This action might not be possible to undo. Are you sure you want to continue?
Generic Name labetalol Classification Dose Route Time/frequency antianginals, antihypertensives, 40mg/8mL IVP Q 2 hrs PRN Beta Blockers Peak Onset Duration Normal dosage range 5 min 2-5 min 16-18 hrs 20 mg (0.25 mg/kg) initially, additional doses of 40-80 mg may be given q 10 min as needed (not to exceed 300 mg total dose)or 2 mg/min infusion (range 50-300 mg total dose required) Rate: Administer slowly over 2 min. Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions HTN High Alert: IV vasoactive medications are inherently dangerous. Before administering intravenously, have second practitioner independently check original order, dosage calculations, and infusion pump settings. Do not confuse labetalol with Lamictil Administer undiluted Y-Site Incompatibility: amphotericin B cholesteryl sulfate Complex, cefoperazone, ceftriaxone, nafcillin, tobramycin, Warfarin Trade Name Trandate
A dditi vie Inco mpa tibili ty: sodi um bicar bona te
Mechanism of action and indications (Why med ordered) Blocks stimulation of beta1 (myocardial)- and beta2 (pulmonary, vascular, and uterine)-adrenergic receptor sites. Also has alpha1-adrenergic blocking activity, which may result in more orthostatic hypotension.
Nursing Implications (what to focus on) Contraindications/warnings/interactions Uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia or heart block. Use cautiously in: Renal impairment, hepatic impairment, geriatric patients (increased sensitivity to beta blockers; initial dosage reduction recommended), pulmonary disease (including asthma), Diabetes mellitus (may mask signs of hypoglycemia), thyrotoxicosis (may mask symptoms). Patients with a history of severe allergic reactions (intensity of reactions may be increased), pregnancy, lactation, or children (safety not established; may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression). Common side effects Fatigue, weakness, orthostatic hypotension, impotence, ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA
Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Xopenex: Beta blockers may antagonize the effects of bronchodilator beta-adrenergic agonists, which may result in life-threatening bronchospasm. The mechanism is increased airway resistance and inhibition of beta-agonist-induced bronchodilation due to beta-2-adrenergic blockade. Lorazepam: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents may additively increase hypotensive and/or central nervous system depressant effects. Detrol: Anticholinergic agents frequently cause drowsiness and other central nervous system-depressant effects that may be additive with those induced by beta blockers. In addition, these agents may increase heart rate and theoretically may counteract the bradycardic effects of beta blockers. Pharmacokinetically, anticholinergic agents may delay the gastrointestinal absorption of beta blockers and other drugs that are administered orally. The proposed mechanism involves increased gastrointestinal transit time due to reduction of stomach and intestinal motility by anticholinergic agents. In healthy volunteers, pretreatment with propantheline has been shown to prolong the time to reach peak plasma concentration (Tmax) for both atenolol and metoprolol. Propantheline also decreased metoprolol peak plasma concentration (Cmax) but had no effect on its systemic exposure (AUC). In contrast, propantheline increased atenolol AUC but had no effect on its Cmax. The clinical relevance of these changes is probably minimal. Morphine: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents may additively increase hypotensive and/or central nervous system depressant effects. Calcium carbonate: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. Norvasc: Additive reductions in heart rate, cardiac conduction, and cardiac contractility may occur when calcium channel blockers are used concomitantly with beta blockers, particularly in patients with ventricular or conduction abnormalities. While this combination may be useful and effective in some situations, potentially serious cardiovascular adverse effects such as congestive heart failure, severe hypotension, and/or exacerbation of angina may occur. Baclofen: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents may additively increase hypotensive and/or central nervous system depressant effects. Linezolid: Monoamine oxidase inhibitors (MAOIs) may theoretically potentiate the hypotensive effect of some medications. This effect may stem from a gradual MAOIinduced accumulation of false neurotransmitters in peripheral adrenergic neurons that have minimal activity at alpha- and beta-adrenergic receptors, resulting in a functional block of sympathetic neurotransmission. Indeed, MAOIs alone quite commonly produce orthostatic hypotension. In addition,
Lab value alterations caused by medicine May cause increased BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels. May cause increased ANA titers. May cause increase in blood glucose levels, May cause increased serum alkaline phosphatase, LDH, AST, and ALT levels. Discontinue if jaundice or laboratory signs of hepatic function impairment occur. Be sure to teach the patient the following about this medication Instruct patient to take medication exactly as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. If a dose is missed, it should be taken as soon as possible up to 8 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. Advise patients to make position changes slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased. Patients taking oral labetalol should be especially cautious when drinking alcohol, standing for long periods, or exercising, and during hot weather, because orthostatic hypotension is enhanced. Caution patient that this medication may increase sensitivity to cold. Instruct patient to consult health care professional before taking any OTC medications, 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 tachycardia and increased blood pressure as 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, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs. Instruct patient to inform health care professional of medication regimen prior to 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 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).
Assessment Why would you hold or not give this med? Signs of overdose (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. Glucagon has been used to treat bradycardia and hypotension.
Evaluation Check after giving Decrease in blood pressure.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.