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CARDIOVASCULAR MEDICATIONS
ANTERIOR VIEW OF THE HEART
From Ignatavicius, D. & Workman, M. (2002). Medical-surgical nursing:
Critical thinking for collaborative care, ed 4, Philadelphia: W.B. Saunders.
MAJOR ARTERIES
Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
MAJOR VEINS
Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
PYRAMID POINTS
• Monitoring specific laboratory values such as the
activated partial thromboplastin time (aPTT),
prothrombin time (PT), international normalized
ratio (INR), cardiac enzymes, and cholesterol and
triglyceride levels
• Dietary measures related to the administration of
cardiac medications
• Monitoring for side effects of medications
• Toxic effects of digoxin (Lanoxin)
PYRAMID POINTS
• Significant laboratory values
• Beta-blockers, calcium channel blockers,
diuretics, and antihypertensive medications
• Client teaching related to nitroglycerin
• Monitoring for therapeutic effects of cardiac
medications
• Client teaching related to the administration of
medications and potential adverse effects
ANTICOAGULANTS
• DESCRIPTION
– Prevent the extension and formation of clots
by inhibiting factors in the clotting cascade
and decreasing blood coagulability
– Used for thrombosis, pulmonary embolism,
and myocardial infarction (MI)
– Contraindicated with active bleeding, except
for disseminated intravascular coagulation
(DIC), bleeding disorders or blood dyscrasias,
ulcers, liver and kidney disease, and spinal
cord or brain injuries
ANTICOAGULANTS
• SIDE EFFECTS
– Hemorrhage
– Hematuria
– Epistaxis
– Ecchymosis
– Bleeding gums
– Thrombocytopenia
– Hypotension
SUBSTANCES TO AVOID WITH
ANTICOAGULANTS
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Green leafy vegetables and foods high in vitamin K
Allopurinol (Zyloprim)
Cimetadine (Tagamet)
Corticosteroids
Nonsteroidal antiinflammatory drugs (NSAIDs)
Oral hypoglycemic agents
Phenytoin (Dilantin)
Salicylates
Sulfonamides
HEPARIN SODIUM (LIQUAEMIN SODIUM)
• DESCRIPTION
– An anticoagulant
– Prevents thrombin from converting fibrinogen
to fibrin
– Prevents thromboembolism
– The therapeutic dose does not dissolve clots,
but prevents new thrombus formation
HEPARIN SODIUM (LIQUAEMIN SODIUM)
• BLOOD LEVELS
– Normal aPTT time is 20 to 36 seconds
– Maintain aPTT at 1.5 to 2.5 times normal
– At therapeutic levels, heparin will increase the
aPTT by a factor of 1.5 to 2
– The aPTT should be measured every 4 to 6
hours during initial therapy, then on a daily
basis
HEPARIN SODIUM (LIQUAEMIN SODIUM)
• BLOOD LEVELS
– If the aPTT is too long (greater than 80
seconds), the dosage should be lowered
– If aPTT is too short (less than 60 seconds), the
dosage should be increased
– Normal clotting time is 8 to 15 minutes;
maintain the clotting time at 15 to 20 minutes
HEPARIN SODIUM (LIQUAEMIN SODIUM)
• IMPLEMENTATION
– Monitor clotting time and aPTT
– Monitor platelet count
– Observe for bleeding gums, bruises,
nosebleeds, hematuria, hematemesis, occult
blood in the stool, and petechiae
HEPARIN SODIUM (LIQUAEMIN SODIUM)
• IMPLEMENTATION
– When administering heparin subcutaneously,
inject into the abdomen using a small needle
(25- to 28-gauge) at a 90-degree angle and do
not aspirate or rub the injection site
– Instruct the client regarding measures to
prevent bleeding
– Antidote: protamine sulfate
WARFARIN SODIUM (COUMADIN)
• DESCRIPTION
– An anticoagulant
– Decreases prothrombin activity and prevents
the use of vitamin K by the liver
– Used for long-term anticoagulation
– Prolongs clotting time and is monitored by the
prothrombin time (PT)
WARFARIN SODIUM (COUMADIN)
• DESCRIPTION
– Used mainly to prevent thromboembolitic
conditions such as thrombophlebitis,
pulmonary embolism, and embolism formation
caused by atrial fibrillation, thrombosis,
myocardial infarction (MI), or heart valve
damage
– Usually given for 2 to 3 months after an MI to
decrease the incidence of deep vein
thrombosis and thromboembolism
WARFARIN SODIUM (COUMADIN)
• BLOOD LEVELS
– PT
• Average PT is 9.6 to 11.8 seconds
• Warfarin sodium prolongs the PT
WARFARIN SODIUM (COUMADIN)
• BLOOD LEVELS
– INR
• The normal INR is 1.3 to 2.0
• An INR of 2 to 3 is appropriate for most
clients, although for some clients, the target
INR is 3.0 to 4.5
• If the INR is below the recommended range,
warfarin sodium should be increased
• If the INR is above the recommended range,
warfarin sodium should be reduced
