NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

metoprolol Lopressor antianginals, 100 mg po BID
antihypertensives
Peak Onset Duration Normal dosage range
unknown 15 min 6-12 hr 25-100mg/day as a single dose initially or 2 divided doses;
may be increased q 7 days as needed up to 450mg/day (for
angina give in divided doses).
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Hypertension. Decreased blood pressure and heart solutions
rate. Prevention of MI and decreased mortality in patients N/A
with recent MI
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Blocks stimulation of beta1(myocardial)-adrenergic Geriatric patients (increased sensitivity to beta blockers;
receptors. Does not usually affect beta2(pulmonary, initial dosage reduction recommended)
vascular, uterine)-adrenergic receptor sites. Thyrotoxicosis (may mask symptoms)
Common side effects
fatigue, weakness, impotence, anxiety, depression,
dizziness, drowsiness, insomnia, memory loss, mental
status changes, nervousness, nightmares, hypotension,
peripheral vasoconstriction, BRADYCARDIA, CHF,
PULMONARY EDEMA
Interactions with other patient drugs, OTC or Lab value alterations caused by medicine
herbal medicines (ask patient specifically) May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric
None for this patient acid levels
May cause ↑ ANA titers, May cause ↑ in blood glucose levels, May
cause ↑ serum alkaline phosphatase, LDH, AST, and ALT levels
Be sure to teach the patient the following about this
medication
Instruct patient to take medication as directed, at the same time each day, even
if feeling well; do not skip or double up on missed doses. Take missed doses 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 change positions slowly to minimize orthostatic hypotension.
Teach patient and family how to check pulse daily and blood pressure biweekly
and to report significant changes to health care professional. Caution patient
that this medication may increase sensitivity to cold. Instruct patient to consult
health care professional before taking any OTC medications or herbal products,
especially cold preparations, concurrently with this medication. Patients on
antihypertensive therapy should also avoid excessive amounts of caffeinated
coffee, tea, and cola. 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. 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
Medication does not block sweating as a sign of hypoglycemia
Nursing Process- Assessment
(Pre-administration assessment)
Take apical pulse before
administering. If <50 bpm or if
arrhythmia occurs, withhold
medication and notify physician or
other health care professional
Monitor blood pressure, ECG,
and pulse frequently during dose
adjustment and periodically
during therapy. Monitor frequency
of prescription refills to determine
compliance
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Decrease in blood pressure
Monitor intake and output ratios and daily Reduction in frequency of
weights. Assess routinely for signs and anginal attacks
symptoms of CHF (dyspnea, Increase in activity tolerance
rales/crackles, weight gain, peripheral Prevention of MI
edema, jugular venous distention),
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, If <50 bpm or if
arrhythmia occurs, withhold medication
and notify physician or other health care
professional