In this episode of Think Like a Nurse, we dive deep into one of the most foundational cardiac medications—metoprolol. Nursing students and new grads will learn how this beta-1 selective blocker works primarily on the heart (“one heart, beta-1”) and how at higher doses, it can begin to affect the lungs (“two lungs, beta-2”). Understanding this distinction is essential for patient safety, especially in those with asthma or COPD. Brooke Wallace breaks down what every nurse needs to know to safely administer metoprolol, avoid common medication mix-ups, and master this high-yield NCLEX topic. You’ll learn how to differentiate metoprolol tartrate (immediate release) from metoprolol succinate (extended release), safely perform IV administration over 1–2 minutes, and apply critical hold parameters (HR < 60, SBP < 100). We’ll also cover subtle signs of worsening heart failure, discuss masked hypoglycemia in diabetic patients, and review a classic NCLEX-style question to lock it all in. This episode turns pharmacology into bedside wisdom — practical, memorable, and built to help you think like a nurse.
Mechanism of Action: Cardioselective beta-1 blocker that slows HR, reduces contractility, and lowers myocardial oxygen demand.
Formulations:
Tartrate (Lopressor) — Immediate release, given BID or IV for acute use.
Succinate (Toprol XL) — Extended release, given once daily for chronic use, especially in heart failure.
IV Administration: Give slowly — 5 mg IV over 1–2 minutes, reassess HR and BP between doses.
Hold Parameters: Hold if HR < 60 or systolic BP < 100, and notify provider.
Major Adverse Effects: Bradycardia, hypotension, worsening heart failure (weight gain, crackles), bronchospasm in asthma/COPD.
Key Nursing Pearls:
Always verify tartrate vs. succinate before giving.
Never crush extended-release tablets.
Never stop suddenly — risk of rebound hypertension or MI.
Change positions slowly to prevent orthostatic hypotension.
Educate diabetic patients about masked hypoglycemia.
NCLEX Practice Question Highlight: Hold and notify the provider when HR < 60 before administering metoprolol.
Nursing Pearls Wrap-Up:
Know your formulation.
Monitor before you medicate.
Assess symptoms, not just numbers.
Teach safety before discharge.