Beta blockers monitoring

AMIODARONE BETA-BLOCKERS Risk of bradycardia (occasionally severe), 1 BP and heart failure. Also, t plasma levels of metoprolol Additive negative inotropic and chronotropic effects. In addition, high-dose amiodarone is associated with t plasma levels of metoprolol due to inhibition of CYP2D6 For patients on beta-blockers, monitor BP closely when loading with amiodarone... 

BETA-BLOCKERS CYTOTOXICS Imatinib may cause an t in plasma concentrations of metoprolol, propanolol and timolol, with a risk of toxic effects Imatinib is a potent inhibitor of CYP2D6 isoenzymes, which metabolize beta-blockers Monitor for clinical efficacy and toxicity of beta-adrenergic blockers... 

BETA-BLOCKERS AMITRIPTYUNE, CLOMIPRAMINE Risk of T levels of beta-blockers with amitriptyline and clomipramine These TCAs inhibit CYP2D6-mediated metabolism of beta-blockers Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (light-headedness, dizziness on standing, etc)... 

BETA-BLOCKERS QUININE Risk oft plasma concentrations and effects of labetalol, metoprolol and propranolol t systemic effects of timolol eye drops Quinine inhibits CYP2D6, which metabolizes these beta-blockers Monitor BP at least weekly until stable... 

BETA-BLOCKERS SYMPATHOMIMETICS -INDIRECT 1 hypotensive efficacy of beta-blockers The hypertensive effect of sympathomimetics opposes the hypotensive actions of beta-blockers Monitor BP at least weekly until stable watch for poor response to beta-blockers... 

Sotalol (Betapace) [Antiarrhythmic, Antihypertensive/Beta Blocker] WARNING Monitor pts for 1st 3 d of Rx to 4- risks of arrhythmia Uses Ventricular arrhythmias, AF Action p-Adrenergic blocking agent Dose Adults. 80 mg PO bid may be T to 240-320 mg/d Peds. Neonates 9 mg/m tid... 

Older patients with CHF may be faced with multiple therapies of diuretics, ACE inhibitors/angioten-sion II blockers and beta-blockers. This puts them at risk of hypotension, orthostatic hypotension, azo-taemia and electrolyte imbalance. Drugs should be added carefully, starting at low dose and patients should be monitored for volume depletion and changes in serum creatinine and electrolyte concentrations. 

Geriatric Considerations - Summary Systemic absorption of ophthalmic drugs may occur and cause adverse effects in older adults. Since betaxolol is beta-selective, cardiovascular, respiratory and CNS adverse effects occur less frequently than with beta-nonselective topical opthalmics. These effects may still occur therefore close monitoring for systemic side effects is warranted. Betaxolol maybe less effective than the nonselective topical beta-blockers with an average lOP reduction of 18%-26%. Tachyphylaxis may occur after long-term therapy. 

Oral minoxidil administration should be closely monitored, usually given with a beta-blocker to prevent tachycardia and a diureticto prevent fluid accumulation. 

The most common side effects are Raynaud s phenomenon with cold or even cyanotic distal extremities and digits, tiredness or weakness, bradycardia, and sexual impotence. Less common side effects are depression and dysphoria, bronchoconstriction, congestive heart failure, hallucinations, hypotension, vomiting or nausea, diarrhea, insomnia and nightmares, dizziness, and hypoglycemia. When due attention is paid to contraindications and the treatment is carefully monitored, the side effects of beta-blocker treatment are generally mild. 

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