In this episode of Think Like a Nurse, we unpack metoprolol—one of the most commonly prescribed and most misunderstood cardiac medications in nursing practice. Brooke Wallace (ICU nurse, transplant coordinator, and educator) breaks down how to think critically about beta-blocker safety, drug formulations, and vital sign parameters to help nursing students not only pass the NCLEX but deliver safer bedside care. You’ll learn why tartrate vs. succinate isn’t just a detail—it’s a life-or-death distinction, what “never crush the extended-release” really means, and how to interpret those hold parameters every nurse must know cold.
Two Forms, Two Purposes
Metoprolol tartrate (immediate-release): short-acting, used for acute control (e.g., post-MI, hypertension crisis).
Metoprolol succinate (extended-release): long-acting, used for chronic control (heart failure, hypertension, stable angina).
Never crush succinate — it destroys the time-release mechanism and can cause severe bradycardia or hypotension.
Vital Sign Safety Checks
Hold if HR < 60 (apical pulse)
Hold if systolic BP < 100
Always assess before giving, not after.
Administration Alert
IV metoprolol tartrate must be given slowly over 1–2 minutes to prevent sudden bradycardia or collapse.
Patient Education Pearls
Never stop abruptly → risk of rebound hypertension or MI.
Change positions slowly → prevent orthostatic hypotension.
For diabetic patients, teach that metoprolol masks hypoglycemia symptoms like tachycardia or palpitations.