Labetalol / Trandate

Question 1

Alternate Names and cost

Answer 1

Carvediolol / Coreg ; Class cost 4$ (carvediol generic) to 26$ per month

Question 2

Drug Class

Answer 2

Pharmacologic: mixed alpha and beta receptor blocker

Therapeutic Class: antihypertensive, treatment of stable CHF (coreg)

Question 3

Pharmacodynamics

Answer 3

Reduces BP by blocking access of NE to beta-receptors and alpha-1 receptors, thereby lowering BP by several different mechanisms; patients differ in degree of beta-blockade vs alpha-blockade

Question 4

Pharmacokinetics

Answer 4

Excellent absorption but high first-pass effect, leading to F~25%; onset 1-2 hours after po, 2-5 minutes when given IV; extensively metabolized in liver by 2D6

Question 5

Toxicity

Answer 5

Avoid in patients with bradycardia, heartblock, CHF, asthma, shock; use with caution in patients with cardiomyopathy, pheochromocytoma; Pregnancy Class C

Question 6

Interactions

Answer 6

Additive effects with most other antihypertensives

Question 7

Special Considerations

Answer 7

Use reduced doses in patients with impaired liver function; dizziness is most troubling early side effect; most often used for hypertensive crises (as with nitroprusside)

Question 8

Indications and Dose / Route

Answer 8

Most commonly given IV with initial small boluses of 20mg, followed by continuous infusion at 2 mg/min; not usually given po for chronic treatment; 80 mg thrice daily, or 240 mg SR once daily

Question 9

Monitor

Answer 9

BP, HR