WARFARIN SODIUM (COUMADIN)
• IMPLEMENTATION
– Monitor PT and INR
– Observe for bleeding gums, bruises,
nosebleeds, hematuria, hematemesis, occult
blood in the stool, and petechiae
– Instruct the client regarding measures to
prevent bleeding
– Antidote: vitamin K, phytonadione
(AquaMEPHYTON)
THROMBOLYTIC MEDICATIONS
• DESCRIPTION
– Activate plasminogen; plasminogen generates
plasmin (the enzyme that dissolves clots)
– Used early in the course of myocardial infarct
(within 4 to 6 hours of the onset of the infarct)
to restore blood flow, limit myocardial damage,
preserve left ventricular function, and prevent
death
THROMBOLYTIC MEDICATIONS
• CONTRAINDICATIONS
– Active internal bleeding
– History of cerebrovascular accident (CVA)
– Intracranial problems
– Intracranial surgery or trauma within the
previous 2 months
THROMBOLYTIC MEDICATIONS
• CONTRAINDICATIONS
– History of thoracic, pelvic, or abdominal
surgery in the previous 10 days
– History of hepatic or renal disease
– Uncontrolled hypertension
– Recent prolonged cardiopulmonary
resuscitation (CPR)
THROMBOLYTIC MEDICATIONS
• SIDE EFFECTS
– Bleeding
– Dysrhythmias
– Fever
– Allergic reactions
THROMBOLYTIC MEDICATIONS
• IMPLEMENTATION
– Obtain aPTT, PT, fibrinogen level, hematocrit,
and platelet count
– Monitor vital signs
– Assess pulses
– Monitor for bleeding; check all excretions for
occult blood
– Monitor for neurological changes such as
slurred speech, lethargy, confusion, and
hemiparesis
THROMBOLYTIC MEDICATIONS
• IMPLEMENTATION
– Monitor for hypotension and tachycardia
– Avoid injections if possible; apply direct
pressure over a puncture sites for 20 to 30
minutes
– Handle the client as little as possible when
moving
– Discontinue the medication if bleeding
develops and notify the physician
– Instruct the client in measures to prevent
bleeding
THROMBOLYTIC MEDICATIONS
• ANTIDOTE
– Aminocaproic acid (Amicar)
– Used only in acute, life-threatening conditions
ANTIPLATELET MEDICATIONS
• DESCRIPTION
– Inhibit the aggregation of platelets in the
clotting process, thereby prolonging the
bleeding time
– May be used in conjunction with
anticoagulants
– Used in the prophylaxis of long-term
complications following MI, coronary
revascularization, and CVAs
– Contraindicated in bleeding disorders and
known sensitivity
ANTIPLATELET MEDICATIONS
• SIDE EFFECTS
– Bruising
– Hematuria
– Gastrointestinal (GI) bleeding
– Tarry stools
ANTIPLATELET MEDICATIONS
• IMPLEMENTATION
– Determine sensitivity prior to administration
– Monitor vital signs
– Monitor bleeding time
– Monitor for side effects related to bleeding
– Instruct the client to take medication with food
if GI upset occurs
– Instruct the client to monitor for side effects
related to bleeding and in the measures to
prevent bleeding
POSITIVE INOTROPIC/CARDIOTONIC
MEDICATIONS
• DESCRIPTION
– Stimulates myocardial contractility and
produces a positive inotropic effect
– The increase in myocardial contractility
increases cardiac, peripheral, and kidney
function by increasing cardiac output,
decreasing preload, improving blood flow to
the periphery and kidneys, decreasing edema,
and increasing fluid excretion; as a result, fluid
retention in the lungs and extremities is
decreased
POSITIVE INOTROPIC/CARDIOTONIC
MEDICATIONS
• AMRINONE (INOCOR)
– Used for short-term management of
congestive heart failure in those who have not
responded adequately to cardiac glycosides,
diuretics, and vasodilators
• MILRINONE (PRIMACOR)
– Used for short-term management of
congestive heart failure or may be given prior
to heart transplantation
POSITIVE INOTROPIC/CARDIOTONIC
MEDICATIONS
• SIDE EFFECTS
– Headache
– Dysrhythmias
– Hypotension
– Thrombocytopenia
POSITIVE INOTROPIC/CARDIOTONIC
MEDICATIONS
• TOXIC/ADVERSE REACTIONS
– Hepatotoxicity manifested by elevated liver
enzyme levels
– Hypersensitivity manifested by wheezing,
shortness of breath, pruritus, urticaria, clammy
skin, and flushing
POSITIVE INOTROPIC/CARDIOTONIC
MEDICATIONS
• IMPLEMENTATION
– For intravenous (IV) administration
• Do not dilute with dextrose-containing
solutions
• For continuous IV, administer using an
infusion pump
• Stop infusion if the client’s blood pressure
(BP) drops or dysrhythmias occur
– Monitor apical pulse and BP
– Monitor for hypersensitivity
– Assess lung sounds for wheezing and rales
POSITIVE INOTROPIC/CARDIOTONIC
MEDICATIONS
• IMPLEMENTATION
– Monitor for edema
– Monitor for relief of congestive heart failure
