A.

DRUGS AFFECTING BLOOD PRESSURE

(a) ANTIHYPERTENSIVE AGENTS
Angiotensin- Converting-Enzyme Inhibitors
benazepril fosinopril quinapril
captopril lisinopril ramipril
enalapril moexipril trandolapril
enalaprilat perindopril

Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. renal impairment, hyponatremia,
hypovolemia, etc.) to prevent potential adverse effects.
o Obtain baseline status for weight, vital signs, overall skin condition, and laboratory tests like
renal and hepatic function tests, serum electrolyte, and complete blood count (CBC) with
differential to assess patient’s response to therapy.
Nursing Diagnoses
o Decreased cardiac output related to effect of drug in increasing fluid volume excre tion
o Impaired skin integrity related to dermatological effects of the drug
o Increased risk for infection related to potential decreasing effect of drug to circulating blood
cells
Implementation with Rationale
o Educate patient on importance of healthy life style choices which include regular exercise, weight
loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy.
o Administer drug on empty stomach one hour before or two hours after meal to ensure optimum
drug absorption.
o Monitor renal and hepatic function tests to alert doctor for possible development of renal
and/or hepatic failure as well as to signal need for reduced drug dose.
o Monitor for presence of manifestations that signal decreased in fluid volume (e.g. diarrhea ,
vomiting, dehydration) to prevent exacerbation of hypotensive effect of drug.
o Educate patient and family members about drug’s effect to the body and manifestations that
would need reporting to enhance patient knowledge on drug therapy and promote adheren ce.
Evaluation
o Monitor patient response to therapy through blood pressure monitoring.
o Monitor for adverse effects (e.g. hypotension, arrhythmias, renal failure, cough, and
pancytopenia).
o Evaluate patient understanding on drug therapy by asking patient to n ame the drug, its indication,
and adverse effects to watch for.
o Monitor patient compliance to drug therapy.

Angiotensin II–Receptor Blockers

candesartan losartan valsartan
eprosartan olmesartan
irbesartan telmisartan
Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. drug allergy, hypovolemia, renal
impairment, etc.) to prevent potential adverse effects.
o Obtain baseline status for weight, vital signs, overall skin condition, and laboratory tests like
renal and hepatic function tests, and serum electrolyte to assess patient’s response to therapy.
Nursing Diagnoses
o Ineffective tissue perfusion related to fluid excretory effect of the drug
o Impaired skin integrity related to dermatological effects of the drug
o Risk for injury related to CNS side effects of the drug
Implementation with Rationale
o Educate patient on importance of healthy lifestyle choices which include regular exercise,
weight loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive
therapy.
o Administer drug with food to prevent GI distress associated with drug intake.
o Monitor renal and hepatic function tests to alert doctor for possible development of renal
and/or hepatic failure as well as to signal need for reduced drug dose.
o Provide comfort measures (e.g. quiet environment, relaxation techniques, etc.) to help patient
tolerate drug effects.
o Educate patient and family members about drug’s effect to the body and manifestations that
would need reporting to enhance patient knowledge on drug therapy and promote adherence.
Evaluation
o Monitor patient response to therapy through blood pressure monitoring.
o Monitor for adverse effects (e.g. skin reactions, cough, headache, etc.)
o Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
o Monitor patient compliance to drug therapy

Calcium Channel Blockers

amlodipine diltiazem felodipine
isradipine nifedipine verapam
nicardipine nisoldipine

Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. headache, rash, bradycardia, etc.)
to prevent potential adverse effects.
o Monitor cardiopulmonary status closely as the drug can cause severe effects on these two
body systems.
Nursing Diagnoses
o Decreased cardiac output related to hypotension and vasodilating effect of the drug
o Risk for injury related to cardiovascular and CNS adverse drug effects
Implementation with Rationale
o Educate patient on importance of healthy lifestyle choices which include regular exercise, weight
loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy.
o Monitor blood pressure and heart rate and rhythm to detect possible development of adverse
effects.
o Provide comfort measures for the patient to tolerate side effects (e.g. small frequent meals for
nausea, limiting noise and controlling room light and temperature to prevent aggravation of
stress which can increase demand to the heart, etc.)
o Educate patient and family members about drug’s effect to the body and manifestations that
would need reporting to enhance patient knowledge on drug therapy and promote adherence.
o Emphasize to the client the importance of strict adherence to drug therapy to ensure maximum
therapeutic effects.
Evaluation
o Monitor patient response to therapy through blood pressure monitoring.
o Monitor for presence of mentioned adverse effects.
o Monitor for effectiveness of comfort measures.
o Monitor for compliance to drug therapy regimen.
o Monitor laboratory tests.

Vasodilators
diazoxide
hydralazine
minoxidil
nitroprusside
Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. drug allergy, CAD, cerebral
insufficiency etc.) to prevent potential adverse effects.
o Obtain baseline status for weight, vital signs, overall skin condition, and laboratory tests like
renal and hepatic function tests, and serum electrolyte to assess patient’s r esponse to therapy.
Nursing Diagnoses
o Decreased tissue perfusion related to changes in volume of blood pumped out by the heart
o Acute pain related to GI distress, headache, and skin effects of the drug
Implementation with Rationale
o Educate patient on importance of healthy lifestyle choices which include regular exercise, weight
loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy.
o Monitor blood pressure and heart rate and rhythm closely to evaluate for effecti veness and
ensure quick response if blood pressure falls rapidly or too much.
o Provide comfort measures for the patient to tolerate side effects (e.g. small frequent meals for
nausea, limiting noise and controlling room light and temperature to prevent aggr avation of
stress which can increase demand to the heart, etc.)
o Monitor patient for any manifestations that could decrease fluid volume inside the body (e.g.
vomiting, diarrhea, excessive sweating, etc.) to detect and treat excessive hypotension.
o Educate patient and family members about drug’s effect to the body and manifestations that
would need reporting to enhance patient knowledge on drug therapy and promote adherence.
o Emphasize to the client the importance of strict adherence to drug therapy to ensure maximum
therapeutic effects.
Evaluation
o Monitor patient response to therapy through blood pressure monitoring.
o Monitor for presence of mentioned adverse effects (e.g. hypotension, GI distress, skin
reactions, etc.)
o Monitor for effectiveness of comfort measures.
o Monitor for compliance to drug therapy regimen.
o Monitor laboratory tests.
Other Antihypertensive
Agents
Diuretic Agents Thiazide and Thiazide-Like Diuretics
bendroflumethiazide hydroflumethiazide indapamide
chlorothiazide methyclothiazide metolazone
hydrochlorothiazide chlorthalidone
Potassium-Sparing Diuretics
amiloride spironolactone triamterene
Ganglionic Blocker
mecamylamine
Renin Inhibitor
aliskiren
Sympathetic Nervous System Drug Beta-Blockers
acebutolol bisoprolol nadolol
atenolol carteolol nebivolol
betaxolol metoprolol penbutolol
 pindolol
propranolol
timolol
Alpha- and Beta-Blockers
carvedilol guanabenz
labetalol

