Class: Alpha2-Adrenergic Agonists

Agent(s) Common Uses Contraindications Route Onset of Action Interactions

Clonidine (Catapres) Hypertension Narrow-angle PO 30 min - 2 hours Do not give with Beta
Methyldopa Management of Glaucoma Blockers – accentuates
opioid withdrawal bradycardia and rebound
(Aldomet) Cardiogenic Shock Transdermal 2-3 days
Dysrhythmias patch hypertension of therapy
(Clonidine) discontinuation.

Mechanism of Action

Decreases the release of norepinephrine from sympathetic nerves and decreases peripheral adrenergic receptor activation.
Produce vasodilation which decreases blood pressure.
Advantages/Disadvantages
Side Effects Adverse Effects

Methyldopa can be used in PIH Sedation Orthostatic hypotension

Dizziness Pulmonary edema
Headache Dyspnea
Can cause sodium and water retention. Nausea/Vomiting
Often given with diuretics for this reason. Urinary retention
Dry mouth

Nursing Interventions Client Education

Monitor vital signs Do not stop abruptly: rebound hypertension can occur.
Monitor liver enzymes Instruct on how to take BP
I&O
Daily weight

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Angiotensin-converting Enzyme (ACE) Inhibitors
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Captopril (Capoten), DOC for Heart failure Do not give during PO 1-2 hours Hyperkalemia can result if
Enalapril (Vasotec), Hypertension pregnancy taken in combination with
MI potassium-sparing diuretics
Lisinopril (Zestril, IV 15-30 minutes
Prinivil), or eating salt substitutes.
Moexipril (Univasc),
Ramipril (Altace)

Mechanism of Action

Suppress the Renin Angiotensin System (RAS). Prevents the conversion of Angiotensin I to Angiotensin II. This results in arterial
dilation and increased stroke volume. ACE inhibitors block aldosterone so the client loses sodium and water and retains potassium.
Advantages/Disadvantages
Side Effects Adverse Effects

Effective in treating heart failure. Dizziness Angioedema

Hyperkalemia Orthostatic hypotension
African Americans and older adults do Hypermagnesemia
not respond to ACE inhibitors with the Fatigue
desired reduction in blood pressure Headache
without the addition of a diuretic. Dry, nonproductive cough

Nursing Interventions Client Education

Monitor BP and HR. Rise slowly from lying or sitting to standing position.
Monitor potassium and magnesium levels. Safety precautions.
Initiate safety precautions. Can be administered with food (EXCEPT: Moexipril)
Do not use salt substitutes with potassium.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Angiotensin II Receptor Blockers (ARBS)
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Losartan (Cozaar), Hypertension Pregnancy PO 2 hours MAOIs, alcohol,
Olmesartan (Benicar), Heart Failure diuretics may increase
Valsartan (Diovan) hypotensive effects.
ACE inhibitors and
ASA may increase
hyperkalemia and renal
dysfunction.

Mechanism of Action

Prevent the release of aldosterone. They act on the renin-angiotensin system (RAS). ARBS block angiotensin II from the
angiotensin I receptors found in tissue. Potent vasodilator. Decreases peripheral resistance. Decrease the workload of the heart by
decreasing afterload. This will increase cardiac output and keep blood moving forward out of the heart.
Advantages/Disadvantages
Side Effects Adverse Effects

Do not cause the constant, irritating dry Headache Orthostatic hypotension

cough that ACE inhibitors do. Dizziness Hypoglycemia
Drowsiness Hyperkalemia
Less effective for treating hypertension in GI complaints Renal dysfunction
African-American clients. Fatigue Angioedema

Nursing Interventions Client Education

Monitor BP and HR. Rise slowly from lying and sitting position to standing position.
Monitor AST, ALT, BUN, Creatinine. Safety precautions.
Can be taken on empty or full stomach.
Do not use salt substitutes.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antianginal / Nitrates
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Nitroglycerin Angina Pre-existing SL – 1 tab every SL /IV – 1-3 min Enhance hypotensive
(Nitrostat, Nitro-Bid) MI Hypertension 5 min. up to 3 PO – 20-30 min effects: Beta blockers,
Pulmonary Calcium channel blockers,
Isosorbide (Isordil) Head trauma doses. Ointment – 20-60 min
edema Vasodilators, Alcohol,
Increased ICP Tablet Transdermal – 30-60
Erectile dysfunction meds
Pericardial tamponade Spray min May antagonize effects of
Heparin: IV nitroglycerin

