Product Details

 Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle.

 Indications Hypertension; chronic stable angina; vasospastic (Prinzmetal's or variant) angina.

 Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except with a functioning pacemaker.

 Route/Dosage

ADULTS: PO 5 to 10 mg qd. ELDERLY: PO Initially 2.5 mg qd.

HEPATIC IMPAIRMENT PO Initially 2.5 mg qd.

 Interactions

Beta-blockers: May cause increased adverse cardiac effects as a result of myocardial depression. Fentanyl: Severe hypotension or increased fluid volume requirements have occurred with similar drug.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; peripheral edema; syncope; tachycardia; bradycardia; arrhythmias; ventricular asystoles. CNS: Headache; dizziness; lightheadedness; fatigue; lethargy; somnolence. DERM: Dermatitis; rash; pruritus; urticaria. GI: Nausea; abdominal discomfort; cramps; dyspepsia. RESP: Shortness of breath; dyspnea; wheezing. OTHER: Flushing; sexual difficulties; muscle cramps, pain or inflammation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. CHF: Cautious use is required with this condition. Hepatic impairment: Cautious use is required.

 Administration/Storage

• Administer medication in morning.
• If patient has difficulty swallowing, crush tablets.
• Store in tightly closed container in cool location.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note any diabetes, liver disease, cardiac disease or sensitivity to calcium channel blockers.
• Monitor BP and pulse before administration.
• Review baseline ECG.
• Assess for signs of withdrawal syndrome. Abrupt withdrawal may cause increased frequency and duration of angina. Gradual tapering of dose is necessary.
• Assess patient for signs of CHF during therapy.
• If chest pain occurs, assess for location, intensity, duration, and radiation. Nitroglycerin preparations may be administered in conjunction with this medication.
• If drug is used with other calcium channel blockers or beta-blockers, observe for intensification of side effects.
• Withhold medication and notify physician if any of the following signs and symptoms occur: Sudden severe dyspnea; edema of hands and feet; changes in ECG (widened QRS, prolonged QT segments); pulse falls below 50 bpm.
• If the patient experiences chest pain not relieved by medication, continue medication and notify physician.

 Patient/Family Education

• Teach patient how to monitor pulse before taking medication. Tell patient not to take medication if pulse if < 50 bpm and to call physician.
• Explain to patient how to monitor BP daily.
• Instruct patient not to stop taking this medication suddenly because doing so can cause chest pain and MI.
• Teach patient importance of good oral hygiene and frequent visits to dentist while taking medication.
• Inform patient that frequent follow-up appointments with physician are important to adjust medication dosage.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient not to take otc medications without consulting physician.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts

(ah-TEN-oh-lahl)

Tenormin,  APO-Atenol, Gen-Atenolol, Med-Atenolol, Novo-Atenol, Nu-Atenol, Schein Pharm Atenolol, Taro Atenolol, Tenolin, Tenormin

Class: Beta-adrenergic blocker

 Action Blocks beta receptors, primarily affecting heart (slows rate), vascular system (decreases BP) and, to lesser extent, lungs (reduces function).

 Indications Treatment of hypertension (used alone or in combination with other drugs), angina pectoris resulting from coronary atherosclerosis, acute MI. Unlabeled use(s): Migraine prophylaxis, alcohol withdrawal syndrome, ventricular arrhythmias, supraventricular arrhythmias or tachycardias, esophageal varices rebleeding, anxiety.

 Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock.

 Route/Dosage

Hypertension

ADULTS: PO 50 to 100 mg/day.

Angina Pectoris

May require up to 200 mg/day.

Acute MIIV 5 mg over 5 min; second IV Follow with dose 10 min later. PO 50 to 100 mg/day.

 Interactions

Ampicillin: May impair antihypertensive and antianginal effects. Clonidine: May add to or reverse antihypertensive effects; potentially life-threatening situations may occur, especially on withdrawal. NSAIDs: Some agents may impair antihypertensive effect. Prazosin: May increase orthostatic hypotension. Verapamil: Effects of both drugs may be increased.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypotension; bradycardia; CHF; cold extremities; second- or third-degree heart block. CNS: Insomnia; fatigue; dizziness; depression; lethargy; drowsiness; forgetfulness; slurred speech. DERM: Rash; hives; fever; alopecia. EENT: Dry eyes; blurred vision; tinnitus; dry mouth; sore throat. GI: Nausea; vomiting; diarrhea. GU: GU:Impotence; painful, difficult or frequent urination. HEMA: Agranulocytosis; thrombocytopenic purpura. HEPA: Elevated liver enzymes and bilirubin. RESP: Bronchospasm; dyspnea; wheezing. OTHER: Weight changes; facial swelling; muscle weakness; hyperglycemia; hypoglycemia; antinuclear antibodies; hyperlipidemia.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety not established. Anaphylaxis: Deaths have occurred; aggressive therapy may be required. CHF: Administer cautiously in patients with CHF controlled by digitalis and diuretics. Diabetes mellitus: May mask symptoms of hypoglycemia (eg, tachycardia, BP changes). Elderly: Dosage reduction may be necessary. Nonallergic bronchospastic diseases (eg, chronic bronchitis, emphysema): In general, do not give beta-blockers to patients with bronchospastic diseases. Peripheral vascular disease: May precipitate or aggravate symptoms of arterial insufficiency. Thyrotoxicosis: May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm. Renal/Hepatic impairment: Reduce dose.

 Administration/Storage

• May be administered with or without food.
• If patient has difficulty swallowing, tablet may be crushed and mixed with fluid.
• Store in a tightly-closed container in a cool location.

 Assessment/Interventions

• Obtain patient history, including drug history and any allergies. Note diabetes; respiratory, liver, or cardiac disease, or sensitivity to other beta-blockers.
• Review baseline ECG.
• Assess BP and pulse before administration. If pulse is < 60 bpm, withhold medication and notify physician.
• Monitor I&O and daily weight during therapy for signs of fluid retention.
• If sudden severe dyspnea or edema of hands and feet develops, withhold medication and notify physician.
• If chest pain occurs, assess for location, intensity, duration, and radiation. Nitroglycerin preparations may be administered in conjunction with this medication if ordered.
• If patient experiences chest pain not relieved by medication, continue medication and notify physician.
• If there are changes in the ECG (eg, long PR interval, low- or high-grade heart blocks, ventricular ectopic beats), withhold dose and notify physician.

 Patient/Family Education

• Explain that full effectiveness of drug may not occur for up to 1 to 2 wk after initiation of therapy, and that dosage will be tapered slowly before stopping. Warn that sudden discontinuation can cause chest pain or heart attack.
• Teach patient how to take pulse and instruct patient to check before taking drug. Warn patient not to take drug if pulse is < 60 bpm, and to call physician.
• When medication is being used for treatment of hypertension, teach patient how to take BP and advise patient to take daily.
• Advise patient that medication may cause increased sensitivity to cold.
• Inform diabetic patients to monitor blood glucose level carefully. It may be necessary to alter insulin dose while taking drug.
• Inform patient that frequent follow-up appointments with physician are important to adjust medication dosage.
• Instruct patient to report the following symptoms to physician: Difficulty breathing, swelling of feet, legs, and hands, irregular heart beat, altered mood or depression.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.
• Caution patient not to take otc medications without consulting physician.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts