Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

labetalol Trandate antianginals, antihypertensives, 40mg/8mL IVP Q 2 hrs PRN
Beta Blockers
Peak Onset Duration Normal dosage range
5 min 2-5 min 16-18 hrs 20 mg (0.25 mg/kg) initially, additional doses of 40-80 mg may be
given q 10 min as needed (not to exceed 300 mg total dose)or 2
mg/min infusion (range 50-300 mg total dose required)
Rate: Administer slowly over 2 min.
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
HTN High Alert: IV vasoactive medications are inherently dangerous.
Before administering intravenously, have second practitioner
independently check original order, dosage calculations, and infusion
pump settings. Do not confuse labetalol with Lamictil
Administer undiluted
Y-Site Incompatibility: amphotericin B cholesteryl sulfate
Complex, cefoperazone, ceftriaxone, nafcillin, tobramycin,
Warfarin

A
dditi
vie
Inco
mpa
tibili
ty:
sodi
um
bicar
bona
te

Mechanism of action and indications Nursing Implications (what to focus on)

(Why med ordered)
Blocks stimulation of beta1 (myocardial)- and beta2
(pulmonary, vascular, and uterine)-adrenergic receptor sites.
Also has alpha1-adrenergic blocking activity, which may result
in more orthostatic hypotension.
Contraindications/warnings/interactions
Uncompensated CHF, pulmonary edema, cardiogenic shock,
bradycardia or heart block. Use cautiously in: Renal impairment,
hepatic impairment, geriatric patients (increased sensitivity to beta
blockers; initial dosage reduction recommended), pulmonary disease
(including asthma), Diabetes mellitus (may mask signs of
hypoglycemia), thyrotoxicosis (may mask symptoms). Patients with a
history of severe allergic reactions (intensity of reactions may be
increased), pregnancy, lactation, or children (safety not established;
may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or
respiratory depression).
Common side effects
Fatigue, weakness, orthostatic hypotension, impotence,
ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA
Interactions with other patient drugs, OTC or herbal
medicines (ask patient specifically)
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.
Lorazepam: The concomitant administration of agents with
hypotensive effects and psychotherapeutic agents may
additively increase hypotensive and/or central nervous system
depressant effects.
Detrol: Anticholinergic agents frequently cause drowsiness and
other central nervous system-depressant effects that may be
additive with those induced by beta blockers. In addition, these
agents may increase heart rate and theoretically may counteract
the bradycardic effects of beta blockers. Pharmacokinetically,
anticholinergic agents may delay the gastrointestinal
absorption of beta blockers and other drugs that are
administered orally. The proposed mechanism involves
increased gastrointestinal transit time due to reduction of
stomach and intestinal motility by anticholinergic agents. In
healthy volunteers, pretreatment with propantheline has been
shown to prolong the time to reach peak plasma concentration
(Tmax) for both atenolol and metoprolol. Propantheline also
decreased metoprolol peak plasma concentration (Cmax) but
had no effect on its systemic exposure (AUC). In contrast,
propantheline increased atenolol AUC but had no effect on its
Cmax. The clinical relevance of these changes is probably
minimal.
Morphine: The concomitant administration of agents with
hypotensive effects and psychotherapeutic agents may
additively increase hypotensive and/or central nervous system
depressant effects.
Calcium carbonate: Concurrent administration with calcium
salts may decrease the oral bioavailability of atenolol and
possibly other beta-blockers. The exact mechanism of
interaction is unknown.
Norvasc: Additive reductions in heart rate, cardiac conduction,
and cardiac contractility may occur when calcium channel
blockers are used concomitantly with beta blockers,
particularly in patients with ventricular or conduction
abnormalities. While this combination may be useful and
effective in some situations, potentially serious cardiovascular
adverse effects such as congestive heart failure, severe
hypotension, and/or exacerbation of angina may occur.
Baclofen: The concomitant administration of agents with
hypotensive effects and psychotherapeutic agents may
additively increase hypotensive and/or central nervous system
depressant effects.
Linezolid: Monoamine oxidase inhibitors (MAOIs) may
theoretically potentiate the hypotensive effect of some
medications. This effect may stem from a gradual MAOI-
induced accumulation of false neurotransmitters in peripheral
adrenergic neurons that have minimal activity at alpha- and
beta-adrenergic receptors, resulting in a functional block of
sympathetic neurotransmission. Indeed, MAOIs alone quite
commonly produce orthostatic hypotension. In addition,
Lab value alterations caused by medicine
May cause increased BUN, serum lipoprotein, potassium, triglyceride,
and uric acid levels. May cause increased ANA titers. May cause
increase in blood glucose levels, May cause increased serum alkaline
phosphatase, LDH, AST, and ALT levels. Discontinue if jaundice or
laboratory signs of hepatic function impairment occur.
Be sure to teach the patient the following about this medication
Instruct patient to take medication exactly as directed, at the same time
each day, even if feeling well; do not skip or double up on missed
doses. If a dose is missed, it should be taken as soon as possible up to 8
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. Advise patients to make position changes slowly to
minimize orthostatic hypotension, especially during initiation of
therapy or when dose is increased. Patients taking oral labetalol should
be especially cautious when drinking alcohol, standing for long
periods, or exercising, and during hot weather, because orthostatic
hypotension is enhanced. Caution patient that this medication may
increase sensitivity to cold. Instruct patient to consult health care
professional before taking any OTC medications, 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 tachycardia and
increased blood pressure as 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, light-headedness, confusion, depression, rash,
fever, sore throat, unusual bleeding, or bruising occurs. Instruct patient
to inform health care professional of medication regimen prior to
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 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).
Assessment Evaluation
Why would you hold or not give this med? Check after giving
Signs of overdose (bradycardia, severe Decrease in blood pressure.
dizziness or fainting, severe drowsiness,
dyspnea, bluish fingernails or palms,
seizures). Notify physician or other health
care professional immediately if these signs
occur. Glucagon has been used to treat
bradycardia and hypotension.