Metoprolol Flashcards
Trade name
Kapspargo Sprinkle, Lopressor, Toprol XL
Generic name
metoprolol
Class of drug
Therapeutic: antianginals, antihypertensives
Pharmacologic: beta blockers
Usual dosage
PO (Adults): Hypertension/angina: 25-100 mg/day as a single dose initially or 2 divided doses; may be t every 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). Extended-release products are given once daily. Ml: 25-50 mg (starting 15 min after last IV dose) every 6 hr for 48 hr, then 100 mg twice daily. Heart failure: 12.5-25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day. Migraine prevention: 50-100 mg 2-4 times daily (unlabeled).
IV (Adults): MI: 5 mg every 2 min for 3 doses, followed by oral dosing.
PO (Children ≥6 yr): Hypertension: 1 mg/kg once daily (extended-release capsules); may be titrated, as needed (not to exceed 50 mg/day)-
How administered
P.O., IV
What is it used for?
Hypertension.
Angina pectoris.
Prevention of MI and decreased mortality in patients with recent MI.
Stable, symptomatic (class I| or III) heart failure due to ischemic, hypertensive, or cardiomyopathic origin (Toprol XL only).
Unlabeled Uses: Ventricular arrhythmias/tachycardia. Migraine prophylaxis. Tremors. Aggressive behavior. Drug-induced akathisia. Anxiety.
Therapeutic Effects: Decreased BP and heart rate. Decreased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure.
Complications/Precautions:
Do NOT use this medication if the patient has:
• Uncompensated heart failure (heart can’t pump enough blood and needs immediate support)
• Pulmonary edema (fluid in the lungs)
• Cardiogenic shock (heart suddenly can’t pump enough blood)
• Slow heart rate (bradycardia), heart block, or sick sinus syndrome unless they have a pacemaker
Use with caution in patients with:
• Kidney or liver problems
• Lung diseases like asthma or COPD (especially at higher doses, the drug might affect breathing)
• Diabetes or poor nutrition (can hide signs of low blood sugar)
• Overactive thyroid (thyrotoxicosis) (can mask symptoms)
• History of severe allergic reactions (reactions may be harder to treat)
• Untreated pheochromocytoma (must start alpha blocker before beta blocker)
Pregnancy and Breastfeeding:
• Use only if the benefit outweighs the risk.
• May cause side effects in breastfed infants, especially if the mother processes the drug slowly (CYP2D6 poor metabolizers).
Children:
• Not approved for:
• Kids under 18 years (tablets/injections)
• Kids under 6 years (extended-release capsules)
Older Adults (Geriatric):
• May be more sensitive to the effects.
• Start at a lower dose.
Adverse effects
ADVERSE REACTIONS/SIDE EFFECTS
CV: BRADYCARDIA, heart block, HF, hypotension, peripheral vasoconstriction. Derm: rash. EENT: blurred vision, stuffy nose. Endo: hyperglycemia, hypoglycemia. Gl: increased liver enzymes, constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, nausea, vomiting. GU: erectile dysfunction, decreased libido, urinary frequency. MS: arthralgia, back pain, joint pain. Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares. Resp: bronchospasm, PULMONARY EDEMA, wheezing. Misc: drug-induced lupus syndrome.
Nursing Considerations
Monitor BP, ECG, and pulse frequently during dose adjustment and periodically during therapy.
• Monitor frequency of prescription refills to determine compliance.
• Monitor vital signs and ECG every 5-15 min during and for several hrs after parenteral administration. If heart rate <40 bpm, especially if cardiac output is also decreased, administer atropine 0.25-0.5 mg IV.
• Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).
• Angina: Assess frequency and characteristics of anginal attacks periodically during therapy.
Lab Test Considerations
• May cause increase BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
• May cause increase ANA titers.
• May cause increase in blood glucose levels.
• May cause increase serum alkaline phosphatase, LDH, AST, and ALT levels.
