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Download Medications - Metoprolol
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Transcript
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