Alpha-Adrenergic Blockers
phenoxybenzamine phentolamine
Alpha1-Blockers
doxazosin terazosin
prazosin
Alpha2-Blockers
clonidine
guanfacine methyldopa

(b) ANTIHYPOTENSIVE AGENTS

Sympathetic Adrenergic Agonists or Vasopressors
dobutamine epinephrine norepinephrine
dopamine isoproterenol phenylephrine
ephedrine metaraminol
 Alpha-Specific Adrenergic Agent
Midodrine

B. CARDIOTONIC AGENTS
(a) CARDIOTONIC AGENTS
Cardiac Glycoside
digoxin
Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. renal insufficiency, acute MI,
hypersensitivity, etc.) to prevent potential adverse effects.
o Conduct thorough physical assessment before beginning drug therapy to establish baseline
status, determine effectivity of therapy and evaluate potential adverse effects.
o Obtain baseline status for weight while noting recent manifestations that increase or decreases
to determine patient’s fluid status.
o Assess closely patient’s heart rate and blood pressure to identify cardiovascular changes that
may warrant a change in digoxin drug dose.
o Auscultate heart sounds to note the presence of abnormal sounds and possible conduction
problems.
o Determine urinary pattern and output to assess gross indication of renal function.
o Obtain baseline electrocardiogram (ECG) to identify heart rate and rhythm.
o Monitor serum electrolyte and renal function tes t results to determine whether changes in drug
dose is needed or not.
Nursing Diagnoses
o Risk for fluid volume deficit related to increased renal perfusion as effect of the drug
o Decreased cardiac output related to inefficient myocardial contractility
o Ineffective tissue perfusion related to decreased blood flow to different parts of the body
Implementation with Rationale
o Check drug dose and preparation carefully to avoid medication errors because drug has narrow
safety margin.
o Do not administer drug with food and antacids to prevent decreased in drug absorption.
o IMPORTANT! Count apical pulse for one full minute before administering drug to monitor for
adverse effects.
o Drug is withheld if pulse is less than 60 beats per minute in adults and 90 beats per minute in
infants.
o Apical pulse is taken after one hour and if it remains low, nurse must document it, withhold the
dose, and inform doctor.
o Assess pulse rhythm to detect arrhythmias which are early signs of drug toxicity.
o Weigh the patient daily to monitor for fluid retention and HF. Assess dependent areas for
presence of edema and note its degree of pitting to assess severity of fluid retention.
o Monitor serum digoxin level as ordered (normal: 0.5 -2 ng/mL) to evaluate therapeutic dosing
and development of adverse effects.
o Provide comfort measures (e.g. small frequent meals for GI upset, instituting safety measures
for drowsiness and weaknesses, and providing adequate room lighting for patients with visual
disturbances) to help patient tolerate drug effects.
o Promote rest periods and relaxation techniques to balance supply and demand of oxygen.
 o Ensure maintenance of emergency drugs and equipment at bedside (e.g. potassium salts and
lidocaine for arrhythmias, phenytoin for seizures, atropine in case of clinicall y significant low
heart rate, and cardiac monitor) to promote prompt treatment in cases of severe toxicity.
o Educate patient on drug therapy including drug name, its indication, and adverse effects to
watch out for to enhance patient understanding on drug t herapy and thereby promote
adherence to drug regimen.
Evaluation
o Monitor patient response to therapy through assessing manifestations of HF, arrhythmia, and
serum level of digoxin.
o Monitor for adverse effects (e.g. visual changes, HF, and arrhythmias).
o Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
o Monitor patient compliance to drug therapy.

Phosphodiesterase Inhibitors
inamrinone
milrinone
Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. fluid volume deficit, acute MI,
hypersensitivity, etc.) to prevent potential adverse effects.
o Conduct thorough physical assessment before beginning drug therapy to establish baseline
status, determine effectivity of therapy, and evaluate potential adverse effects.
o Obtain baseline status for weight while noting recent manifestations that increases or
decreases to determine patient’s fluid status.
o Assess closely patient’s heart rate and blood pressure to iden tify cardiovascular changes that
may warrant change in drug dose.
o Determine urinary pattern and output to assess gross indication of renal function.
o Obtain baseline electrocardiogram (ECG) to identify heart rate and rhythm.
o Monitor serum electrolyte, complete blood count, and renal and hepatic function test results to
determine whether changes in drug dose is needed or not.
Nursing Diagnoses
o Risk for fluid volume deficit related to increased renal perfusion as effect of the drug
o Decreased cardiac output related to inefficient myocardial contractility and hypotension
o Risk for injury related to easy bruising 20 thrombocytopenia
o Ineffective tissue perfusion related to decreased blood flow to different parts of the body
Implementation with Rationale
o Protect drug from light to prevent drug from degradation.
o Ensure patency of intravenous access to promote safe administration of drug.
o Weigh patient daily and fluid intake and output to evaluate resolution of HF.
o Assess skin condition, noting presence of petechi ae and other manifestations of easy bruising
and bleeding to assess presence of thrombocytopenia.
o Monitor intravenous injection site to promote prompt interventions in cases of burning
sensation and/or irritation.
 o Provide comfort measures (e.g. small frequent meals for GI upset, instituting safety measures
for drowsiness and weaknesses, and providing adequate room lighting for patients with visual
disturbances) to help patient tolerate drug effects.
o Educate patient on drug therapy including drug name, its i ndication, and adverse effects to
watch out for to enhance patient understanding on drug therapy and thereby promote
adherence to drug regimen.
Evaluation
o Monitor patient response to therapy through assessing for manifestations of resolution of HF.
o Monitor for adverse effects (e.g. thrombocytopenia, HF, and arrhythmias).
o Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
o Monitor patient compliance to drug therapy.

