quinidine CLASS I-A antiarrythmics (sodium channel blockers)
Why is pt receiving this? restoration or maintanence of sinus rhythm in pts w/ atrial fibrillation or flutter; LONG TERM prevention of recurrent
ventricular arrhythmias (often used after cardioversion. Also used for treatment of malaria. NEGATIVE dromotrope (conduction velocity) and
decreases myocardial excitability
Dosage Quinidine gluconate (62%)
PO: 324-972 mg q8-12 hrs; IV: 200-400 mg given at a rate of less than or equal to 10mg/min until arrhythmia is suppressed, QRS complex
widens, or hypotension occurs
Quinidine Sulfate (83%)
PO: atrial/ventricular arrhythmias: 200-400 mg q4-6 hr; may be increased to achieve therapeutic effect
Side Effects CNS: dizziness, fatigue, HA, syncope, vertigo; EENT: blurred vision, diplopia, mydriasis, photophobia, tinnitus CV: HYPOTENSION,
TORSADDES DE POINTES, arrhythmias, palpitations, tachycardia; GI: anorexia, abd cramping, diarrhea, nausea/vomiting, drug induced hepatitis
DERM: rash, HEMAT: agranulocytosis (severe leukopenia); fever, ataxia
Administration guidelines MONITOR FOR SIGNS OF HEART BLOCK, monitor ECG BP and pulse periodically; take apical for 1 minute before
administration GOAL: cessation/decrease of cardiac arrhythmia;
Medication concerns Widens the QRS complex, need to measure and discontinue if widened 50% or greater! May increase digoxin toxicity;
pt teaching points avoid taking medication with grapefruit juice (may lead to toxicity); take exactly as prescribed, take missed dose when
remembered within 2 hrs, if over two hours DO NOT; may cause dizziness or blurred vision (fall risk, avoid driving), may cause sensitivity to light,
teach pts to take carotid pulse for full minute
lidocaine (Xylocaine) CLASS I-B antiarrythmics (sodium channel blockers), local anesthetic HIGH ALERT
Why is pt receiving this? IV: ventricular arrhythmias, Local: infiltration, muscosal, topical anesthetic; has preferential effect on abnormally
functioning tissue, slows depolarization of muscle contraction (negative dromotrope) by altering influx of sodium acorss membrane; little to no
effect on heart rate
Dosage
IV: 1-1.5mg/kg bolus; may repeat doses of .5-.75 mg/kg q5-10 min up to total dose of 3 mg/kg; can start continuous infusion of 1-4 mg/min;
ENDOTRACHEAL: give 2-2.5 times using IV loading dose down endotracheal tube, followed by 10 mL saline flush
Side Effects CNS: SEIZURES, confusion, drowsiness, blurred vision, dizziness, nervousness, slurred speech, tremor; CV: cardiac arrest, arrhythmias,
bradycardia, heartblock, hypotension, GI: n/v RESP: bronchospasm, HEMAT: methemoglobinemia, HYPERSENSTIVITY INCL ANAPHYLAXIS
Administration guidelines monitor ECG CONSTANTLY BP and RR periodically; Take Apical for 1 full minute prior to administration, GOAL:
decrease in ventricular arrhythmias, local anesthesia
Medication concerns Contraindicated in third degree heart block; may increase levels of CCBS, benzodiasopines, LEVELS MAY BE INCREASED BY
propranolol and cimetidine; narrow therapeutic index; MAX DOSE: 3mg/Kg
pt teaching points teach pts to take carotid pulse for full minute, may cause dizziness/drowsiness (fall risk, avoid driving, etc)
flecainide (Tambocor) Class I-C antiarrythmics (sodium channel blockers)
Why is pt receiving this? life threatening ventricular arrhythmias incl v. tach. Prophylaxis of supraventricular tacharrythmias incl:
paroxysmal supraventricular tachycardia (PSVT), Paroxysmal atrial fibrillation/flutter (PAF). Supresses Premature ventricular complex (PVC’s)
ATOMIC BOMB of Antiarrythmics (pt in bad condition)
Dosage PO: 100 mg q 12hr initially, increased by 50 mg twice daily until response is obtained or max daily dose of 400 mg is reached; some pts
may require q 8 hr dosing.; Renal impairment (creatinine clearance) <35mL/min; 100 mg once a d day or 50 mg q 12 hr initially
