NUR 460 - Carvedilol
NUR 460 - Carvedilol 460
Popular in Nursing Concepts IV: Health of Maturing Adults / Chronic Disease
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This 3 page Class Notes was uploaded by ndp33 on Wednesday July 13, 2016. The Class Notes belongs to 460 at Niagara University taught by in Summer 2016. Since its upload, it has received 6 views. For similar materials see Nursing Concepts IV: Health of Maturing Adults / Chronic Disease in Nursing and Health Sciences at Niagara University.
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Date Created: 07/13/16
Carvedilol: Also known as Coreg What is it?: Carvedilol is a betablocker; more specifically, it is an alphaand betaadrenergic antagonist. It can be used to treat: Essential hypertension, HF(if there is a left ventricular ejection fraction less than 40%) o Carvedilol helps to improve the morbidity and mortality, along with exercise tolerance, and it may not worsen s/sx of HF as much, since it is a negative inotropic drug cardiomyopathy, and left ventricular dysfunction postmI o Leads to left ventricular remodeling Normal dose for adults varies, depending on what it is being used to treat (heart failure, left ventricular function post –MI, hypertension): There are immediate release and extended release dosages Overall, dosage can start with 3.125 mg6.125 mg twice a day, and dosage can double, usually as tolerated; and if on extended release; it can start with 1020 mg daily and increase to 4080 mg daily, depending on what the condition the drug is being used to treat If Heart failure, the normal dose for a person weighing less than 85 kg would be 3.125 mg twice a day for 2 weeks, and you may double dose every 2 weeks as tolerated up to 25 mg twice a day If heart failure, the normal dose for a person weighing greater than 85 kg would be 50 mg twice a day If heart failure and taking extended release, take 10 mg daily for two weeks, may increase up to 80 mg If hypertension and taking immediate release, start with 6.25 mg twice a day, may increase by 6.25 mg twice a day to a max of 50 mg/day If hypertension and taking extended release, take 20 mg daily, may increase to 40 mg daily If left ventricular dysfunction postMI and taking immediate release, take 3.1256.235 mg bid, can double every 310 days as tolerated If left ventricular dysfunction postMI and taking extended release, take 1020 mg daily Its method of action is: It primarily blocks the SNS blocks the release of catecholamines on the body (including norephinephrine and epinephrine that increase HR and BP during fightorflight response) It inhibits the action of the SNS by blocking alpha1 and beta1 and beta2 adrenergic receptors o Alpha1 adrenergic receptors are located in the smooth muscle cells of blood vessels (and elsewhere); in this case, they promote contraction of the smooth muscles of peripheral vessels; they are activated for vasoconstriction of the blood vessels (reduced blood flow and increased BP) during the fightorflight response, once stimulated by the SNS o Beta1 adrenergic receptors are located in the cardiac muscle cells (and elsewhere); they promote increased HR of SA node, increased atrial and ventricular contractility when stimulated, along with increased cardiac output o beta2 adrenergic receptors are located in the blood vessels, including coronary arteries (as well as the lungs and other organs); they promote increased HR of the SA node when stimulated, along with increased atrial contractility and cardiac output So, by blocking the alpha and beta adrenergic receptors of the smooth muscles of the vessels, the blood vessels, and of the cardiac muscle cells, and thereby blocking the stimulating effects of the SNS, there is decreased peripheral vascular resistance and decreased contractility of the heart. (With decreased resistance of the vessels, there is also vasodilation and improved coronary blood flow.) o Furthermore, effects of the drug seen are: slower heart rhythm; decreased HR; decreased BP (by decreasing the stroke volume) With improved blood flow through the heart, the oxygen requirements of the heart are lowered, and so are the workload of the heart and the cardiac output o For HF patients, there is likely less ischemia of the cardiac muscle cells from improved oxygenation Major side effects of Carvedilol include: Allergy Chest pain, pain, arthralgia Dizziness, fatigue, lightheadedness SOB Bradycardia (<60 beats per minute) watch out for; may need to hold off Hypotension Weight gain (r/t fluid retention) Generalized edema or edema of lower extremities Paresthesias Thrombocytopenia Bronchitis (b/c the beta2 receptors of lungs are blocked), so, you would not want to give to an asthmatic or a patient w/ emphysema or bronchitis Hypoglycemia s/sx masked (eg fatigue, sweating, heart palpitations) Contraindications include: Having asthma or Having bronchitis or emphysema (b/c the drugs can result in a bronchospasm by blocking beta2 adrenergic receptors of the lungs) Allergy to Carvedilol Liver disease (b/c it would affect the metabolism of the drug and could lead to toxicity) Pulmonary edema Patients who already have severe bradycardia (since bradycardia, as mentioned, is a side effect), Second and thirddegree AV block, or sick sinus syndrome (since Carvedilol’s side effects can include AV block) Cardiogenic shock (in which the heart is unable to supply enough blood, oxygen and nutrients to the rest of the body, leading to decreased BP and to organ failure) Nursing implications would include: Monitor for therapeutic effectiveness You look for improvements in s/sx of CHF and BP readings Monitor for major s/e, including dizziness and orthostatic hypotension; prevent fall risks Monitor liver function tests (to prevent liver toxicity) Monitor digoxin levels if taking concurrently in that digoxin levels may increase can otherwise lead to digoxin toxicity if not monitored carefully Patient and family education, such that: o patient must take drug on regimen as prescribed and must not stop drug abruptly o S/e (major) of Carvedilol o Patient should slowly change positions d/t risk of orthostatic hypotension o Patient knows how to monitor pulse and BP o If experiencing dizziness, do not participate in hazardous activities o Carvedilol may mask hypoglycemic s/sx in diabetics (eg fatigue, sweating, palpitations)
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