Alpha/Beta Adernergic Blockers

Question 1

What class are the following drugs: carvedilol and labetalol?

Answer 1

α/β-Adrenergic Blocker

Question 2

What are the brand name for Labetalol?

Answer 2

Normodyne

Question 3

What is the brand name of carvedilol?

Answer 3

Coreg, Coreg CR

Question 4

What is the dosage form for Carvedilol?

Answer 4

oral tablet

oral capsules ER

Question 5

What is the dosage form for Labetalol?

Answer 5

Oral Tablet

Question 6

What are the indications for labetalol and carvedilol?

Answer 6

Labetalol: HTN in adults (off label– HTN in children and urgency)

Carvedilol: Heart failure with reduced ejection fraction, HTN, and impaired left ventricular function post-MI

Question 7

Contraindication for Carvedilol?

Answer 7

Hypersensitivity, bronchial asthma, severe sinus bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment

Question 8

Contraindication of Labetalol?

Answer 8

Hypersensitivity; bronchial asthma or related bronchospastic condition; severe sinus bradycardia, 2nd- or 3rd-degree AV block; overt heart failure; cardiogenic shock, conditions associated with severe and prolonged hypotension

Question 9

Labetalol ADR?

Answer 9

Common: Dizziness, fatigue and nausea

Less Common: Bradyarrhythmias, constipation, diaphoresis, diarrhea, disorder of glucose regulation, dyspnea, headache, impotence, increased liver enzymes, orthostatic hypotension, somnolence, wheezing

Serious: Hepatotoxicity, bronchospasm

Question 10

Labetalol Monitoring:

Answer 10

Efficacy: decreased BP and HR

Toxicity: Signs/symptoms of peripheral edema, increased HR, signs/symptoms of liver damage.

Question 11

Carvedilol ADR?

Answer 11

Common: Cold extremities, dizziness, erectile dysfunction, fatigue, hypotension, weight gain

Less Common: Arthralgia, bradyarrhythmias, bronchospasm, diarrhea, hyperglycemia, dyspnea, depression, headache, nausea, somnolence, syncope, vomiting

Serious: Heart failure, hepatotoxicity, Stevens-Johnson syndrome

Question 12

Carvedilol Monitoring:

Answer 12

Efficacy: Decreased BP and HR, reduction in chest pain, decreased number of weekly angina attacks, reduction in use of prophylactic nitroglycerin to relieve chest pain, improvement in signs/symptoms of heart failure.

Toxicity Monitoring Parameters: Signs/symptoms of heart failure, bronchospasm, increased or decreased blood glucose levels in diabetic patients, and hepatotoxicity.

Question 13

Carvedilol Key Patient Counseling point?

Answer 13

Take carvedilol with food or milk. Report signs/symptoms of heart failure, bradyarrhythmias, bronchospasm, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes. Avoid abrupt discontinuation, may cause rebound HTN. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Diabetic patients should carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.

**safety and efficacy not established in children and reduce the dose on pt with bradycardia)

Question 14

Labetalol key patient counseling point?

Answer 14

Report signs/symptoms of hypotension with initial dosing and dose changes. Avoid alcohol while taking drug. May cause dizziness. Instruct patient to rise slowly from a sitting/supine position, as labetalol may cause orthostatic hypotension. Report signs/symptoms of bronchospasm, slow HR, hepatotoxicity, or syncope. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Advise patients against sudden discontinuation of drug as this may cause rebound HTN.

**safety and efficacy not established in children under 6 and is not considered first line for managing HTN, can be used in pregnant women*