Beta Blockers

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

60 is my bottom line

yup, unless they have a pacemaker!

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?

Good grief, is this the trend nowadays?

My thoughts exactly. That is crazy.

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.

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).

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.