CONTINUING EDUCATION DRUG/ INITIAL STRENGTH(S)/ DOSE & MANUFACTURER(S) TITRATION IN ADULTS
INITIAL DOSE & TITRATION IN ELDERLY
MAXIMUM DAILY DOSE IN ADULTS/ ELDERLY
DURATION OF ACTION
POSSIBLE ADVERSE REACTIONS
COMMENTS
Mechanisms of Action: binds to the mineralocorticoid receptor and blocks the binding of aldosterone Eplerenone
25mg tablet 50 mg tablet Various manufacturers (Inspra®)
25mg daily
No initial dosage adjustment needed
50mg daily
n/a
Hyperkalemia Avoid concomitant administration of strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, and nelfinavir)
Renal impairment-creatinine clearance ≤30 mL/min -contraindicated Hepatic impairment - no dosage adjustment provided by manufacturer.
BETA BLOCKERS Mechanisms of Action: beta1-selective (cardioselective) adrenoceptor blocking agent without significant membrane stabilizing activity or intrinsic sympathomimetic activity 1.25 mg Bradycardia 10 mg once n/a Bradycardia Renal impairment- caution Bisoprolol 5mg tablet 10 mg tablet Various manufacturers (Zebeta®)
once daily
may be observed - dosage reductions may be necessary.
daily
-Contraindicated in patients with cardiogenic shock, overt cardiac failure, second or third degree AV block and marked sinus bradycardia -Use caution in diabetics may mask some of the manifestations of hypoglycemia, particularly tachycardia
should be used in dose titration Hepatic impairment- caution should be used in dose titration
Mechanisms of Action: nonselective β-adrenergic blocking agent with α1-blocking activity with no intrinsic sympathomimetic activity 3.125 mg Bradycardia 50 mg twice n/a Bradycardia Renal impairment-No dosage Carvedilol 3.125mg tablet 6.25mg tablet 12.5mg tablet 25mg tablet Various manufacturers (Coreg®)
twice daily
may be observed - dosage reductions may be necessary.
daily
Carvedilol CR
10 mg once daily
Bradycardia may be observed - dosage reductions may be necessary.
80 mg once daily
10mg capsule 20mg capsule 40mg capsule 80mg capsule Various manufacturers (Coreg CR®)
n/a
-Bronchial asthma or related bronchospastic conditions. Deaths from status asthmaticus have been reported following single doses -Floppy iris syndrome -Use caution in diabetics may mask some of the manifestations of hypoglycemia, particularly tachycardia Bradycardia -Bronchial asthma or related bronchospastic conditions. Deaths from status asthmaticus have been reported following single doses -Floppy iris syndrome -Use caution in diabetics may mask some of the manifestations of hypoglycemia, particularly tachycardia
adjustment necessary Hepatic impairment -Severe impairment: Use is contraindicated **take with food to slow the rate of absorption and reduce the incidence of orthostatic effects
Renal impairment-No dosage adjustment necessary Hepatic impairment -Severe impairment: Use is contraindicated **take with food to slow the rate of absorption and reduce the incidence of orthostatic effects **Do not crush or chew
Mechanisms of Action: Selective inhibitor of beta1-adrenergic receptors; competitively blocks beta1-receptors, with little or no effect on beta2-receptors at oral doses <100 mg -does not exhibit any membrane stabilizing or intrinsic sympathomimetic activity 12.5 to 25mg 200mg once about 24 Severe bradycardia Renal impairment-No dosage Metoprolol once daily daily hours cardiogenic shock adjustment necessary succinate decompensated heart Hepatic impairment-initiate extended release (metoprolol CR/XL) 25mg tablet 50mg tablet 100mg tablet 200mg tablet Various manufacturers (Toprol XL®)
30 |
Insight
failure sick sinus syndrome -Bronchial asthma or related bronchospastic conditions-Deaths from status asthmaticus -Use caution in diabetics may mask some of the manifestations of hypoglycemia, particularly tachycardia
therapy at doses lower than those recommended for a given indication; and increase doses gradually in patients with impaired hepatic function. **Do not crush or chew