Carvedilol

INTRODUCTION

Indications

Hypertension. CHF (ischemic or cardiomyopathic) with digoxin, diuretics, and ACE inhibitors. Left ventricular dysfunction after myocardial infarction.

Action

Blocks stimulation of beta₁(myocardial) and beta₂ (pulmonary, vascular, and uterine)–adrenergic receptor sites. Also has alpha₁ blocking activity, which may result in orthostatic hypotension. Therapeutic Effects: Decreased heart rate and blood pressure. Improved cardiac output, slowing of the progression of CHF and decreased risk of death.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, weakness, anxiety, depression, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares. EENT: blurred vision, dry eyes, nasal stuffiness. Resp: bronchospasm, wheezing. CV: BRADYCARDIA, CHF, PULMONARY EDEMA. GI: diarrhea, constipation, nausea. GU: erectile dysfunction, decreased libido. Derm: itching, rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back pain, muscle cramps. Neuro: paresthesia. Misc: drug-induced lupus syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess signs and symptoms of CHF, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Document changes in these symptoms to help determine whether drug therapy is effective in treating CHF.

• Assess any breathing problems or signs of pulmonary edema, including cough, shortness of breath, bronchospasm, chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function. Repeated or prolonged bronchoconstriction may require a change in dose or medication (e.g., switch to a more cardioselective beta blocker).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Be alert for signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur. Patients with diabetes mellitus should check blood glucose levels frequently.

• Assess any back or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess signs of paresthesia (numbness, tingling) or muscle cramping. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor mood and personality changes, including depression, anxiety, nervousness, memory loss, or other changes in mental status. Notify physician if these changes become problematic.

• Monitor excessive fatigue or weakness. Beta blockers ...