A client prescribed propranolol (Inderal) for angina asks the nurse why this drug should not be abruptly discontinued. The nurse would be correct in telling the client that abrupt withdrawal could lead to which result?
1. Extreme weight loss
2. Increase in blood glucose levels
3. Rebound chest pain or heart attack
4. Insomnia
Correct Answer: 3
Rationale 1: Extreme weight loss does not occur with abrupt withdrawal of propranolol (Inderal).
Rationale 2: Increase in blood glucose levels is not seen with abrupt withdrawal of propranolol (Inderal).
Rationale 3: Beta blockers should be withdrawn gradually over several weeks. If withdrawn abruptly, the heart displays hypersensitivity to catecholamines, and sweating, palpitations, headache, and tremulousness can occur. This phenomenon is called rebound cardiac excitation. Clients with coronary artery disease might experience a worsening of angina symptoms, and MIs have been recorded in some clients.
Rationale 4: Insomnia is not seen with abrupt withdrawal of propranolol (Inderal).
Global Rationale: Beta blockers should be withdrawn gradually over several weeks. If withdrawn abruptly, the heart displays hypersensitivity to catecholamines, and sweating, palpitations, headache, and tremulousness can occur. This phenomenon is called rebound cardiac excitation. Clients with coronary artery disease might experience a worsening of angina symptoms, and MIs have been recorded in some clients. Extreme weight loss, an increased in blood glucose levels, and insomnia do not occur with abrupt withdrawal of propranolol (Inderal).
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