Generic Name : Ansimar

- Effective against strains of Escherichia coli, Proteus mirabilis, Haemophilus influenzae, Streptococcus faecalis, Streptococcus pneumoniae and some beta-lactamaseproducing organisms. Contraindications

Mechanism of Action Bronchodilator. Indications Bronchial asthma & pulmonary disease w/ spastic bronchial component. Contraindications Acute MI, hypotension, lactation. Adverse Drug Reactions Nausea, vomiting, epigastric pain, cephalalgia, irritability, insomnia, tachycardia, extrasystole, tachypnea, hyperglycemia, albuminuria. NURSING RESPONSIBILITIES:

- Penicillin hypersensitivity. - History of co-amoxiclav-associated or penicillin-associated jaundice or hepatic dysfunction. Cautions - History of allergy. - Renal impairment. - Erythematous rashes common in glandular fever.

> Use with caution in patients with hypoxemia, hyperthyroidism, liver disease, renal disease, in those with history of peptic ulcer and in elderly. Frequently, patients with CHF have markedly prolonged drug serum levels following discontinuation of Ansimar. > assess for allergic reaction > assess for breath sounds >should be given to a pregnant woman only if clearly needed

- Cytomegalovirus infection. - Acute or chronic lymphocytic leukaemia. - Hepatic impairment. - Pregnancy. - Cholestatic jaundice.

Co-amoxiclav. 4 February, 2005 VOL: 101, ISSUE: 26, PAGE NO: 29 Generic and proprietary names Generic and proprietary names - Co-amoxiclav. - Augmentin, Augmentin-Duo. Action - An antibiotic that combines amoxicillin and clavulanic acid. It destroys bacteria by disrupting their ability to form cell walls. - Clavulanic acid blocks the chemical defence, known as beta-lactamase, that some bacteria have against penicillins. l Co-amoxiclav is active against bacterial infections that have become resistant to amoxicillin. Classification - Broad-spectrum penicillin. Indications - Known or suspected amoxicillin-resistant infections including respiratory tract, skin and soft tissue, genitourinary, and ear, nose and throat infections.

Common side-effects - Hepatitis. - Cholestatic jaundice. - Erythema multiforme (including Stevens-Johnson syndrome). - Toxic epidermal necrolysis. - Exfoliative dermatitis. - Vasculitis. - Dizziness. - Headache. - Convulsions (especially in high doses or in renal impairment). - Superficial teeth staining when using the suspension. - Phlebitis at injection site. Rare side-effects - Prolonged bleeding. Administration - Oral: tablets and suspension. - Intravenous injection.

Nursing considerations - Assess bowel pattern before and during treatment as pseudomembranous colitis may occur. - Report haematuria or oliguria as high doses can be nephrotoxic. - Assess respiratory status. ipratropium-ug classes - Observe for anaphylaxis. Anticholinergic - Ensure that the patient has adequate fluid intake during any diarrhoea attack. Patient teaching - If the patient develops a rash, wheezing, itching, fever or swelling in the joints, this could indicate an allergy and should be reported. - Patients must ensure they take the full course of the medicine. - The medicine must be taken in equal doses around the clock to maintain level in the blood. - If oral contraceptives are used, use alternative contraception. COPD (solution, aerosol), chronic bronchitis, and emphysema - Report diarrhoea, cramping and blood in stools as pseudomembranous colitis may occur. Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines
Anticholinergics

tachycardia occurs

Antimuscarinic agent Parasympatholytic Therapeutic actions Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Causes bronchodilation and inhibits secretion from serous and seromucous glands lining the nasal mucosa. Indications

Bronchodilator for maintenance treatment of bronchospasm associated with

Nasal spray: Symptomatic relief of rhinorrhea associated with perennial rhinitis Nursing considerations Assessment

