DRUG CLASSIFICATION DRUG NAME ADVERSE EFFECTS

NURSING CONSIDERATION

Cardiac Glycosides Digoxin (Lanoxin) - Indicated to heart failure to increase cardiac output Anorexia, diarrhea, n/v, bradycardia (severe & most common), PVC (premature ventricular contraction), visual disturbances (glaucoma-like symptoms) 1. Check apical pulse ( below 60 or above 120 do not give) 2. Best given with meals 3. Monitor hypokalemia (precipitates toxicity) 4. Diet: inc. K fresh fruits, potato, avocado (highest K content) 5. Prepaare drugs like: a. Digibind antidote (bradycardia) b. Atropine Sulfate (cardiac stimulant, anticholinergic for severe bradycardia) c. Lidocaine drug of choice; common antiarrythmic drug for PVC
Cardiac Stimulants

DRUG CLASSIFICATION DRUG NAME ADVERSE EFFECTS NURSING CONSIDERATION

Atropine Sulfate, Epinephrine, Isoproterenol Inotropic

Tachycardia, headache, dysrhythmias, anticholinergic (sympathetic) dry mouth 1. Assess vital signs. 2. Use cardiac monitoring during IV administration. 3. Ensure follow up ECG. effects

DRUG CLASSIFICATION DRUG NAME

Coronary Vasodilators dilates coronary arteries

Nitrates (Nitroglycerin) oral. Sublingual (emergency), topical - 4-5 min. peak of the medicine Note: Given in 3 doses in 5 min. interval - >15min. MI
Headache, flushing, orthostatic hypotension, tachycardia, dizziness 1. Assess the potency (sublingual) (+) burning or tingling sensation in tongue 2. Assess efficacy: dec./(-) chest pain 3. Assess for hypotension 4. Encourage client to change positions slowly and use safety precautions 5. Maintain potency by storing in: a. Room temperature b. Dark place (medicine cabinet) c. Dark, light-resistant, air-tight container d. Within 3-6 months

ADVERSE EFFECTS NURSING CONSIDERATION

DRUG CLASSIFICATION DRUG NAME

Antidysrhythmics

Ca-channel Blockers PINE (Amlodipine, Nifedipine) Beta Blockers LOL (Metoprolol, Atenolol) Disopyramide Phosphate coronary vasodilators, platelet aggregate inhibitor (Persantine)

Lidocaine ventricular antiarrhythmic Procainamide HCL antiarrhythmic (Pronestyl) Quinidine antiarrhythmic Amiodarone ventricular antiarrhythmic (Cordarone, Pacerone) ADVERSE EFFECTS NURSING CONSIDERATION
Hypotension, dizziness, n/v, anticholinergic effect, blood dyscrasias 1. Assess vital signs during course of therapy. 2. Use cardiac monitoring and use infusion control for IV 3. Instruct client to notify physician of the side effect or report changes in heart rhythm and rate

DRUG CLASSIFICATION DRUG NAME

Antihypertensive

ACE inhibitor PRIL (Captopril) Angiotensin II Receptor Blocker TAN (Losartan, Valsartan) Ca-channel blockers Beta Blockers Alpha 1 blockers Peripherally (Doxazosin mesylate, Prazosin HCL, Terazosin HCL) Central Alpha 2 Agonist (Clonidine HCL, Methyldopa) Direct Vasodilators (Diozoxide, Hydralazine HCL) Diuretics
Orthostatic hypotension, dizziness, either bradycardia or tachycardia, sxual disturbances, blood dyscrasias; Beta Blockers bronchospasm & mask hypoglycemia) 1. Assess vital signs, esp. pulse; monitor BP in supine and standing 2. Monitor urine output. 3. Instruct client to a low sodium diet and to continue medication as prescribed.

