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• Lopresor
• Nu-Metop
• Toprol XL

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• Antihypertensive
• Antianginal
• β1-Blocker

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Lowers B/P by β-blocking effects; reduces elevated renin plasma levels; blocks β2- adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect

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Slows heart rate, decreases cardiac output, reduces B/P. Decreases myocardial ischemia severity.

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• Injection Solution: 1 mg/mL.
• Tablets (Immediate-Release): 25 mg, 50 mg, 100 mg.
• Tablets (Extended-Release): 25 mg, 50 mg, 100 mg,
200 mg.

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To relieve mild to moderate pain from headache, muscle ache, backache, minor arthritis, common cold, toothache, or menstrual cramps; to reduce fever.

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• Hypersensitivity to metoprolol. (Immediate-Release):
• MI: Severe sinus bradycardia, MI with heart rate less
than 45 beats/min or systolic B/P less than 100 mmHg,
moderate to severe HF, significant first-degree heart
block, second- or third-degree heart block.
• (Immediate-Release): HTN/Angina: Sinus bradycardia,
second- or third-degree heart block, cardiogenic
shock, overt HF, sick sinus syndrome (except with
pacemaker), severe peripheral arterial disease,
pheochromocytoma. (Extended-Release): Severe
bradycardia, secondor third-degree heart block,
cardiogenic shock, decompensated HF, sick sinus
syndrome (except with functioning pacemaker).
Hypersensitivity to acetaminophen.
• (Ofirmev): severe hepatic impairment or severe active
liver disease.
• Cautions: Arterial obstruction, bronchospastic disease,
hepatic impairment, peripheral vascular disease,
hyperthyroidism, diabetes mellitus, myasthenia gravis,
psychiatric disease, history of severe anaphylaxis to
allergens.
• (Extended-Release): Compensated HF.

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• Frequent: Diminished sexual function, drowsiness,
insomnia, unusual fatigue/weakness.
• Occasional: Anxiety, diarrhea, constipation, nausea,
vomiting, nasal congestion, abdominal discomfort,
dizziness, difficulty breathing, cold hands/feet.
• Rare: Altered taste, dry eyes, nightmares, paresthesia,
allergic reaction (rash, pruritus).

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Overdose may produce profound bradycardia, hypotension, bronchospasm. Abrupt withdrawal may result in diaphoresis, palpitations, headache, tremulousness, exacerbation of angina, MI, ventricular arrhythmias. May precipitate HF, MI in pts with heart disease, thyroid storm in those with thyrotoxicosis, peripheral ischemia in those with existing peripheral vascular disease. Hypoglycemia may occur in pts with previously controlled diabetes (may mask signs of hypoglycemia).

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• Assess baseline renal function, LFT.
• Assess B/P, apical pulse immediately before drug
administration (if pulse is 60/min or less or systolic B/P          is less than 90 mm Hg, withhold medication, contact
physician).
• Antianginal: Record onset, type (sharp, dull,
squeezing), radiation, location, intensity, duration of
anginal pain, precipitating factors (exertion, emotional
stress).
• If given for analgesia, assess onset, type, location,
duration of pain.

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• Measure B/P near end of dosing interval (determines
whether B/P is controlled throughout day).
• Monitor B/P for hypotension, respiration for shortness
of breath.
• Assess pulse for quality, rate, rhythm.
• Assess for evidence of HF: dyspnea (esp. on exertion,
lying down), night cough, peripheral edema, distended
neck veins.
• Monitor I&O (increased weight, decreased urinary
output may indicate HF).
• Therapeutic response to hypertension noted in 1–2
wks.

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• Do not abruptly discontinue medication.
• Compliance with therapy regimen is essential to
control hypertension, arrhythmias.
• If dose is missed, take next scheduled dose (do not
double dose).
• Go from lying to standing slowly.
• Report excessive fatigue, dizziness.
• Avoid tasks that require alertness, motor skills until
response to drug is established.
• Do not use nasal decongestants, OTC cold
preparations (stimulants) without physician approval.
• Monitor B/P, pulse before taking medication.
• Restrict salt, alcohol intake.

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• Nitrojet
• Nitronal
• Nitrostat

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• Coronary vasodilator
• Antianginal

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• Decreases preload and afterload, which are responsible
for decreasing left ventricular end-diastolic pressure,
systemic vascular resistance; dilates coronary arteries,
improves blood flow through coronary vasculature,
dilates arterial and venous beds systemically.

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• Infusion, Pre-Mix: 25 mg/250 mL, 50 mg/500 mL,
50 mg/250 mL, 100 mg/250 mL.
• Injection, Solution: 5 mg/mL.
• Ointment (Nitro-Bid): 2%.
• Ointment, Rectal (Rectiv): 0.4%.
• Translingual Spray: 0.4 mg/spray.
• Transdermal Patch: 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr,
0.6 mg/hr.
• Capsules, Extended-Release: 2.5 mg, 6.5 mg, 9 mg.
• Tablets, Sublingual: 0.4 mg.Capsules: 75 mg, 150 mg,
300 mg.

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• Treatment/prevention of angina pectoris. Extended-
release, topical forms used for prophylaxis, long-term
angina management. IV form used in treatment of HF,
acute MI, perioperative hypertension, induction of
intraoperative hypotension.
• Rectiv: Treatment of moderate to severe pain
associated with chronic anal fissure.
• OFF-LABEL: Short-term management of pulmonary
hypertension, esophageal spastic disorders, uterine
relaxation, treatment of sympathomimetic vasopressor
extravasation.

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• Hypersensitivity to nitroglycerin. Allergy to adhesives (
transdermal); increased ICP; severe anemia;
concurrent use of sildenafil, tadalafil, vardenafil (PDE5
inhibitors).
• (Additional)IV: Restrictive cardiomyopathy, pericardial
tamponade, constrictive pericarditis.
• Sublingual, Rectal: Increased intracranial pressure,
severe anemia.
• Cautions: Blood volume depletion, severe hypotension (systolic B/P less than 90 mm Hg), bradycardia (less than 50 beats/min), inferior wall MI and suspected right ventricular involvement.

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• Frequent: Headache (possibly severe; occurs mostly in
early therapy, diminishes rapidly in intensity, usually
disappears during continued treatment), transient
flushing of face/neck, dizziness (esp. if pt is standing
immobile or is in a warm environment), weakness,
orthostatic hypotension.
• Sublingual: Burning, tingling sensation at oral point of
dissolution.
• Ointment: Erythema, pruritus.
• Occasional: GI upset.
• Transdermal: Contact dermatitis.

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Discontinue drug if blurred vision, dry mouth occurs. Severe orthostatic hypotension may occur, manifested by syncope, pulselessness, cold/clammy skin, diaphoresis. Tolerance may occur with repeated, prolonged therapy; minor tolerance may occur with intermittent use of sublingual tablets. High doses tend to produce severe headache.

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• Record onset, type (sharp, dull, squeezing), radiation,
location, intensity, duration of anginal pain;
precipitating factors (exertion, emotional stress).
• Assess B/P, apical pulse before administration and
periodically following dose.
• Pt must have continuous EKG monitoring for IV
administration.
• Rule out rightsided MI, if applicable (may precipitate
life-threatening hypotension).
• Receive full medication history, and screen for
interactions, esp. use of PDE5 inhibitors.
• Question medical history and screen for
contraindications.

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• Monitor B/P, heart rate.
• Assess for facial, neck flushing.
• Cardioverter/defibrillator must not be discharged through
paddle electrode overlying nitroglycerin (transdermal,
ointment) system (may cause burns to pt or damage to
paddle via electrical arcing).
• Consider NS boluses for hypotension.

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• Go from lying to standing slowly.
• Take oral form on empty stomach (however, if
headache occurs during therapy, take medication with
meals).
• Use spray only when lying down.
• Dissolve sublingual tablet under tongue; do not
swallow.
• Take at first sign of angina.
• May take additional dose q5min if needed up to a total
of 3 doses.
• If not relieved within 5 min, contact physician or
immediately go to emergency room.
• Do not change brands.
• Keep container away from heat, moisture.
• Do not inhale lingual aerosol but spray onto or under
tongue (avoid swallowing after spray is administered).
• Expel from mouth any remaining lingual, sublingual,
intrabuccal tablet after pain is completely relieved.
• Place transmucosal tablets under upper lip or buccal
pouch (between cheek and gum); do not
chew/swallow tablet.
• Avoid alcohol (intensifies hypotensive effect). If
alcohol is ingested soon after taking nitroglycerin,
possible acute hypotensive episode (marked drop in
B/P, vertigo, diaphoresis, pallor) may occur.
• Do not use within 48 hrs of sildenafil, tadalafil,
vardenafil (PDE5 inhibitors); may cause acute
hypotensive episode.

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Hodgson, B. B., & Kizior, R. J. (2019). Saunders Nursing Drug
Handbook 2019. St. Louis: Elsevier.

Skidmore-Roth, L. (2019). Mosby's 2019 Nursing Drug
Reference.