CT Angios, where we give 100mg metoprolol PO, and then up to 15mg IV if the HR remains above 55. You'd be surprised at how little it will lower the HR.

[psu_213, BSN, RN]

The other thing that often gets overlooked (including by myself), is that a pt who has used a beta blocker for a while will get rebound hypertension if the beta blocker is quit 'cold turkey.' Also, how does the patient take their pulse before taking their beta blocker at home? Their HR may often be high 50s, low 60s and they always take it without a second thought (they may not know better).

[llg, PhD, RN]

The other thing that often gets overlooked (including by myself), is that a pt who has used a beta blocker for a while will get rebound hypertension if the beta blocker is quit 'cold turkey.' Also, how does the patient take their pulse before taking their beta blocker at home? Their HR may often be high 50s, low 60s and they always take it without a second thought (they may not know better).

It's always important to know what the patient's usual numbers and home routines are. I take a beta blocker twice daily and don't even check my pulse rate, though I know my resting pulse is in the 60's. My daytime & evening BP's are often around 95/55. My doctor and I agree that as long as I seem to tolerate these low numbers with no problems, I should keep taking my 2 BP meds (each twice per day) in order to minimize the BP spikes I have as I wake up in the morning. My "upon wakening" BP's are more like 145/75 even with those meds.

I worry that some well-meaning, but ill-informed nurse might withhold my meds if they take my BP in the evening and see those low numbers -- not realizing that I tolerate those numbers well -- and that I need those evening doses to keep my BP down to a safe level between 3 and 8 am.

[Kooky Korky, BSN, RN]

OK, I stand updated. I have learned here that I need to look at the pt's trend, not just the right now pulse rate, also to not fear giving it for

Many thanks to all for your input.

KK

[BluegrassRN]

Good grief, is this the trend nowadays?

Out on the floors, it is. In my facility, apparently only ICU and ED nurses have good judgement when it comes to deciding whether to hold insulin, BB, etc if no specific parameters are written. On the floor, we need to call if we hold something. To be fair, it's probably because a few bad apples/rushed and over worked nurses made some bad decisions on whether to hold or not hold something. But still, it's rather insulting, and it makes the physicians angry *and* less trusting of us when we call for every little hold.