Download Medications - Metoprolol

MEDICATIONS (a)
Student: Erin Nowlin
Drug
Generic:
Metoprolol tartrate
Client Information:
Dosage, Route,
& Frequency
Client:
50 mg via PEG
tube every 12
hours
Brand:
Lopressor
Onset:
15 minutes
Peak:
1 hour
Duration:
12 hours
Usual:
Initially, 50 mg
by mouth twice
daily or 100 mg
by mouth once
daily; then up to
100 to 400 mg
daily in two or
three divided
doses. Adjust
dosage as needed
and tolerated at
intervals of not
less than 1 week
to maximum of
400 mg daily.
Classification
JE, Rm 33A, 80
yr old black
female
Allergies: NKDA
Purpose of the Drug
Pharmacologic
Classification:
Beta blocker
Specific to this Client:
antihypertensive
Therapeutic
Action:
Unknown. A
selective beta
blocker that
selectively blocks
beta1 receptors;
decreases cardiac
output, peripheral
resistance and
cardiac oxygen
consumption; and
depresses renin
secretion.
Usual:
antihypertensive
Date:
Oct 29, 2010
Nursing Implications
Side Effects/Adverse Reactions:
CNS: fatigue, dizziness,
depression.
CV: hypotension, bradycardia,
heart failure, AV block, edema.
GI: nausea, diarrhea.
Respiratory: dyspnea
Skin: rash
Interactions:
Drug-drug. Amobarbital,
butabarbital, butalbital,
pentobarbital, phenobarbital,
primidone, secobarbital: May
reduce metoprolol effect. May
need to increase metoprolol dose.
Cardiac glycosides, diltiazem:
May cause excessive bradycardia
and increased depressant effect
on myocardium. Use together
cautiously.
Catecholamine-depleting drugs
such as MAO inhibitors,
reserpine: May have additive
Drug
Dosage, Route,
& Frequency
Classification
Purpose of the Drug
Nursing Implications
effect. Monitor patient for
hypotension and bradycardia.
Chlorpramazine: May decrease
hepatic clearance. Watch for
greater beta-blocking effect.
Cimetidine: May increase
metoprolol effects. Give another
H2 agonist or decrease dose of
metoprolol.
Fluoxetine, paroxetine,
propafenone, quinidine: May
increase metoprolol level.
Monitor vital signs.
Hydralazine: May increase levels
of both drugs. Monitor patient
closely. May need to adjust
dosage.
Indomethacin, NSAIDs: May
decrease antihypertensive effect.
Monitor blood pressure and
adjust dosage.
Insulin, oral antibiotics: May
alter dosage requirements in
previously stabilized diabetic
patients. Monitor patient closely.
I.V. lidocaine: May reduce
hepatic metabolism of lidocaine,
increasing risk of toxicity. Give
bolus doses of lidocaine at a
slower rate, and monitor
Drug
Dosage, Route,
& Frequency
Classification
Purpose of the Drug
Nursing Implications
lidocaine level closely.
Prazosin: May increase risk of
orthostatic hypotension in the
early phases of use together.
Assist patient to stand slowly
until effects are known.
Rifampin: May increase
metoprolol metabolism. Watch
for decreased effect.
Terbutaline: May antagonize
bronchodilatory effects of
terbutaline. Monitor patient.
Verapamil: May increase effects
of both drugs. Monitor cardiac
function closely, and decrease
dosages as needed.
Drug-herb. Ma-huang: May
decrease antihypertensive effects.
Discourage use together.
Drug-food. Food: May increase
absorption. Encourage patient to
take drug with food.
Effects on Labs:
-May increase transaminase,
alkaline phosphatase, LDH, and
uric acid levels.
Nursing Considerations:
-Always check patient’s apical
Drug
Dosage, Route,
& Frequency
Classification
Purpose of the Drug
Nursing Implications
pulse rate before giving drug. If
it’s slower than 60 beats/minute,
withhold drug and call prescriber
immediately.
-In diabetic patients, monitor
glucose level closely because
drug masks common signs and
symptoms of hypoglycemia.
-Monitor blood pressure
frequently; drug masks common
signs and symptoms of shock.
-Beta blockers may mask
tachycardia caused by
hyperthyroidism. In patients with
suspected thyrotoxicosis, taper
off beta blocker to avoid thyroid
storm.
-Black box warning: When
stopping therapy, taper dosage
over 1 to 2 weeks. Abrupt
discontinuation may cause
exacerbations of angina or
myocardial infarction. Don’t
discontinue therapy abruptly even
in patients treated only for
hypertension.
Beta selectivity is lost at higher
doses. Watch for peripheral side
effects.
Drug
Dosage, Route,
& Frequency
Classification
Purpose of the Drug
Nursing Implications
Client Teaching:
-Instruct patient to take drug
exactly as prescribed and with
meals.
-Caution patient to avoid driving
and other tasks requiring mental
alertness until response to
therapy has been established.
-Advise patient to inform dentist
or prescriber about use of this
drug before procedures or
surgery.
-Tell patient to alert prescriber is
shortness of breath occurs.
-Instruct patient not to stop drug
suddenly but to notify prescriber
about unpleasant adverse
reactions. Inform him that drug
must be withdrawn gradually
over 1 to 2 weeks.
-Inform patient that use isn’t
advisable in breast-feeding
women.
Antidote: none listed
References: Lippincott Williams and Wilkins