Biselect-10mg

Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, cardiac contractility and BP) and lungs (promotes bronchospasm). Indications Hypertension. Unlabeled use(s): Angina pectoris; supraventricular tachycardias; premature ventricular contractions. Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock. Route/Dosage Hypertension ADULTS: PO 5 to 20 mg qd. Dosage should be individualized; some patients may be given starting dose of 2.5 mg/day. Interactions Clonidine: May enhance or reverse antihypertensive effect; potentially life-threatening situations may occur, especially on withdrawal. NSAIDs: Some agents may impair antihypertensive effect. Prazosin: May increase orthostatic hypotension. Verapamil: May potentiate effects of both drugs. Lab Test Interferences None well documented. Adverse Reactions CV: Hypotension; bradycardia; CHF; cold extremities; second- or third-degree heart block. CNS: Insomnia; fatigue; dizziness; depression; lethargy; drowsiness; forgetfulness; anxiety; headache; slurred speech. DERM: Rash; hives; alopecia. EENT: Dry eyes; blurred vision; tinnitus; sore throat. GI: Nausea; vomiting; diarrhea; constipation; abdominal pain; dry mouth. GU: Impotence; painful, difficult or frequent urination; increased creatinine and BUN. HEMA: Agranulocytosis; thrombocytopenic purpura. HEPA: Elevated liver function test results. META: Hyperglycemia; hypoglycemia. RESP: Bronchospasm; dyspnea; wheezing. OTHER: Weight changes; fever; facial swelling; muscle weakness; increased serum uric acid, potassium and phosphorus; elevated serum lipids; possible development of antinuclear antibodies. Precautions Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Anaphylaxis: Deaths have occurred; aggressive therapy may be required. CHF: Administer cautiously in patients whose CHF is controlled by digitalis and diuretics. Diabetes mellitus: May mask symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia. Nonallergic bronchospastic disease (eg, chronic bronchitis, emphysema): In general, beta-blockers are not given to patients with bronchospastic diseases. Peripheral vascular disease: May precipitate or aggravate symptoms of arterial insufficiency. Renal/hepatic impairment: Reduce daily dose. Thyrotoxicosis: May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm. PATIENT CARE CONSIDERATIONS Administration/Storage May be given without regard to meals. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Note CHF, diabetes mellitus or hypertension. Assess for withdrawal syndrome. Beta-blocker withdrawal syndrome (eg, hypertension, tachycardia, anxiety, angina, MI) may occur 1 to 2 wk after sudden discontinuation. Gradually withdraw therapy over 1 to 2 wk if possible. Ensure that baseline AST, ALT, uric acid, creatinine, BUN, serum potassium, glucose and phosphorus levels have been obtained before starting treatment with this medication. Monitor BP and pulse prior to each dosage. In diabetic patients, monitor blood glucose level and diabetic medications closely. Carefully monitor patients with CHF, COPD or asthma and report changes in cardiac or respiratory status to physician. OVERDOSAGE: SIGNS & SYMPTOMS Bradycardia, CHF, hypotension, bronchospasm, hypoglycemia Patient/Family Education Explain that drug will be tapered slowly before stopping to prevent rebound symptoms and adverse effects. Teach patients how to monitor pulse before taking oral medication and advise to contact physician if pulse is < 50 bpm. Inform diabetic patient to monitor blood glucose level closely. Instruct patient to report the following symptoms to physician: Dizziness, decreased pulse, shortness of breath, confusion, rash or any unusual bleeding. Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness. Instruct patient not to take otc medications (including diet aids, cold or nasal preparations [alpha-adrenergic stimulants]) without consulting physician.