PVST/PAF: 50 mg q 12 hr initially, increased by 50 mg twice daily until response is obtained or maximum total daily dose of 300 mg is reached,
some require 8 hr dosing; A FIB: (unlabeled) 200 mg or 300 mg single dose
Side Effects CNS: dizziness, anxiety, fatigue, HA, mental depression; EENT: blurred vision, visual disturbances CV: arrhythmias, chestpain, HF GI:
anorexia, constipation, drug induced hepattis, nausea, stomach pain, vomiting; DERM: rash, NEURO: tremor
Administration guidelines monitor ECG (May cause QRS widening, PR prolongation, and QT prolongation) BP and RR periodically; Take Apical for
1 full minute prior to administration *Don’t just look on heart monitor, Monitor Is and Os and aily weight, assess for signs of HF GOAL: decrease
in frequency of life threatening ventricular arrhythmias, decrease in supraventricular tachyarrhytmias
Medication concerns MAY INCREASE ANTIARRHYTMICS including CCB’s, serum levels can be doubled by amioderone, can increase digoxin by
minimal amount, concurrent beta blocker therapy may increase levels of beta blocker AND flecainide. Alkalinizing agents promote reabsorption
pt teaching points teach pts to take carotid pulse for full minute, may cause dizziness/drowsiness (fall risk, avoid driving, etc), take doses as
prescribed take missed doses w/in 6 hr or omit; notify provider for signs of chest pain, sob, or diaphoresis
Generic Name:propranolol
Classification: nonselective betablocker , high alert (IV); Class II antiarrythmic
Why is patient/client receiving this? Mgmt. of HTN, angina, arrhythmias; controls dyshtmia originating from excessive sympathetic stimulation,
slows conduction (negative dromotroe), slows HR (negative chronotrope), Increases CO, Decreases Renin, decreases BP, decreases workload
CAN also be used for hyperanxiety or hyperthyroid
Dosage/Route:
Rate of administration with IV meds:
PO antianginal: 80-320 mg/day in 2 divided doses or once as extended
.5 mg/min
release (DNC)
Intermittent: infuse over 10-15 min
antihypertensive: 40 mg twice daily
IV diluents compatible with IV medication: direct iv: undiluted or
IV antiarrythmhic: 1-3 mg, repeated after 2 min, again in 4hr if needed
each mg in 10mL of D5W Intermittent: may be diluted in 50mL
normal saline, D5W, D51/2 saline, D5normal saline
Major Side effects:
-CNS: fatigue, weakness, mental depression, mental status change
-RESP: bronchospasm , wheezing -CV: bradycardia, HF, arrhythmias, pulmonary edema, hypotension, peripheral vasoconstriction
-GI: constipation, diharrhea, DERM: rashes - ENDO: hyperglycemia, hypoglycemia -anaphylaxis
Data used to indicate medication is effective: Monitor BP, pulse (60), ECG (decreased BP, pulse), I’s and O’s (normal to increased urine output),
daily weights (no weight gain indicative of edematous HF)
Medication administration concerns: take apical pulse for 1 min (withhold if arrythmatic or <50) hold under 45, monitor signs of HF NO
LONGER FIRST LINE however given after MI for ventricular remodeling and protection, use in caution with brittle diabetics (masks s/e of
hypoglycemia UNTIL SEVERE) ; abrupt withdrawl can result in life threatening arrhythmias; anesthesia and verapamil (periph and central acting
CCB) can exacerbate myocardial depression; additive bradycahrdia can occur with digoxin, additivie hypotension with antihypertensives
Patient/client teaching points:
Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Inform pt of fall risk status
and interventions to prevent falls Don’t withdraw immediately
amiodarone (Cordarone) Class III antiarrythmics (Dealy of repolarization) HIGH ALERT
Why is pt receiving this? life threatening ventricular arrhythmias unresponsive to less toxic agnets; prolongs action potential, increases
refractory period: decreased automaticity (negative dromotrope), prolonged AV conduction (blocks Na+ K+ and Ca2+ channels) ALSO used for
atrial fib conversion
