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Drug Name bisoprolol fumarate (bis oh' pro lole) Zebeta Pregnancy Category C Drug classes Beta1selective adrenergic blocker Antihypertens ive

Dosages PO Angina pectoris; HTN 2.5-10 mg/day. Max: 20 mg/day. Heart failure Initial: 1.25 mg once daily, may increase gradually. Max: 10 mg/day.

Therapeutic Actions Bisoprolol selectively and competitively blocks -1 receptors but has little or no effect on -2 receptors except at high doses.

Indications Management of hypertension, used alone or with other antihypertensive s

Adverse effects Giddiness, headache, fatigue, bradycardia. Nausea, vomiting, diarrhoea or constipation, stomach discomfort, mild ocular stinging, photophobia, keratitis, decreased sexual ability. GI disturbances, dyspnoea, cold extremities, insomnia, hallucination, drowsiness and mood alterations. Potentially Fatal: AV block, bradycardia. Rare but may occur in patients with preexisting cardiac disease. Includes severe bronchospasm, hypoglycaemia, hypotension, orthostatic hypotension, bradyarrhythmias. 'Rebound phenomenon' leading to unstable angina or MI on sudden withdrawal.

Contraindicatio ns Low cardiac output and uncompensate d cardiac failure; sinus bradycardia, 1st heart block, cardiogenic shock, bronchospasm ; severe haemorrhage. Pregnancy.

Nursing considerations CLINICAL ALERT! Name confusion has occurred between Zebeta (bisoprolol) and DiaBeta (glyburide); use caution. Assessment History: Sinus bradycardia, cardiac arrhythmias, cardiogenic shock, CHF, renal failure, diabetes or thyrotoxicosis, pregnancy, lactation Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, R, LFTs, renal function tests, blood and urine glucose Interventions WARNING: Do not discontinue drug abruptly after long-term 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). Teaching points

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Do not stop taking this drug unless instructed to do so by a health care provider. Avoid over-the-counter medications. Avoid driving or dangerous activities if dizziness, weakness occur. You may experience these side effects: Dizziness, lightheadedness, loss of appetite, nightmares, depression, sexual impotence. Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.

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