C. ANTIARRHYTHMIC AGENTS
(a) ANTIARRHYTHMIC AGENTS
Class I Antiarrhythmics
Class Ia
disopyramide procainamide quinidine

Class Ib
lidocaine mexiletine
 Class Ic
flecainide propafenone
Class II Antiarrhythmics
acebutolol esmolol propranolol

Class III Antiarrhythmics

amiodarone ibutilide
dofetilide sotalol

Class IV Antiarrhythmics
diltiazem verapamil

Other Antiarrhythmics
adenosine digoxi
Nursing Assessment
o Assess for the mentioned contraindications to this drug (e.g. fluid volume deficit, acute MI,
hypersensitivity, etc.) to prevent potential adverse effects.
o Conduct thorough physical assessment before beginning drug therapy to establish baseline
status, determine effectivity of therapy, and evaluate potential adverse effects.
 o Obtain baseline status for weight while noting recent manifestations that increases or
decreases to determine patient’s fluid status.
o Assess closely patient’s heart rate and blood pressure to identify cardiovascular changes that
may warrant change in drug dose.
o Determine urinary pattern and output to assess gross indicatio n of renal function.
o Obtain baseline electrocardiogram (ECG) to identify heart rate and rhythm.
o Monitor serum electrolyte, complete blood count, and renal and hepatic function test results to
determine whether changes in drug dose is needed or not.
Nursing Diagnoses
o Risk for fluid volume deficit related to increased renal perfusion as effect of the drug
o Decreased cardiac output related to inefficient myocardial contractility and hypotension
o Risk for injury related to easy bruising 20 thrombocytopenia
o Ineffective tissue perfusion related to decreased blood flow to different parts of the body
Implementation with Rationale
o Protect drug from light to prevent drug from degradation.
o Ensure patency of intravenous access to promote safe administration of drug.
o Weigh patient daily and fluid intake and output to evaluate resolution of HF.
o Assess skin condition, noting presence of petechiae and other manifestations of easy bruising
and bleeding to assess presence of thrombocytopenia.
o Monitor intravenous injection site to promote prompt interventions in cases of burning
sensation and/or irritation.
 o Provide comfort measures (e.g. small frequent meals for GI upset, instituting safety measures
for drowsiness and weaknesses, and providing adequate room lighting for patients w ith visual
disturbances) to help patient tolerate drug effects.
o Educate patient on drug therapy including drug name, its indication, and adverse effects to
watch out for to enhance patient understanding on drug therapy and thereby promote
adherence to drug regimen.
Evaluation
o Monitor patient response to therapy through assessing for manifestations of resolution of HF.
o Monitor for adverse effects (e.g. thrombocytopenia, HF, and arrhythmias).
o Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication,
and adverse effects to watch for.
o Monitor patient compliance to drug therapy.

D. ANTIANGINAL AGENTS
(a) ANTIANGINAL AGENTS
Nitrates
amyl nitrate isosorbide mononitrate
isosorbide dinitrate nitroglycerin

Nursing Assessment
o Presence of mentioned contraindications and cautions
o Skin color and integrity, especially for transdermal or topical forms of nitrates
o Pain and activity level
o Neurological status (level of consciousness, affect, reflexes, etc.)
o Cardiopulmonary status (BP; take heart rate in full minute)
o Electrocardiogram as ordered
o Laboratory tests (e.g. CBC, liver and kidney function tests, etc.)
Nursing Diagnoses
o Decreased cardiac output related to vasodilation and hypotensive e ffects of the drug
o Risk for Injury related to adverse effects on neurological and cardiovascular status
o Ineffective Tissue Perfusion related to low oxygen supply to myocardial cells
Implementation with Rationale
o Instruct patient not to swallow sublingual p reparations to ensure therapeutic effects. Take three
tablets with a 5-minute interval, for a total of three doses. If the pain does not subside, seek
medical help.
o Ask for presence of burning sensation to ensure drug potency.
o Protect drug from sunlight to maintain drug potency.
o For sustained release forms, take drug with water and do not crush for these preparations need
to reach GIT intact.
o Rotate injection sites and provide skin care as appropriate to prevent skin abrasion and
breakdown.
o Avoid abrupt stop of long-term therapy. Taper doses for 4-6 weeks to prevent myocardial
infarction.
o Provide comfort measures: small frequent meals, appropriate room temperature and lights, noise
reduction, ambulation assistance, reorientation, and skin care.
Evaluation
o Monitor patient response to therapy (pain assessment).
o Monitor for presence of mentioned adverse effects.
o Monitor for effectiveness of comfort measures.
o Monitor for compliance to drug

Beta-Blockers
metoprolol nadolol propranolol

Nursing Assessment
o Assess for presence of mentioned contraindications and cautions.
o Assess neurological status to determine presence of neurological adverse effects. Focus on level
of orientation and sensory function.
o Monitor blood pressure and heart rate accurately. Be sure to count the heart rate in one full
minute.
o Auscultate lungs to determine presence of possible respiratory adverse effects.
o Check color and sensation of extremities. Measure capillary refill. This is to evaluate presence o f
insufficiencies in the peripheral vascular system.
o Monitor laboratory test results (e.g. electrolyte levels and renal function tests) to ascertain risk
for arrhythmia and discern whether dose adjustment is needed.
Nursing Diagnosis
o Decreased Cardiac Output related to decreased heart rate, blood pressure, and contractile
properties of the heart
o Ineffective Tissue Perfusion related to decreased blood flow to the heart
o Risk for Injury related to possible alterations in CNS while on drug therapy
Implementation with Rationale
o Give drug as ordered following safe and appropriate administration to ensure therapeutic
effects.
o Provide comfort measures: ambulation assistance, raised siderails, appropriate room light and
temperature, and rest periods
o Monitor cardiopulmonary status closely to detect possible alterations in vital signs which signal
need for dose adjustment and to prevent related adverse effects.
o Educate client about the need to not abruptly stop therapy as this can lead to rebound
hypertension and myocardial infarction.
Evaluation
o Monitor patient response to therapy.
o Monitor for presence of mentioned adverse effects.
o Monitor for effectiveness of comfort measures.
o Monitor for compliance to drug therapy regimen.
o Monitor laboratory tests.

Calcium Channel Blockers

amlodipine nicardipine nifedipine
diltiazem verapamil
Nursing Assessment
o Assess for presence of mentioned contraindications and cautions.
o Inspect skin color and integrity to determine presence of adverse effects on skin.
o Assess the patient’s complaint of pain and the activity level prior to and after the onset of pain to
aid in identifying possible contributing factors to the pain and its progression.
o Monitor cardiopulmonary status closely as the drug can cause severe effects on these two body
systems.
Nursing Diagnosis
o Decreased Cardiac Output related to hypotension and vasodilating effect of the drugs
o Risk for Injury related to cardiovascular and CNS adverse drug effects
Implementation with Rationale
o Monitor blood pressure and heart rate and rhythm to detect possible development of adverse
effects.
o Provide comfort measures for the patient to tolerate side effects (e.g. small frequent meals for
nausea, limiting noise and controlling room light and temperat ure to prevent aggravation of
stress which can increase demand to the heart, etc.)
o Educate client on measures to avoid angina attacks (e.g. diet changes, rest periods, etc.)
o Emphasize to the client the importance of strict adherence to drug therapy to ensu re maximum
therapeutic effects.
Evaluation
o Monitor patient response to therapy.
o Monitor for presence of mentioned adverse effects.
o Monitor for effectiveness of comfort measures.
 o Monitor for compliance to drug therapy regimen.
o Monitor laboratory tests.