(CHF) as noted by reduction in edema,
lessening of dyspnea, orthopnea, and fatigue
– Monitor electrolytes, liver enzymes, platelet
count, and renal function studies; may
decrease potassium level and increase liver
enzymes
CARDIAC GLYCOSIDES
• DESCRIPTION
– Inhibit sodium potassium pump, thus
increasing intracellular calcium, which causes
the heart muscle fibers to contract more
efficiently
– Produce a positive inotropic action, which
increases the force of myocardial contractions
– Produce a negative chronotropic action, which
depresses the sinoatrial (SA) node, reduces
conduction of the impulse through the
atrioventricular (AV) node, and slows the heart
rate
CARDIAC GLYCOSIDES
• DESCRIPTION
– Produces a negative dromotropic action that
decreases the conduction of the heart cells
– The increase in myocardial contractility
increases cardiac, peripheral, and kidney
function by increasing cardiac output,
decreasing preload, improving blood flow to
the periphery and kidneys, decreasing edema,
and increasing fluid excretion; as a result, fluid
retention in the lungs and extremities is
decreased
CARDIAC GLYCOSIDES
• DESCRIPTION
– Used for CHF, atrial tachycardia, atrial
fibrillation, and atrial flutter
– Contraindicated in ventricular dysrhythmias
and second- or third-degree heart block
– Used with caution in clients with renal disease,
hypothyroidism, and hypokalemia
CARDIAC GLYCOSIDES
• Digoxin (Lanoxicaps, Lanoxin)
• Digitoxin (Crystodigin)
CARDIAC GLYCOSIDES
• SIDE EFFECTS AND TOXIC EFFECTS
– Anorexia, nausea, vomiting
– Headache
– Visual disturbances: diplopia, blurred vision,
yellow-green halos
– Photophobia
– Drowsiness
– Bradycardia
– Fatigue, weakness
CARDIAC GLYCOSIDES
• IMPLEMENTATION
– Monitor for toxicity as evidenced by anorexia,
nausea, vomiting, visual disturbances,
confusion, bradycardia, heart block, premature
ventricular contractions (PVCs), and
tachydysrhythmias
– Monitor serum digoxin level, electrolyte levels,
and renal function tests
– Therapeutic digoxin range is 0.5 to 2.0 ng/ml
and levels above 2.0 ng/ml are toxic
CARDIAC GLYCOSIDES
• IMPLEMENTATION
– An increased risk of toxicity exists in clients
with hypercalcemia, hypokalemia,
hypomagnesemia, or hypothyroidism
– Monitor potassium level, and if hypokalemia
occurs (potassium below 3.5 mEq/L), notify the
physician
– Monitor the client taking a potassium-wasting
diuretic or corticosteroids closely for
hypokalemia, because the hypokalemia can
cause digoxin toxicity
CARDIAC GLYCOSIDES
• IMPLEMENTATION
– Note that elderly clients are more sensitive to
toxicity
– Monitor the apical pulse; if below 60 beats per
minute, medication should be held and the
physician notified
– Antidote: digoxin immune FAB (Digibind) is
used in extreme toxicity
CARDIAC GLYCOSIDES
• CLIENT EDUCATION
– Avoid over-the-counter medications
– Eat foods high in potassium, such as fresh and
dried fruits, fruit juices, vegetables, and
potatoes
– How to measure the pulse and to notify the
physician if the pulse rate is below 60 or above
100 beats per minute
– The signs and symptoms of toxicity
DIURETICS
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Thiazide diuretics
Loop diuretics
Osmotic diuretics
Potassium-sparing diuretics
Carbonic anhydrase inhibitors
THIAZIDE DIURETICS
• DESCRIPTION
– Increase sodium and water excretion by
inhibiting sodium reabsorption in the distal
tubule of the kidney
– Used for hypertension and peripheral edema
– Used in clients with normal renal function
– Not effective for immediate diuresis
THIAZIDE DIURETICS
• DESCRIPTION
– Contraindicated in renal failure
– Used with caution in the client taking lithium
because lithium toxicity can occur
– Used with caution in the client taking digoxin,
corticosteroids, and antidiabetic medications
THIAZIDE DIURETICS
• SIDE EFFECTS
– Hypercalcemia, hyperglycemia, hyperuricemia
– Hypokalemia, hyponatremia
– Hypovolemia
– Hypotension
– Headaches
– Nausea, vomiting, constipation
– Rashes
– Photosensitivity
– Blood dyscrasias
THIAZIDE DIURETICS
• IMPLEMENTATION
– Monitor vital signs
– Monitor weight
– Monitor urine output
– Monitor electrolytes, glucose, calcium, and
uric acid levels
– Check peripheral extremities for edema
– The client with diabetes mellitus needs to have
the blood glucose checked periodically
THIAZIDE DIURETICS
• CLIENT EDUCATION
– Take the medication in the morning to avoid
nocturia and sleep interruption
– How to record the BP
