See also Adrenergic Blocking Agents. Action/Kinetics: Has both alpha-and beta-adrenergic blocking activity. Thus, the drug decreases cardiac output, reduces exercise- or isopro-terenol-induced tachycardia, reduc es reflex orthostatic hypotension, causes vasodilation, and reduces peripheral vascular resistance. Significant beta-blocking activity occurs within 60 min while alpha-blocking action is observed within 30 min. BP is lowered more in the standing than in the supine position. Significantly lowers plasma renin activity when given for at least 4 weeks. Rapidly absorbed after PO administration, but there is a significant first-pass effect. Terminal tV2: 7-10 hr. Food delays the rate of absorption. Over 98% is bound to plasma protein. Plasma levels average 50% higher in geriatric compared with younger clients. Extensively metabolized in the liver, with metabolites excreted primarily via the bile into the feces. Uses: Essential hypertension used either alone or in combination with other antihypertensive drugs, especially thiazide diuretics. Used with digitalis, diuretics, and ACE inhibitors to reduce the progression of mild to moderate CHF of ischemic or cardiomyopathic origin. Non-FDA Approved Uses: Angina pectoris, id-iopathic cardiomyopathy. Contraindications: Clients with New York Heart Association Class IV decompensated cardiac failure, bronchial asthma, or related bron-chospastic conditions, second- or third-degree AV block, sick sinus syndrome (unless a permanent pacemaker is in place), cardiogenic shock, severe bradycardia, drug hy-persensitivity. Hepatic impairment. Lactation.
Special Concerns: Use with caution in hypertensive clients with CHF controlled with digitalis, diuretics, or an ACE inhibitor. Use with caution in peripheral vascular disease, in surgical procedures using anesthetic agents that depress myocar-dial function, in diabetics receiving insulin or oral hypoglycemic drugs, in those subject to spontaneous hypogly-cemia, or in thyrotoxicosis. Clients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated chal-
lenge while taking beta blockers. Safety and efficacy have not been established in children less than 18 years of age.
Side Effects: CV: Bradycardia, postural hypotension, dependent or peripheral edema, AV block, extrasystoles, hypertension, hypotension, palpitations, peripheral ischemia, syncope, angina, cardiac failure, myocardial ischemia, tachycardia, CV disorder. CNS: Dizziness, headache, somnolence, insomnia, ataxia, hypesthesia, paresthesia, vertigo, depression, nervousness, migraine, neuralgia, paresis, amnesia, confusion, sleep disorder, impaired concentration, abnormal thinking, paranoia, emotional lability. Body as a whole: Fatigue, viral infection, rash, allergy, asthenia, malaise, pain, injury, fever, infection, somnolence, sweating, sudden death. Oral: Dry mouth. GI: Diarrhea, abdominal pain, biliru-binemia, N&V, flatulence, anorexia, dyspepsia, melena, periodontitis, increased hepatic enzymes, GI hemorrhage. Respiratory: Rhinitis, pharyngitis, sinusitis, bronchitis, dyspnea, asthma, bronchospasm, pulmonary edema, respiratory alkalosis, dyspnea, respiratory disorder, URTI, coughing. GU: UTI, albuminuria, hematuria, frequency of micturition, abnormal renal function, impotence. Dermatologic: Pruritus; erythema-tous, maculopapular, and psoria-form rashes, photosensitivity reaction, exfoliative dermatitis. Metabolic: Hypertriglyceridemia, hypercholes-terolemia, hyperglycemia, hypo-volemia, hyperuricemia, increased weight, gout, dehydration, hyper-volemia, glycosuria, hyponatremia, hypokalemia, hyperkalemia, diabetes mellitus. Hematologic: Throm-bocytopenia, anemia, leukopenia, pancytopenia, purpura, atypical lymphocytes. Musculoskeletal: Back pain, arthralgia, myalgia, arthritis. Otic: Decreased hearing, tinnitus. Miscellaneous: Hot flushes, leg cramps, abnormal vision, anaphylac-toid reaction.
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