Piperazineacetamide
Ranolazine

E. LIPID-LOWERING AGENTS
(a) LIPID-LOWERING AGENTS
Bile Acid Sequestrants
cholestyramine colestipol
colesevelam
Assessment
o Assess for contraindications or cautions: known allergies to these drugs to avoid hypersensitivity reactions;
impaired intestinal function, which could be exacerbated by these drugs; biliary obstruction, which could block the
effectiveness of these drugs; and current status related to pregnancy and lactation because of the potential for
adverse effects on the fetus or nursing baby.
o Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine
the effectiveness of therapy and evaluate for any potential adverse effects.
o Weigh the patient to establish a baseline and evaluate for changes reflecting lifestyle changes that accompany
drug therapy. Inspect the patient’s skin for color, bruising, and rash to evaluate for possible adverse effects.
o Assess neurological status, including level of orientation and alertness, to determine any central nervous system
effects.
o Monitor pulse and blood pressure for changes related to changes in CAD risk factors.
o Inspect the abdomen for distention and auscultate bowel sounds for changes in gastrointestinal motility.
o Assess bowel elimination patterns, including frequency of stool passage and stool characteristics, to identify
possible constipation and fecal impaction.
o Monitor the results of laboratory tests, including serum cholesterol and lipid levels, to evaluate the effectiveness
of drug therapy.
Nursing Diagnoses
o Acute Pain related to headache and GI effects
o Constipation related to GI effects
o Risk for Injury related to CNS changes and potential for bleeding
o Deficient Knowledge regarding drug therapy
Implementation
o Do not administer powdered agents in dry form; these drugs must be mixed in fluids to be effective. Mix with fruit
juices, soups, liquids, cereals, or pulpy fruits. Mix colestipol, but not cholestyramine, with carbonated beverages.
Stir, and encourage the patient to swallow all of the dose.
o If the patient is taking tablets, ensure that tablets are not cut, chewed, or crushed because they are designed to
be broken down in the GI tract; if they are crushed, the active ingredients will not be effective. Urge the patient to
swallow tablets whole with plenty of fluid.
o Give the drug before meals to ensure that the drug is in the GI tract with food.
o Administer other oral medications 1 hour before or 4 to 6 hours after the bile sequestrant to avoid drug–drug
interactions.
o Arrange for a bowel program as appropriate to effectively deal with constipation if it occurs.
o Provide comfort measures to help the patient tolerate the drug effects. These include small, frequent meals to
reduce the risk of nausea; ready access to bathroom facilities to prevent constipation; safety precautions to
 prevent injury if dizziness, central nervous system (CNS) changes, or bleeding is a problem; replacement of fat-
soluble vitamins; skin care as needed; and analgesics for headache.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen and lifestyle
changes that may be necessary; refer the patient to services that might help with the high cost of these drugs.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, and schedule for
administration; method to administer the drug, such as mixing the powder form in fluids or taking tablets whole
(with- out crushing, chewing, or cutting); appropriate fluids for mixing drug; measures to avoid adverse effects,
warning signs of problems, and the need for follow-up laboratory testing to monitor cholesterol and lipid levels;
dietary and lifestyle changes for risk reduction; and monitoring and evaluation to enhance patient knowledge
about drug therapy and to promote compliance.
Evaluation
o Monitor patient response to the drug as appropriate (reduction in serum cholesterol levels).
o Monitor for adverse effects (headache, vitamin deficiency, increased bleeding times, constipation, nausea, rash).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and
specific measures to avoid them; patient understands the importance of continued follow-up).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

