Metoprolol Brand Name: Apo-Metoprolol (CAN), Betaloc (CAN), Lopresor (CAN), Lopressor, Novometoprol (CAN), Nu-Metop (CAN), Toprol-XL

Pregnancy Category C Drug classes: Beta1-selective adrenergic blocker, Antihypertensive Therapeutic action:Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone. Indications Hypertension, alone or with other drugs, especially diuretics Prevention of reinfarction in MI patients who are hemodynamically stable or within 310 days of the acute MI (immediate-release tablets and injection) Treatment of angina pectoris Treatment of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin (Toprol-XL only) Contraindications Contraindicated with sinus bradycardia (HR <> 0.24 sec), cardiogenic shock, CHF, systolic BP Adverse effects Pharyngitis, erythematous rash, fever, sore throat, laryngospasm Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CHF, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Rash, pruritus, sweating, dry skin Eye irritation, dry eyes, conjunctivitis, blurred vision Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination

Brand Names: Aldomet, Apo-Methyldopa, Dopamet, Novamedopa, NuMedopa Classification: Therapeutic: antihypertensives; Pharmacologic: centrally acting antiadrenergics Indications Management of moderate to severe hypertension (with other agents).

Mechanism of Action Stimulates CNS alpha-adrenergic receptors, producing a decrease in sympathetic outflow to heart, kidneys, and blood vessels. Result is decreased blood pressure and peripheral resistance, a slight decrease in heart rate, and no change in cardiac output. Therapeutic Effects: Lowering of blood pressure. Contraindications/Precautions Contraindicated in: Hypersensitivity; Active liver disease; Oral suspension contains alcohol and bisulfites and should be avoided in patients with known intolerance. Use Cautiously in: Previous history of liver disease; Geri: Increase risk of adverse reactions; consider age-related impairment of hepatic, renal and cardiovascular function as well as other chronic illnesses. Appears on Beers list. May cause bradycardia and exacerbate depression in geriatric patients; OB: Pregnancy (has been used safely); Lactation. Adverse Reactions/Side Effects CNS: sedation, decreased mental acuity, depression. EENT: nasal stuffiness.CV: MYOCARDITIS, bradycardia, edema, orthostatic hypotension. GI: DRUG-INDUCED HEPATITIS, diarrhea, dry mouth. GU: erectile dysfunction.Hemat: eosinophilia, hemolytic anemia. Misc: fever.
otassium Chloride Apo-K , K-10, Kalium Durules,Kaochlor,Kaochlor-20 Concentrate, Kaon-Cl, Kato, Kay Ciel, KCl 5% and 20%, K-Long , Klor, Klor-10%, Klor-Con, Kloride, Klorvess, Klotrix, KDur, K-Lyte/Cl, K-tab, Micro-K Extentabs, Novolente K , Roychlor 10% and 20% , Rum-K, SK-Potassium Chloride, Slo-Pot , Slow-K Potassium Gloconate Kaon, Kaylixir, K-G Elixir, Potassium Rougier , Royonate Classifications: electrolytic and water balance agent;replacement solution Pregnancy Category: A Availability 6.7 mEq, 8 mEq, 10 mEq, 20 mEq sustained release tablets; 500 mg, 595 mg tablets; 20 mEq, 25 mEq, 50 mEq effervescent tablets; 20 mEq/15 mL, 40 mEq/15 mL, 45 mEq/15 mL liquid; 15 mEq, 20 mEq, 25 mEq powder; 2 mEq/mL injection; 10 mEq, 20 mEq, 30 mEq, 40 mEq, 60 mEq, 90 mEq vials; 20 mEq/15 mL liquid Actions Principal intracellular cation; essential for maintenance of intracellular isotonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscles,

maintenance of normal kidney function, and for enzyme activity. Plays a prominent role in both formation and correction of imbalances in acidbase metabolism. Therapeutic effects Given special importance as therapeutic agents but are also dangerous if improperly prescribed and administered. Utilized for treatment of hypokalemia. Uses To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy. Also indicated when potassium is depleted by severe vomiting, diarrhea; intestinal drainage, fistulas, or malabsorption; prolonged diuresis, diabetic acidosis. Effective in the treatment of hypokalemic alkalosis (chloride, not the gluconate). Contraindications Severe renal impairment; severe hemolytic reactions; untreated Addisons disease; crush syndrome; early postoperative oliguria (except during GI drainage); adynamic ileus; acute dehydration; heat cramps, hyperkalemia, patients receiving potassiumsparing diuretics, digitalis intoxication with AV conduction disturbance. Cautious use Cardiac or kidney disease; systemic acidosis; slow-release potassium preparations in presence of delayed GI transit or Meckels diverticulum; extensive tissue breakdown (such as severe burns); pregnancy (category A); lactation. Route & dosage Hypokalemia Adult: PO 10100 mEq/d in divided doses IV 1040 mEq/h diluted to at least 1020 mEq/100 mL of solution (max: 200400 mEq/d, monitor higher doses carefully) Child: PO 13 mEq/kg/d in divided doses; sustained release tablets not recommended in children IV Up to 3 mEq/kg/24 h at a rate <0.02 mEq/kg/min Administration Oral

Give while patient is sitting up or standing (never in recumbent position) to

prevent druginduced esophagitis. Some patients find it difficult to swallow the large sized KCl tablet.

