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(PIN-doe-lahl)
Visken,  Alti-Pindolol, APO-Pindol, Gen-Pindolol, Novo-Pindol, Nu-Pindol
Class: Beta-adrenergic blocker

 Action Nonselectively blocks beta receptors, which primarily affect heart (slows rate), vascular musculature (decreases blood pressure) and lungs (reduces function).

 Indications Management of mild-to-moderate hypertension.

 Contraindications Greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; bronchial asthma or bronchospasm, including severe COPD.

 Route/Dosage

ADULTS: PO 5 mg bid. May be increased by 10 mg q 3 to 4 wk until desired response; maximum dose is 60 mg/day.

 Interactions

Clonidine: May enhance or reverse antihypertensive effect; potentially life-threatening situations may occur, especially on withdrawal. Epinephrine: Initial hypertensive episode followed by bradycardia may occur. Ergot alkaloids: Peripheral ischemia, manifested by cold extremities and possible gangrene, may occur. Insulin: Prolonged hypoglycemia with masking of symptoms may occur. Lidocaine: Lidocaine levels may increase, leading to toxicity. Nonsteroidal anti-inflammatory agents: Some agents may impair antihypertensive effect. Prazosin: Orthostatic hypotension may be increased. Theophyllines: Elimination of theophylline may be reduced. Also, effects of both drugs may be reduced by pharmacologic antagonism. Verapamil: Effects of both drugs may be increased.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Bradycardia; hypotension; congestive heart failure; edema; worsening angina. CNS: Depression; visual disturbances; short-term memory loss; dizziness. DERM: Skin rash; increased sensitivity to cold. EENT: Dry eyes; visual disturbances. GI: Nausea; vomiting; diarrhea. GU: Impotence; urinary retention; difficulty with urination. HEMA: Agranulocytosis. HEPA: May increase AST or ALT; rarely increases LDH or alkaline phosphatase. META: May increase or decrease blood glucose, uric acid. RESP: Wheezing; bronchospasm; difficulty breathing (at higher doses).

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Anaphylaxis: Deaths have occurred; aggressive therapy may be required. Diabetics: May mask signs and symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia. Peripheral vascular disease: May precipitate or aggravate symptoms of arterial insufficiency. Thyrotoxicosis: May mask clinical signs of developing or continuing hyperthyroidism (eg, tachycardia). Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm. CHF: Administer cautiously in CHF patients controlled by digitalis and diuretics. Notify physician at first sign or symptom of CHF or unexplained respiratory symptoms in any patient.

Renal/Hepatic function impairment: Dosage may need to be reduced.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Give orally.
  • Give medication at same time each day.
  • May be taken without regard to meals.
  • Store at room temperature and protect from moisture, light, and air.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess pulse and BP prior to initiation of therapy.
  • Monitor BP, apical, and radial pulses, intake and output, daily weight, respiration, and circulation in extremities.
  • Review baseline serum glucose level, results of liver and renal function studies, and monitor lab data throughout therapy.
  • Monitor blood glucose closely for diabetic patients.
  • Notify physician if symptoms of CHF occur (eg, difficulty breathing, cough, or swelling in extremities).
  • Report bothersome side effects to physician, especially new-onset depression.
  • Reduce dose gradually upon discontinuation of therapy. Abrupt withdrawal is associated with adverse effects, including precipitation, or worsening of angina.
OVERDOSAGE: SIGNS & SYMPTOMS
  Bradycardia, hypotension, seizures, respiratory depression

 Patient/Family Education

  • Teach patient and family technique for measuring BP and pulse rates and to keep written record.
  • Instruct patient to notify physician if pulse rate is < 50 bpm or systolic BP is < 90 mm Hg.
  • Warn patient not to engage in activities that require mental alertness until drug effects are apparent because it may cause blurred vision, drowsiness, and dizziness.
  • Explain that decreased blood supply to extremities may cause patient to be more sensitive to cold temperatures.
  • Encourage patients with diabetes to monitor blood glucose carefully.
  • Advise patient to report the following symptoms to physician: Any asthma-like symptoms, cough or nasal stuffiness, skin rash, fever, sore throat, unusual bleeding or bruising.
  • Instruct patient not to take any otc medications without consulting physician.
  • Instruct patient to sit or lie down immediately if dizziness or faintness occurs.

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