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Drug Name carvedilol (kar vah' da lol) Coreg Pregnancy Category C Drug classes Alpha- and betaadrenergic blocker Antihypertens ive Oral

Dosages

hypertension o Adult: Initially, 12.5 mg once daily increased to 25 mg once daily after 2 days. Alternatively, initial dose of 6.25 mg bid increased to 12.5 mg bid after 1-2 wk, increased further if necessary to 50 mg once daily or in divided doses. o Elderly: 12.5 mg once daily. Angina pectoris o Adult: Initially, 12.5 mg bid increased to 25 mg bid after 2 days. heart failure o Adult: Initially, 3.125 mg bid, doubled to 6.25 mg bid after 2 wk if tolerated, then gradually increased to the max dose the patient can tolerate at intervals of not <2 wk. Max dose: >85 kg: 50

Therapeutic Actions Carvedilol causes vasodilation by blocking the activity of blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM. Absorption: Absorbed well from the GI tract (oral); peak plasma concentrations after 1-2 hr. Distribution: Enters breast milk. Protein-binding: >98%. Metabolism: Hepatic: Considerable firstpass effect. Excretion: Via bile (as metabolites); 610 hr (elimination half-life).

Indications Hypertension, alone or with other oral drugs, especially diuretics Treatment of mild to severe CHF of ischemic or cardiomyopathic origin with digitalis, diuretics, ACE inhibitors Left ventricular dysfunction (LVD) after MI Unlabeled uses: Angina (2550 mg bid)

Adverse effects Bradycardia, AV block, angina pectoris, hypervolemia, leucopenia, hypotension, peripheral edema, allergy, malaise, fluid overload, melena, periodontitis, hyperuricemia, hyponatremia, increased alkaline phosphatase, glycosuria, prothrombin time, SGPT and SGOT levels, purpura, somnolence, impotence, albuminuria, hypokinesia, nervousness, sleep disorder, skin reaction, tinnitus, dry mouth, anemia, sweating, fatigue, arthralgia, aggravation, dizziness. Diarrhea, nausea, vomiting, insomnia, hypercholesterol emia, weight

Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Patients with NYHA class IV cardiac failure, 2nd or 3rd AV block, sick sinus syndrome (unless a permanent pacemaker is in place), cardiogenic shock or severe bradycardia. Lactation.

Nursing considerations Assessment History: CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to carvedilol, pregnancy, lactation, hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia or major surgery Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, respiratory status, LFTs, renal and thyroid function tests, blood and urine glucose Interventions WARNING: Do not discontinue drug abruptly after chronic therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias); taper drug gradually over 2 wk with monitoring. Consult with physician about withdrawing drug if patient is to

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mg bid; <85 kg: 25 mg bid. Left ventricular dysfunction post myocardial infarction o Adult: Initially: 6.25 mg bid, if tolerated, after 310 days, increase to 12.5 mg bid and then to a target dose of 25 mg bid.

gain, abnormal vision, rhinitis, pharyngitis and hypertriglyceride mia.

undergo surgery (withdrawal is controversial). Give with food to decrease orthostatic hypotension and adverse effects. Monitor for orthostatic hypotension and provide safety precautions. Monitor diabetic patient closely; drug may mask hypoglycemia or worsen hyperglycemia. WARNING: Monitor patient for any sign of hepatic impairment (pruritus, dark urine or stools, anorexia, jaundice, pain); arrange for LFTs and discontinue drug if tests indicate liver injury. Do not restart carvedilol.

Teaching points Take drug with meals. Do not stop taking drug unless instructed to do so by a health care provider. Avoid use of over-thecounter medications. Advise the diabetic patient to promptly report changes in glucose. You may experience

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these side effects: Depression, dizziness, lightheadedness (avoid driving or performing dangerous activities; getting up and changing positions slowly may help ease dizziness). Report difficulty breathing, swelling of extremities, changes in color of stool or urine, very slow heart rate, continued dizziness.

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