Mechanism of Action
Acts directly on the smooth muscle of venous and arterial blood vessels, causing relaxation and dilation. Dilates coronary arteries. Sublingual
administration rapidly absorbs into the internal jugular vein and right atrium. IV nitroglycerin vasodilates the client to decrease afterload which
increases cardiac output, so that more blood can be pumped forward.
Advantages/Disadvantages
Side Effects Adverse Effects

Decreases preload, afterload, and Headache Faintness/Syncope Hypotension

workload of the heart Nausea/vomiting Dizziness Reflex Tachycardia
Increases blood flow to heart muscle Flushing Palpitations Paradoxical Bradycardia
Reduces myocardial oxygen demand
Diaphoresis Tolerance Circulatory Collapse
Contact dermatitis with topical

Nursing Interventions Client Education

Monitor Blood pressure. Activate EMS if pain unrelieved after taking 1 tab SL or spray.
Do not leave client until BP stabilizes. Do not swallow SL nitro.
Assess cardiac output. Keep in dark, glass bottle.
Evaluate pain relief. Do not mix medications in bottle with nitroglycerin.
Safety precautions. Do not open bottle frequently.
Maintain adequate hydration. Keep dry and cool.
IV: Use a pump; hold for systolic BP < 100 May or may not burn or fizz in mouth.
Renew every 3-5 months; 2 years of spray.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidysrhythmic Class III
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Amiodarone Used when V-fib Cardiogenic shock IV Rapid MAOIs-hyperpyretic
(Cordarone) and pulseless V-tach 2nd degree heart block crisis, seizures.
are resistant to a
3rd degree heart block PO
vasopressor and
defibrillation. Iodine allergy
Fast arrhythmias.

Mechanism of Action

Prolongs duration of action potential and refractory period to decrease heart rate. Decreases peripheral vascular resistance and
increases PR and QT intervals. First antiarrhythmic of choice.
Advantages/Disadvantages
Side Effects Adverse Effects

Very little negative inotropic activity Photophobia Hypotension Bradycardia

making it advantageous for use in clients Weakness Difficulty breathing Wheezing
with heart failure. Skin discoloration Chest pain Light-headed
Potentially serious side effects requiring Tremors Vision loss Jaundice
careful monitoring. Impaired thinking/reactions

Nursing Interventions Client Education

IV: Continuous ECG monitoring and BP monitoring Do not skip a dose or discontinue abruptly.
PO: Assess BP lying, standing. If systolic BP drops 20 mmHg, hold. Do not take with grapefruit juice.
Monitor Hepatic studies: AST, ALT, bilirubin. Use sunscreen or stay out of sun to prevent burns.
Dark glasses may be needed for photophobia.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Antidysrhythmic Class Ib
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Lidocaine Frequent PVCs Adams-Stokes IV 45-90 seconds Lidocaine toxicity
(Xylocaine) Ventricular tachycardia syndrome – cimetidine, beta
Alternative antiarrhythmic agent to blockers.
Heart block
amiodarone in the treatment of cardiac
arrest secondary to VF or pulseless
Increase
VT resistant to CPR, cardioversion lidocaine effects
(after 2 to 3 shocks) and a vasopressor – barbiturates,
(epinephrine). ciprofloxacin

Mechanism of Action

Decreases irritability of the heart muscle. Increases electrical stimulation threshold of ventricles, which stabilizes cardiac
membrane and decreases automaticity.
Advantages/Disadvantages
Side Effects Adverse Effects

Headache Heart block Seizures

Dizziness CNS depression
Drowsiness Respiratory depression
Severe adverse effects from lidocaine toxicity Blurred vision Malignant hyperthermia
Phlebitis Lidocaine toxicity

Nursing Interventions Client Education

Administer IVP at a rate of 25-50 mg/minute. Monitor lidocaine blood levels. About the use of lidocaine.
Continuous ECG monitoring. Observe for prolonged PR interval and QRS Report signs of toxicity (hearing impairment,
complex. muscle twitching, confusion)
Have resuscitative equipment readily available.
Watch for malignant hyperthermia: tachypnea, tachycardia, changes in BP,
increased temperature.
Monitor for signs of toxicity (hearing impairment, muscle twitching, confusion,
seizures).