Do not crush or allow to chew any potassium salt tablets. Observe to

make sure patient does not suck tablet (oral ulcerations have been reported if tablet is allowed to dissolve in mouth).

Swallow whole tablet with a large glass of water or fruit juice (if allowed) to

wash drug down and to start esophageal peristalsis.

Follow directions for diluting various liquid forms of KCl exactly. In general,

dilute each 20 mEq potassium in at least 90 mL water or juice and allowed to completely before administration.

Dilute liquid forms as directed before giving it through nasogastric tube.

Intravenous PREPARE IV Infusion: Add desired amount to 1001000 mL IV solution (compatible with all standard solutions). Usual maximum is 80 mEq/1000 mL, however, 40 mEq/L is preferred to lessen irritation to veins. Note: NEVER add KCl to an IV bag/bottle which is hanging. After adding KCl invert bag/bottle several times to ensure even distribution. ADMINISTER IV Infusion: KCl is never given IV push or in concentrated amounts by any route. Infuse at rate not to exceed 10 mEq/h. Adult patients with severe potassium depletion may be able to tolerate 20 mEq/h. Too rapid infusion may cause fatal hyperkalemia. Take extreme care to prevent extravasation and infiltration. At first sign, discontinue infusion and select another site. Incompatibilities Solution / Additive: Amphotericin B, dobutamine (potassium phosphate only).Y-site: Amphotericin B cholesteryl complex, diazepam, ergotamine, methylprednisolone, phenytoin, promethazine. Adverse effects GI:Nausea, vomiting, diarrhea, abdominal distension. BodyWhole:Pain, mental confusion, irritability, listlessness, paresthesias of extremities, muscle weakness and heaviness of limbs, difficulty in swallowing, flaccid paralysis. Urogenital:Oliguria, anuria. Hematologic:Hyperkalemia. Respiratory:Respiratory distress. CV:Hypotension, bradycardia; cardiac depression, arrhythmias, or arrest; altered sensitivity to digitalis glycosides. ECG changes in hyperkalemia: Tenting (peaking) of T wave (especially in right precordial leads), lowering of R with deepening of S waves and depression of RST; prolonged P-R interval, widened QRS complex, decreased amplitude and disappearance of P waves, prolonged Q-T interval, signs of right and left bundle block, deterioration of QRS contour and finally ventricular fibrillation and death. Nursing implications Assessment & Drug Effects

Monitor I&O ratio and pattern in patients receiving the parenteral drug. If Lab test: Frequent serum electrolytes are warranted.

oliguria occurs, stop infusion promptly and notify physician.

Monitor for and report signs of GI ulceration (esophageal or epigastric pain Monitor patients receiving parenteral potassium closely with cardiac

or hematemesis).

monitor. Irregular heartbeat is usually the earliest clinical indication of hyperkalemia.

Be alert for potassium intoxication (hyperkalemia, see S&S, Appendix F);

may result from any therapeutic dosage, and the patient may be asymptomatic.

The risk of hyperkalemia with potassium supplement increases (1) in older

adults because of decremental changes in kidney function associated with aging, (2) when dietary intake of potassium suddenly increases, and (3) when kidney function is significantly compromised. Patient & Family Education

Do not be alarmed when the tablet carcass appears in your stool. The

sustained release tablet (e.g., Slow-K) utilizes a wax matrix as carrier for KCl crystals that passes through the digestive system.

Learn about sources of potassium with special reference to foods and Avoid licorice; large amounts can cause both hypokalemia and sodium Do not use any salt substitute unless it is specifically ordered by the

OTC drugs.

retention.

physician. These contain a substantial amount of potassium and electrolytes other than sodium.

Do not self-prescribe laxatives. Chronic laxative use has been associated Notify physician of persistent vomiting because losses of potassium can Report continuing signs of potassium deficit to physician: Weakness, Advise dentist or new physician that a potassium drug has been Do not open foil-wrapped powders and tablets before use. Do not breast feed while taking this drug without consulting physician.

with diarrheainduced potassium loss.

occur.

fatigue, polyuria, polydipsia.

prescribed as long-term maintenance therapy.