ADVERSE EFFECTS NURSING CONSIDERATION

DRUG CLASSIFICATION DRUG NAME

Diuretics - increase renal excretion of Na, Cl, water, K, & Ca

Thiazides direct arteriolar vasodilation (Chlorothiazide, Metazolone (Thiazide-like) Potassium-Sparers (acts on aldosterone & renal tubules) inhibit Na reabsorption & K excretion (Spironolactone) Loop Diuretics inhibit Na & Cl reabsorption, inc. excretion of Na, Cl, water & K. (Furosemide-Lasix)
GI irritation, hyponatremia, orthostatic hypotension, hyperuricemia, DHN can cause hypokalemia except Potassium-sparers because it cn cause hyperkalemia, hypomagnesemia & hypocalcemia; Furosemide can cause aspirin toxicity if given together & can cause hyperglycemia in clients with DM 1. Maintain intake and output weigh daily (same time, cloth, weighing scale) 2. Assess for signs of fluid & electrolyte imbalance 3. Administer drug in the morning so that the maximal effect occurs during the waking hours. 4. Monitor BP & pulse rate instruct client to change position slowly 5. Encourage intake of foods high in Ca, Mg, zinc & K.

ADVERSE EFFECTS

NURSING CONSIDERATION

DRUG CLASSIFICATION DRUG NAME

Peripheral Vasodilator to increase BP

Norepinephrine, Dopamine, Phenylephrine HCL

Metaraminol

Bitartate,

ADVERSE EFFECTS NURSING CONSIDERATION

HPN, headache, GI disturbance 1. Assess vital signs monitor BP frequently. 2. Assess IV infiltration (slow infusion) 3. Encourage intake of high fiber foods to reduce the potential of constipation = shock

DRUG CLASSIFICATION DRUG NAME

Anticoagulants, Antiplatelets Aspirin (water-soluble- can cross stomach)

Heparin accelerates formation of antithrombin III- thrombin complex & deactivates thrombin, preventing conversion of fibrinogen to fibrin; dec. ability to blood clot Coumadin or Warfarin Sodium inhibits vitamin K-dependent activation of clotting factors II, VII, IX, & V formed in liver
Fever, chills, skin rash (hypersensitivity, hemorrhage & diarrhea) 1. Monitor blood work during the course of therapy esp. coagulation studies, platelet count, PT for Warfarin, PTT for Heparin 2. Assess for signs of bleeding Antidote: Warfarin Vitamin K Heparin Protamine Sulfate 3. Avoid IM injections with the contaminant of administration of coagulants; watch for signs of bleeding & notify the physician immediately. Follow schedule for coagulation studies.

ADVERSE EFFECTS NURSING CONSIDERATION

DRUG CLASSIFICATION DRUG NAME ADVERSE EFFECTS NURSING CONSIDERATION

Thrombolytics dissolve thrombus & clots; 2-4 hours Golden period for MI

Streptokinase, Activator

Altepase,

Retaplase,

Tissue

Plasminogen

Massive bleeding (most common complication), esp. if client has history of PUD (Pepetic Ulcer disease), allergic reaction, low grade fever, arrhythmias 1. Assess for history of bleeding, hemorrhagic, PUD, actibe bleeding & intake of anticoagulant. 2. Monitor PTT & fibrinogen concentration. 3. Monitor Vital signs & neurologic status. 4. Assess for signs of allergic reaction like chills, urticaria, pruritus, rash 5. Keep Aminocarproic Acid available 6. Assess pain (to assess the efficacy) a. (-) chest pain b. Normalized ECG c. PVCs (4 episodes) >4 arrhythmias d. Inc. or peaked CKMB 7. Maintain continuous IV infusion of 8-12 hours after thrombolytic therapy.

DRUG CLASSIFICATION DRUG NAME ADVERSE EFFECTS NURSING CONSIDERATION

Antilipidemics STATINs

Provastin, Lovastatin, Simvastatin, Clofibrate, Fenofibrate

N/v, diarrhea, constipation, facial flushing, myopathy, Hepatic toxicity 1. Reduced absorption of vits. ADEK as well as vit. B12 & iron 2. Administer at bedtime 3. Monitor SGPT/ALT, cholesterol, LDL, HDL, triglycerides, RBC, Hbg, and fat-soluble vitamins.