Discussion Board response beta

Discussion Board response beta

Order Description

formulate a response to a topic another student posted on discussion bvoard. Use current US evidnce based practice. This is a Nurse Prctioner program. Did the student miss anything? Can anyutghiung be added?

COLLAPSE

Parent Post
Beta-adrenergic antagonists or beta “blockers” prevent sympathetic (adrenergic) neurotransmitters like epinephrine and norepinephrine from occupying beta-receptor sites. They are most commonly used for the treatment of hypertension and heart failure. The primary difference within this drug class is whether they are selective or nonselective. “Beta blockers may be relatively selective for beta1-adrenergic receptors or nonselective blocking both beta1- and beta2-adrenergic receptors” (Vallerand, Sanoski, & Deglin, 2015). Carvedilol and labetalol are nonselective beta blockers with additional alpha-adrenergic blocking properties. This differentiation is of clinical significance due to which organs contain beta1 and beta2 receptor sites. Beta1-receptor sites are located primarily in the heart and kidneys resulting in decreased heart rate, decreased contractility and conduction velocity, and decrease systemic blood pressure. Beta2-recpetors are located throughout the body and clinically significant sites are bronchial and vascular smooth muscle and the liver. Blockade of beta2-receptor sites result in passive bronchial constriction, increased triglycerides, and cholesterol and impaired insulin response.
Selective beta blockers are relatively specific to beta1-recptor sites. Currently beta1-selective drugs have less of an effect on beta2-receptors, but risk still remains particularly for patients with reactive airway disease. This affect is reported to be dose dependent with low doses producing less affect and the risk increasing at higher doses.

First Generation    Second Generation    Combined
Non-selective:
Block ß1 & ß2 receptors    Selective:
Block ß1 receptors    Combined:
Block ß1 & ß2 and a1-adrenergic receptors
Affects heart, kidney, lungs, GI tract, liver, uterus, vascular smooth muscle, and skeletal muscle    Mostly affect the heart and kidney    Blocking the a1-adrenergic receptors in addition to the ß blocker lowers blood pressure which provides additional vasodilatory action of the arteries
propranolol, nadolol, timolol, penbutolol, sotalol, pindolol    metoprolol, acebutolol, bisoprolol, esmolol, betaxolol    labetolol and carvedilol

The dosing of carvedilol varies depending on what condition it is being prescribed for: hypertension, CHF, LV dysfunction following MI, chronic stable angina, or idiopathic cardiomyopathy.  When prescribing for hypertension the initial dose is 6.25mg BID. The tolerance and up-titration of carvedilol is elevated by measuring standing systolic blood pressure 1 hour after the dose. If the dose is tolerated it is maintained for 1 to 2 weeks and then increased to 12.5mg BID. Up-titration is based on trough BP elevated by the same standing BP 1 hour after dose. The 12.5mg BID should be maintained for 1 to 2 weeks followed by elevation by trough BP with an increase to 25mg BID if needed. Additionally heart rate should be measured and maintained above 55 beats per minute for adults. Recommendations for the first increased dose include taking at bedtime or with food to decrease or avoid orthostatic hypotension (Woo & Wynne, 2012).
For congestive heart failure carvedilol dosing begins at 3.125mg BID for two weeks. If this dose is tolerated double the dose to 6.25mg BID for 2 weeks. This schedule of doubling the dose every two weeks can be followed to the maximum dose tolerated by the patient or 25mg BID for <85kg and 50mg BID for >85kg (Woo & Wynne, 2012).
LV dysfunction following MI: 6.25mg BID with increase after 3-10 days if tolerated to 12.5mg BID, then to 25mg BID if tolerated. Chronic stable angina is an off-label use of carvedilol: 12.5mg BID increasing as needed and if tolerated to 25-50mg BID. For idiopathic cardiomyopathy in adults 6.25mg daily increasing as needed and tolerated to a maximum dose of 75mg/day for a period of 6-8 months (Woo & Wynne, 2012).
Education points to be discussed with patient that is prescribed carvedilol.
• Take this drug at the same time of day.
• To gain the most benefit, do not miss doses. If you miss a dose you can take the missed dose up to 4 hours before the next dose if due, otherwise just skip the missed dose.
• Take this medication a prescribed, even if you feel well. This drug should not be stopped abruptly as this could cause life threatening complications.
• Take this drug with food to reduce the risk of orthostatic hypotension which is dizziness upon standing.
• To lower the chance of feeling dizzy or passing out, rise slowly over a few minutes when sitting or lying down. Be careful climbing stairs.
• Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.
• Check blood pressure and heart rate every two weeks. Call if your heart is <50 bpm or there is a sudden change in your blood pressure.
• You will need to have regular blood work at routine intervals while on this medication.
For Diabetics
• This drug may hide the signs of low blood sugar. It does not affect the sweating that occurs with low blood sugar so check your blood sugar anytime you have unexplained sweating.
• Rare but serious adverse reactions are possible if you have any of these call the office or get medical help right away. They included very bad dizziness or passing out, not being able to pee or a change in how much pee comes out, chest pain, a heartbeat that does not feel normal, wheezing, shortness of breath, a big weight gain, or swelling in the arms or legs.
• All drugs can cause side effects. Hopefully you will have no or only minor side effects. Call the office if you develop bothersome side effects. The common side effects of this medication are dizziness, feeling tired or weak, loose stools, headache, upset stomach or throwing up, weight gain, or joint pain.
For Men
• If you develop impotence or the inability to ejaculate call the office or come as the dose may be able to be adjusted or another medication tried.
For Women of childbearing age
• If you plan on becoming pregnant this medication will need to be stopped during the first trimester. Schedule an appointment if you get pregnant or decide to try.
(Carvedilol: Patient drug information, n. d.; Woo & Wynne, 2012)
References
Carvedilol: Patient drug information. (n. d.). Available from http://www.uptodate.com/contents/carvedilol-patient-drug-information
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (Eds.). (2015). Beta Blockers. Davis’s Drug Guide for Nurses (14th Ed.).  Available from http://online.statref.com/Document.aspx
Woo, T. M., & Wynne, A. L. (2012). Drugs affecting the autonomic nervous system. Pharmacotherapeutics for Nurse Practitioner Prescribers (3rd Ed.). F.A. Davis.

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