Anticoagulants

Prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing
blood coagulability.
Are used for thrombosis, pulmonary embolism, and myocardial infarction.
Are contraindicated with activate bleeding, except for disseminated intravascular coagulation, bleeding
disorders or blood dyscrasias, ulcers, liver and kidney disease, and spinal cord or brain injuries.
Side effects
Hemorrhage
Hematuria
Epistaxis
Ecchymosis
Bleeding gums
Thrombocytopenia
Hypotension

Heparin
Interventions
Monitor clotting time and aPTT.
Monitor platelet count
Observe for bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool, and
petechiae
When administering heparin subcutaneously, inject into the abdomen with a 5/8inch needle (25 to 28
gauge) at a 90-degree angle and do not aspirate or rub the injection site
Instruct the client regarding measures to prevent bleeding
Antidote to heparin is protamine sulphate.
Warfarin (Coumadin)
Interventions
Monitor PT and INR
Observe for bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool, and
petechiae
Instruct the client regarding measures to prevent bleeding
Antidote for warfarin is vitamin K

Thrombolytic Medications
Thrombolytic medications activate plasminogen; plasminogen generates plasmin (the enzyme that
dissolves clot)
Thrombolytic medications are used early in the course of myocardial infarct (within 4 to 6 hours of the
onset of the infarct) to restore blood flow, limit myocardial damage, preserve left ventricular function,
and prevent death
Contraindications
Active internal bleeding
Intracranial problems
Intracranial surgery or trauma within the previous 2 months.
History of thoracic, pelvic, or abdominal surgery in the previous 10 days.
History of hepatic or renal disease
Uncontrolled hypertension
Recently required, prolonged cardiopulmonary resuscitation
Side Effects
Bleeding
Dysrhythmias
Fever
Allergic reactions

Interventions
Obtain aPTT, PT, fibrinogen level, hematocrit, and platelet count
Monitor vital signs
Assess pulses
Monitor for bleeding
Monitor all excretions for occult blood
Monitor for neurological changes such as slurred speech, lethargy, confusion, and hemiparesis
Monitor for hypotension and tachycardia
Avoid injections if possible
Apply direct pressure over a puncture site for 20 to 30 minutes
Handle the client as little as possible when moving
Instruct the client to use electric razor for shaving and to brush teeth gently
Discontinue the medication if bleeding develops and notify the physician
Antidote
Aminocaproic acid (amicar)
Used only in acute, life-threatening

Antiplatelet Medications
It inhibit the aggregation of platelets in the clotting process, theryby prolonging the bleeding time
Antiplatelet medications may be used with anticoagulants
Antiplatelet medications are used in the prophylaxis of long-term complications following myocardial
infarction, coronary revascularization, stents, and cerebrovascular accidents.
Antiplatelet medications are contraindicated in bleeding disorders and known sensitivity.
Side Effects
Gastrointestinal bleeding
Bruising
Hematuria
Tarry stools

Interventions
Determine sensitivity before administration
Monitor vital signs
Instruct the client to take medication with food if gastrointestinal upset occurs.
Monitor bleeding time
Monitor for side effects related to bleeding
Instruct the client in the use of medication
Instruct the client to monitor for side effects related to bleeding and in the measures to prevent
bleeding

Aspirin (Acetylsalicylic acid

Clopidogrel (Plavix)
Dipyridamole (Persantine)
Tirofiban (Aggrastat)
TIclopidine (Ticlid)

Positive Inotropic/ Cardiotonic Medications

These medications stimulate myocardial contractility and produce a positive inotropic effect.
Used for congestive heart failure, the increase in myocardial contractility increases cardiac, peripheral,
and kidney function by increasing cardiac output decreasing preload, improving blood flow to the
periphery and kidneys, decreasing edema and increasing fluid excretion; as a result, fluid retention in
the lungs and extremities is decreased
Side effects
dysrhythmias
hypotension
thrombocytopenia
Toxic/adverse reactions
Hepatotoxicity manifested by elevated liver enzyme levels
Hypersensitivity manifested by wheezing, shortness of breath, pruritis, urticaria, clammy skin, and
flushing
Interventions
Positive inotropic/cardiotonic medications are for intravenous (IV) administration
Monitor apical pulse and BP
Monitor for hypersensitivity
Assess lung sounds for wheezing and crackles
Monitor for edema
Monitor for relief of congestive heart failure (CHF) as noted by reduction in edema, lessening of
dyspnea, orthopnea, and fatigue
Monitor electrolytes, liver enzymes, platelet count, and renal function studies; the medications may
decrease potassium and increase liver enzymes.