– Eat foods high in potassium content
– How to take potassium supplements if
prescribed
– Take medication with food to avoid GI upset
– Change positions slowly to prevent orthostatic
hypotension
– Use sunscreen when in direct sunlight
LOOP DIURETICS
• DESCRIPTION
– Inhibit sodium and chloride reabsorption from
the loop of Henle and the distal tubule
– They have little effect on the blood glucose;
however, they cause marked depletion of water
and electrolytes, increased uric acid levels,
and cause the excretion of calcium
– Are more potent than the thiazide diuretics,
causing rapid diuresis, thus decreasing
vascular fluid volume, decreasing cardiac
output, and blood pressure
LOOP DIURETICS
• DESCRIPTION
– Used for hypertension, edema associated with
CHF, hypercalcemia, and renal disease
– Used with caution in the client taking digoxin
or lithium
– Use with caution in the client on
aminoglycosides, anticoagulants,
corticosteroids, and amphotericin B
LOOP DIURETICS
• SIDE EFFECTS
– Hypokalemia, hyponatremia, hypocalcemia,
hypomagnesemia, hypochloremia
– Hyperuricemia
– Thrombocytopenia
– Orthostatic hypotension
– Skin disturbances
– Ototoxicity and deafness
– Thiamine deficiency
– Dehydration
LOOP DIURETICS
• IMPLEMENTATION
– Monitor vital signs
– Monitor weight and urine output
– Monitor electrolytes, calcium, magnesium, and
uric acid levels
– Check the peripheral extremities for edema
– Monitor for signs of digoxin or lithium toxicity
if the client is on these medications
– Administer IV furosemide (Lasix) slowly,
because hearing loss can occur if injected
rapidly
LOOP DIURETICS
• CLIENT EDUCATION
– Take the medication in the morning to avoid
nocturia and sleep interruption
– How to record the BP
– Eat foods high in potassium
– How to take potassium supplements if
prescribed
– Take medication with food to avoid GI upset
– Change positions slowly to prevent orthostatic
hypotension
OSMOTIC DIURETICS
• Refer to module titled Neurological Medications
for information on osmotic diuretics
CARBONIC ANHYDRASE INHIBITORS
• DESCRIPTION
– Block the action of the enzyme carbonic
anhydrase needed to maintain acid-base
balance
– Inhibition of carbonic anhydrase causes
increased sodium, potassium, and bicarbonate
excretion
– Metabolic acidosis can occur with prolonged
use
CARBONIC ANHYDRASE INHIBITORS
• DESCRIPTION
– Used to decrease intraocular pressure in openangle (chronic) glaucoma, to produce diuresis,
manage epilepsy, treat high-altitude sickness
– Used to treat metabolic alkalosis
– Contraindicated in narrow-angle or acute
glaucoma
CARBONIC ANHYDRASE INHIBITORS
• SIDE EFFECTS
– Hyperglycemia, hyperuricemia, hypercalcemia
– Hypokalemia
– Anorexia, nausea, vomiting
– Orthostatic hypotension
– Renal calculi
– Hemolytic anemia
CARBONIC ANHYDRASE INHIBITORS
• IMPLEMENTATION
– Monitor vital signs
– Monitor weight
– Monitor urine output
– Monitor electrolytes, glucose, calcium, and
uric acid levels
– Monitor mental status
– Instruct the client to monitor for signs of renal
calculi
POTASSIUM-SPARING DIURETICS
• DESCRIPTION
– Act on the distal tubule to promote sodium and
water excretion and potassium retention
– Used for edema and hypertension, to increase
urine output, to treat fluid retention and
overload associated with CHF, hepatic
cirrhosis, or nephrotic syndrome, and for
diuretic-induced hypokalemia
POTASSIUM-SPARING DIURETICS
• DESCRIPTION
– Contraindicated in severe kidney or hepatic
disease or in severe hyperkalemia
– Used with caution in the client
• With diabetes mellitus
• Taking antihypertensives or lithium
• Taking angiotensin-converting enzyme
(ACE) inhibitors, because hyperkalemia can
result
• Taking potassium supplements
POTASSIUM-SPARING DIURETICS
• SIDE EFFECTS
– Hyperkalemia
– Nausea, vomiting, diarrhea
– Rash
– Dizziness, weakness
– Headache
– Dry mouth
– Photosensitivity
– Anemia
– Thrombocytopenia
POTASSIUM-SPARING DIURETICS
• IMPLEMENTATION
– Monitor vital signs
– Monitor urine output
– Monitor for signs and symptoms of
hyperkalemia
– Monitor for a potassium level greater than 5.3
mEq/L, which indicates hyperkalemia
POTASSIUM-SPARING DIURETICS
• CLIENT EDUCATION
– Avoid foods high in potassium
– Avoid exposure to direct sunlight
– Instruct the client to monitor for signs of
hyperkalemia
– Instruct the client to avoid salt substitutes
because they contain potassium
– Instruct the client to take with or after meals to
decrease GI irritation
PERIPHERALLY ACTING
