Clinical Medications WorksheetsGeneric Namecarvedilol

Trade NameCoreg

ClassificationBeta blocker

Dose6.25 mg

RoutePO

Time/frequencyqd

Peak1-2 hrs

OnsetWithin 1 hr

Duration12 hrs

Normal dosage range6.25 mg twice daily, may be increased q 7-14 days up to 25 mg twice daily

Why is your patient getting this medicationHTN

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and uterine)-adrenergic receptor sites. Also has alpha1 blocking activity, which may result in orthostatic hypotension.

Nursing Implications (what to focus on) Contraindications/warnings/interactionsPulmonary edema, cardiogenic shock, bradycardia, heart block or sick sinus syndrome (unless a pacemaker is in place), severe hepatic impairment, asthma or other bronchospastic disorders. Use caution in: Diabetes mellitus (may mask signs of hypoglycemia), history of severe allergic reactions (intensity of reactions may be increased).Common side effectsDizziness, fatigue, weakness, diarrhea, hyperglycemia, BRADYCARDIA, CHF, PULMONARY EDEMA.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Proventil, Xopenex: Beta blockers may antagonize the effects of bronchodilator beta-adrenergic agonists, which may result in life-threatening bronchospasm. The mechanism is increased airway resistance and inhibition of beta-agonist-induced bronchodilation due to beta-2-adrenergic blockade.Fludrocortisone, Hydrocortisone: Corticosteroids may antagonize the effects of antihypertensive medications by causing sodium and fluid retention. These effects may be more common with the natural corticosteroids (cortisone, hydrocortisone) because they have greater mineralocorticoid activity.NovoLog FlexPen, Lantus: Beta-blockers may inhibit some of the normal physiologic response to hypoglycemia. Symptoms of hypoglycemia such as tremors and tachycardia may be absent, making it more difficult for patients to recognize an oncoming episode. In addition, multiple effects on glucose metabolism have been reported, usually with the noncardioselective beta-blockers (e.g., propranolol, pindolol, timolol) but occasionally also with relatively beta-1 selective agents (e.g., metoprolol). Specifically, inhibition of catecholamine-mediated glycogenolysis and glucose mobilization in association with beta-blockade can potentiate insulin-induced hypoglycemia in diabetics and delay the recovery of normal blood glucose levels. Prolonged and severe hypoglycemia may occur, although these events have rarely been reported. Significant increases in blood pressure and bradycardia can also occur during hypoglycemia in diabetics treated with insulin and beta-blockers due to antagonism of epinephrine's effect on beta-2 adrenergic receptors, which leads to unopposed alpha-adrenergic effects including vasoconstriction. Other effects reported with various beta-blockers include decreased glucose tolerance and decreased glucose-induced insulin secretion.Demadex: Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of

Lab value alterations caused by medicineMay cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels. May cause ↑ ANA titers. May cause ↑ in blood glucose levels.Be sure to teach the patient the following about this medicationInstruct patient to take medication as directed, at the same time each day, even if feeling well. Do not skip or double up on missed doses. Take missed doses as soon as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. Advise patient to make sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency. Teach patient and family how to check pulse and blood pressure Instruct them to check pulse daily and blood pressure biweekly. Advise patient to hold dose and contact health care professional if pulse is <50 bpm or blood pressure changes significantly. May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known. Advise patient to change positions slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased. Caution patient that this medication may increase sensitivity to cold. Instruct patient to consult health care professional before taking any Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur. Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs. Instruct patient to inform health care professional of medication regimen before treatment or surgery. Advise patient to carry identification describing disease process and medication regimen at all times. Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.

Coreg (carvedilol)

hyperglycemia and hypertriglyceridemia in some patients, especially in patients with diabetes or latent diabetes. In addition, the risk of QT interval prolongation and arrhythmias (e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics.Seroquel: Neuroleptic agents may potentiate the hypotensive effect of some medications secondary to their peripheral alpha-1 adrenergic blocking activity. Orthostatic hypotension and syncope associated with vasodilation may occur, particularly during the initial dose titration period of neuroleptic therapy.Lanoxin: Concomitant use of digitalis glycosides and beta-blockers including carvedilol may increase the risk of bradycardia. These agents slow atrioventricular conduction and decrease heart rate, hence they may have additive cardiac effects during coadministration. Pharmacokinetically, carvedilol has been shown to modestly increase the systemic bioavailability of digoxin. The mechanism may involve enhanced absorption as well as reduced renal excretion of digoxin due to inhibition of intestinal and renal P-glycoprotein efflux transporter by carvedilol.ASA: High doses of salicylates may blunt the antihypertensive effects of beta-blockers. The proposed mechanism is inhibition of prostaglandin synthesis. Low-dose aspirin does not appear to affect blood pressure. In addition, beta-blockers may exert an antiplatelet effect, which may be additive with the effects of some salicylates. Metoprolol may also increase aspirin absorption and/or plasma concentrations of salicylates; however, the clinical significance of this effect is unknown. Data have been conflicting. Until more information is available, patients who require concomitant therapy should be monitored for altered antihypertensive response whenever a salicylate is introduced or discontinued, or when its dosage is modified.Synthroid: Thyroid hormone therapy may reverse decreased hepatic blood flow associated with hypothyroidism. Increased hepatic metabolism and decreased serum levels of some beta-blockers may result. Data are available for propranolol only. No special precautions are necessary. When hypothyroidism is converted to a euthyroid state, a decrease in beta-blocking effectiveness is possible.

Nursing Process- Assessment(Pre-administration assessment)Monitor blood pressure and pulse frequently during dose adjustment period and periodically during therapy Assess for orthostatic hypotension when assisting patient up from supine position. Monitor intake and output ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention). Patients may experience worsening of symptoms during initiation of therapy for CHF. Check frequency of refills to determine adherence.

AssessmentWhy would you hold or not give this med?Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures). Notify physician or other health care professional immediately if these signs occur. Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional.

EvaluationCheck after givingDecrease in blood pressure without appearance of detrimental side effects.

Coreg (carvedilol)