Mechanism of Action: Ipratropium is a bronchodilator which is a competitive inhibitor of muscarinic cholinergic receptors. In asthma, inhaled anticholinergics are less potent bronchodilators than inhaled beta-2 agonists and are of unclear benefit. Indications and Usage: Ipratropium may be used for the relief of acute bronchospasm. It may provide additive effects to beta-2 agonist, but it has a slower onset of action. It may be considered for patients who are intolerant of beta-2 agonists. It is not to be used to block exercise-induced bronchospasm. Adverse Effects: Ipratropium has been associated with drying of the mouth and respiratory secretions. It may increase wheezing.
Summary

History: Hypersensitivity to atropine, soy beans, peanuts (aerosol preparation); acute bronchospasm, narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, pregnancy, lactation Physical: Skin color, lesions, texture; T; orientation, reflexes, bilateral grip strength; affect; ophthalmic exam; P, BP; R, adventitious sounds; bowel sounds,

Nursing responsibilities:

normal output; normal urinary output, prostate palpation Interventions

Monitor heart rate, CNS stimulation, notify physician if palpitations, chest pain, Protect solution for inhalation from light. Store unused vials in foil pouch.

 Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of narrow-angle glaucoma. Can mix albuterol in nebulizer for up to 1 hr. Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia. Have patient void before taking medication to avoid urinary retention. Teach patient proper use of inhalator. Teaching points Use this drug as an inhalation product. Review the proper use of inhalator; for nasal spray, initiation of pump requires 7 actuations; if not used for 24 hr, 2 actuations will be needed before use. Protect from light; do not freeze. These side effects may occur: Dizziness, headache, blurred vision (avoid driving or performing hazardous tasks); nausea, vomiting, GI upset (proper nutrition is important; consult with your dietitian to maintain nutrition); cough.

activity); prevents or diminishes secondary degeneration and pathological changes in reversibly damaged cell systems by membrane stabilization and maintenance of osmotic and ionic homeostasis. Dental Adhesive Paste: The topical anesthetic polidocanol contained at low concentration effects rapid and persistent pain relief. The paste adheres to the mucosa forming a film protecting against irritation during food intake. Thus, Solcoseryl protects tissue at risk from hypoxia and/or substrate deficiency. It promotes the viability of cells reversibly damaged by deficiencies of oxygen and/or substrates and increases the rate of healing and improves the quality of scar formation. Pharmacokinetics: Methods of chemical analysis cannot be used in investigations of the absorption, distribution and elimination of the active components of Solcoseryl because the ingredients are physiological substances. To date, the pharmacological effects of Solcoseryl have been found to be unaffected in situations where the kinetics are changed (eg, hepatic and renal insufficiency, age-related metabolic changes)

Contents

Protein-free & antigen-free hemodialysate (extractum sanguinis vituli deproteinisatum speciale)

Solcoseryl

Indications Eye Gel: Corneal ulcers of various origin; lesions of the cornea; caustic lesions of the cornea due to alkalis or acids; keratitis bullosa; degenerative changes in the cornea and conjunctiva. Jelly/Ointment: Trophic lesions in patients with arterial occlusive disease (pre-gangrene, gangrene); trophic lesions in patients with chronic venous insufficiency (stasis ulcers); burn injuries; impaired wound healing: Non-healing wounds, decubital ulcer; skin ulcers caused by irradiation. Dental Adhesive Paste: Painful and inflammatory affections of the oral mucosa, gums and lips; aphthae, rhagades, herpes labialis; gingivitis, paradontitis, stomatitis; denture

In cases of hypoxia and/or substrate deficiency and where there is an increased energy requirement (repair, regeneration), Solcoseryl promotes energy-dependent processes in maintenance and functional metabolism. Eye Gel: The formulation of Solcoseryl for the eye gel has been developed specifically for the treatment of disorders and lesions of the cornea and conjunctiva. The viscous ophthalmic gel formulation adheres to the cornea and ensures uniform distribution. The active agent is thus released continuously into the diseased or injured tissue. The stability of the film of tears is guaranteed. Jelly/Ointment: Solcoseryl increases aerobic energy metabolism and oxidative phosphorylation and thus the supply of high-energy phosphates to the cells; improves repair and regeneration processes in ischemic tissue (secondary promotion of blood flow owing to metabolic