Cardiac Glycosides
Inhibit the sodium-potassium pump, thus increasing intracellular calcium, which causes the heart muscle
fibers to contract more efficiently
Cardiac glycosides produce a positive inotropic action, which increases the force of myocardial
contraction
Cardiac glycosides produce a negative chronotropic action, which depresses the sinatrial node, reduces
conduction of the impulse through the atrioventricular node, and slows the heart rate.
Cardiac glycosides produce a negative dromotropic action that slows conduction velocity.
The increase in myocardial contractility increase cardiac, peripheral, and kidney function by increasing
cardiac output, decreasing preload, improving cardiac output, decreasing preload, improving blood flow
to the periphery and kidneys, decreasing edema, and increasing fluid excretion; as a result, fluid
retention in the lungs and extremities is decreased.
Cardiac glycosides are used for CHF, atrial tachycardia, atrial fibrillation, and atrial flutter
Cardiac glycosides are contraindicated in ventricular dysrhythmias and second- or third degree heart
block
Cardiac glycosides should be used with caution in clients with renal disease, hypothyroidism, and
hypokalemia
Side Effects
Anorexia, nausea, vomiting
Headache
Visual disturbance
Photophobia
Drowsiness
Bradycardia
Fatigue, weakness
Interventions
Monitor for toxicity as evidenced by anorexia, nausea, vomiting, visual disturbances, confusion,
bradycardia, heart block, premature ventricular contractions, and tachydysrhythmias
Monitor serum digoxin level, electrolyte levels, and renal function tests
Therapeutic digoxin range is 0.5 to 2 ng/ml, and levels above 2 ng/ml are toxic.
An increased risk for toxicity exists in clients w

Antihypertensive Medications
Thiazide
Increase sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney
Are used for hypertension and peripheral edema
Loop diuretics
Osmotic Diuretics
Carbonic anhydrase inhibitors
Potassium-Sparing Diuretics
Interventions
Monitor vital signs
Monitor weight
Monitor urine output
Monitor electrolytes, glucose, calcium, and uric acid levels.
Check peripheral extremities for edema
Instruct the client to take the medication in the morning to avoid nocturia and sleep interruption
Instruct the client to eat foods rich in potassium
Instruct the client in how to take potassium supplements if prescribed
Instruct the client to take medication with food to avoid gastrointestinal upset
Instruct the client to change positions slowly to prevent orthostatic hypotension
Instruct the client to use sunscreen when in direct sunlight
Instruct the client with diabetes mellitus to have the blood glucose checked periodically.

Peripherally Acting α-Adrenergic Blockers

These medications decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at
peripheral nerve endings, resulting in vasodilation and decreased BP.
These medications are used to maintain renal blood flow
Side Effects
Orthostatic Hypertension
Reflex tachycardia
Sodium and water retention
Gastrointestinal disturbances
Nausea
Drowsiness
Nasal congestion
Edema
Weight gain
Monitor vital signs
Monitor for fluid retention and edema
Instruct the client to change positions slowly to prevent orthostatic hypotension
Instruct the client in how to monitor the BP
Instruct the client to monitor for edema
Instruct the client to decrease salt intake.
Instruct the client to avoid over-the-counter medications

Centrally Acting Sympatholytics (Adrenergic Blockers

Centrally acting sympatholytics stimulate alpha receptors in the central nervous system to inhibit
vasoconstriction, thus reducing peripheral resistance.
Centrally acting sympatholytics are used to treat hypertension
Centrally acting sympatholytics are contraindicated in impaired liver function
Ide Effects
Sodium and water retention
Drowsiness, dizziness
Dry mouth
Bradycardia
Edema
Impotence
Hypotension
Depression
Instruct client not to discontinue medication because abrupt withdrawal can cause severe rebound
hypertension
Monitor liver function tests

Angiotensin-Converting Enzyme Inhibitors

These medications prevent peripheral vasoconstriction by blocking the conversion of angiotensin I to
angiotensin II.
These medications are used to treat hypertension
Avoid use with potassium supplement and potassium-sparing diuretics.
Side Effects
Nausea, vomiting, diarrhea
Persisten cough
Hypotension
Hyperkalemia
Tachycardia
Headache
Dizziness, fatigue
Insomnia
Hypoglycaemic reaction in the client with diabetes mellitus
Bruising, petechia, bleeding
Diminished taste
Interventions
Monitor protein, albumin, blood urea nitrogen, creatinine, white blood cells, and potassium level.
Monitor for hypoglycaemic reactions in the client with diabetes mellitus
Instruct the client to take captopril 20 minutes to 1 hour before meals.
Monitor for bruising, petechiae, or bleeding with captopril
Instruct the client not to discontinue medications because rebound hypertension can occur.
Instruct the client not to take over-the-counter medications.
Instruct the client in how to take the BP
Instruct the client that if dizziness occurs and persists to notify the physician.
Inform the client that the taste of food may e diminished during the first month of therapy.

