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Cardiac Glycosides Digoxin (Lanoxin) - Indicated to heart failure to increase cardiac output Anorexia, diarrhea, n/v, bradycardia (severe & most common), PVC (premature ventricular contraction), visual disturbances (glaucoma-like symptoms) 1. Check apical pulse ( below 60 or above 120 – do not give) 2. Best given with meals 3. Monitor hypokalemia (precipitates toxicity) 4. Diet: inc. K – fresh fruits, potato, avocado (highest K content) 5. Prepaare drugs like: a. Digibind – antidote (bradycardia) b. Atropine Sulfate – (cardiac stimulant, anticholinergic – for severe bradycardia) c. Lidocaine – drug of choice; common antiarrythmic drug for PVC
Cardiac Stimulants


Atropine Sulfate, Epinephrine, Isoproterenol – Inotropic
Tachycardia, headache, dysrhythmias, anticholinergic (sympathetic) – dry mouth 1. Assess vital signs. 2. Use cardiac monitoring during IV administration. 3. Ensure follow up ECG. effects


Coronary Vasodilators – dilates coronary arteries

Nitrates (Nitroglycerin) oral. Sublingual (emergency), topical - 4-5 min. peak of the medicine Note: Given in 3 doses in 5 min. interval - >15min. – MI
Headache, flushing, orthostatic hypotension, tachycardia, dizziness 1. Assess the potency (sublingual) – (+) burning or tingling sensation in tongue 2. Assess efficacy: dec./(-) chest pain 3. Assess for hypotension 4. Encourage client to change positions slowly and use safety precautions 5. Maintain potency by storing in: a. Room temperature b. Dark place (medicine cabinet) c. Dark, light-resistant, air-tight container d. Within 3-6 months




Ca-channel Blockers “PINE” (Amlodipine, Nifedipine) Beta Blockers “LOL” (Metoprolol, Atenolol) Disopyramide Phosphate – coronary vasodilators, platelet aggregate inhibitor (Persantine)

zinc & K. Instruct client to notify physician of the side effect or report changes in heart rhythm and rate DRUG CLASSIFICATION DRUG NAME Antihypertensive ACE inhibitor “PRIL” (Captopril) Angiotensin II Receptor Blocker “TAN” (Losartan. 2. Furosemide – can cause aspirin toxicity if given together & can cause hyperglycemia in clients with DM 1. blood dyscrasias. (Furosemide-Lasix) GI irritation. Cl. blood dyscrasias 1. 4. ADVERSE EFFECTS NURSING CONSIDERATION DRUG CLASSIFICATION DRUG NAME Peripheral Vasodilator – to increase BP Norepinephrine. Metazolone (Thiazide-like) Potassium-Sparers (acts on aldosterone & renal tubules) inhibit Na reabsorption & K excretion (Spironolactone) Loop Diuretics –inhibit Na & Cl reabsorption. Dopamine. Valsartan) Ca-channel blockers Beta Blockers Alpha 1 blockers – Peripherally (Doxazosin mesylate.Lidocaine – ventricular antiarrhythmic Procainamide HCL – antiarrhythmic (Pronestyl) Quinidine – antiarrhythmic Amiodarone – ventricular antiarrhythmic (Cordarone. anticholinergic effect. water. n/v. sxual disturbances. hyperuricemia. Encourage intake of foods high in Ca. Pacerone) ADVERSE EFFECTS NURSING CONSIDERATION Hypotension. dizziness. dizziness. cloth. Beta Blockers – bronchospasm & mask hypoglycemia) 1. Methyldopa) Direct Vasodilators (Diozoxide. either bradycardia or tachycardia. Prazosin HCL. excretion of Na. Monitor BP & pulse rate’ instruct client to change position slowly 5. Hydralazine HCL) Diuretics Orthostatic hypotension. orthostatic hypotension. hyponatremia. ADVERSE EFFECTS NURSING CONSIDERATION DRUG CLASSIFICATION DRUG NAME Diuretics . Mg. inc. Assess vital signs during course of therapy. pulse. Instruct client to a low sodium diet and to continue medication as prescribed. Monitor urine output. Cl. weighing scale) 2. monitor BP in supine and standing 2. esp. . & Ca Thiazides – direct arteriolar vasodilation (Chlorothiazide. Administer drug in the morning so that the maximal effect occurs during the waking hours. Assess vital signs. hypomagnesemia & hypocalcemia. Use cardiac monitoring and use infusion control for IV 3. DHN – can cause hypokalemia except Potassium-sparers because it cn cause hyperkalemia. Terazosin HCL) Central Alpha 2 Agonist (Clonidine HCL.increase renal excretion of Na. K. Maintain intake and output – weigh daily (same time. Phenylephrine HCL Metaraminol Bitartate. Assess for signs of fluid & electrolyte imbalance 3. water & K. 3.

chills. esp. Normalized ECG c. PT for Warfarin.ADVERSE EFFECTS NURSING CONSIDERATION HPN. LDL. & V formed in liver Fever. Activator Altepase. PUD. IX. Assess vital signs’ monitor BP frequently. and fat-soluble vitamins. actibe bleeding & intake of anticoagulant. Tissue Plasminogen Massive bleeding (most common complication). ADVERSE EFFECTS NURSING CONSIDERATION DRUG CLASSIFICATION DRUG NAME ADVERSE EFFECTS NURSING CONSIDERATION Thrombolytics – dissolve thrombus & clots. Reduced absorption of vits. Clofibrate. pruritus. platelet count. Monitor blood work during the course of therapy esp. HDL. Encourage intake of high fiber foods to reduce the potential of constipation = shock DRUG CLASSIFICATION DRUG NAME Anticoagulants. Inc. Follow schedule for coagulation studies. Hbg. low grade fever. ability to blood clot Coumadin or Warfarin Sodium – inhibits vitamin K-dependent activation of clotting factors II. Assess for history of bleeding. Simvastatin. Monitor PTT & fibrinogen concentration. RBC.thrombin complex & deactivates thrombin. preventing conversion of fibrinogen to fibrin. Hepatic toxicity 1. dec.can cross stomach) Heparin – accelerates formation of antithrombin III. B12 & iron 2. triglycerides. Monitor Vital signs & neurologic status. skin rash (hypersensitivity. watch for signs of bleeding & notify the physician immediately. constipation. 2-4 hours Golden period for MI Streptokinase. rash 5. Monitor SGPT/ALT. PTT for Heparin 2. 4. Avoid IM injections with the contaminant of administration of coagulants. Assess pain (to assess the efficacy) a. facial flushing. Antiplatelets – Aspirin (water-soluble. Administer at bedtime 3. (-) chest pain b. Maintain continuous IV infusion of 8-12 hours after thrombolytic therapy. 2. headache. or peaked CKMB 7. if client has history of PUD (Pepetic Ulcer disease). urticaria. ADEK as well as vit. cholesterol. coagulation studies. hemorrhagic. Lovastatin. hemorrhage & diarrhea) 1. arrhythmias 1. allergic reaction. 3. Fenofibrate N/v. Assess for signs of bleeding Antidote: Warfarin – Vitamin K Heparin – Protamine Sulfate 3. VII. DRUG CLASSIFICATION DRUG NAME ADVERSE EFFECTS NURSING CONSIDERATION Antilipidemics “STATINs” Provastin. Keep Aminocarproic Acid available 6. Assess for signs of allergic reaction like chills. Retaplase. 2. diarrhea. myopathy. PVC’s (4 episodes) >4 – arrhythmias d. GI disturbance 1. Assess IV infiltration (slow infusion) 3. .