bisoprolol fumarate Nursing Considerations & Management

Drug Name

Generic Name : bisoprolol fumarate

Brand Name: Zebeta

Classification: Beta1-selective adrenergic blocker, Antihypertensive

Pregnancy Category C

Dosage & Route
  • PO Angina pectoris; HTN 2.5-10 mg/day. Max: 20 mg/day. Heart failure Initial: 1.25 mg once daily, may increase gradually. Max: 10 mg/day.
Therapeutic actions
  • Bisoprolol selectively and competitively blocks β-1 receptors but has little or no effect on β-2 receptors except at high doses.
Indications
  • Management of hypertension, used alone or with other antihypertensives
Adverse effects
  • Giddiness, headache, fatigue, bradycardia. Nausea, vomiting, diarrhea or constipation, stomach discomfort, mild ocular stinging, photophobia, keratitis, decreased sexual ability. GI disturbances, dyspnoea, cold extremities, insomnia, hallucination, drowsiness and mood alterations.
  • Potentially Fatal: AV block, bradycardia. Rare but may occur in patients with preexisting cardiac disease. Includes severe bronchospasm, hypoglycaemia, hypotension, orthostatic hypotension, bradyarrhythmias. ‘Rebound phenomenon’ leading to unstable angina or MI on sudden withdrawal.
Contraindications
  • Low cardiac output and uncompensated cardiac failure; sinus bradycardia, 1st ° heart block, cardiogenic shock, bronchospasm; severe hemorrhage.
  • Pregnancy.
Nursing considerations

CLINICAL ALERT! Name confusion has occurred between Zebeta (bisoprolol) and DiaBeta (glyburide); use caution.

Assessment
  • History: Sinus bradycardia, cardiac arrhythmias, cardiogenic shock, CHF, renal failure, diabetes or thyrotoxicosis, pregnancy, lactation
  • Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, R, LFTs, renal function tests, blood and urine glucose
Interventions
  • WARNING: Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring.
  • Consult with physician about withdrawing drug if patient is to undergo surgery (withdrawal is controversial).
Teaching points
  • Do not stop taking this drug unless instructed to do so by a health care provider.
  • Avoid over-the-counter medications.
  • Avoid driving or dangerous activities if dizziness, weakness occur.
  • You may experience these side effects: Dizziness, light-headedness, loss of appetite, nightmares, depression, sexual impotence.
  • Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.
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