Antianginal Medications
Nitrates
Produce vasodilation
Decrease preload and afterload and reduce myocardial oxygen consumption
Nitrates are contraindicated in the client with significant hypotension, increased intracranial pressure, or
severe anemia
Nitrates should be used with caution with severe renal or hepatic disease
Avoid abrupt withdrawal of long-acting preparations to prevent the rebound effect of severe pain from
myocardial ischemia
Side Effects
Headache
Orthostatic hypotension
Dizziness, weakness
Faintness
Nausea, vomiting
Flushing or pallor
Confusion
Rash
Dry mouth
Reflex tachycardia
Paradoxic bradycardia
Nursing interventions
Sublingual Medications
Monitor vital signs
Sublingual
Offer sips of water before giving because dryness may inhibit medication absorption
Instruct the client to place under the tongue and leave until fully dissolved
Instruct the client not to swallow the medication
Instruct the client to take one tablet for pain and repeat every 5 minutes for a total of three doses.
Inform the client to seek medical help immediately if pain is not relieved in 15minutes, following three
doses
Inform the client that a stinging or burning sensation may indicate that the tablet is fresh.
Instruct the client to store medication in a dark, tightly closed bottle.
Instruct the client to check the expiration date on the medication bottle because expiration may occur
within 6months of obtaining medication.
instruct the client to take Tylenol for headache.

Β-Adrenergic Blockers
Inhibit the response to β-adrenergic stimulation, thus decreasing cardiac output
Block the relase of the catecholamines, epinephrine, and norepinephrine, thus decreasing the heart rate
and blood pressure.
Decrease the workload of the heart and decrease oxygen demands
Used for angina, dysrhythmias, hypertension, migraine headaches, prevention of myocardial infarction,
and glaucoma
Are contraindicated in the client with asthma, bradycardia, CHF, severe renal or hepatic disease,
hyperthyroidism, or cerebrovascular accident.
Should be used with caution in the client with diabetes mellitus because the medication may mask
symptoms of hypoglycaemia
Should be used with caution in the client taking antihypertensive medications
Side Effects
Bradycardia
Bronchospasm
Hypotension
Weakness, fatigue
Nausea, vomiting
Dizziness
Hyperglycemia
Agranulocytosis
Behavioural or psychotic response
Depression
Nightmares
Interventions
Monitor vital signs
Hold the medication if the pulse or BP is not within the prescribed parameters
Monitor for signs of CHF
Assess for respiratory distress and for signs of wheezing and dyspnea.
Instruct the client to report dizziness, lightheadedness, or nasal congestion
Instruct the client not to stop the medication because rebound hypertension, rebound tachycardia, or
an angina attack can occur.
Advise the client taking insulin that the β blocker can mask early signs of hypoglycaemia such as
tachycardia and nervousness.
Instruct the client taking insulin to monitor the blood glucose level
Instruct the client in how to take pulse and BP.
Instruct the client to change positions slowly to prevent orthostatic hypotension
Instruct the client to avoid over-the-counter cold medications and nasal decongestants.

Calcium Channel Blockers

Decrease cardiac contractility (negative inotropic effect by relaxing smooth muscle) and the workload of
the heart thus decreasing the need for oxygen
Calcium channel blockers promote vasodilation of the coronary and peripheral vessels
Calcium channel blockers are used for angina, dysrhythmias, or hypertension
Should be used with caution in the client with CHF, bradycardia or atrioventricular block
Side effects
Bradycardia
Hypotension
Reflex tachycardia as a result of hypotension
Headache
Dizziness, light-headedness
Fatigue
Peripheral edema
Constipation
Flushing of the skin
Changes in liver and kidney function
Interventions
Monitor vital signs
Monitor for signs of CHF
Monitor liver enzyme levels
Monitor kidney function tests.
Instruct the client not to discontinue the medication
Instruct the client in how to take a pulse
Instruct the client to notify the physician if dizziness or fainting occurs
Instruct the client no to crush or chew sustained-release tablets