CARTEOLOL HYDROCHLORIDE

CARTEOLOL HYDROCHLORIDE (car'tee-oh-lole) Cartrol, Ocupress Classifications: beta-adrenergic antagonist; antihypertensive; Therapeutic: antihypertensive; beta-adrenergic blocking agent Prototype: Propranolol Pregnancy Category: C

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 5–10 mg if needed (max: 10 mg/d) Open-Angle Glaucoma Adult: Ophthalmic 1 drop in affected eye b.i.d.

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: 1–3 h. Duration: 24–48 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver to active metabolite. Elimination: Primarily in urine. Half-Life: 4–6 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.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug