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My patient has just been diagnosed with sinus tachycardia and has been prescribed Metoprolol Tartrate 25mg.(half a pill twice a day). It seems like a roll a coaster ride high and low pulse, before and after the drug. Is this way it works?
It’s imperative that the physician’s orders be followed. Your concerns can and should be brought to their attention but it is not your call to change the orders/instructions. You do not have the depth of education to understand how dangerous this is or the liability you’re opening yourself (and your employer) up to.
Example, my father’s target heart rate and blood pressure are actually below what is considered “normal.” Because of his complex cardiac issues, it is his therapeutic range that helps prevent a stroke or heart attack. If I chose to follow the advice of the internet and hold his medication because his pulse was low, it could potentially kill him. And there are many medications that require time to build up in the body to achieve best results. By starting and stopping, the therapeutic level is never achieved.
I can’t count the number of times I’ve seen well-intentioned family members, caregivers, CNAs and med techs skirt the dr’s orders with tragic and sometimes lethal results.
I get that you find “providers” frustrating and I get that you care about your client but there are LAWS. You are making medical decisions without the authority, the license or the education. Not okay.
Please realize you should get a doctors order If you are holding doses. Only doctors or physician extenders (PA, CRNP) can write orders. If you are regularly holding the dose because of low HR discuss it with the providers & have them write it as an order. See if the doctor can prescribe a sleeping aide for her.
I appreciate what you are saying, but too many providers “go by the book”. In my patient’s case if I did not intercede they would have been worse off. I do let the providers know what we did do. Keep in mind providers are not gods.
My dad takes this med and has for quite awhile. His pulse and BP stay really steady. It's usually the same no matter when it's checked and we have a home meter that we check on it occasionally too.
As a CG watch your patient for s/s low blood pressure, feeling faint, standing up & dropping their blood pressure.
Speak to the family about your concerns so they can discuss them with the prescribing doctor.
Metoprolol tartrate is a very commonly prescribed beta blocker. You can look up nursing considerations in caring for a person on a beta blocker. Ask the doctor for parameters to “hold” this Med if heart rate goes below the level the doctor specifies.
Metoprolol Tartrate is considered a "fast acting" medication and is often taken in small dosages several times a day. It produced a roll-a-coaster ride in heart rate and blood pressure when I took it to reduce blood pressure. Coming off of it significantly increases heart attack risk and causes anxiety in some people, but I stopped taking it because it aggravated my asthma (in fact it should never have been prescribed to me because of my severe asthma, a little fact the hospital doctor missed during a 10 day stay for cellulitis). When a doctor prescribed this as a first blood pressure medication for my nephew, I sent him back to the doctor for something else since dizziness and reflex impairment when operating heavy equipment or driving are well known side effects and my nephew worked in construction, operating heavy equipment and often walking on roofs and beams dozens of feet above the ground. The doctor is the expert, but patients (or their family) need to read those medication enclosures because sometimes the doctor misses something in the personal history that contraindicates a particular drug.
NEVER discontinue ANY heart or blood pressure medication without a doctor's supervision. There are lots of good drugs out there so call the doctor and discuss your concerns so he/she has an opportunity to consider something more appropriate or with less distressing side effects.
Presumably a cardiologist prescribed this for the tachycardia? Your patient (or friend, if I interpret your profile correctly) needs to raise the pulse fluctuation issue with either a cardio doctor or whatever doctor prescribed it. The dose may need to be adjusted, or a different drug used.
But either way, this is a question for a doctor. Perhaps you can make a conference call with your patient and the doctor tomorrow to get this addressed, ASAP.
You may want to research the drug, using the PDR (gold standard for drug info years ago; don't know if it still is):
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
It’s imperative that the physician’s orders be followed. Your concerns can and should be brought to their attention but it is not your call to change the orders/instructions. You do not have the depth of education to understand how dangerous this is or the liability you’re opening yourself (and your employer) up to.
Example, my father’s target heart rate and blood pressure are actually below what is considered “normal.” Because of his complex cardiac issues, it is his therapeutic range that helps prevent a stroke or heart attack. If I chose to follow the advice of the internet and hold his medication because his pulse was low, it could potentially kill him. And there are many medications that require time to build up in the body to achieve best results. By starting and stopping, the therapeutic level is never achieved.
I can’t count the number of times I’ve seen well-intentioned family members, caregivers, CNAs and med techs skirt the dr’s orders with tragic and sometimes lethal results.
I get that you find “providers” frustrating and I get that you care about your client but there are LAWS. You are making medical decisions without the authority, the license or the education. Not okay.
Speak to the family about your concerns so they can discuss them with the prescribing doctor.
Metoprolol tartrate is a very commonly prescribed beta blocker. You can look up nursing considerations in caring for a person on a beta blocker. Ask the doctor for parameters to “hold” this Med if heart rate goes below the level the doctor specifies.
I have asked the PCP to review his vitals as I keep them online for them to see.
NEVER discontinue ANY heart or blood pressure medication without a doctor's supervision. There are lots of good drugs out there so call the doctor and discuss your concerns so he/she has an opportunity to consider something more appropriate or with less distressing side effects.
But either way, this is a question for a doctor. Perhaps you can make a conference call with your patient and the doctor tomorrow to get this addressed, ASAP.
You may want to research the drug, using the PDR (gold standard for drug info years ago; don't know if it still is):
https://www.pdr.net/drug-summary/Metoprolol-Tartrate-metoprolol-tartrate-3114.5976
Read the Contraindications/Precautions section, and do a page search for all references to Tachycardia. You can see how complex these issues are.
But this would just be to familiarize yourself with the drug so you can help your patient discuss it when she/he/you call the doctor.