Dosage VENTRICULAR ARRYTHMIAS PO: 800-1600 mg/day in 1-2 doses for 1-3 wk, then 600-800 mg/day in 1-2 doses for 1 mo, then 400 mg/day
maintenance dose IV: 150 mg over 10 min, followed by 360 mg over next 6 hr and then 540 mg over the next 18 hr. Continue infusion at .5
mg/min until oral therapy initiated, if arrhythmia recurs, a loading infusion of 150 mg over 10 min should be given (in addition maintanence rate
may be increased) SUPRAVENTRICULAR TACHYCARDIA: 600-800 mg/day for one wk then drop to 400 mg/day for 3 wk then maintanece dose of
200-400 mg/day
Side Effects CNS: confusional state, disorientation, hallucinations, dizziness, fatigue, malaise, HA, insomnia EENT: corneal microdeposits,
abnormal sense of smell, dry eyes, optic neuritis, optic neuropathy RESP: adult respiratory distress syndrome ARDS, pulmonary fibrosis,
pulmonary toxicity CV: CHF, Worsening of arrhythmias bradycardia, hypotension; GI: anorexia, constipation, n/v, abd pain, abnormal sense
of taste, increased liver enzymes, GU: epidimytis, decreased libidoDERM: toxic epidermal necrolysis, photosensitivity blue discoloration(not
related to toxicity)
Administration guidelines take apical for full minute, monitor ECG: monitor HR and rhythm throughout therapy. PR prolongation, slight QRS
widening, T wave amplitude reduction with widening and bifurcation and U waves may occur. Report bradycardia or increase in arrhythmias
PROMPTLY. Assess for signs of pulmonary toxicity (rales/crackles, decreased breath sounds, pleuritic friction, fatigue, dyspnea, cough, wheezing,
fever, hemoptysis, hypoxia, Assess for signs/symptoms of ARDS, Assess BP, ophthalmic exams, thyroid dysfunction GOAL: cessation n of lifethreatening ventricular arrhythmias. Adverse effects may take up to 4 mo to resolve.
Medication concerns fibrotic lung conditions can be permanent, although not as prevalent in pts with previous lung disease, increases digoxin
levels, increases levels of class I antiarrythmics AND anticoagulants, increased risk of bradyarrythmias, sinus arrest or AV heart block with Beta
blockers or calcium channel blockers,
pt teaching points teach pts to take carotid pulse for full minute, avoid missed dose, do not take w/ grapefruit juice, side effects may not appear
until days/weeks/yr after initation may persist,
Generic Name:verapamil
Brand name:
Classification: calcium channel blocker, class IV antiarrythmics
Why is patient/client receiving this? HTN, treatment of angina, prophylaxis of vasc. HA, Supraventricualr tachycardia (Negative notrope,
negative dromotrope [autorhythmicity of SA]) Acts at arteries AND heart, decreases peripheral resistance
Dosage/Route:
PO: 80-120 mg 3 times daily
Extended release 120-240 mg/single dose
Rate of administration with IV meds: 2 min
IV diluents compatible with IV medication:
undiluted, concentration= 2.5mg/mL
IV: 5-10 (75-150 mcg/kg); may repeat with 10mg after 15-30 min
Major Side effects:
-CNS: abnormal dreams, anxiety, confusion, dizziness/lightheadednesss, psychiatric disturbances, EENT: blurred vision, disturbed equilibrium,
epistaxis, RESP: cough, dyspnea, SOB CV: arrhythmias, HF, bradycardia, chest pain, hypotension, palpations, edema of lower extremities GI:
increase liver enzymes, constipation, diarrhea, GU: dysuria, polyuria, frequency DERM: rash, photosensitivity, ENDO: gynecomastia
Data used to indicate medication is effective: monitor bp and pulse frequently MUST HAVE PULSE OF 50, monitor ecg can result in
prolonged PR interval, monitor Is and Os, signs of HF, monitor for angina
Medication administration concerns: use in caution with decreased kidney/liver function, effects dampened by NSAIDs, may increase serum
digoxin levels; MAY MAKE HF worse; grape juice can increase serum levels, more effective in blacks
Patient/client teaching points: SIGNS EFFECTIVE: urinary frequency (fall risk interventions) , encourage pts to continue taking medications
