Details About Generic Salt ::  Metoprol

Main Medicine Class:: Beta-adrenergic blocker   

(meh-TOE-pro-lahl)
Lopressor
Class: Beta-adrenergic blocker

 

Drugs Class ::

 Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm).

Indications for Drugs ::

 Indications Used alone or in combination with other antihypertensive agents, for management of hypertension, long-term management of angina pectoris, myocardial infarction (immediate-release tablets and injection).

Drug Dose ::

 Route/Dosage

Hypertension

ADULTS: PO 100 mg/day in single or divided doses initially; maintenance: 100–450 mg/day.

Angina

ADULTS: PO 100 mg/day in 2 divided doses initially; maintenance: 100–400 mg/day.

Myocardial Infarction

ADULTS: IV bolus injection 5 mg slowly; may repeat every 2 min up to total of 15 mg. If tolerated, give PO 50 mg q 6 hr beginning 15 min after last IV dose; continue for 48 hr followed by PO 100 mg bid for 1–3 mo. If patient is intolerant of full IV dose, give PO 25–50 mg q 6 hr starting 15 min after last IV dose.

Contraindication ::

 Contraindications Greater than first-degree heart block; congestive heart failure unless secondary to tachyarrhythmia treatable with beta-blockers; overt or moderate to severe cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; systolic blood pressure < 100 mm/Hg; MI in patients with heart rate < 45 beats/min.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Anaphylaxis: Deaths have occurred; aggressive therapy may be required. AV block: Slows AV conduction and may cause heart block. Bradycardia: Metoprolol decreases heart rate in most patients. Congestive heart failure: Administer cautiously in CHF patients controlled by digitalis and diuretics. Notify physician at first sign or symptom of CHF or of unexplained respiratory symptoms in any patient. Peripheral vascular disease: May precipitate or aggravate symptoms of atrial insufficiency. Renal/hepatic function impairment: Reduced daily dose advised. Thyrotoxicosis: May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Hypotension; edema; flushing; bradycardia. CNS: Headache; fatigue; dizziness; depression; lethargy; drowsiness; forgetfulness; leepiness; vertigo; paresthesias. DERM: Rash; facial erythema; alopecia; urticaria; pruritus. EENT: Dry eyes; visual disturbances. GI: Nausea; vomiting; diarrhea. GU: Impotence; urinary retention; difficulty with urination. RESP: Bronchospasm; dyspnea; wheezing. OTHER: Increased hypoglycemic response to insulin; may mask hypoglycemic signs; uscle cramps; asthenia; systemic lupus erythematosus.

Drug Mode of Action ::  

 Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm).

Drug Interactions ::

 Interactions

Barbiturates: Bioavailability of metoprolol may decrease. Cimetidine: May increase metoprolol levels. Clonidine: May enhance or reverse antihypertensive effect; potentially life-threatening situations may occur, especially on abrupt withdrawal of clonidine. Hydralazine: Serum levels of both drugs may increase. Lidocaine: Lidocaine levels may increase, leading to toxicity. NSAIDs: Some agents may impair antihypertensive effect. Prazosin: Orthostatic hypotension may increase. Propafenone, quinidine, thioamines: Effects of metoprolol may increase. Rifampin: May decrease effects of metoprolol. Verapamil: Effects of both drugs may be increased.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Implement periodic ECG or telemetry monitoring, as ordered, if bradyarrhythmias occur.
  • Check BP and pulse every 8 hours.
  • Monitor levels of BUN, LDH and uric acid and glucose tolerance.
  • In diabetic patients, monitor blood sugar closely.
  • Notify physician of CNS changes, unstable diabetes, rash, pruritus, visual disturbance or eye irritation, dyspnea, bronchospasm, asthma, arthralgia, muscle cramps.
  • Avoid abrupt withdrawal of therapy, which may precipitate ventricular arrhythmia, angina, MI, death.
  • Assess peripheral pulses for evidence of arterial occlusion.
OVERDOSAGE: SIGNS & SYMPTOMS
  Bradycardia, hypotension, bronchospasm, cardiac failure

Drug Storage/Management ::

 Administration/Storage

  • Tablets (immediate release) and injection: ive at same time every day.
  • When switching from immediate-release tablets, give same total daily dose.
  • Give drug at same time consistently with or without meals. Food slightly enhances drug’s bioavailability.
  • Store at room temperature and protect from light.

Drug Notes ::

 Patient/Family Education

  • Teach patient how to check pulse and BP.
  • Advise patient to contact physician if pulse is < 50 bpm.
  • Explain why medication should not be discontinued abruptly.
  • Tell patient to check blood sugar regularly and consult physician if levels are unstable.
  • Explain that adverse effects are usually mild and transient and will generally subside with continued therapy.
  • Instruct patient to report these symptoms to physician: difficulty breathing, night cough or edema.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing tasks requiring mental alertness.
  • Instruct patient not to take otc cold preparations without consulting physician.

Disclaimer ::

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