ALPHA-ADRENERGIC BLOCKERS
• DESCRIPTION
– Decrease sympathetic vasoconstriction by
reducing the effects of norepinephrine at
peripheral nerve endings, resulting in
vasodilation and decreased BP
– Used to maintain renal blood flow
– Used to treat hypertension
PERIPHERALLY ACTING
ALPHA-ADRENERGIC BLOCKERS
• SIDE EFFECTS
– Orthostatic hypotension
– Reflex tachycardia
– Sodium and water retention
– GI disturbances
– Nausea
– Drowsiness
– Nasal congestion
PERIPHERALLY ACTING
ALPHA-ADRENERGIC BLOCKERS
• SIDE EFFECTS
– Edema
– Weight gain
– Reserpine (Serpasil) can cause depression, GI
irritation, and impotence
PERIPHERALLY ACTING
ALPHA-ADRENERGIC BLOCKERS
• IMPLEMENTATION
– Monitor vital signs
– Monitor for fluid retention and edema
• CLIENT EDUCATION
– Change positions slowly to prevent orthostatic
hypotension
– How to monitor the BP
– Monitor for edema
– Decrease salt intake
– Avoid over-the-counter medications
CENTRALLY ACTING SYMPATHOLYTICS
(ADRENERGIC BLOCKERS)
• DESCRIPTION
– Stimulate alpha-receptors in the central
nervous system (CNS) to inhibit
vasoconstriction, thus reducing peripheral
resistance
– Used to treat hypertension
– Contraindicated in impaired liver function
CENTRALLY ACTING SYMPATHOLYTICS
(ADRENERGIC BLOCKERS)
• SIDE EFFECTS
– Sodium and water retention
– Drowsiness, dizziness
– Dry mouth
– Bradycardia
– Edema
– Hypotension
– Impotence
– Depression
CENTRALLY ACTING SYMPATHOLYTICS
(ADRENERGIC BLOCKERS)
• IMPLEMENTATION
– Monitor vital signs
– Monitor liver function tests
– Instruct the client not to discontinue the
medication, because abrupt withdrawal can
cause severe rebound hypertension
ANGIOTENSIN-CONVERTING
ENZYMES (ACE) INHIBITORS
• DESCRIPTION
– Prevent peripheral vasoconstriction by
blocking conversion of angiotensin I to
angiotensin II
– Used to treat hypertension
– Avoid use with potassium supplements and
potassium-sparing diuretics
ANGIOTENSIN-CONVERTING
ENZYMES (ACE) INHIBITORS
• SIDE EFFECTS
– Nausea, vomiting, diarrhea
– Persistent cough
– Hypotension
– Hyperkalemia
– Tachycardia
– Headache
ANGIOTENSIN-CONVERTING
ENZYMES (ACE) INHIBITORS
• SIDE EFFECTS
– Dizziness, fatigue
– Insomnia
– Hypoglycemic reactions in the client with
diabetes mellitus
– Bruising, petechiae, bleeding
– Diminished taste
ANGIOTENSIN-CONVERTING
ENZYMES (ACE) INHIBITORS
• IMPLEMENTATION
– Monitor vital signs
– Monitor protein, albumin, blood urea nitrogen
(BUN), creatinine, white blood cells (WBC),
potassium levels
– Monitor for hypoglycemic reactions in the
client with diabetes mellitus
– Monitor for bruising, petechiae, or bleeding
with captopril (Capoten)
ANGIOTENSIN-CONVERTING
ENZYMES (ACE) INHIBITORS
• CLIENT EDUCATION
– Do not discontinue medications because
rebound hypertension can occur
– Do not take over-the-counter medications
– How to take the BP
– If dizziness occurs and persists, to notify the
physician
– The taste of food may be diminished during
the first month of therapy
– Take captopril (Capoten) 20 minutes to 1 hour
before a meal
NITRATES
• DESCRIPTION
– Antianginal medications that produce
vasodilation
– Decrease preload and afterload and reduce
myocardial oxygen consumption
– Contraindicated in the client with marked
hypotension, increased intracranial pressure
(ICP), or severe anemia
– Used with caution with severe renal or hepatic
disease
– Avoid abrupt withdrawal of long-acting
preparations to prevent the rebound effect of
severe pain from myocardial ischemia
NITRATES
• SIDE EFFECTS
– Headache
– Orthostatic hypotension
– Dizziness, weakness
– Nausea, vomiting
– Flushing or pallor
– Dry mouth
– Rash
– Reflex tachycardia
– Paradoxical bradycardia
– Confusion
NITRATES
• SUBLINGUAL MEDICATIONS
– Monitor vital signs
– Offer sips of water before giving, because
dryness may inhibit medication absorption
– Instruct the client to place under the tongue
and leave until fully dissolved
– Instruct the client to take 1 tablet for pain, and
repeat every 5 minutes for a total of three
doses
– Instruct the client to seek medical help
immediately if pain is not relieved in 15
minutes, following the three doses
NITRATES
• SUBLINGUAL MEDICATIONS
– Inform the client that a stinging or biting
sensation may indicate that the tablet is fresh
– Instruct the client to store medication in a dark,
tightly closed bottle
– Instruct the client to check the expiration date on
the medication bottle, because expiration may
occur within 6 months of obtaining medication
