NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

carvedilol Coreg Beta blocker 25 mg PO Q am
Peak Onset Duration Normal dosage range
1-2 hrs Within 1 hr 12 hrs 6.25 mg twice daily, may be increased q 7-14 days up to 25
mg twice daily
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
HTN solutions
N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Blocks stimulation of beta1(myocardial) and beta2 Pulmonary edema, cardiogenic shock, bradycardia, heart
(pulmonary, vascular, and uterine)-adrenergic block or sick sinus syndrome (unless a pacemaker is in
receptor sites. Also has alpha1 blocking activity, place), severe hepatic impairment, asthma or other
which may result in orthostatic hypotension. bronchospastic disorders. Use caution in: Diabetes
mellitus (may mask signs of hypoglycemia), history of
severe allergic reactions (intensity of reactions may be
increased), pregnancy, lactation, or children (safety not
established; crosses the placenta and may cause
fetal/neonatal bradycardia, hypotension, hypoglycemia, or
respiratory depression).
Common side effects
Dizziness, fatigue, weakness, diarrhea, hyperglycemia,
BRADYCARDIA, CHF, PULMONARY EDEMA.
Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
↑ hypotension may occur with other
antihypertensives (Norvasc, Prinivil) , acute
ingestion of alcohol. May alter the effectiveness of
insulins (Lantus, Novolin R) or oral hypoglycemic
agents (Glucophage) (dose adjustments may be
necessary).
Lab value alterations caused by medicine
May cause ↑ BUN, serum lipoprotein, potassium,
triglyceride, and uric acid levels. May cause ↑ ANA titers.
May cause ↑ in blood glucose levels.
Be sure to teach the patient the following about this
medication
Instruct patient to take medication as directed, at the same
time each day, even if feeling well. Do not skip or double
up on missed doses. Take missed doses as soon as possible
up to 4 hr before next dose. Abrupt withdrawal may
precipitate life-threatening arrhythmias, hypertension, or
myocardial ischemia. Advise patient to make sure enough
medication is available for weekends, holidays, and
vacations. A written prescription may be kept in wallet in
case of emergency. Teach patient and family how to check
pulse and blood pressure Instruct them to check pulse daily
and blood pressure biweekly. Advise patient to hold dose
and contact health care professional if pulse is <50 bpm or
blood pressure changes significantly. May cause
drowsiness or dizziness. Caution patients to avoid driving
or other activities that require alertness until response to
the drug is known. Advise patient to change positions
slowly to minimize orthostatic hypotension, especially
during initiation of therapy or when dose is increased.
Caution patient that this medication may increase
sensitivity to cold. Instruct patient to consult health care
professional before taking any Rx, OTC, or herbal
products, especially cold preparations, concurrently with
this medication. Patients with diabetes should closely
monitor blood glucose, especially if weakness, malaise,
irritability, or fatigue occurs. Medication may mask some
signs of hypoglycemia, but dizziness and sweating may
still occur. Advise patient to notify health care professional
if slow pulse, difficulty breathing, wheezing, cold hands
and feet, dizziness, confusion, depression, rash, fever, sore
throat, unusual bleeding, or bruising occurs. Instruct
patient to inform health care professional of medication
regimen before treatment or surgery. Advise patient to
carry identification describing disease process and
medication regimen at all times. Reinforce the need to
continue additional therapies for hypertension (weight loss,
sodium restriction, stress reduction, regular exercise,
moderation of alcohol consumption, and smoking
cessation). Medication controls but does not cure
hypertension.
Nursing Process- Assessment
(Pre-administration assessment)
Monitor blood pressure and pulse
frequently during dose adjustment period
and periodically during therapy Assess for
orthostatic hypotension when assisting
patient up from supine position. Monitor
intake and output ratios and daily weight.
Assess patient routinely for evidence of
fluid overload (peripheral edema,
dyspnea, rales/crackles, fatigue, weight
gain, jugular venous distention). Patients
may experience worsening of symptoms
during initiation of therapy for CHF.
Check frequency of refills to determine
adherence.
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Decrease in blood pressure
Monitor patients receiving beta without appearance of
blockers for signs of overdose detrimental side effects.
(bradycardia, severe dizziness or
fainting, severe drowsiness, dyspnea,
bluish fingernails or palms, seizures).
Notify physician or other health care
professional immediately if these
signs occur. Take apical pulse before
administering. If <50 bpm or if
arrhythmia occurs, withhold
medication and notify physician or
other health care professional.