for angina (nitro, beta blockers)
adenosine (Adenocard) Class V antiarrythmics
Why is pt receiving this? conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm when vagal manuvers are
unsuccessful; slows AV node conduction (negative dromtrope) and produces coronary artery dilation
PSVT is arrhythmia of unknown cause resulting in decreased coronary atery profusion
Dosage IV 6 mg by rapid IV bolus, if no results, as 12 mg bolus Dose may be repeated (single dose not to exceed 12 mg) IF NOT WORKING BY
SECOND, MED IS INEFFECTIVE FOR PT
Side Effects CNS: apprehension, dizziness, HA, head pressure, light-headedness EENT: blurred vision, throat tightness, RESP: SOB, chest pressure,
hyperventilation, CV: facial flushing, transient arrhythmias, chest pain, hypotension, palpitations GI: metallic taste, nausea, DERM: burning
sensation, sweating, MS: neck/back pain NEURO: numbness, tingling, Pressure senstations
Administration guidelines take apical for full minute, monitor HR frequently (every 15-30 seconds) and ECG continuously during therapy;
monitor BP, assess resp status GOAL: conversion of supraventricular tachycardia to normal sinus rhythm
Medication concerns use with digoxin may increase risk of ventricular fibrillation; SHORT transient period of 1st 2nd or 3rd degree heart block or
asystole may occur following injection, pts with history of asthma may experience bronchospasm; Half life of less than 10 seconds
pt teaching points caution pts to move slowly to minimize orthostatic hypotension,
Generic Name:digoxin
Brand name:
Classification: digitalis glycosilide
HIGH ALERT
Why is patient/client receiving this? HF, atrial fib and atrial flutter paroxysmal atrial tachycardia (positive inotrope, negative chronotrope
and dromotrope; increases refractory period
Dosage/Route:
IV: .5-1 mg given as ½ dose initially and one quare of initial dose
Direct; undiluted or dilute 1 mL in 4mL of sterile water for IM injection,
in each of 2 subsequent doses at 6-12 hrs
D5W or NS Admiinster over at least 5 min
PO: .75-1.5 mg given as 50% dose initially and one quarer of
initial dosein each of 2 subsequent doses at 6-12 hr intervals
Major Side effects: less side effects
-CNS: fatigue, HA, weakenss, EENT: blurred, yellow or green vision, CV: arrhythmias, bradycardia, ECG changes, AV block, SA block GI:
anorexia, n/v, Hemat: thrombocytopenia, Metab: electrolyte imbalances
Data used to indicate medication is effective: monitor bp and pulse, APICAL for 1 full minute, must be above 60, Monitor ECG through IV
administration and each dose (notify for bradycardia or new rythms), monitor is and os, daily weights, asses for edema, auscultate for
rales/crackles
Medication administration concerns: loop diuretics, thiazide, corticosteroids and laxatives may cause hypokalemia which can result in
toxicity; addative bradycardia with betablockers, diltiazem (CCB), verapamil (CCB) clonidine (vasodialator), use with sympathomimetics may
increase risk of toxicity DIGITALIS TOXICITY: biggest sign is unresponsiveness with dose
Goals: Decrease HR, Increase CO
atropine anticholinergic (antimuscarinic), antiarrythmics
Why is pt receiving this? bradycardia and heart block; blocks vagal stimulation and increases HR (increase conduction through AV node)
Dosage IV ..5-1 mg may repeat as needed q 5 min, not to exceed total of 2 mg (q3-5 min) or .04 mg/kg
Side Effects CNS: drowsiness, confusion, hyperpyrexia; EENT: blurred vision, cyclopegia, photophobia, dry eyes, mydriasis CV: tachycardia,
palpitations, arrhythmias, GI: dry mouth, constipation, impaired GI motility, GU: urinary hesitancy, retention, impotency RESP: tachypnea,
pulmonary edema MISC: flushing, decreased sweating
Administration guidelines take apical for full minute, assess vital signs and ECG tracings frequently during IV therapy; monitor Is and OS (may