– Instruct the client to take acetaminophen
(Tylenol) for a headache
NITRATES
• TRANSLINGUAL MEDICATIONS
– Instruct the client to direct spray against the
oral mucosa
– Instruct the client to avoid inhaling the spray
• SUSTAINED-RELEASED MEDICATIONS
– Instruct the client to swallow, not to chew or
crush, the medication
NITRATES
• TRANSMUCOSAL-BUCCAL MEDICATIONS
– Instruct the client to place between the upper
lip and gum or in the buccal area between the
cheek and gum
– Inform the client that the medication will
adhere to the oral mucosa and slowly dissolve
NITRATES
• TOPICAL OINTMENTS
– Remove the ointment on the skin from the
previous dose
– Squeeze a ribbon of ointment of the prescribed
length onto the applicator paper
– Spread the ointment over a 6x6-inch area
using the chest, back, abdomen, upper arm, or
anterior thigh (avoiding hairy areas), and cover
with a plastic wrap
– Rotate sites and to avoid touching the
ointment when applying
NITRATES
• TRANSDERMAL PATCH
– Instruct the client to apply the patch to a
hairless area, using a new patch and a
different site each day
– As prescribed, instruct the client to remove the
patch after 12 to 14 hours, allowing 10 to 12
“patch-free” hours each day to prevent
tolerance
– Do not apply the patch or ointments on the
chest in the area of defibrillator-cardioverter
paddle placement, because skin burns can
result
BETA-ADRENERGIC BLOCKERS
• DESCRIPTION
– Inhibit response to beta-adrenergic
stimulation, thus decreasing cardiac output
– Block the release of the catecholamines,
epinephrine, and norepinephrine, thus
decreasing the heart rate and blood pressure
– Decrease the workload of the heart and
decrease oxygen demands
– Used for angina, dysrhythmias, hypertension,
migraine headaches, prevention of MI, and
glaucoma
BETA-ADRENERGIC BLOCKERS
• DESCRIPTION
– Contraindicated in the client with asthma,
bradycardia, CHF, severe renal or hepatic
disease, hyperthyroidism, and CVA
– Used with caution in the client with diabetes
mellitus, because it may mask symptoms of
hypoglycemia
– Used with caution in the client on
antihypertensives
BETA-ADRENERGIC BLOCKERS
• SIDE EFFECTS
– Bradycardia
– Bronchospasm
– Hypotension
– Weakness, fatigue, dizziness
– Nausea, vomiting
– Hyperglycemia
– Agranulocytosis
– Behavioral or psychotic responses,
depression
– Nightmares
BETA-ADRENERGIC BLOCKERS
• IMPLEMENTATION
– Monitor vital signs
– Hold the medication if the pulse or BP is not
within the prescribed parameters
– Monitor for signs of CHF
– Assess for respiratory distress and for signs
of wheezing and dyspnea
BETA-ADRENERGIC BLOCKERS
• CLIENT EDUCATION
– Report dizziness, lightheadedness, or nasal
congestion
– Do not stop the medication because rebound
hypertension, rebound tachycardia, or an
anginal attack can occur
– Advise the client taking insulin to monitor the
blood glucose level because early signs of
hypoglycemia, such as tachycardia and
nervousness, can be masked by the betablocker
BETA-ADRENERGIC BLOCKERS
• CLIENT EDUCATION
– How to take a pulse and BP
– Change positions slowly to prevent orthostatic
hypotension
– Avoid over-the-counter cold medications and
nasal decongestants
CALCIUM CHANNEL BLOCKERS
• DESCRIPTION
– Decrease cardiac contractility (negative
inotropic effect by relaxing smooth muscle)
and the workload of the heart, thus decreasing
the need for oxygen
– Promote vasodilatation of the coronary and
peripheral vessels
– Used for angina, dysrhythmias, or
hypertension
– Used with caution in the client with CHF,
bradycardia, or AV block
CALCIUM CHANNEL BLOCKERS
• SIDE EFFECTS
– Bradycardia
– Hypotension
– Reflex tachycardia as a result of hypotension
– Headache
– Dizziness, lightheadedness, fatigue
– Peripheral edema
– Constipation
– Flushing of the skin
– Changes in liver and kidney function
CALCIUM CHANNEL BLOCKERS
• IMPLEMENTATION
– Monitor vital signs
– Monitor for signs of CHF
– Monitor liver enzyme levels and kidney
function tests
• CLIENT EDUCATION
– Do not discontinue the medication
– How to take a pulse
– Notify the physician if dizziness or fainting
occurs
– Do not crush or chew sustained-released
tablets
PERIPHERAL VASODILATORS
• DESCRIPTION
– Decrease peripheral resistance by exerting a
direct action on the arteries or on both the
arteries and veins
– Increase blood flow to the extremities
– Used in peripheral vascular disorders of
venous and arterial vessels
– Most effective for disorders resulting from
vasospasm (Raynaud’s disease)
