NAME Metoprolol Rx Toprol XL FC Antihypertensive antianginal CC 1 Adrenergic blocker TU Decreased B P heart rate AV conduction USE Mild to moderate hypertension acute MI to reduce cardiovascular mortality angina pectoris New York Heart Association class II III heart failure cardiomyopathy DOSAGE Hypertension Adult PO 50 mg bid or 100 mg day may give 100 450 mg in divided doses ext rel 25 100 mg qday titrate at weekly intervals max 400 mg day Geriatric PO 25 mg day initially increase weekly as needed Myocardial infarction Adult IV BOL early treatment 5 mg q2min 3 doses then 50 mg PO 15 min after last dose and q6hr 48 hr late treatment PO maintenance 50 100 mg bid for 1 3 yr Heart failure NYHA class II III Adult PO ext rel 25 mg qd 2 wk class II 12 5 mg qd class III Angina Adult PO 100 mg day as a single dose or in 2 divided doses increase qwk as needed or 100 mg ext rel tab daily max 400 mg day ext rel PT EDUCATION BBW Teach patient not to discontinue product abruptly taper over 2 wk may cause precipitate angina if stopped abruptly Teach patient not to use OTC products containing adrenergic stimulants such as nasal decongestants cold preparations to avoid alcohol smoking and to limit sodium intake as prescribed Teach patient how to take pulse and B P at home advise when to notify prescriber Teach patient to rise from sitting slowly to decreased orthostatic hypotension Instruct patient to comply with weight control dietary adjustments modified exercise program Tell patient to carry wear emergency ID to identify product being taken allergies tell patient product controls symptoms but does not cure Caution patient to avoid hazardous activities if dizziness drowsiness is present to avoid driving until product response is known Teach patient to report symptoms of HF difficult breathing especially with exertion or when lying down night cough swelling of extremities or bradycardia dizziness confusion depression fever decreased vision Teach patient to take product as prescribed not to double doses or skip doses take any missed doses as soon as remembered if at least 4 hr until next dose Advise patient to monitor blood glucose closely if diabetic monitor for hypo hyperglycemia Advise patient to report Raynaud s symptoms NAME Isosorbide mononitrate Rx Monoket Imdur FC Antianginal CC Nitrate TU Relief and prevention of angina pectoris USE Treatment prevention of chronic stable angina pectoris DOSAGE Adult PO Monoket 10 20 mg bid 7 hr apart Imdur initiate at 30 60 mg day as a single dose increase q3day as needed may increase to 120 mg day max 240 mg day PT EDUCATION Teach patient that tolerance may occur if taken over long periods to prevent allow intervals of 12 14 hr day without product Advise patient to treat headache with OTC analgesics Instruct patient to not skip or double doses if dose is missed take when remembered if 2 hr before next dose dinitrate 6 hr before next dose sus rel or 8 hr before next dose mononitrate Caution patient to avoid alcohol and OTC medications unless approved by prescriber Inform patient that product may be taken before stressful activity exercise sexual activity Advise patient that SL tab may sting mucous membranes Caution patient to avoid driving and hazardous activities if dizziness occurs Advise patient to comply with complete medical regimen Caution patient to make position changes slowly to prevent orthostatic hypotension Teach patient not to use with avanafil sildenafil tadalafil vardenafil with nitrates may cause serious drop in B P Teach patient not to discontinue abruptly may cause heart attack Teach patient to use at beginning of angina symptoms may repeat every 15 min if no relief seek medical attention immediately ACTION Lowers B P by blocking effects reduces elevated renin plasma levels blocks 2 adrenergic receptors in bronchial vascular smooth muscle only at high doses negative chronotropic effect SIDE EFFECTS Insomnia dizziness mental changes hallucinations depression anxiety headaches nightmares confusion fatigue weakness HF palpitations dysrhythmias cardiac arrest hypotension bradycardia pulmonary peripheral edema chest pain Blurred vision Nausea vomiting colitis cramps diarrhea constipation flatulence dry mouth hiccups Impotence urinary frequency Agranulocytosis eosinophilia thrombocytopenic purpura Rash purpura alopecia dry skin urticaria pruritus Bronchospasm dyspnea wheezing Hyper hypoglycemia ANTIDOTE Lavage IV atropine for bradycardia digoxin O2 diuretic for cardiac failure hemodialysis IV glucose for hyperglycemia IV diazepam or phenytoin for seizures NURSING CONSIDERATIONS 1 BBW Abrupt withdrawal may cause MI ventricular dysrhythmias myocardial ischemia taper dose over 7 14 days 2 Hypertension angina monitor ECG directly when giving IV during initial treatment 3 Monitor B P during beginning treatment periodically thereafter pulse note rate rhythm quality check apical radial pulse before administration notify prescriber of any significant changes pulse 40 bpm if cardiac output is decreased atropine may be needed ECG q 5 15 min during and after use 4 Check for baselines in renal liver function tests before therapy begins and periodically thereafter 5 Assess for edema in feet legs daily monitor I O daily weight check for jugular vein distention crackles bilaterally dyspnea HF 6 Pregnancy breastfeeding Use only if clearly needed excreted in breast milk in small quantities the American Academy of Pediatrics considers this product to be compatible with breastfeeding ACTION Relaxation of vascular smooth muscle which leads to decreased preload afterload thus decreasing left ventricular end diastolic pressure and systemic vascular resistance and reducing cardiac O2 demand SIDE EFFECTS Vascular headache flushing dizziness weakness Orthostatic hypotension tachycardia collapse syncope Nausea vomiting Pallor sweating rash Twitching hemolytic anemia methemoglobinemia tolerance xerostomia NURSING CONSIDERATIONS 1 Assess for angina pain duration time started activity being performed character intensity 2 Monitor for orthostatic B P pulse at baseline during treatment and periodically thereafter 3 Beers Use with caution in older adults may exacerbate episodes of syncope CONTRAINDICTATION Hypersensitivity to this product or nitrates severe anemia closed angle glaucoma NAME omeprazole Rx OTC PriLOSEC FC antiulcer proton pump inhibitor CC Benzimidazole TU Absence of duodenal ulcers decreased gastroesophageal reflux USE Gastroesophageal reflux disease