pressure sores, teething pains (milk teeth, wisdom teeth); dressing after scaling, curettage and dental extractions, oral and maxillofacial surgery; collocation of immediate dentures. Dosage Eye Gel: 1 drop of gel 3-4 times. Apply by letting a drop fall directly from the tube into the eye. Close the tube immediately after use. Jelly: Usual Dosage: Apply to the wound 2-3 times daily. Solcoseryl jelly enhances wound surface debridement and the granulation tissue formation. In Skin Ulcer: Deep, exudating, non-healing wounds and trophic lesions; the ulcer-bed should be treated initially with Solcoseryl jelly applied in a thin layer, 2-3 times daily until healthy granulation is formed. Ointment: To enhance wound margin re-epithelization and complete wound closure, it is recommended to apply Solcoseryl ointment to the wound edges and reepithelizing zone. Superficial ulcers, dry reepithelizing wounds are treated with Solcoseryl ointment until the wounds are completely healed. Dental Adhesive Paste: Dry the area with gauze or cotton. Apply Solcoseryl dental adhesive paste thinly with a cotton bud or finger. Dab the area with water and smoothen out paste for better adherence. Apply to the lesion 3-5 times daily. Application is particularly recommended before retiring. Do not rub in the paste. Adverse Drug Reactions

Remarks: The slightly dry, granular consistency of Solcoseryl dental adhesive paste ensures optimal adhesiveness; it is not an indication of loss of quality. A greasy layer may occasionally appear at the tube outlet. It has no influence on the efficacy of the preparation. Overdosage There are no reports of adverse symptoms or signs resulting from overdosage in use according to the indications. Special In case of infections of the eye, Precautions appropriate antimicrobial treatment should be administered together with Solcoseryl eye gel. Solcoseryl contains methyl- and propyl-p-hydroxybenzoate (E216 and E218) as preservatives and traces of their free acid (E210). Caution is warranted in patients with allergic predisposition to these substances. Eye Gel: Treatment with Solcoseryl eye gel, even in high dosage is not associated with safety risks. On applying, there are rare instances of a brief, local burning sensation. This does not require discontinuing the treatment. Allergic reactions after repeated use are possible as with all locally administered ophthalmic preparations. Jelly/Ointment: On applying Solcoseryl on large-sized wounds, there are also rare instances of brief, local burning sensations which do not require discontinuing the treatment. Dental Adhesive Paste: Allergic predisposition to peppermint and menthol flavorings. Click to view ADR Monitoring Website

Drug None are known. Interactions View more drug interactions with Solcoseryl Ophthalmic Gel Storage Keep at room temperature (1525C). Solcoseryl is stable for 5 years. Eye Gel: A tube which has been opened >1 month previously should not be used.
Fecal impactions are a common problem in debilitated elderly people and may present as a life-threatening event. The atypical presentations of fecal impactions are not wellrecognized, and the incidence, morbidity and mortality of fecal impactions in the elderly are largely unknown. Elderly debilitated people have reduced organ system reserve. An acute illness may worsen underlying chronic diseases. Fecal impactions may upset the fragile homeostasis of an elderly debilitated person. The signs and symptoms of fecal impaction may not be manifested in the gastrointestinal system; rather, the patient may present with circulatory, cardiac or respiratory symptoms. If the diagnosis of fecal impaction is unrecognized and untreated, signs and symptoms may progress, leading to death. The causes, mechanisms, appropriate history, physical examination, diagnostic techniques, therapy and prevention of fecal impactions in elderly people are presented.

y y

Do not move around much and spend most of their time in a chair or bed Have diseases of the brain or nervous system that damage the nerves that go to the muscles of the intestines

Certain drugs slow the passage of stool through the bowels: y y y Anticholinergics, which affect the interaction between nerves and muscles of the bowel Medicines used to treat diarrhea, if they are taken too often Narcotic pain medication, such as methadone and codeine

