Interactions with other patient drugs, OTC or herbalmedicines
(ask patient specifically)
Beta blockers may antagonize the effectsof bronchodilator beta-adrenergic agonists, which may result inlife-threatening bronchospasm. The mechanism is increasedairway resistance and inhibition of beta-agonist-induced bronchodilation due to beta-2-adrenergic blockade.
Corticosteroids mayantagonize the effects of antihypertensive medications bycausing sodium and fluid retention. These effects may be morecommon with the natural corticosteroids (cortisone,hydrocortisone) because they have greater mineralocorticoidactivity.
NovoLog FlexPen, Lantus:
Beta-blockers may inhibit someof the normal physiologic response to hypoglycemia.Symptoms of hypoglycemia such as tremors and tachycardiamay be absent, making it more difficult for patients torecognize an oncoming episode. In addition, multiple effectson glucose metabolism have been reported, usually with thenoncardioselective beta-blockers (e.g., propranolol, pindolol,timolol) but occasionally also with relatively beta-1 selectiveagents (e.g., metoprolol). Specifically, inhibition of catecholamine-mediated glycogenolysis and glucosemobilization in association with beta-blockade can potentiateinsulin-induced hypoglycemia in diabetics and delay therecovery of normal blood glucose levels. Prolonged and severehypoglycemia may occur, although these events have rarely been reported. Significant increases in blood pressure and bradycardia can also occur during hypoglycemia in diabeticstreated with insulin and beta-blockers due to antagonism of epinephrine's effect on beta-2 adrenergic receptors, which leadsto unopposed alpha-adrenergic effects includingvasoconstriction. Other effects reported with various beta- blockers include decreased glucose tolerance and decreasedglucose-induced insulin secretion.
Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in some patients,especially in patients with diabetes or latent diabetes. Inaddition, the risk of QT interval prolongation and arrhythmias(e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics.
Neuroleptic agents may potentiate the hypotensiveeffect of some medications secondary to their peripheral alpha-1 adrenergic blocking activity. Orthostatic hypotension andsyncope associated with vasodilation may occur, particularlyduring the initial dose titration period of neuroleptic therapy.
Concomitant use of digitalis glycosides and beta- blockers including carvedilol may increase the risk of bradycardia. These agents slow atrioventricular conduction anddecrease heart rate, hence they may have additive cardiaceffects during coadministration. Pharmacokinetically,carvedilol has been shown to modestly increase the systemic bioavailability of digoxin. The mechanism may involveenhanced absorption as well as reduced renal excretion of digoxin due to inhibition of intestinal and renal P-glycoproteinefflux transporter by carvedilol.
Lab value alterations caused by medicine
May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uricacid levels. May cause ↑ ANA titers. May cause ↑ in blood glucoselevels.
Be sure to teach the patient the following about this medication
Instruct patient to take medication as directed, at the same time eachday, 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 sureenough 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 pressureInstruct 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 thatrequire alertness until response to the drug is known. Advise patient tochange 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 anyRx, OTC, or herbal products, especially cold preparations, concurrentlywith this medication. Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigueoccurs. Medication may mask some signs of hypoglycemia, butdizziness and sweating may still occur. Advise patient to notify healthcare professional if slow pulse, difficulty breathing, wheezing, coldhands and feet, dizziness, confusion, depression, rash, fever, sorethroat, unusual bleeding, or bruising occurs. Instruct patient to informhealth 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 tocontinue additional therapies for hypertension (weight loss, sodiumrestriction, stress reduction, regular exercise, moderation of alcoholconsumption, and smoking cessation). Medication controls but doesnot cure hypertension.