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INTRODUCTION

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bisoprolol (bis-oh-proe-lol)

Monocor, Zebeta

Classification

Therapeutic: antihypertensives

Pharmacologic: beta blockers

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Indications
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Management of hypertension.

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Action
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Blocks stimulation of beta1 (myocardial)–adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine) receptor sites. Therapeutic Effects: Decreased blood pressure and heart rate.

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Adverse Reactions/Side Effects
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CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares. EENT: blurred vision, stuffy nose. Resp: bronchospasm, wheezing. CV: BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction. GI: constipation, diarrhea, liver function abnormalities, nausea, vomiting. GU: erectile dysfunction, decreased libido, urinary frequency. Derm: rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back pain, joint pain. Misc: drug-induced lupus syndrome.

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PHYSICAL THERAPY IMPLICATIONS

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

  • Assess routinely for signs of CHF and pulmonary edema, including dyspnea, rales/crackles, weight gain, peripheral edema, and jugular venous distention. Report these signs to the physician immediately.

  • Assess blood pressure (BP) periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

  • Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest). Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K). Repeated or prolonged bronchoconstriction may require a change in dose or medication.

  • Monitor signs of peripheral vasoconstriction, such as extreme coldness in the hands and feet, cyanosis, and muscle cramping. Notify physician of severe or prolonged signs of vasoconstriction.

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

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

  • 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 excessive fatigue or weakness. Beta blockers often cause some degree of fatigue and weakness, but any sudden or severe change in muscle strength or energy levels should be reported.

  • Monitor signs of drug-induced lupus syndrome, including increased BP, fever, joint pain, ...

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