Symptoms Common symptoms include: y y Abdominal cramping and bloating Leakage of liquid or sudden episodes of watery diarrhea in someone who has chronic constipation Rectal bleeding Small, semi-formed stools Straining when trying to pass stools

ecal impaction

y y y

Other possible symptoms include: A fecal impaction is a large lump of dry, hard stool that remains stuck in the rectum. It is most often seen in patients with long-term constipation. Causes Exams and Tests Constipation is when you are not passing stool as often as you normally do. Your stool becomes hard and dry, and it is difficult to pass. Fecal impaction is often seen in people who have had constipation for a long time and have been using laxatives. Impaction is even more likely when the laxatives are stopped suddenly. The muscles of the intestines forget how to move stool or feces on their own. Persons at risk for chronic constipation and fecal impaction include those who: The health care provider will examine your stomach area and rectum. The rectal exam will reveal a hard mass of stool in the rectum. If there has been a recent change in your bowel habits, your doctor may recommend a colonoscopy to evaluate for colon or rectal cancer. Treatment Treating a fecal impaction involves removing the impacted stool. After that, measures are taken to prevent future fecal impactions. y y y Bladder pressure or loss of bladder control Lower back pain Rapid heartbeat or light-headedness from straining to pass stool

Often a warm mineral oil enema is used to soften and lubricate the stool. However, enemas alone are usually not enough to remove a large, hardened impaction. The mass may have to be broken up by hand. This is called manual removal: y A health care provider will need to insert one or two fingers into the rectum and slowly break up the mass into smaller pieces so that it can come out. This process must be done in small steps to avoid causing injury to the rectum. Suppositories inserted into the rectum may be given between attempts to help clear the stool.

period of constipation. Also notify your health care provider if you are experiencing any of the following symptoms: y y y Abdominal pain and bloating Blood in the stool Sudden constipation with abdominal cramps, and an inability to pass gas or stool. In this case, do not take any laxatives. Call your health care provider immediately. Very thin, pencil-like stools

y y

Alternative Names Impaction of the bowels

Surgery is rarely needed to treat a fecal impaction. An overly widened colon (megacolon) or complete blockage of the bowel may require emergency removal of the impaction. Almost anyone who has had a fecal impaction will need a bowel retraining program. Your doctor and a specially trained nurse or therapist will: y Take a detailed history of your diet, bowel patterns, laxative use, medications, and medical problems Examine you carefully Recommend changes in your diet, how to use laxatives and stool softeners, special exercises, lifestyle changes, and other special techniques to retrain your bowel Follow you closely to make sure the program works for you

Chronic obstructive pulmonary disease

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic
Last reviewed: May 1, 2011.

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: y Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time

y y

Most people with COPD have a combination of both conditions.

Causes, incidence, and risk factors

Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: y Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution

Outlook (Prognosis) With treatment, the outcome is good. Possible Complications y y Tear (ulceration) of the rectal tissue Tissue death (necrosis) or rectal tissue injury

When to Contact a Medical Professional Tell your health care provider if you are experiencing chronic diarrhea or fecal incontinence after a long

Frequent use of cooking fire without proper ventilation

Symptoms
y y y y Cough, with or without mucus y Fatigue Many respiratory infections Shortness of breath (dyspnea) that gets worse with mild activity Trouble catching one's breath Wheezing y y y y y

Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used

In severe cases or during flare-ups, you may need to receive: Steroids by mouth or through a vein (intravenously) Bronchodilators through a nebulizer Oxygen therapy Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)

Because the symptoms of COPD develop slowly, some people may not know that they are sick.

Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse. You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help maintain muscle strength in the legs. Walk to build up strength. y y y Ask the doctor or therapist how far to walk. Slowly increase how far you walk. Try not to talk when you walk if you get short of breath. Use pursed lip breathing when breathing out (to empty your lungs before the next breath)

Signs and tests

The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to radiation. Using a stethoscope to listen to the lungs can also be helpful. However, sometimes the lungs sound normal even when COPD is present. Pictures of the lungs (such as x-rays and CT scans) can be helpful, but sometimes look normal even when a person has COPD (especially chest x-ray). Sometimes patients need to have a blood test (called arterial blood gas) to measure the amounts of oxygen and carbon dioxide in the blood.