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Anti-hypertensive / Beta-Adrenergic Blockers (Beta Blockers)
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Atenolol (Tenormin) Hypertension 2nd & 3rd degree - PO PO - 15 minutes Digitalis worsens bradycardia.
Metoprolol Angina Heart block IV IV - Immediate Other antihypertensives and
Dysrhythmias alcohol worsen htn.
(Lopressor) Cardiogenic shock NSAIDS, Licorice, ma-haung,
MI
Propranolol (Inderal)
Unlabeled Use: Hypotension ephedra decrease effect
Carvedilol (Coreg) Migraines; Acute Heart Failure of beta blockers causing
Tachycardia due to Sinus Bradycardia hypertension.
stage fright. Black cohosh, Hawthorn,
Parsley, Goldenseal increase
hypotensive effect.

Mechanism of Action

Blocks beta receptor cells (catecholamines) to decrease vascular resistance, decrease BP, decrease HR, decrease myocardial
contractility, decrease workload of the heart, decrease cardiac output, decrease renin release.
Advantages/Disadvantages
Side Effects Adverse Effects

Well tolerated in low doses. Blurred vision Mental changes Bradycardia

Nasal stuffiness Photosensitivity Hypotension
Sexual dysfunction Fatigue 2nd & 3rd degree Heart block
African Americans do not respond well Weakness Dizziness Thrombocytopenia
to Beta Blockers alone for control of
Lethargy Nausea/ Vomiting Bronchospasm
HTN. Use in conjunction with diuretics
Diarrhea Headache Wheezing
Depression Insomnia

Nursing Interventions Client Education

Monitor for increased BUN, Creatinine, AST, LDH, Glucose. Teach how to take radial pulse and BP.
Do not discontinue abruptly: Rebound HTN, angina, dysrhythmias, MI Rise slowly to prevent postural hypotension.
can result. May cause sexual dysfunction.
Monitor BP & pulse. Report constipation: Eat foods high in fiber.
Hold for HR < 60 / min.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Calcium Antagonists / Calcium Channel Blockers
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Amlodipine Angina Heart Block PO 10-30 minutes Increased levels of digitalis,
(Norvasc), Diltiazem Hypertension Hypotension IV 3 minutes theophylline.
Dysrhythmias Decreased effects of lithium.
(Cardizem), Severe heart failure
Migraines Increased hypotensive
Ranolazine (Ranexa)
Raynaud’s Disease effects with grapefruit juice.

Mechanism of Action

Blocks the calcium channel in the vascular smooth muscle cells. This causes vasodilation of the arterial system to decrease arterial
resistance and decrease blood pressure. This decreases afterload, which decreases the workload of the heart. These medications
dilate the coronary arteries so more oxygen reaches the heart muscle.
Advantages/Disadvantages
Side Effects Adverse Effects

Decreases afterload and increases GI upset Ankle edema Bradycardia

oxygen to the heart muscle. Dermatitis Flushing Reflex Tachycardia
Decreases BP better in African Headache Dizziness Heart Block
Americans than drugs in other categories Hypotension
Need to reduce dose with known liver Dyspnea
disease Wheezing

Nursing Interventions Client Education

Taper dose: Do not discontinue abruptly. Do not stop taking abruptly. Rise slowly.
Monitor BP, HR – Notify PHCP for HR < 50 or Systolic BP < 90. Increase fluids and fiber to counteract constipation.
Monitor for increased AST, ALT, Alk phosphatase, BUN, Creatinine, Teach how to take pulse and BP.
and cholesterol. Avoid hazardous activities until dizziness is no longer a
problem. Avoid grapefruit products.
Report chest pain, palpitations, irregular heart rate, swelling
of extremities, tremor

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Cardiac Glycosides
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Digoxin (Lanoxin, Heart failure Ventricular PO 30 min-2 hours. Loop diuretics can cause
Digitek) Atrial fibrillation dysrhythmias. hypokalemia and dig toxicity.
Heart blocks IV 5-30 min. Ginseng may elevate digoxin
levels
St John’s wort decreases
absorption of digoxin.
Decrease dig absorption with
antacids.