– It may take up to 3 months for a desired
therapeutic response
PERIPHERAL VASODILATORS
• SIDE EFFECTS
– Lightheadedness, dizziness
– Postural hypotension
– Tachycardia
– Palpitations
– Flushing
– GI distress
PERIPHERAL VASODILATORS
• IMPLEMENTATION
– Monitor vital signs, especially the BP and heart
rate
– Monitor for orthostatic hypotension and
tachycardia
– Monitor for signs of inadequate blood flow to
the extremities such as pallor, coldness of the
extremities, and pain
PERIPHERAL VASODILATORS
• CLIENT EDUCATION
– Do not smoke because smoking increases
vasospasm
– Avoid aspirin or aspirin-like compounds
unless approved by the physician
– Take the medication with meals if GI
disturbances occur
– Avoid alcohol because it may cause a
hypotensive reaction
– Change positions slowly to avoid orthostatic
hypotension
DIRECT-ACTING ARTERIOLAR VASODILATORS
• DESCRIPTION
– Relax the smooth muscles of the blood vessels,
mainly the arteries, causing vasodilation
– Promote an increase in blood flow to the brain
and kidneys
– With vasodilation, the blood pressure drops and
sodium and water are retained, resulting in
peripheral edema; diuretics may be given to
decrease the edema
– Used in the client with moderate to severe
hypertension and during acute hypertensive
emergencies
DIRECT-ACTING ARTERIOLAR VASODILATORS
• SIDE EFFECTS
– Hypotension
– Reflex tachycardia caused by vasodilatation
and the drop in BP
– Palpitations
– Edema
– Dizziness
– Headaches
– Nasal congestion
– GI bleeding
DIRECT-ACTING ARTERIOLAR VASODILATORS
• SIDE EFFECTS
– Neurological symptoms
– Confusion
– Excess hair growth with minoxidil (Loniten)
– With sodium nitroprusside (Nipride), cyanide
toxicity and thiocyanate toxicity can occur
DIRECT-ACTING ARTERIOLAR VASODILATORS
• IMPLEMENTATION
– Monitor vital signs
• SODIUM NITROPRUSSIDE
– Monitor cyanide and thiocyanate levels
– Protect from light because the medication
decomposes
– When administering, solution must be
wrapped in aluminum foil and is stable for 24
hours
– Discard if the medication is red or blue
ANTIDYSRHYTHMIC MEDICATIONS
• DESCRIPTION
– Suppress dysrhythmias by inhibiting abnormal
pathways of electrical conduction through the
heart
ANTIDYSRHYTHMIC MEDICATIONS
• SIDE EFFECTS
– Dizziness
– Fatigue
– Hypotension
– Bradycardia
– Heart failure
– Dysrhythmias
– Heart block
– Bronchospasms
– GI distress
ANTIDYSRHYTHMIC MEDICATIONS
• IMPLEMENTATION
– Monitor heart rate, respiratory rate, and BP
– Provide cardiac monitoring and monitor ECG
– Monitor thyroid and neurological function
– Maintain therapeutic serum drug levels
– Before administering lidocaine, always check
the vial label to prevent administering a form
that contains epinephrine or preservatives,
because these solutions are used for local
anesthesia only
– Always administer IV antidysrhythmics via an
infusion pump
ANTIDYSRHYTHMIC MEDICATIONS
• IMPLEMENTATION
– Do not administer oral medications with food
because food may affect absorption
– Mexiletine hydrochloride (Mexitil) or tocainide
hydrochloride (Tonocard) may be administered
with food or antacids to reduce GI distress
– Monitor for signs of fluid retention, such as
weight gain, peripheral edema, or shortness of
breath
– Advise the client to limit fluid and salt intake to
minimize fluid retention
ANTIDYSRHYTHMIC MEDICATIONS
• IMPLEMENTATION
– After administering bretylium tosylate (Bretylol),
keep the client supine and monitor for
hypotension
– Instruct the client to change positions slowly to
minimize orthostatic hypotension
– Instruct the client taking amiodarone
hydrochloride (Cordarone) to use sunscreen
and protective clothing to prevent
photosensitivity reactions
– Assess for bradycardia when administering
atropine sulfate in low doses or by slow infusion
ADRENERGIC AGONISTS
•
•
•
•
•
Dobutamine (Dobutrex)
Dopamine (Intropin)
Epinephrine (Adrenalin)
Isoproterenol (Isuprel)
Norepinephrine levarterenol (Levophed)
ADRENERGIC AGONISTS
• DOBUTAMINE (DOBUTREX)
– Increases myocardial force and cardiac output
through stimulation of beta receptors
– Used in CHF and for clients undergoing
cardiopulmonary bypass surgery
ADRENERGIC AGONISTS
• DOPAMINE HYDROCHLORIDE (INTROPIN)
– Increases BP and cardiac output through
positive inotropic action and increases renal
blood flow through its action on alpha and beta
receptors
– Used to treat mild renal failure caused by low
cardiac output
ADRENERGIC AGONISTS
• EPINEPHRINE (ADRENALIN)