HMG-CoA Reductase Inhibitors

atorvastatin lovastatin rosuvastatin
fluvastatin pravastatin simvastatin
Assessment
o Assess for contraindications and cautions: any known allergies to these drugs or to fungal byproducts to avoid
hypersensitivity reactions; active liver disease or history of alcoholic liver disease, which could be exacerbated by
the effects of these drugs; current status of pregnancy or lactation because of potential adverse effects on the
fetus or neonate; and impaired endocrine function, which could be exacerbated by effects on steroid hormones.
o Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine its
effectiveness and evaluate for any potential adverse effects.
o Weigh the patient to establish a baseline and evaluate for changes reflecting lifestyle changes that accompany drug
therapy.
o Assess the patient’s neurological status, including level of orientation, affect, and reflexes, which show early
changes related to CNS function, to evaluate for possible
o CNS effects of the drug.
o Obtain vital signs, including pulse and blood pressure, to identify changes.
o Inspect the abdomen for distention and auscultate bowel sounds for changes in gastrointestinal motility.
o Assess bowel elimination patterns, including frequency of stool passage and stool characteristics, to identify
possible constipation.
o Monitor the results of laboratory tests, including renal and liver function tests, to identify possible toxicity and
serum lipid levels to evaluate the drug’s effectiveness.
Nursing Diagnoses
o Disturbed Sensory Perception (Visual, Kinesthetic, Gustatory) related to CNS effects
o Risk for Injury related to CNS, liver, and renal effects
o Acute Pain related to headache, myalgia, and GI effects
o Deficient Knowledge regarding drug therapy
Implementation
o Administer the drug at bedtime because the highest rates of cholesterol synthesis occur between midnight and 5
AM , and the drug should be taken when it will be most effective; give atorvastatin at any time during the day.
o Monitor serum cholesterol and LDL levels before and periodically during therapy to evaluate the effectiveness of
this drug.
o Arrange for periodic ophthalmic examinations to monitor for cataract development.
o Monitor liver function tests before and periodically during therapy to monitor for liver damage; consult with the
prescriber to discontinue the drug if the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) level
increases to three times normal.
o Ensure that the patient has attempted a cholesterol-lowering diet and exercise program for at least 3 to 6 months
before beginning therapy to ensure the need for drug therapy.
o Encourage the patient to make the lifestyle changes necessary to decrease the risk of CAD and to increase the
effectiveness of drug therapy.
o Withhold lovastatin, atorvastatin, or fluvastatin in any acute, serious medical condition (e.g., infection, hypotension,
major surgery or trauma, metabolic endocrine disorders, seizures) that might suggest myopathy or serve as a risk
factor for the development of renal failure.
o Suggest the use of barrier contraceptives for women of childbearing age because there is a risk of severe fetal
abnormalities if these drugs are taken during pregnancy.
o Provide comfort measures to help the patient tolerate drug effects. These include small, frequent meals to minimize
nausea and vomiting; access to bathroom facilities to ensure adequate bowel evacuation; bowel program as needed
to address constipation; use of food with the drug if GI upset is severe to decrease direct irritating effects;
environmental controls, such as temperature and lighting controls, to help deal with headaches; and safety
 precautions, such as lighting control and activity restrictions, to protect the patient if vision changes and muscle
effects occur.
o Offer support and encouragement to help the patient deal with the diagnosis, needed lifestyle changes, and the drug
regimen.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, and administration at bedtime
for best effectiveness; measures to avoid adverse effects, warning signs of problems, and the need for follow-up
laboratory testing to monitor cholesterol and lipid levels; importance of follow-up renal and liver function testing;
dietary and lifestyle changes for risk reduction; and monitoring and evaluation, to enhance patient knowledge about
drug therapy and to promote compliance.
Evaluation
o Monitor patient response to the drug (lowering of serum cholesterol and LDL levels, prevention of first MI, slowing
of progression of CAD).
o Monitor for adverse effects (headache, dizziness, blurred vision, cataracts, GI upset, liver failure, rhabdomyolysis).
o Monitor the effectiveness of comfort measures and compliance with the regimen.
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and
specific measures to avoid them; patient understands the importance of continued follow-up).
 Cholesterol Absorption Inhibitor
Ezetimibe
Nursing Assessment
o Assess for contraindications or cautions: any known allergies to any component of the drug to avoid hypersensitivity
reactions; liver dysfunction or advanced age because the processing of the drug may differ from the norm; current
status of pregnancy or lactation because the possible effects on the fetus or neonate are not known.
o Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine its
effectiveness and evaluate for any potential adverse effects.
o Monitor orientation and reflexes to detect changes in CNS function, such as dizziness, that could require safety
measures.
o Monitor respirations and auscultate lungs for evidence of adventitious sounds to monitor changes in cardiac output.
o Inspect the abdomen for distention and auscultate bowel sounds for changes in gastrointestinal motility.
o Assess bowel elimination patterns, including frequency of stool passage and stool characteristics, to identify possible
changes that could require intervention.
o Monitor the results of laboratory tests, including serum cholesterol and lipid levels, to evaluate the effectiveness of
drug therapy, and liver function studies to monitor for toxic effects.
Nursing Diagnoses
o Disturbed Sensory Perception (Visual, Kinesthetic, Gustatory) related to CNS effects
o Acute Pain related to headache, myalgia, and GI effects
o Deficient Knowledge regarding drug therapy
Implementation
o Monitor serum cholesterol, triglyceride, and LDL levels before and periodically during therapy to evaluate the
effectiveness of this drug.
o Monitor liver function tests before and periodically during therapy to detect possible liver damage.
o Ensure that the patient has attempted a cholesterol lowering diet and exercise program for at least several months
before beginning therapy to ensure the need for drug therapy.
o Encourage the patient to make the lifestyle changes necessary to decrease the risk of CAD and to increase the
effectiveness of drug therapy.
o Suggest the use of barrier contraceptives for women of childbearing age if the drug is being used in combination with a
statin because there is a risk of severe fetal abnormalities if these drugs are taken during pregnancy.
o Provide comfort measures to help the patient tolerate drug effects. These include readily available access to bathroom
facilities to help with episodes of diarrhea; safety precautions to protect the patient if dizziness is an issue; and
analgesics for headache and muscle aches if appropriate.
o Offer support and encouragement to help the patient deal with the diagnosis, needed lifestyle changes, and the drug
regimen.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, and schedule for administration;
measures to avoid adverse effects, warning signs of problems, and the need for follow-up laboratory testing to
monitor cholesterol and lipid levels; dietary and lifestyle changes for reducing the risk of CAD and increasing the
effectiveness of drug therapy; and monitoring and evaluation to enhance patient knowledge about drug therapy and to
promote compliance.
Evaluation
o Monitor patient response to the drug (lowering of serum cholesterol and LDL levels, lowering of sitosterol and
campesterol levels).
o Monitor for adverse effects (headache, dizziness, GI pain, muscle aches and pains, URI).
o Monitor the effectiveness of comfort measures and compliance with the regimen.
 o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and
specific measures to avoid them; patient understands the importance of continued follow-up).

(b) OTHER LIPIDLOWERING AGENTS

Fibrates
fenofibrate gemfibrozil

Vitamin B
niacin
Peroxisome proliferator receptor alpha activator
fenofibric acid

F. DRUGS AFFECTING BLOOD COAGULATION

(a) DRUGS AFFECTING CLOT FORMATION AND RESOLUTION
Antiplatelet Agents
abciximab eptifibatide
anagrelide sulfinpyrazone
aspirin ticlopidine
cilostazol tirofiban
clopidogrel
dipyridamole
Nursing Assessment
o Assess for the following conditions, which could be cautions or contraindications to use of the drug: any known allergies
to these drugs; pregnancy or lactation because of the potential adverse effects on the fetus or neonate; and bleeding
disorders, recent surgery, or closed head injury because of the potential for excessive bleeding.
o Assess baseline status before beginning therapy to determine any potential adverse effects. This includes body
temperature; skin color, lesions, and temperature; affect, orientation, and reflexes; pulse, blood pressure, and
perfusion; respirations and adventitious sounds; complete blood count (CBC); and clotting studies
Nursing Diagnoses
o Risk for Injury related to bleeding effects or CNS effects
o Acute Pain related to GI or CNS effects
o Deficient Knowledge regarding drug therapy
Implementation
o Provide small, frequent meals to relieve GI discomfort if GI upset is a problem.
o Provide comfort measures and analgesia for headache to relieve pain and improve patient compliance with the drug
regimen.
o Suggest safety measures, including the use of an electric razor and avoidance of contact sports, to decrease the risk
of bleeding.
o Monitor platelet count if the patient is using anagrelide to detect thrombocytopenia and increased risk of bleeding.
o Provide increased precautions against bleeding during invasive procedures; use pressure dressings and ice to
decrease excessive blood loss caused by anticoagulation.
o Mark the chart of any patient receiving this drug to alert medical staff that there is a potential for increased bleeding.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse
effects, warning signs of problems, the need for periodic monitoring and evaluation, and the need to wear or carry a
 MedicAlert notification, to enhance patient knowledge about drug therapy and to promote compliance with the drug
regimen.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
Evaluation
o Monitor patient response to the drug (increased bleeding time, prevention of occlusive events).
o Monitor for adverse effects (bleeding, GI upset, dizziness, headache).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and
specific measures to avoid them; patient understands the importance of continued follow-up).
o Monitor the effectiveness of comfort measures and compliance with the regimen.
Anticoagulants
antithrombin fondaparinux
argatroban heparin
bivalirudin warfarin
desirudin

