Names and pronunciation
(bis-oh′pro-lole)
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Individual generic drug information
Extracted information for bisoprolol only.
(bis-oh′pro-lole)
Source page 172
Func. class.: Antihypertensive
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Chem. class.: β1-blocker
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Do not confuse: bisoprolol/buPROPion/busPIRone
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ACTION: Blocks stimulation of β1- adrenergic receptors within cardiac mus- cle (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, which decreases O2 consumption in myocardium; decreases renin-angioten- sin-aldosterone system; inhibits beta 2 receptors (bronchial/vascular smooth muscle) at high doses
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USES: Mild to moderate hypertension
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Unlabeled uses: Heart failure with reduced ejection fraction
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Extracted information for bisoprolol only.
CONTRAINDICATIONS: Hyper- sensitivity to beta-blockers, cardiogenic shock, heart block (second, third degree), sinus bradycardia, acute car- diac failure Precautions: Pregnancy, breastfeeding, children, major surgery, diabetes melli- tus, HF, thyroid/renal/hepatic disease, COPD, asthma, well-compensated heart failure, aortic or mitral valve disease, peripheral vascular disease, myasthenia gravis, abrupt discontinuation
Source page 173
SIDE EFFECTS CNS: Insomnia, fatigue, dizziness, headache CV: Bradycardia, HF, postural hypoten- sion, peripheral edema, cold extremities EENT: Blurred vision, dry mouth ENDO: Hypoglycemia GI: Nausea, diarrhea, vomiting INTEG: Rash, sweating RESP: Dyspnea, cough
Source page 173
INTERACTIONS Increase: myocardial depression—calcium channel blockers, phenytoin (IV), verapamil Increase: antihypertensive effect—ACE inhibitors, alpha-blockers, calcium channel blockers, diuretics, nitrates Increase: bradycardia—digoxin, amio darone cloNIDine, dilTIAZem, verapamil, reserpine, guanethidine Increase: antidiabetic effect—antidiabetics; may mask hypoglycemic symptoms Increase: peripheral ischemia—ergots Decrease: antihypertensive effect—NSAIDs, salicylates Drug/Herb Increase: Beta-blocking effect—hawthorn Decrease: Beta-blocking effect—ephe- dra, licorice root Drug/Lab Test Increase: AST, ALT, blood glucose, BUN, uric acid, potassium, creatinine, phos- phorus
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TREATMENT OF OVERDOSE: Lavage, IV atropine for bradycardia; IV theophylline for bronchospasm; digoxin, O2, diuretic for cardiac failure; hemodi- alysis, IV glucose for hypoglycemia; IV diazePAM or phenytoin for seizures HIGH ALERT
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Extracted information for bisoprolol only.
DOSAGE AND ROUTES Hypertension • Adult: PO 5 mg/day; reduce to 2.5 mg in bronchospastic disease; may increase to 20 mg/day if necessary; max 20 mg/day Heart failure with reduced injection frac- tion (unlabeled) Adult: PO 1.25 mg daily, max 10 mg daily Renal/hepatic dose • Adult: PO CCr <40 mL/min 2.5 mg, titrate upward
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Available forms: Tablets 5, 10 mg
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Administer: • Take apical pulse before each dose, if <50 bpm, withhold • Do not crush, swallow whole; may give without regard to meals, at same time of day • Store protected from light, moisture; at room temperature
Source page 173
Extracted information for bisoprolol only.
Assess: • Hypertension: B/P, pulse during begin- ning treatment, periodically thereafter; pulse: note rate, rhythm, quality; apical/ radial pulse prior to administration; no- tify prescriber of any significant changes (pulse <50 bpm); monitor ECG baseline and periodically • Baselines of renal, hepatic studies prior to beginning therapy • Heart failure: I&O, weight daily; in- creased weight, jugular venous distention, dyspnea, crackles, edema in feet, legs daily, avoid use in severe heart failure • Skin turgor, dryness of mucous mem- branes for hydration status, especially for geriatric patients • Abrupt discontinuation: Taper over 1 wk, abrupt discontinuation may in- crease angina • Surgery: Do not discontinue before surgery • Pregnancy/breastfeeding: Use only if clearly needed in pregnancy, use cau- tiously in breastfeeding
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Evaluate: • Therapeutic response: decreased B/P after 1-2 wk
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to discontinue product abruptly, taper over 1 wk; may cause precipitate angina, rebound hypertension; evaluate noncompliance • Not to use OTC products that contain alpha-adrenergic stimulants (e.g., nasal decongestants, OTC cold preparations) unless directed by prescriber • To report slow heart rate, dizziness, confusion, depression, fever, cold extremi- ties • To take pulse at home; advise when to notify prescriber • To avoid alcohol, smoking; to limit sodium intake • To comply with weight control, di- etary adjustments, modified exercise program • To carry emergency ID to identify product, allergies • To avoid hazardous activities if dizzi- ness is present • To report symptoms of heart failure: difficulty breathing especially on exertion or when lying down, night cough, swelling of extremities • That if diabetic, product may mask signs of hypoglycemia or alter blood glucose levels Pregnancy/breastfeeding: To notify health care professional if pregnancy is planned or suspected or if breastfeeding
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Extracted information for bisoprolol only.
PHARMACOKINETICS B Onset 1-2 hr, peak 2-4 hr, duration unknown, half-life 9-12 hr, 50% excreted unchanged in urine, protein binding 30%-36%, metabolized in liver to inac- tive metabolites
Source page 173
Filter the extracted dose blocks for this individual drug.
Hypertension
• Adult: PO 5 mg/day; reduce to 2.5 mg in bronchospastic disease; may increase to 20 mg/day if necessary; max 20 mg/day Heart failure with reduced injection frac- tion (unlabeled) Adult: PO 1.25 mg daily, max 10 mg daily Renal/hepatic dose
Candidate age grouping · source page 173
Hypertension
• Adult: PO CCr <40 mL/min 2.5 mg, titrate upward
Candidate age grouping · source page 173