Mechanism of Action

Promotes increased force of cardiac contraction, cardiac output, and tissue perfusion. Decreases ventricular rate. So heart
contraction is stronger, heart rate slows down. This allows more blood to be ejected out of the ventricles in a forward
direction.
Advantages/Disadvantages
Side Effects Adverse Effects

Headache Dig toxicity: anorexia, n/v, weird arrhythmias,

Dizziness vision changes.
Can cause digoxin toxicity. elderly are
Heart block
more prone to dig toxicity
Nursing Interventions Client Education

Monitor Digoxin level (Normal 0.5-2 ng/mL) Teach client how to take pulse.
Monitor potassium (Low K+ can increase risk for dig toxicity) Teach the signs of dig toxicity.
Monitor apical pulse. Hold dig for HR < 60 bpm in adults.
Administer IV dose slowly over 5 minutes.
Monitor for signs of dig toxicity: anorexia, nausea/vomiting, weird
arrhythmias, vision changes.
Antidote: Digoxin immune Fab (Digibind)

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Catecholamine
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Norepinephrine Shock Hypersensitivity IV 1-2 minutes Increase pressor effect
(Levophed) Acute hypotension Tachy dysrhythmias with tricyclics, MAOIs.
Pheochromocytoma Decreased
Hypovolemia norepinephrine action
with alpha blockers.

Mechanism of Action

Potent vasoconstrictor action (alpha-adrenergic effect). It is used in shock states, often when drugs such as dopamine and
dobutamine have failed to produce adequate blood pressure. Causes increased contractility and heart rate by acting on beta
receptors of the heart.
Advantages/Disadvantages
Side Effects Adverse Effects

Headache Anxiety Myocardial ischemia/Dysrhythmias

Dizziness Insomnia Impaired organ perfusion
Has potential to impair cardiac Tremor Palpitations Tissue necrosis with extravasation.
performance and decrease organ and Nausea/vomiting Cerebral hemorrhage
tissue perfusion. Anaphylaxis

Nursing Interventions Client Education

Correct hypovolemia prior to use. Reason for drug administration

Continuous cardiac monitoring.
Precise blood pressure monitoring and HR every 2-3 min.
Taper drug slowly as abrupt discontinuation can result in severe
hypotension.
Monitor IV site for extravasation frequently. If extravasation occurs,
inject with phentolamine.
I&O

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Direct Acting Vasodilators
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Hydralazine Hypertension Systemic Lupus PO 20-30 min Increase antihypertensive
(Apresoline) Hypertensive crisis effects: ACE inhibitors,
Severe heart failure vasodilators, diuretics,
Nitroprusside Severe tachycardia IV Rapid
Acute MI with
(Nipride)
hypertension and with heart failure alcohol, MAOIs, tricyclic
persistent chest pain and antidepressants,
/or left ventricular failure hawthorn.

Mechanism of Action

Relaxes smooth muscles of the blood vessels, mainly arteries, causing vasodilation. Promotes an increase in blood flow to the
brain and kidneys.
Advantages/Disadvantages
Side Effects Adverse Effects

Nitroprusside is a potent vasodilator that Headache Reflex tachycardia

rapidly decreases BP in hypertensive crisis. Dizziness Hypotension
Hyperglycemia Rebound hypertension
Adverse effects eliminate use of these drugs Sodium and water retention
as drug of choice. Peripheral edema

Nursing Interventions Client Education

Monitor vital signs, I&O, glucose. Purpose of medication

Daily weight Safety precautions
Nitroprusside: Monitor BP frequently with continuous cardiac Move slowly from lying or sitting to standing position.
monitoring.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Direct Vasodilators
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Nesiritide (Natrecor) Acute treatment of heart Valvular stenosis IV 15 minutes
failure in clients with Cardiomyopathy
dyspnea at rest
Pericardial tamponade
and/or minimal activity.

Mechanism of Action

A B-type natriuretic peptide, which is normally produced by the ventricular myocardium. It relaxes and dilates blood vessels,
lowering blood pressure.
Advantages/Disadvantages
Side Effects Adverse Effects

Useful for clients decompensating from Headache Hypotension

acute heart failure Dizziness Irregular HR
Nausea/Vomiting Chest pain
For short term IV use only: up to 48 hrs. Fever
Nephrotoxic Unusual weakness

Nursing Interventions Client Education

Monitor creatinine level Purpose of medication

Monitor vital signs, hourly urine output Report s/s of allergic reaction.
ECG monitoring
Daily weight
Monitor for allergic reaction (rash, pruritus, laryngeal edema, wheezing).