– Used for cardiac stimulation in cardiac arrest
– Used for bronchodilation in asthma or allergic
reactions
– Produces mydriasis
– Produces local vasoconstriction when
combined with local anesthetics and prolongs
anesthetic action by decreasing blood flow to
the site
ADRENERGIC AGONISTS
• ISOPROTERENOL HYDROCHLORIDE (ISUPREL)
– Stimulates beta receptors
– Used for cardiac stimulation and
bronchodilation
ADRENERGIC AGONISTS
• NOREPINEPHRINE LEVARTERENOL (LEVOPHED)
– Stimulates the heart in cardiac arrest
– Vasoconstricts and increases the BP in
hypotension and shock
ADRENERGIC AGONISTS
• SIDE EFFECTS
– Dysrhythmias
– Tachycardia
– Angina
– Restlessness
– Urgency or urinary incontinence
ADRENERGIC AGONISTS
• IMPLEMENTATION
– Monitor vital signs
– Monitor lung sounds
– Monitor urinary output
– Monitor ECG
– Administer the medication through a large vein
– If extravasation occurs, infiltrate the site with
normal saline and phentolamine
(Regitine) as prescribed
ANTILIPEMIC MEDICATIONS
• DESCRIPTION
– Reduce serum levels of cholesterol,
triglycerides, or low-density lipoprotein (LDL)
– When cholesterol, triglycerides, and LDL are
elevated, the client is at increased risk for
coronary artery disease
– In many cases diet alone will not lower blood
lipid levels; therefore, antilipemic medications
may be prescribed
ANTILIPEMIC MEDICATIONS
• BILE SEQUESTRANTS
– DESCRIPTION
• Bind with acids in the intestines
• Bile acid sequestrants should not be used
as the only therapy in clients with elevated
triglycerides, because they typically raise
triglyceride levels
– SIDE EFFECTS
• Constipation
• Peptic ulcer
ANTILIPEMIC MEDICATIONS
• BILE SEQUESTRANTS
– IMPLEMENTATION
• Cholestyramine (Questran) comes in a gritty
powder that must be mixed thoroughly in
juice or water prior to administration
• Monitor the client for early signs of peptic
ulcer such as nausea and abdominal
discomfort followed by abdominal pain and
distention
• Instruct the client that the medication must
be taken with and followed by sufficient
fluids
ANTILIPEMIC MEDICATIONS
• HMG-CoA REDUCTASE INHIBITORS
– DESCRIPTION
• Lovastatin (Mevacor) is highly protein
bound and should not be administered with
anticoagulants
• Lovastatin should not be administered with
gemfibrozil (Lopid)
• Administer lovastatin with caution to the
client on immunosuppressive medications
ANTILIPEMIC MEDICATIONS
• HMG-CoA REDUCTASE INHIBITORS
– SIDE EFFECTS
• Nausea
• Abdominal pain or cramps, flatulence,
diarrhea or constipation
• Dizziness
• Headache, fatigue
• Muscle cramps
• Blurred vision
• Rash, pruritus
• Elevated liver enzymes
ANTILIPEMIC MEDICATIONS
• HMG-CoA REDUCTASE INHIBITORS
– IMPLEMENTATION
• Monitor serum liver enzymes
• Instruct the client to receive an annual eye
exam because the medication causes
cataract formation
• If lovastatin is not effective in lowering the
lipid level after 3 months, it should be
discontinued
OTHER ANTILIPEMIC MEDICATIONS
• DESCRIPTION
– Gemfibrozil (Lopid) should not be taken with
anticoagulants because they compete for
protein sites and if the client is on an
anticoagulant, the anticoagulant dose should
be reduced during antilipemic therapy and the
INR monitored closely
– Do not administer gemfibrozil with lovastatin
(Mevacor)
– Clofibrate (Atromid-S) should not be used
long term because of its side effects such as
dysrhythmias, angina, thromboembolism, and
gallbladder stones
OTHER ANTILIPEMIC MEDICATIONS
• IMPLEMENTATION
– Monitor vital signs
– Monitor liver enzyme levels
– Monitor serum cholesterol and triglyceride
levels
– Instruct the client to restrict intake of fats,
cholesterol, carbohydrates, and alcohol
– Instruct the client to follow an exercise
program
OTHER ANTILIPEMIC MEDICATIONS
• IMPLEMENTATION
– Instruct the client to have an annual eye exam
and to report any changes in vision
– Instruct the client with diabetes mellitus taking
gemfibrozil to monitor blood glucose levels
regularly
– Instruct the client to increase fluid intake
– Instruct the client that it will take several weeks
before the lipid level declines
OTHER ANTILIPEMIC MEDICATIONS
• IMPLEMENTATION
– Note that nicotinic acid (Niacor) has numerous
side effects that include GI disturbances,
flushing of the skin, elevated liver enzymes,
hyperglycemia, and hyperuricemia
– Instruct the client that aspirin may help to
reduce the side effects of nicotinic acid
– Instruct the client to take nicotinic acid with
meals to reduce GI discomfort