Treatment
There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse. Persons with COPD MUST stop smoking. This is the best way to slow down the lung damage. Medications used to treat COPD include: y Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol Inhaled steroids to reduce lung inflammation

Things you can do to make it easier for yourself around the home include: y y y Avoiding very cold air Making sure no one smokes in your home Reducing air pollution by getting rid of fireplace smoke and other irritants

Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories. Surgery may be used, but only a few patients benefit from these surgical treatments: y Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema

Lung transplant for severe cases

carvedilol
(kar vah' da lol)
Coreg

Support Groups
People often can help ease the stress of illness by joining a support group in which members share common experiences and problems. See also: Lung disease - support group

Pregnancy Category C
Drug classes

Expectations (prognosis)
COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking. Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with their doctor about breathing machines and end-of-life care.

Alpha- and beta-adrenergic blocker Antihypertensive

Therapeutic actions

Complications
y y y Irregular heartbeat (arrhythmia) Need for breathing machine and oxygen therapy Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease) Pneumonia Pneumothorax Severe weight loss and malnutrition Thinning of the bones (osteoporosis)

Competitively blocks alpha-, beta-, and beta2adrenergic receptors and has some sympathomimetic activity at beta2-receptors. Both alpha and beta blocking actions contribute to the BP-lowering effect; beta blockade prevents the reflex tachycardia seen with most alphablocking drugs and decreases plasma renin activity. Significantly reduces plasma renin activity.
Indications

y y

y y y y

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase inshortness of breath.

y y

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)

Prevention
Not smoking prevents most COPD. Ask your doctor or health care provider about quit-smoking programs. Medicines are also available to help kick the smoking habit. The medicines are most effective if you are motivated to quit.

Contraindications and cautions

Contraindicated with decompensated CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to carvedilol, pregnancy, lactation. Use cautiously with hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia, major surgery.

Available forms

Tablets3.125, 6.25, 12.5, 25 mg

Dosages ADULTS

Hypertension: 6.25 mg PO bid; maintain for 714 days, then increase to 12.5 mg

PO bid if needed to control BP. Do not exceed 50 mg/day. CHF: Monitor patient very closely, individualize dose based on patient response. Initial dose, 3.125 mg PO bid for 2 wk, may then be increased to 6.25 mg PO bid. Maximum dose, 25 mg PO bid in patients < 85 kg or 50 mg PO bid in patients > 85 kg.

y y

Increased plasma levels of carvedilol with rifampin Potential for dangerous conduction system disturbances with verapamil or diltiazem; if this combination is used, closely monitor ECG and BP

PEDIATRIC PATIENTS

Drug-food y Slowed rate of absorption but not decreased effectiveness with food
Nursing considerations Assessment

Safety and efficacy not established.

PATIENTS WITH HEPATIC IMPAIRMENT

Do not administer to any patient with severe hepatic impairment.

Pharmacokinetics
Route Oral Onset Rapid Peak 30 min Duration 810 hr

Metabolism: Hepatic; T1/2: 710 hr Distribution: Crosses placenta; may enter breast milk Excretion: Bile, feces
Adverse effects

y y y

CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances CV: Bradycardia, orthostatic hypertension, CHF, cardiac arrhythmias, pulmonary edema, hypotension GI: Gastric pain, flatulence, constipation, diarrhea, hepatic failure Respiratory: Rhinitis, pharyngitis, dyspn ea Other: Fatigue, back pain, infections

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, kidney and thyroid function, blood and urine glucose, liver function tests

Interventions

Interactions

y y y

Drug-drug y Increased effectiveness of antidiabetics; monitor blood glucose and adjust dosages appropriately y Increased effectiveness of clonidine; monitor patient for potential severe bradycardia and hypotension y Increased serum levels of digoxin; monitor serum levels and adjust dose accordingly

