Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (266 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(meh-toe′proe-lole)
Lopressor, Nu-Metop
, Toprol-XL
Func. class.:
Antihypertensive, antianginal
Chem. class.:
β
1
-Blocker
Do not confuse:
metoprolol
/misoprostol
Lowers B/P by β-blocking effects; reduces elevated renin plasma levels; blocks β
2
-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect
Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure
Unlabeled uses:
Migraine prevention, heart rate control for atrial fibrillation/flutter without accessory pathway, essential tremor, unstable angina
Hypersensitivity to β-blockers, cardiogenic shock, heart block (2nd, 3rd degree),
sinus bradycardia, pheochromocytoma, sick sinus syndrome
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, major surgery, diabetes mellitus, thyroid/renal/hepatic disease, COPD, CAD, nonallergic bronchospasm, CHF, bronchial asthma, CVA, children, depression, vasospastic angina
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
PO
50 mg bid or 100 mg/day; may give up to 200-450 mg in divided doses;
EXT REL
25-100 mg daily, titrate at weekly intervals; max 400 mg/day
• Geriatric:
PO
25 mg/day initially, increase weekly as needed
• Child and adolescent 6-16 yr:
PO ER
1 mg/kg up to 50 mg daily
• Adult:
IV BOL
(early treatment) 5 mg q2min × 3 then 50 mg
PO
15 min after last dose and q6hr × 48 hr; (late treatment)
PO
maintenance 50-100 mg bid for 1-3 yr
• Adult:
PO EXT REL
25 mg daily × 2 wk (class II); 12.5 mg daily (class III);
PO
(unlabeled) 5 mg bid, titrate to 100-150 mg/day in 2-3 divided doses
• Adult:
PO
100 mg/day as a single dose or in 2 divided doses, increase weekly prn or 100 mg
EXT REL
daily, max 400 mg/day ext rel
• Adult:
PO
25-100 mg bid-qid; 50-200 mg daily (XL)
• Adult:
IV BOL
(acute setting) 2.5-5 mg over 2 min, may repeat dose × 3;
PO
(nonacute setting) 25-100 mg bid
• Adult:
PO
50 mg/day, may increase, max 300 mg/day in divided doses;
EXT REL
100 mg/day, max 400 mg/day
Available forms:
Tabs 50, 100 mg; inj 1 mg/ml; ext rel tab (succinate) (XL) 25, 50, 100, 200 mg; ext rel tabs, tartrate: 100 mg
•
Do not break, crush, or chew ext rel tabs
•
Regular release tab after meals, at bedtime; tab may be crushed or swallowed whole; take at same time each day
•
IV, undiluted, give over 1 min × 3 doses at 2 to 5-min intervals; start
PO
15 min after last IV dose
Y-site compatibilities:
Abciximab, acyclovir, alemtuzumab, alfentanil, alteplase, amikacin, aminophylline, amiodarone, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, metho
trexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pancuronium, papaverine, PEMEtrexed, penicillin G, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, rocuronium, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
CNS:
Insomnia, dizziness
, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue
CV:
Hypotension
,
bradycardia,
CHF,
palpitations
, dysrhythmias,
cardiac arrest, AV block, pulmonary/peripheral edema, chest pain
EENT:
Sore throat; dry, burning eyes
GI:
Nausea, vomiting
, colitis, cramps,
diarrhea
, constipation, flatulence, dry mouth,
hiccups
GU:
Impotence
HEMA:
Agranulocytosis, eosinophilia, thrombocytopenia, purpura
INTEG:
Rash, purpura, alopecia, dry skin, urticaria, pruritus
RESP:
Bronchospasm,
dyspnea, wheezing
Half-life 3-4 hr, metabolized in liver (metabolites), excreted in urine, crosses placenta, enters breast milk
PO:
Peak 2-4 hr, duration 13-19 hr
PO-ER:
Peak 6-12 hr, duration 24 hr
IV:
Onset immediate, peak 20 min, duration 6-8 hr
•
Do not use with MAOIs
Increase:
hypotension, bradycardia—reserpine, hydrALAZINE, methyldopa, prazosin, amphetamines, EPINEPHrine, H
2
-antagonists, calcium channel blockers
Increase:
hypoglycemic effects—insulin, oral antidiabetics
Increase:
metoprolol level—cimetidine
Increase:
effects of benzodiazepines
Decrease:
antihypertensive effect—salicylates, NSAIDs
Decrease:
metoprolol level—barbiturates
Decrease:
effects of—xanthines
Increase:
absorption with food
Increase:
BUN, potassium, ANA titer, serum lipoprotein, triglycerides, uric acid, alk phos, LDH, AST, ALT
Black Box Warning:
Abrupt withdrawal: may cause MI, ventricular dysrhythmias, myocardial ischemia; taper dose over 7-14 days
•
Hypertension/angina:
ECG directly when giving IV during initial treatment
•
I&O, weight daily; check for CHF (weight gain, jugular venous distention, crackles, edema, dyspnea)
•
Monitor B/P during initial treatment, periodically thereafter; pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes or pulse <60 bpm
•
Baselines of renal, hepatic studies before therapy begins
•
Storage in dry area at room temp; do not freeze
•
Therapeutic response: decreased B/P after 1-2 wk, decreased anginal pain
•
To take immediately after meals; to take medication at bedtime to prevent effect of orthostatic hypotension
Black Box Warning:
Not to discontinue product abruptly; to taper over 2 wk; may cause angina
•
Not to use OTC products containing α-adrenergic stimulants (nasal decongestants, OTC cold preparations) unless directed by prescriber; to avoid alcohol, smoking, sodium intake
•
To report bradycardia, dizziness, confusion, depression, fever, sore throat, SOB, decreased vision to prescriber
•
To take pulse, B/P at home; when to notify prescriber
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product, allergies
•
To monitor blood glucose closely if diabetic
•
To avoid hazardous activities if dizziness is present
•
To report symptoms of CHF: difficult breathing, especially on exertion or when lying down; night cough; swelling of extremities
•
To wear support hose to minimize effects of orthostatic hypotension
•
To report Raynaud’s symptoms
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O
2
, diuretic for cardiac failure, hemodialysis, administer vasopressor