Nursing Assessment
o Assess for any known allergies to these drugs. Also screen for conditions that could be exacerbated by increased
bleeding tendencies, including hemorrhagic disorders, recent trauma, spinal puncture, GI ulcers, recent surgery,
intrauterine device placement, tuberculosis, presence of indwelling catheters, and threatened abortion. Also screen for
pregnancy to ensure that benefits outweigh any potential risks (contraindicated with warfarin); lactation, because of
the potential for risks to the baby (use of heparin is suggested if an anticoagulant is needed during lactation); renal or
hepatic disease, which could interfere with the metabolism and effectiveness of these drugs; HF; thyrotoxicosis; senility
 or psychosis because of the potential for unexpected effects; and diarrhea or fever, which could alter the normal
clotting process.
o Assess baseline status before beginning therapy to determine any potential adverse effects. This includes body
temperature; skin color, lesions, and temperature; affect, orientation, and reflexes; pulse, blood pressure, and
perfusion; respirations and adventitious sounds; clotting studies, renal and hepatic function tests, CBC, and stool guaiac;
and electrocardiogram (ECG), if appropriate.
Nursing Diagnoses
o Risk for Injury related to bleeding effects and bone marrow depression Disturbed Body Image related to alopecia and
skin rash
o Ineffective Tissue Perfusion (Total Body) related to blood loss
o Deficient Knowledge regarding drug therapy
Implementation
o Evaluate for therapeutic effects of warfarin—prothrombin time (PT) 1.5 to 2.5 times the control value or ratio of PT to
INR (International Normalized Ratio) of 2 to 3—to evaluate the effectiveness of the drug dose.
o Evaluate for therapeutic effects of heparin—whole blood clotting time (WBCT) 2.5 to 3 times control or activated partial
thromboplastin time (APTT) 1.5 to 3 times the control value—to evaluate the effectiveness of the drug dose.
o Evaluate the patient regularly for any sign of blood loss (petechiae, bleeding gums, bruises, dark-colored stools, dark-
colored urine) to evaluate the effectiveness of the drug dose and to determine the need to consult with the prescriber
if bleeding becomes apparent.
o Establish safety precautions to protect the patient from injury.
o Provide safety measures, such as use of an electric razor and avoidance of contact sports, to decrease the risk of
bleeding.
o Provide increased precautions against bleeding during invasive procedures; use pressure dressings; avoid
intramuscular injections; and do not rub SQ injection sites because the state of anticoagulation increases the risk of
blood loss.
o Mark the chart of any patient receiving this drug to alert the medical staff that there is a potential for increased
bleeding.
o Maintain antidotes on standby (protamine sulfate for heparin, vitamin K for warfarin) in case of overdose.
o Monitor the patient carefully when any drug is added to or withdrawn from the drug regimen of a patient taking
warfarin because of the risk of drug–drug interactions that would change the effectiveness of the anticoagulant.
o Make sure that the patient receives regular follow-up and monitoring, including measurement of clotting times, to
ensure maximum therapeutic effects.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse
effects, warning signs of problems, the need for periodic monitoring and evaluation, and the need to wear or carry a
MedicAlert notification, to enhance patient knowledge about drug therapy and to promote compliance with the drug
regimen.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
Evaluation
o Monitor patient response to the drug: increased bleeding time (warfarin, PT 1.5 to 2.5 times the control value or PT/INR
ratio of 2 to 3; heparin, WBCT of 2.5 to 3 times the control value or APTT of 1.5 to 3 times the control value).
o Monitor for adverse effects (bleeding, bone marrow depression, alopecia, GI upset, rash).
 Thrombolytic Agents
alteplase streptokinase
reteplase tenecteplase
urokinase

Nursing Assessment
o Assess for any known allergies to these drugs to prevent hypersensitivity reactions. Also screen for any conditions
that could be worsened by the dissolution of clots, including recent surgery, active internal bleeding, CVA within the last
o 2 months, aneurysm, obstetrical delivery, organ biopsy, recent serious GI bleeding, rupture of a noncompressible blood
vessel, recent major trauma (including cardiopulmonary resuscitation), known blood clotting defects, cerebrovascular
disease, uncontrolled hypertension, liver disease (which could affect normal clotting factors and the production of
plasminogen), and pregnancy or lactation (because of the possible adverse effects on the neonate).
o Assess baseline status before beginning therapy to determine any potential adverse effects. Assess the following:
body temperature; skin color, lesions, and temperature; affect, orientation, and reflexes; pulse, blood pressure, and
perfusion; respirations and adventitious sounds; and clotting studies, renal and hepatic function tests, CBC, guaiac test
for occult blood in stool, and ECG.
Nursing Diagnoses
o Risk for Injury related to clot-dissolving effects
o Ineffective Tissue Perfusion (Total Body) related to possible blood loss
o Decreased Cardiac Output related to bleeding and arrhythmias
o Deficient Knowledge regarding drug therapy
Implementation
o Arrange to administer tenecteplase or streptokinase to reduce mortality associated with acute MI as soon as possible
after the onset of symptoms because the timing for the administration of tenecteplase or streptokinase is critical to
resolve the clot before permanent damage occurs to the myocardial cells.
o Discontinue heparin if it is being given before administration of a thrombolytic agent, unless specifically ordered for
coronary artery infusion, to prevent excessive loss of blood.
o Evaluate the patient regularly for any sign of blood loss (petechiae, bleeding gums, bruises, dark-colored stools, dark-
colored urine) to evaluate drug effectiveness and for the need to consult with the prescriber if blood loss becomes
apparent.
o Monitor coagulation studies regularly; consult with the prescriber to adjust the drug dose appropriately.
o Institute treatment within 6 hours after the onset of symptoms of acute MI to achieve optimum therapeutic
effectiveness.
o Arrange to type and cross-match blood in case of serious blood loss that requires whole-blood transfusion.
o Monitor cardiac rhythm continuously if the drug is being given for acute MI because of the risk of alteration in cardiac
function; have life support equipment on standby as needed.
o Provide increased precautions against bleeding during invasive procedures, use pressure dressings and ice, avoid
intramuscular injections, and do not rub SQ injection sites because of the risk of increased blood loss in the anti
coagulated state.
o Mark the chart of any patient receiving this drug to alert medical staff that there is a potential for increased bleeding.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse
effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge
about drug therapy and to promote compliance with the drug regimen.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
Evaluation
o Monitor patient response to the drug (dissolution of the clot and return of blood flow to the area).
o Monitor for adverse effects (bleeding, arrhythmias, hypotension, hypersensitivity reaction).
o Evaluate the effectiveness of the teaching plan (patient can name drug, adverse effects to watch for, and specific
measures to avoid them).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

Other drugs affecting Clot formation

Low-Molecular-Weight Heparins
dalteparin enoxaparin tinzaparin
Anticoagulant Adjunctive Therapy
lepirudin protamine sulfate vitamin K
Hemorrheologic Agent
pentoxifylline
C-Reactive Protein
drotrecogin alfa

