Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

carvedilol Coreg Beta blocker 6.25 mg PO qd
Peak Onset Duration Normal dosage range
1-2 hrs Within 1 hr 12 hrs 6.25 mg twice daily, may be increased q 7-14 days up to 25 mg twice
daily
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
HTN N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, Pulmonary edema, cardiogenic shock, bradycardia, heart block or sick
vascular, and uterine)-adrenergic receptor sites. Also has sinus syndrome (unless a pacemaker is in place), severe hepatic
alpha1 blocking activity, which may result in orthostatic impairment, asthma or other bronchospastic disorders. Use caution in:
hypotension. Diabetes mellitus (may mask signs of hypoglycemia), history of
severe allergic reactions (intensity of reactions may be increased).
Common side effects
Dizziness, fatigue, weakness, diarrhea, hyperglycemia,
BRADYCARDIA, CHF, PULMONARY EDEMA.

Coreg (carvedilol)
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
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.
Coreg (carvedilol)
Lab value alterations caused by medicine
May 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 medication
Instruct 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.
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.
Coreg (carvedilol)
Assessment Evaluation
Why would you hold or not give this med? Check after giving
Monitor patients receiving beta blockers for Decrease in blood pressure
signs of overdose (bradycardia, severe without appearance of detrimental
dizziness or fainting, severe drowsiness, side effects.
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.