Help please, apical pulse before metoprolol?

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Davis online drug guide says to take the apical pulse for a full minute and not administering metoprolol if less than 50. Lippincott's 2012 does not include this for metoprolol. I am trying to find out why the information is different. Have the requirements changed? I've been searching for articles on this but have had no luck. If anybody has a source they can direct me to I would greatly appreciate it.

Thank you

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Specializes in Gerontological, cardiac, med-surg, peds.

Whether the drug guide specifies it or not, it is always best practice to check an apical pulse before giving a beta blocker, calcium channel blocker, or any other type of medication that can affect the heart rate (e.g., clonidine). It has been standard practice in hospitals in which I have worked or have had clinical groups to withhold metoprolol for an apical pulse less than 50 and/or systolic BP less than 90. You would need to check the protocols at your facility and also check with the provider.

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Thank you for the reply. What I'm really looking for is an article stating if that is a new change, and if so why. Or an article stating why to do that. I understand the reasoning for doing so, I'm just looking for someting that I can use as a reliable source of information.

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Specializes in Infusion.

Do you have a pharmacology textbook? I sold mine back to the bookstore otherwise I would have checked.

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Specializes in Pediatrics.
Thank you for the reply. What I'm really looking for is an article stating if that is a new change, and if so why. Or an article stating why to do that. I understand the reasoning for doing so, I'm just looking for someting that I can use as a reliable source of information.

Perhaps the website of the manufacturer (drug co)?

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Specializes in Emergency.

I bet the authors forgot to include it in the text. That's like giving Lasix without checking K+. Or like pulling the trigger playing Russian Roulette. Well, maybe not that drastic, but you get the idea ;)

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Specializes in LDRP.

its just common sense... if their pulse is lower than 50 before you give them something that will lower their heart rate further, why would you give it and risk them become severely bradychardic?

also usually when the doc orders it you will see in the orders "hold if HR

the other drug guide may have left it out because you should go by the docs orders, but beta blockers and like drugs should always have parameters and if they dont you should use your nursing judgement to ask why they dont.

im not seeing why you need some kind of EBP article on this..

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at our facility we do hold if P is less than 50.....we dont take apical pulse like we learned in school....which i questioned when i first started 4 yrs ago...doctors orders i was told...

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"at our facility we do hold if p is less than 50.....we dont take apical pulse like we learned in school....which i questioned when i first started 4 yrs ago...doctors orders i was told..."

first, while nurses are responsible for implementing some parts of the medical plan of care,that doesn't mean they check their brains and education at the door when they come in to work in the morning. as an rn you are responsible for knowing whether or not a part of a medical plan of care is safe if done as written.

take the apical pulse.

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