(b) DRUGS USED TO CONTROL BLEEDING

Antihemophilic Agents
antihemophilic factor recombinant coagulation factor VIIa
antihemophilic factor, factor IX complex
Assessment
o Assess for the following conditions, which could be cautions or contraindications to use of the drug: any known
allergies to these drugs or to mouse proteins with antihemophilic factor; liver disease.
o Assess for baseline status before beginning therapy to determine any potential adverse effects. Assess the
following: body temperature; skin color, lesions, and temperature; affect, orientation, and reflexes; pulse, blood
pressure, and perfusion; respirations and adventitious sounds; clotting studies; and hepatic function tests.
Nursing Diagnoses
o Ineffective Tissue Perfusion (Total Body) related to changes in coagulation
o Acute Pain related to GI, CNS, or skin effects
o Anxiety or Fear related to the diagnosis and use of blood related products
o Deficient Knowledge regarding drug therapy
Implementation
o Administer by the IV route only to ensure therapeutic effectiveness.
o Monitor clinical response and clotting factor levels regularly to arrange to adjust dose as needed.
o Monitor the patient for any sign of thrombosis to arrange to use comfort and support measures as needed (e.g.,
support hose, positioning, ambulation, exercise).
o Decrease the rate of infusion if headache, chills, fever, or tingling occurs to prevent severe drug reaction; in some
individuals the drug will need to be discontinued.
o Arrange to type and cross-match blood in case of serious blood loss that will require whole-blood transfusion.
o Mark the chart of any patient receiving this drug to alert medical staff that there is a potential for increased
bleeding.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse
effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient
knowledge about drug therapy and to promote compliance with the drug regimen.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
Evaluation
o Monitor patient response to the drug (control of bleeding episodes, prevention of bleeding episodes).
o Monitor for adverse effects (thrombosis, CNS effects, nausea, hypersensitivity reaction, hepatitis, AIDS).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage of drug, adverse effects to watch
for, specific measures to avoid them, and warning signs to report).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

Hemostatic Agents
Systemic
aminocaproic acid
Topical
absorbable gelatin
human fibrin sealant
microfibrillar collagen
thrombin
thrombin, recombinant
Nursing Assessment
o Assess for the following conditions, which could be cautions or contraindications to the use of systemic hemostatic
agents: any known allergies to any component of the drug to prevent hypersensitivity reactions; acute DIC because
 of the risk of tissue necrosis; renal and hepatic dysfunction, which could alter the excretion of these drugs and the
normal clotting processes; and lactation because of the potential for adverse effects on the neonate.
o Assess baseline status before beginning therapy to determine any potential adverse effects. Assess the following:
body temperature; skin color, lesions, and temperature; affect, orientation, and reflexes; pulse, blood pressure, and
perfusion; respirations and adventitious sounds; bowel sounds and normal output; urinalysis and clotting studies; and
renal and hepatic function tests.
Nursing Diagnoses
o Disturbed Sensory Perception related to CNS effects
o Acute Pain related to GI, CNS, or muscle effects
o Risk for Injury related to CNS or blood-clotting effects
o Deficient Knowledge regarding drug therapy
Implementation
o Monitor clinical response and clotting factor levels regularly to arrange to adjust dose as needed.
o Monitor the patient for any sign of thrombosis to arrange to use comfort and support measures as needed (e.g.,
support hose, positioning, ambulation, exercise).
o Orient the patient and offer support and safety measures if hallucinations or psychoses occur to prevent patient
injury.
o Offer comfort measures to help the patient deal with the effects of the drug. These include small, frequent meals;
mouth care; environmental controls; and safety measures.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse
effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient
knowledge about drug therapy and to promote compliance with the drug regimen.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
 Evaluation
o Monitor patient response to the drug (control of bleeding episodes).
o Monitor for adverse effects (thrombosis, CNS effects, nausea, hyper sensitivity reaction).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage of drug, adverse effects to watch
for, specific measures to avoid them, and warning signs to report).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

G. DRUGS USED TO TREAT ANEMIAS

(a) ERYTHROPOIESIS-STIMULATING AGENTS

darbepoetin alfa methoxy polyethylene
epoetin alfa glycol-epoetin beta

Nursing Assessment
o Assess for contraindications or cautions: any known allergies to any component of the drug to avoid
hypersensitivity reactions; severe hypertension, which could be exacerbated; and lactation because of potential
adverse effects on the neonate. These drugs should be used with caution in patients with anemia and normal renal
function to prevent rebound decrease in normal erythropoietin production and in patients with cancer receiving the
drugs to increase hematocrit after antineoplastic chemotherapy because of the risk of rapid tumor progression if
hemoglobin levels exceed guidelines.
 o Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine
drug effectiveness and evaluate any potential adverse effects.
o Assess neurological status, including affect, orientation, and muscle strength, to identify possible adverse CNS
effects.
o Monitor vital signs, including pulse and blood pressure, for changes, and assess cardiovascular status, to identify
possible cardiovascular effects; and inspect lower extremities for evidence of edema, which could indicate a change
in cardiovascular function.
o Assess respirations and auscultate lungs sounds for adventitious breath sounds for early detection of changes in
cardiovascular function.
o Monitor the results of laboratory tests, including renal function tests, complete blood count (CBC), hematocrit, iron
concentration, transferrin, and electrolyte levels, to evaluate the effectiveness of therapy. Be aware of variations
in hematological test results due to race
Nursing Diagnoses
o Nausea related to adverse GI effects
o Diarrhea related to GI effects
o Risk for Injury related to CNS effects
o Risk for Imbalanced Fluid Volume related to cardiovascular effects
o Deficient Knowledge regarding drug therapy
Implementation
o Confirm the chronic, renal nature of the patient’s anemia before administering the drug to treat renal failure anemia
to ensure proper use of the drug.
o Give epoetin alfa three times per week, either intravenously or subcutaneously, to achieve appropriate therapeutic
drug levels. Administer darbepoetin alfa once per week, subcutaneously or intravenously. Administer methoxy
 polyethylene glycol-epoetin beta once every 2 weeks, and then once a month when the patient is stabilized, by
subcutaneous injection to achieve appropriate therapeutic drug levels.
o Provide the patient with a calendar of marked days to aid in remembering dates for injection and promote increased
compliance with the drug regimen.
o Do not mix with any other drug solution to avoid potential incompatibilities
o Monitor access lines for clotting and arrange to clear line as needed.
o Ensure that prescribed laboratory testing, such as hematocrit levels, is completed before drug administration to
determine correct dose. If the patient does not respond within 8 weeks, re-evaluate the cause of anemia. Anticipate
a target hemoglobin range between 10 and 12 g/dL.
o Evaluate iron stores before and periodically during therapy because supplemental iron may be needed as the patient
makes more RBCs.
o Maintain seizure precautions on standby in case seizures occur as a reaction to the drug.
o Provide comfort measures to help the patient tolerate the drug effects. These include small, frequent meals to help
minimize nausea and vomiting; readily available access to bathroom facilities should diarrhea occur; and analgesia for
headache or arthralgia.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, administration technique and
frequency of administration, measures to avoid adverse effects, warning signs of problems and need to notify
health care provider, and the need for follow-up laboratory testing, to enhance patient knowledge about drug
therapy and to promote compliance.
Evaluation
o Monitor patient response to the drug (alleviation of anemia, target hemoglobin level a maximum of 12 g/dL).
o Monitor for adverse effects (headache, hypertension, nausea, vomiting, seizures, dizziness).
o Monitor the effectiveness of comfort measures and compliance with the regimen.
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and
specific measures to avoid them; patient understands the importance of continued follow-up).

(b) AGENTS USED FOR IRON-DEFICIENCY ANEMIA

ferrous fumarate ferrous sulfate exsiccated sodium ferric gluconate
ferrous gluconate iron dextran complex
ferrous sulfate iron sucrose

Nursing Assessment
o Assess for contraindications or cautions: any known allergies to this drug to avoid hypersensitivity reactions;
hyperchromatosis to avoid increasing already increased iron levels; colitis, enteritis, or peptic ulcer, which could
lead to increased GI irritation from the drug and exacerbation of the disorder; and hemolytic anemias, which could
increase serum iron levels and lead to toxicity.
o Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine
drug effectiveness and to evaluate for any potential adverse effects.
o Inspect the color and integrity of the skin and mucous membranes to identify potential signs and symptoms
associated with anemia and evaluate for possible adverse effects of the parenteral form.
o Assess patient’s neurological status, including level of orientation, affect, and reflexes, to identify possible CNS
effects and early signs of possible toxicity.
o Monitor pulse, blood pressure, and perfusion, and respirations and adventitious sounds, to check cardiovascular
function and detect early signs of toxicity.
o Inspect abdomen for distention and auscultate bowel sounds to evaluate GI motility.
o Inspect the skin integrity of the intended parenteral administration site to ensure intactness and evaluate for
possible staining.
o Monitor the results of laboratory tests, including CBC, hematocrit, hemoglobin, and serum ferritin assays, to
determine drug effectiveness and identify toxic levels.
Nursing Diagnoses
o Acute Pain related to CNS or GI effects or parenteral administration
o Nausea related to adverse GI effects
o Constipation related to adverse GI effects
o Disturbed Body Image related to drug staining of the skin from parenteral injection
o Risk for Injury related to CNS effects
o Deficient Knowledge regarding drug therapy
Implementation
o Ensure that iron-deficiency anemia is confirmed before administering drugs to ensure proper use of the drug.
o Consult with the physician to arrange for the treatment of the underlying cause of anemia if possible because iron
replacement will not correct the cause of the iron loss.
o Administer the oral form with meals that do not include eggs, milk, coffee, and tea to relieve GI irritation and nausea if
GI upset is severe and to prevent drug–food interactions; have the patient drink oral solutions through a straw to
prevent staining of teeth.
o Caution the patient that stool may be dark or green to prevent undue alarm if this occurs.
o Take measures to help alleviate constipation to prevent discomfort and the adverse effects of severe constipation.
o Administer intramuscularly only by Z-track technique to ensure proper administration and to avoid staining of the
tissues brown. Warn the patient that the injection can be painful.
o Arrange for hematocrit and hemoglobin measurements before administration and periodically during therapy to
monitor drug effectiveness.
o Provide comfort measures to help the patient tolerate drug effects. These include small, frequent meals to minimize
nausea and readily available access to bathroom facilities
o should constipation occur, and increased fiber and fluid intake and increased exercise to help alleviate constipation.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
o Provide thorough patient teaching, including the drug name, dosage and route of administration; administration
technique, such as parenteral Z-track injection or oral solution through a straw, and frequency of administration;
foods and fluids to avoid and to include to ensure proper absorption; need for increased fluids and fiber foods in diet
and exercise to prevent constipation; notification of change in stool color and consistency; potential for pain at site
and staining of skin with parenteral administration; measures to avoid adverse effects; warning signs of problems
and need to notify health care provider; and the need for follow-up laboratory testing, to enhance patient knowledge
about drug therapy and to promote compliance.
Evaluation
o Monitor patient response to the drug (alleviation of anemia).
o Monitor for adverse effects (GI upset and reaction, CNS toxicity, coma).
o Monitor the effectiveness of comfort measures and compliance with the regimen.
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and
specific measures to avoid them; patient understands the importance of continued follow-up).
(c) AGENTS USED FOR OTHER ANEMIAS
Agents forMegaloblastic Anemias
Folic Acid Derivatives
folic acid leucovorin levoleucovorin
Vitamin B 12
cyanocobalamin hydroxocobalamin

Agent for Sickle Cell Anemia

hydroxyurea

Assessment
o Assess for contraindications or cautions: any known allergies to these drugs or drug components, other anemias,
pregnancy, lactation, and nasal erosion.
o Assess baseline status before beginning therapy to determine any potential adverse effects. This includes affect,
orientation, and reflexes; pulse, blood pressure, and perfusion; respirations and adventitious sounds; and CBC,
hematocrit, and iron levels, to determine the effectiveness of drug therapy.
Nursing Diagnoses
o Acute Pain related to injection or nasal irritation
o Risk for Fluid Volume Imbalance related to cardiovascular effects
o Deficient Knowledge regarding drug therapy
Implementation
o Confirm the nature of the megaloblastic anemia to ensure that the proper drug regimen is being used.
o Give both types of drugs in cases of pernicious anemia to ensure therapeutic effectiveness.
o Parenteral vitamin B 12 must be given intramuscularly each day for 5 to 10 days and then once a month for life if used
to treat pernicious anemia.
o Arrange for nutritional consultation to ensure a well-balanced diet.
o Monitor for the possibility of hypersensitivity reactions; have life support equipment on standby in case reactions
occur.
o Arrange for hematocrit readings before and periodically during therapy to monitor drug effectiveness.
o Provide comfort measures to help the patient tolerate drug effects. These include small, frequent meals, access to
bathroom facilities, and analgesia for muscle or nasal pain.
o Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse
effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient
knowledge about drug therapy and to promote compliance with the drug regimen.
o Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.
Evaluation
o Monitor patient response to the drug (alleviation of anemia).
o Monitor for adverse effects (nasal irritation, pain at injection site, nausea).