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 undergo surgery (withdrawal is controversial). Give with food to decrease orthostatic hypotension and adverse effects. Monitor for orthostatic hypotension and provide safety precautions. Monitor patients with diabetes closely; drug may mask hypoglycemia or worsen hyperglycemia. WARNING: Monitor patient for any sign of liver dysfunction (pruritus, dark urine or stools, anorexia, jaundice, pain); arrange for liver function tests and discontinue

drug if tests indicate liver injury. Do not restart carvedilol.

Teaching points

y y

Left ventricular dysfunction (LVD) after MI Unlabeled uses: Angina (2550 mg bid)

y y y y

Take drug with meals. Do not stop taking drug unless instructed to do so by a health care provider. Avoid use of OTC medications. You may experience these side effects: Depression, dizziness, light-headedness (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.

Contraindications and cautions

Contraindicated with decompensated CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to carvedilol, pregnancy, lactation. Use cautiously with hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia, major surgery.

Available forms

Tablets3.125, 6.25, 12.5, 25 mg

Dosages ADULTS

Adverse effects in Italic are most common; those in Bold are life-threatening.

carvedilol
(kar vah' da lol)
Coreg

Pregnancy Category C
Drug classes

Alpha- and beta-adrenergic blocker Antihypertensive

Therapeutic actions

Hypertension: 6.25 mg PO bid; maintain for 714 days, then increase to 12.5 mg PO bid if needed to control BP. Do not exceed 50 mg/day. CHF: Monitor patient very closely, individualize dose based on patient response. Initial dose, 3.125 mg PO bid for 2 wk, may then be increased to 6.25 mg PO bid. Maximum dose, 25 mg PO bid in patients < 85 kg or 50 mg PO bid in patients > 85 kg.

PEDIATRIC PATIENTS

Competitively blocks alpha-, beta-, and beta2adrenergic receptors and has some sympathomimetic activity at beta2-receptors. Both alpha and beta blocking actions contribute to the BP-lowering effect; beta blockade prevents the reflex tachycardia seen with most alphablocking drugs and decreases plasma renin activity. Significantly reduces plasma renin activity.
Indications

Safety and efficacy not established.

PATIENTS WITH HEPATIC IMPAIRMENT

Do not administer to any patient with severe hepatic impairment.

Pharmacokinetics
Route Oral Onset Rapid Peak 30 min Duration 810 hr

y y

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

Metabolism: Hepatic; T1/2: 710 hr Distribution: Crosses placenta; may enter breast milk Excretion: Bile, feces
Adverse effects

CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances

y y y

CV: Bradycardia, orthostatic hypertension, CHF, cardiac arrhythmias, pulmonary edema, hypotension GI: Gastric pain, flatulence, constipation, diarrhea, hepatic failure Respiratory: Rhinitis, pharyngitis, dyspn ea Other: Fatigue, back pain, infections

y
Interactions

Drug-drug y Increased effectiveness of antidiabetics; monitor blood glucose and adjust dosages appropriately y Increased effectiveness of clonidine; monitor patient for potential severe bradycardia and hypotension y Increased serum levels of digoxin; monitor serum levels and adjust dose accordingly y Increased plasma levels of carvedilol with rifampin y Potential for dangerous conduction system disturbances with verapamil or diltiazem; if this combination is used, closely monitor ECG and BP Drug-food y Slowed rate of absorption but not decreased effectiveness with food
Nursing considerations Assessment

y y

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

Teaching points

y y y y

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, kidney and thyroid function, blood and urine glucose, liver function tests

Take drug with meals. Do not stop taking drug unless instructed to do so by a health care provider. Avoid use of OTC medications. You may experience these side effects: Depression, dizziness, light-headedness (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.

Adverse effects in Italic are most common; those in Bold are life-threatening.

Interventions

WARNING: Do not discontinue drug abruptly after chronic therapy