CARTEOLOL HYDROCHLORIDE (car'tee-oh-lole)
Cartrol, Ocupress Classifications: beta-adrenergic antagonist; antihypertensive; Therapeutic: antihypertensive; beta-adrenergic blocking agent Prototype: Propranolol Pregnancy Category: C
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Availability
2.5 mg, 5 mg tablets; 1% solution
Action
Carteolol is a beta-adrenergic blocking agent (antagonist) that competes for available beta receptor sites. It inhibits both
beta1 receptors (chiefly in cardiac muscle) and beta2 receptors (chiefly in the bronchial and vascular musculature). It decreases standing and supine hypertension.
Therapeutic Effect
Effective antihypertensive agent by reducing BP to normotensive range and useful in managing some angina, dysrhythmias,
and CHF by decreasing myocardial oxygen demand and lowering cardiac work load.
Uses
For hypertension, either alone or in combination with other drugs, particularly a thiazide diuretic (not indicated for hypertensive
crisis); chronic open-angle glaucoma.
Unlabeled Uses
To reduce the frequency of anginal attacks.
Contraindications
Sinus bradycardia, severe CHF; greater than first-degree heart block, cardiogenic shock, CHF secondary to tachycardia treatable
with beta-blockers, overt cardiac failure, hypersensitivity to beta-blocking agents, persistent severe bradycardia, bronchial
asthma or bronchospasm, and severe COPD; pulmonary edema; pregnancy (category C).
Cautious Use
CHF patients treated with digitalis and diuretics, peripheral vascular disease; diabetes, hypoglycemia, thyrotoxicosis;
renal disease; CVA; lactation.
Route & Dosage
Hypertension Adult: PO 2.5 mg once/d, may increase to 510 mg if needed (max: 10 mg/d)
Open-Angle Glaucoma Adult: Ophthalmic 1 drop in affected eye b.i.d.
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Administration
Oral
- Consult physician if patient's creatinine clearance is below normal. Dosage adjustment may be needed.
- Administer capsule or tablet whole. Do not crush or break and instruct patient not to chew before swallowing.
- Store away from heat, light, or moisture.
Adverse Effects (≥1%)
Body as a Whole: Rash, muscle cramps, bronchospasm.
CV: Increased angina, hypotension, CHF, bradycardia.
GI: Abdominal pain,
diarrhea, nausea.
Endocrine: Hyperglycemia.
CNS: Headache, dizziness, drowsiness,
insomnia, anxiety, tremor,
paresthesia, weakness.
Interactions
Drug: diuretics and other
hypotensive agents increase hypotensive effect; carteolol and
albuterol, metoproterenol, terbutaline, pirbuterol are mutually antagonistic;
nsaids may blunt hypotensive effect; decreases hypoglycemic effect of
glyburide; may increase bradycardia and sinus arrest with
amiodarone.
Pharmacokinetics
Absorption: Readily from GI tract; 85% reaches systemic circulation.
Peak: 13 h.
Duration: 2448 h.
Distribution: Crosses placenta; distributed into breast milk.
Metabolism: In liver to active
metabolite.
Elimination: Primarily in urine.
Half-Life: 46 h.
Nursing Implications
Assessment & Drug Effects
- Assess heart rate prior to administration. If pulse is less than 50 bpm, withhold drug and notify physician.
- Monitor BP and pulse frequently during period of adjustment and periodically throughout therapy.
- If hypotension (systolic BP <90 mm Hg) occurs, discontinue the drug and carefully assess the hemodynamic status of the patient.
- Monitor daily weight and assess for evidence of fluid overload since drug may precipitate CHF (see Signs & Symptoms, Appendix
F).
- Monitor mental status. Mental depression may be increased by use of this drug.
- Assess respiratory status closely if the patient has history of bronchitis or emphysema, assess for respiratory difficulty.
- Monitor diabetic for loss of diabetic control. Drug may prevent the appearance of early S&S of acute hypoglycemia (see Appendix
F).
- Drug may reduce tolerance to cold temperatures in older adults or in those who have circulatory problems.
Patient & Family Education
- Report the first sign or symptom of impending CHF (see Signs & Symptoms, Appendix F) or unexplained respiratory symptoms.
- Do not discontinue medication abruptly, since sudden withdrawal may precipitate or exacerbate angina.
- Do not use any OTC products such as nasal decongestants and cold preparations without consultation.
- Report slow pulse rate, confusion or depression, dizziness or light-headedness, skin rash, fever, sore throat, or unusual
bleeding or bruising.
- Be cautious while driving or performing other hazardous activities until response to drug is known.
- Continue to take this medication as instructed by your physician no matter how well you feel.
- Take your BP at least twice a week and report significant changes.
- Take your pulse before and after taking the medication. If it is much slower than normal rate (or less than 50 bpm), check
with your physician.