Home Drug Guide Bisoprolol fumarate and hydrochlorothiazide

Drug Guide

Generic Name

Bisoprolol fumarate and hydrochlorothiazide

Brand Names Ziac

Classification

Therapeutic: Antihypertensive, combination

Pharmacological: Beta-adrenergic blocker (bisoprolol), Thiazide diuretic (hydrochlorothiazide)

FDA Approved Indications

  • Hypertension

Mechanism of Action

Bisoprolol reduces heart rate and cardiac output by selective beta1-adrenergic blockade. Hydrochlorothiazide decreases blood volume and peripheral vascular resistance by promoting diuresis and salt excretion, leading to lowered blood pressure.

Dosage and Administration

Adult: Typically 1 tablet once daily. Dose may be adjusted based on response.

Pediatric: Not indicated for pediatric use.

Geriatric: Start at lower doses due to increased sensitivity and comorbidities.

Renal Impairment: Use caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Bisoprolol is highly protein-bound (~30%).

Metabolism: Minimal hepatic metabolism; primarily excreted unchanged.

Excretion: Renally excreted; dose adjustment may be needed in renal impairment.

Half Life: Approximately 10-12 hours for bisoprolol.

Contraindications

  • Known hypersensitivity to bisoprolol, hydrochlorothiazide, or other sulfonamide derivatives.
  • Severe bradycardia, sinus node failure, or second- or third-degree AV block without a pacemaker.
  • Uncompensated heart failure.
  • Pulmonary edema.

Precautions

  • Use cautiously in asthma or obstructive airway disease.
  • Monitor for signs of hypotension or worsening heart failure.
  • Pregnancy category C; use only if clearly needed during pregnancy. Breastfeeding: Use with caution; consult healthcare provider.

Adverse Reactions - Common

  • Dizziness (Common)
  • Fatigue (Common)
  • Headache (Common)
  • Gastrointestinal disturbances (Common)

Adverse Reactions - Serious

  • Bradycardia (Serious)
  • Hypotension (Serious)
  • Electrolyte imbalance (hypokalemia, hyponatremia) (Serious)
  • Bronchospasm (rare) (Serious)

Drug-Drug Interactions

  • Other antihypertensives, digoxin, antiarrhythmics.
  • NSAIDs may reduce diuretic effectiveness.
  • Calcium channel blockers, especially non-dihydropyridines (verapamil, diltiazem).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, serum electrolytes, renal function.

Diagnoses:

  • Risk for electrolyte imbalance
  • Potential for decreased cardiac output

Implementation: Administer as directed, preferably in the morning. Monitor for side effects.

Evaluation: Assess blood pressure and heart rate regularly to ensure therapeutic effect and adjust dose accordingly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not stop abruptly; consult provider before discontinuing.
  • Report signs of dizziness, fatigue, or irregular heartbeat.
  • Limit use of alcohol and avoid hot environments to prevent hypotension.

Special Considerations

Black Box Warnings:

  • Use with caution in patients with bronchospastic conditions.
  • Potential for masking hypoglycemia symptoms in diabetics.

Genetic Factors: Pharmacogenomic differences may influence drug metabolism and response.

Lab Test Interference: Hct and serum electrolyte levels may be altered.

Overdose Management

Signs/Symptoms: Severe bradycardia, hypotension, bronchospasm, cardiogenic shock.

Treatment: Supportive care, atropine for bradycardia, vasopressors for hypotension, mechanical ventilation if needed. Consider activated charcoal if ingestion recent.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions until expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.