Keynotes for medication used in cardiac patients

Digoxin: (used in atrial fibrillation/atrial flutter/heart failure)

Actions:
(i) slows the speed of electrical conduction
(ii) increases the force of contraction
(iii) enhances diuresis
Nursing intervention:
(i) Assess vital signs, esp. heart rate to detect digoxin toxicity
(ii) Assess other complaints related to digoxin toxicity, such as visual disturbance, abdominal pain, and chest
discomfort (probably due to dysrhythmias)
(iii) Check HR for 1 minute before administration of digoxin; if <60/min, withhold the medication
(iv) Regularly check blood for digoxin level to rule out digoxin toxicity
Amiodarone:
i. slows the speed of electrical conduction including the pathway of arrhythmias
ii. prolongs repolarization
Nursing intervention:

• Assess respiratory function such as RR and SpO2

• Assess and monitor lung function such as lung function test as the severe side effect is pulmonary
toxicity/fibrosis
• Fall prevention should be done if IV administration is given due to rapid drug action on heart rate and
blood pressure (bradycardia and hypotension).
Nitroglycerin (TNG)
Administration: sublingual or IV (IV responds faster)
Prescription: PRN only (Given when patient complain chest pain); no frequency
Action: Vasodilator
Purpose of the use: dilate the coronary artery to improve perfusion and reduce ischemia
Side effects: headache, flushing, Bp drops
Nursing intervention: (targeting action & side effects)
• Assess PQRST (chest pain assessment)
• Assess vital signs especially BP
• Inform doctor if the third dose is needed.
• Fall precaution/prevention of fall or injury due to hypotension
Anticoagulants (Warfarin, Aspirin, thrombolytic therapy)
Administration: Oral (warfarin and aspirin) or IV (Thrombolytic therapy)
Prescription: Thrombolytic therapy –screening for eligibility must be done before administration
Warfarin: mainly prevents thrombus formation due to stasis of blood in atrial fibrillation
atrial flutter.
Action: anticoagulant…prolong blood clotting
Purpose of the use: prevent thrombus formation
Side effects: bleeding tendency
Nursing intervention: (targeting action & side effects)
• Assess bleeding/bruising
• Fall precaution/prevention of fall or injury, such as dry floor thoroughly, adequate lighting, lowering the
bed, and raising up the bedrail, due to bleeding tendency
• Minimize injections and punctures
• Avoid using shaver
• Apply pressure to the bleeding point at least 5 to 10 minutes to make sure coagulation.
• Recommend to use soft toothbrush to prevent gum injury
• Assist in checking blood regularly for clotting profile (PT, APTT, INR)

MONA
Oxygen targets at SpO2 > 95%
Rationale: Oxygen therapy increases oxygenation contributing to increase the oxygen supply to the myocardium
Nursing consideration: Oxygen toxicity
Nitroglycerin
Rationale: acts as a vasodilator to increase pooling of blood in order to increase oxygen and nutrient supply to
myocardium.
Nursing consideration: Hypotension and headache. Prevention of fall should be taken into account. TNG can be
administered up to 3 doses but need to inform the doctor if pain still persists.
Morphine
Actions: i) sedative effect to reduce anxiety, ii) reducing pain to promote comfort, iii) mild vasodilation effect to
improve coronary circulation
Nursing consideration: i) monitor respiratory status such as RR and SpO2 due to respiratory suppression effect;
ii) monitor blood pressure and fall prevention because of hypotensive effect
Aspirin
Rationale: aims to prevent platelet aggregation and reduce the incidence of MI and death in patients with CAD.
Nursing consideration: Gastro-intestinal bleeding (GIB); N2 blockers such as famotidine or proton pump
inhibitors, such as omeprazole, should be given to prevent GIB