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Oxygen
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Oxygen Hypoxemia Use cautiously in clients NC
Severe anemia who have lost hypoxic Face mask
Carbon monoxide
respiratory drive. Non-rebreather face
poisoning
Shock However, never deny mask
Heart failure oxygen to someone who ET
needs it. CPAP/BiPAP

Mechanism of Action

Inadequate oxygenation produces hypoxemia and significant physiologic changes to all body systems, therefor oxygen is a
first-line drug for all emergency situations. Oxygen also acts as a potent pulmonary vasodilator and is beneficial for clients in
heart failure.
Advantages/Disadvantages
Side Effects Adverse Effects

Dry or bloody nose Oxygen toxicity

Skin irritation
An FiO2 above 50% for a prolonged Morning headaches
period can lead to oxygen toxicity and Fatigue
detrimental effects to the pulmonary
system. ET: mucus plugs, tracheal injury, infection, ET
misplacement

Nursing Interventions Client Education

Make sure that the client’s airway and breathing are adequate to Purpose of oxygen therapy.
promote optimal oxygenation and ventilation.
Monitor pulse oximetry. Optimal oxygen saturation is at or above Fire risk: Do not smoke or have open flame around oxygen
94%. source.
Notify primary healthcare provider for oxygen saturation less than
90%.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Phosphodiesterase Inhibitors
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Milrinone (Primacor) Short term Acute MI IV (no longer 2-5 minutes Increased effect with
Inamrinone (Inocor) management of heart Severe pulmonic than 48-72 other antihypertensives
failure and diuretics
valvular disease hours)

Mechanism of Action

Inhibits the enzyme phosphodiesterase, promoting a positive inotropic response and vasodilation. Stroke volume and cardiac
output are increased.
Advantages/Disadvantages
Side Effects Adverse Effects

Headache Ventricular arrhythmias

NauseaVomiting Hypotension
Anorexia Chest pain
Do to risk of toxicity these medications Thrombocytopenia
are generally reserved for clients who
do not respond to cardiac glycosides or
ACE inhibitors.
Nursing Interventions Client Education

Continuous cardiac monitoring. BP & pulse every 5 minutes Purpose of medication

I&O Report angina immediately.
Daily weight
Monitor electrolytes, liver function

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Sympathomimetic with Beta Adrenergic activities
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Dobutamine Shock Hypersensitivity IV 1-2 minutes Increased pressor effect
(Dobutrex) Aortic stenosis and dysrhythmias with
tricyclics, MAOIs.

Mechanism of Action

The beta1 effects enhance the force of myocardial contraction (positive inotropic effect) and increasing heart rate (positive
chronotropic effect). The beta 2 effects produce mild vasodilation
Advantages/Disadvantages
Side Effects Adverse Effects

Blood pressure is elevated only through Headache Nausea Dose related:

the increase in cardiac output. Tremors Anxiety Myocardial ischemia
Dizziness Fatigue Tachycardia Dysrhythmias
Palpitations Hypotension Hypertension
Hypokalemia

Nursing Interventions Client Education

Correct hypovolemia prior to use. Reason for drug administration

Usual IV dose is 2-20 mcg/kg/min. Administer via electronic infusion
pump for precision. Taper gradually to avoid clinical deterioration.
Continuous cardiac and blood pressure monitoring.
I&O
Monitor vital signs
Assess for signs of myocardial ischemia.
Continuous ECG monitoring

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Vasopressor/Catecholamine
Agent(s) Common Uses Contraindications Route Onset of Action Interactions
Epinephrine HCL Cardiac arrest Closed-angle glaucoma IVP in Rapid Do not use with
(Adrenalin) Asystole cardiac MAOIs or tricyclics –
V-fib hypertensive crisis may
arrest
Acute asthmatic
attacks
occur.
Anaphylaxis

Mechanism of Action

Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of the blood vessels (arteries and veins)
causing direct vasoconstriction, thus, improving perfusion pressure to the brain and heart.
Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This indirectly improves cardiac output by
increasing heart rate, heart muscle contractility, and conductivity through the AV node

Advantages/Disadvantages
Side Effects Adverse Effects

Used to stimulate the heart muscle. Tremors Palpitations Cerebral hemorrhage

Headache Hypertension bronchospasms
Dizziness Nausea/Vomiting

Nursing Interventions Client Education

WARNING: Ensure that the correct concentration, 1:10,000 is Reason for medication during a code.
administered IV (Not 1:1,000)

Elevate extremity for 10-20 seconds to facilitate drug delivery to the

central circulation.
Auscultate lungs
Monitor pulse, BP, respirations.
Continuous cardiac monitoring
Do not administer in same IV site as Sodium Bicarbonate.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis