Non selective beta blockers and asthma/inhalers

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MARX22

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hey guys,
I remember we were taught not to use non selective BB in asthma/respiratory diseases since they can affect the lungs as well as heart. In real practice, do u guys notify the md/get the ok before dispensing, or do u just dispense and counsel the patient?

My system notified me that labetalol and symbicort are contraindicated. However, they arent lol. Even the package insert for symbicort lists the use of beta blockers as a “caution” in worsening bronchospasm. It doesnt even specify non selective vs selective—just beta blockers in general. Wanted to hear what u guys had to say as labetalol is non selective and is more likely to affect the lungs. Other rph has been dispensing.

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hey guys,
I remember we were taught not to use non selective BB in asthma/respiratory diseases since they can affect the lungs as well as heart. In real practice, do u guys notify the md/get the ok before dispensing, or do u just dispense and counsel the patient?

My system notified me that labetalol and symbicort are contraindicated. However, they arent lol. Even the package insert for symbicort lists the use of beta blockers as a “caution” in worsening bronchospasm. It doesnt even specify non selective vs selective—just beta blockers in general. Wanted to hear what u guys had to say as labetalol is non selective and is more likely to affect the lungs. Other rph has been dispensing.

is the labetalol new? how old/ how healthy overall is the patient?
 
It shouldn’t be an issue unless their lung function is super low
 
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is the labetalol new? how old/ how healthy overall is the patient?
Its a refill, i dont recall how old the patient was but rx from labetalol and symbicort were same md
 
If I’ve noticed they’ve had a lot of breathing issues and the patient has been on a non-specific beta blocker I’ve contacted the prescriber, but even then, the usual response is “meh...it’s probably fine”, especially if the patient’s therapy is pretty established. It’s good to have documented at least, IMO.

You might be best off doing some patient counseling on the potential for an issue as sometimes the patient then will ask the prescriber.
 
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In most people it's not a problem, it's something to be aware of for a fragile patient.
 
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Yeah i dont know if i should refuse to dispense just based on that if md doesnt answer. I can dispense and counsel, then document that? Thanks :)

If I’ve noticed they’ve had a lot of breathing issues and the patient has been on a non-specific beta blocker I’ve contacted the prescriber, but even then, the usual response is “meh...it’s probably fine”, especially if the patient’s therapy is pretty established. It’s good to have documented at least, IMO.

You might be best off doing some patient counseling on the potential for an issue as sometimes the patient then will ask the prescriber.
 
Yeah i dont know if i should refuse to dispense just based on that if md doesnt answer. I can dispense and counsel, then document that? Thanks :)
I would clarify before a new start and encourage a different medication. But I so rarely see this as a new start. I don’t know if clarification will protect you from a lawsuit but at least you are doing what you can for the patient without letting them go without a beta blocker.
 
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