Beta Blockers require the following prior to each administered dose:
1) Nursing staff shall obtain the patient’s pulse and record in the EMR. 2) If the pulse is less than 50, the nurse shall obtain an apical heart rate. If the apical heart rate is less than 50, the nurse shall hold the dose and notify the provider for further orders. 3) This is applicable to all routes of administration
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication:
hydroCHLOROthiazide (HCTZ)
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4)
Drug(s)
diuretics
Rationale
May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation
Use with caution
Quality of evidence: Moderate, Strength of Recommendation: Strong
Last updated: Mar. 14, 2026
Look-Alike/Sound-Alike hydroCHLOROthiazide confused with hydrALAZINE, hydrOXYzine, hydroxyurea, hydroxychloroquine
2) If the pulse is less than 50, the nurse shall obtain an apical heart rate. If the apical heart rate is less than 50, the nurse shall hold the dose and notify the provider for further orders.
3) This is applicable to all routes of administration