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Metoprolol Tartrate

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Prometin

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Losartan Potassium

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Cozaar

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Neosartan

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Kenzar

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Tablets:

25 mg, 50 mg, 100 mg

Hypertension

Adults: Initially, 50 mg/day P.O.; range is 25 to 100 mg/day as a single dose or in two divided doses. May be used alone or with other drugs.

Children ages 6 and older: 0.7 mg/kg P.O. daily, up to total of 50 mg

To prevent cerebrovascular accident (stroke) in hypertensive patients with left ventricular hypertrophy (LVH)

Adults: Initially, 50 mg P.O. daily, increased to 100 mg P.O. daily. May be given concurrently with hydrochlorothiazide.

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Neobloc

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Pharmacologic Class: Angiotensin II receptor antagonist

Therapeutic Class: Antihypertensive

Pregnancy Risk: Category C (first trimester), D (second and third trimesters)

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Blocks vasoconstricting and aldosterone-secreting effects of angiotensin II at various receptor sites,including vascular smooth muscle and adrenal glands.

Therapeutic  Effect:  causes vasodilation, decreases peripheral resistance, decreases B/P

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Hypertension

Stroke Prevention (Hypertension with Left Ventricular Hypertrophy)

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Hypersensitivity to drug or its components

Pregnancy (second and third trimesters)

Concomitant use of aliskiren in patients with diabetes.

Renal/hepatic impairment, unstented renal arterial stenosis,  significant  aortic/mitral  stenosis.

Concurrent  use  of  potassium supplements.

Patients with history of angioedema

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Side Effects:

Frequent  (8%):  Upper  respiratory  tract  infection.

Occasional  (4%–2%): Dizziness, diarrhea, cough.

Rare (1% or less): Insomnia, dyspepsia, heartburn,back/leg pain, muscle cramps, myalgia, nasal congestion, sinusitis, depression.

Adverse Effects:

Hypotension

Tachycardia

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Baseline Assessment:

Obtain B/P, apical pulse immediately before each dose, in addition to regular monitoring  (be  alert  to  fluctuations).

Question  for  possibility  of  pregnancy.

Assess medication history (esp. diuretics).

Intervention/Evaluation:

Maintain  hydration  (offer  fluids  frequently).

Assess  for  evidence  of  upper respiratory  infection,  cough.

Monitor  B/P,  pulse.  Assist  with  ambulation  if dizziness occurs.

Monitor daily pattern of bowel activity, stool consistency.

Watch for angioedema and other hypersensitivity reactions.

Assess liver and kidney function tests and electrolyte levels.

Stay alert for oliguria, progressiveazotemia, and renal failure in patients with severe heart failure whose renal function depends on the renin-angiotensin-aldosterone system.

Patient/Family Teaching

Instruct patients to avoid potassium supplements and salt substitutes con-taining potassium, unless directed by prescriber.

Caution female patients not to take drugs during the second or third trimester of pregnancy. Advise her to contact the prescriber immediately if she suspects pregnancy.

Tell female patients to discuss breastfeeding with prescriber before taking.

Instruct patients to immediately report hypersensitivity reactions, especially lip or eyelid swelling, throat tightness, and difficulty breathing.

Avoid  tasks  that  require  alertness,  motor  skills  until  response  to  drug  was established (possible dizziness effect).

Report any sign of infection (sore throat, fever), chest pain.

Do not take OTC cold preparations, nasal decongestants.

Do not stop taking medication.

As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

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Injection Solution: 1 mg/mL.

Tablets (Immediate-Release):  25  mg,  50  mg,100 mg.

Tablets (Extended-Release): 25 mg, 50 mg, 100 mg, 200 mg.

Myocardial Infarction

IV:

ADULTS: 5 mg q5min for up to 3 doses, followed by 25–50 mg orally q6–12h for 48–72 hrs. Transition over 2–3 days to twice daily Lopressor or once daily Toprol XL. May increase up to a maximum of 200 mg/day.

Angina Pectoris

PO(Immediate-Release):

ADULTS:  Initially,  50  mg  twice  daily.  Increase  at weekly (or longer) intervals. Usual range: 50–200 mg twice daily.

Maximum: 400 mg/day.PO

(Extended-Release):

ADULTS: Initially, 100 mg/day as a single dose. May Increase by at least at weekly intervals until optimum clinical response achieved.

Maximum: 400 mg/day

Hypertension

PO (Immediate-Release):

ADULTS, ELDERLY:  Initially,  50  mg  twice  daily.Increase at wkly (or longer) intervals. Maintenance: 100–450 mg/day in 2–3divided  doses.

CHILDREN:  Initially,  0.5–1  mg/kg/dose. Maximum  InitialDose: 25 mg. Maximum Daily Dose: 6 mg/kg/day or 200 mg/day, whichever is less.

PO (Extended-Release):

ADULTS, ELDERLY:  Initially,  25–100  mg/day  as single dose. May increase at least at weekly intervals until optimum B/P obtained. Maximum: 400 mg/day.

CHILDREN 6 YRS OR OLDER: Initially, 1 mg/kg once daily. Maximum: 50 mg. May increase to 2 mg/kg/day or 200 mg/day,whichever is less.

Heart Failure

PO (Extended-Release):

ADULTS: Initially, 12.5–25 mg/day. May double doseq2wks up to target dose of 200 mg/day.

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Pharmacologic Class: Beta-adrenergic blocker

Therapeutic Class: Antihypertensive, antianginal, myocardial infarction adjunct

Pregnancy Risk: Category C

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Blocks stimulation of beta 1 (myocardial) adrenergic receptors, usually without affecting beta 2 (pulmonary,vascular, uterine) adrenergic receptor sites

Therapeutic Effect: Slows heart rate,  decreases  cardiac  output,  reduces  B/P.  Decreases  myocardial  ischemia severity.

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Hypertension

Angina pectoris

Myocardial infarction

Symptomatic heart failure

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Sinus bradycardia, heart block greater than first degree, cardiogenic shock,overt cardiac failure (with Lopressor used for hypertension or angina)

Heart rate below 45 beats/minute,second- or third-degree heart block,significant first-degree heart block; sys-tolic pressure below 100 mm Hg; or moderate to severe cardiac failure(when Lopressor is used for MI)

Hypersensitivity to drug or its com-ponents, severe bradycardia, heart block greater than first degree, cardio-genic shock, decompensated cardiac failure, sick sinus syndrome (unless permanent pacemaker is in place)(with Toprol-XL)

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Metoprolol  is  generally  well  tolerated,  with  transient  and  mild  side  effects.

Side Effects:

Frequent:  Diminished  sexual  function,  drowsiness,  insomnia,  unusual fatigue/weakness.

Occasional:  Anxiety,  diarrhea,  constipation,  nausea,vomiting,  nasal  congestion,  abdominal  discomfort,  dizziness,  difficulty breathing,  cold  hands/feet.

Rare:  Altered  taste,  dry  eyes,  nightmares,paresthesia, allergic reaction (rash, pruritus).

Adverse Effects:

Overdose  may  produce  profound  bradycardia,  hypotension,  bronchospasm.

Abrupt  withdrawal  may  result  in  diaphoresis,  palpitations,  headache,tremulousness,  exacerbation  of  angina,  MI,  ventricular  arrhythmias.

May Precipitate  HF,  MI  in  pts  with  heart  disease,  thyroid  storm  in  those  with thyrotoxicosis,  peripheral  ischemia  in  those  with  existing  peripheral  vascular disease.

Hypoglycemia  may  occur  in  pts  with  previously  controlled  diabetes(may mask signs of hypoglycemia).

Antidote: Glucagon

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Baseline Assessment

Assess baseline renal function, LFT.

Assess B/P, apical pulse immediately before drug administration (if pulse is 60/min or less or systolic B/P is less than 90 mmHg, withhold medication, contact physician).

Antianginal: Record onset, type(sharp, dull, squeezing), radiation, location, intensity, duration of anginal pain,precipitating factors (exertion, emotional stress)

Intervention/Evaluation

Measure blood pressure closely when starting therapy and titrating dosage. Once the patient stabilizes, measure blood pressure every 3 to 6 months.

Monitor blood pressure and pulse before I.V. administration. If the patient is hypotensive or has bradycardia, consult the prescriber before giving the dose.

Watch for orthostatic hypotension in at risk patients, particularly the elderly.

Assess  pulse  for  quality,  rate,  rhythm.

Assess  for  evidence  of  HF:dyspnea  (esp.  on  exertion,  lying  down),  night  cough,  peripheral  edema,distended neck veins.

Monitor I&O (increased weight, decreased urinary outputmay indicate HF).

Therapeutic response to hypertension noted in 1–2 wks

When discontinuing drug, reduce dosage gradually over 1 to 2 weeks.

Patient/Family Teaching

Advise the patient to take with or immediately after meals.

Tell the patient that extended release tablets are scored and can be divided,but that he should swallow tablets orhalf-tablets whole and not crush or chew them.

Advise the patient with heart failure to report signs or symptoms of worsening condition, including weight gain and increasing shortness of breath.

Caution the patient to avoid driving and other hazardous activities until drug effects are known.

Compliance  with  therapy  regimens  is  essential  to  control  hypertension,arrhythmias.

If dose is missed, take the next scheduled dose (do not double dose).

Do not use nasal decongestants, OTC cold preparations (stimulants) without physician approval.

Restrict salt, alcohol intake

As appropriate, review all other significant and life-threatening adverse reactions and interactions,especially those related to the drugs,tests, foods, and behaviors mentioned above

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Hodgson, B. B., & Kizior, R. J. (2020). Saunders Nursing Drug Handbook 2020 (1st Edition). Saunders.

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Hodgson, B. B., & Kizior, R. J. (2020). Saunders Nursing Drug Handbook 2020 (1st Edition). Saunders.

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Schull, P. (2013). McGraw-Hill Nurses Drug Handbook, Seventh Edition (McGraw-Hill’s Nurses Drug Handbook) (7th ed.). McGraw-Hill Education /Medical.

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Schull, P. (2013). McGraw-Hill Nurses Drug Handbook, Seventh Edition (McGraw-Hill’s Nurses Drug Handbook) (7th ed.). McGraw-Hill Education /Medical.