cause urinary retention in elderly pts) Assess pts for abdominal distension and auscultate for bowel sounds GOAL: Increase in HR
Medication concerns additive anticholinergic effects, may alter absorption of PO medications by decreasing motility of GI tract, may alter
response of betablockers
pt teaching points may cause drowsiness (avoid driving or other activities requiring alertness until response know); oral rinses, sugarless candy
and frequent oral care may help with dry mouth, impairs heat regulation (at risk for heat stroke)
cholestryamine (Questran) bile acid sequestrates
Why is pt receiving this? management of hypercholesterolemia (hyperlipedima, elevated LDLs) binds with bile so it cannot be reabsorbed,
excreted in feces
Dosage PO 4g 1-2 times daily, initially may be increased as needed/tolerated up to 24g/day in 6 doses
Side Effects EENT: irritation of tongue, GI: constipation even fecal impaction esp in elderly if not enough water taken, abd discomfort, nausea,
flatulence, hemorrhoids, perineal irritation, stetattorhea (excess fat in feces) vomiting, DERM: irritation/rash, FandE: hypercholemic acidosis,
METAB: vitamin A,E, and K deficiency
Administration guidelines obtain diet history especially regarding fat consumption GOAL: decrease in serum LDL levels, therapy discontinued
if unresponsive after 3 months
Medication concerns while the body produces more cholesterol and bile than previous, overall loss is greater resulting in net loss of bile; give 1
before or 2 hrs after other PO meds to prevent malabsorption
pt teaching points take before meals, mix with 4-6 oz water, milk, fruit juice, shake vigorously slow stir; should be used in conjunction with
dietary retstrictions, exercise, cessation of smoking; constipation may occur (can be alleviated with fluid, bulk, exercise, stool softeners and
laxatives)
ezetimibe (Zetia) cholesterol absorption inhibitor
Why is pt receiving this? Alone or with statins in management of dyslipidemias including primary hypercholesterolemia, homozygous familial
hypercholesterolemia, and homozygous sitosterolemia; inhibits absorption in intestines
Dosage PO 10 mg once daily ; renal impairment (CCr under 60) do not exceed simvastatin dose of 20 mg
Side Effects GI: cholecystis, cholelithiasis, increased liver enzymes (w/ HMG CoA reductase inhibitors) nausea, pancreatitis DERM: rash
ANGIOEDEMA
Administration guidelines obtain diet history especially regarding fat consumption GOAL: decrease in serum LDL levels, and total cholesterol
Medication concerns effects may be decreased by bile acid sequestrants, may increase risk of rhabdomyosis when used with statins
Statin + ezetimbe lowers cholesterol by 72% (statins alone 30%)
pt teaching points take same time each day; do not take more than 1 dose/day; should be used in conjunction w/ diet restrictions, exercise and
cessation of smoking, notify for symptoms such as muscle pain, tenderness or weakness occur; female pts need to notify healthcare preofesional
promptly if pregnancy planned or suspected; importance of follow up exam
lovastatin (Mevacor) HMG-CoA reductase inhibitor (statin)
Why is pt receiving this? adjunctive mgmt. of primary hypercholesterolemia and mixed dyslipidemias; primary prevention of coronary heart
disease (MI, unstable angina, and coronary revascularization) in asymptomatic pts with increased total and low density lipids and
decreased high density lipids (most effective at lowering LDL’s); slows coronary atherosclerosis in patients with coronary artery
disease; inhibits formation of cholesterol resulting in decreased LDL, VLDL, triglycerides and increasing HDL (no known hormonal
deficits)
Dosage PO 20 mg once daily with evening meal; may be increased every 4 weeks for maximum of 80 mg/day (immediate release) or 60 mg/day
(extended release); RENAL IMPAIRMENT (CCR <30mL/min) dosage should not exceed 20 mg/day unless carefully titrated
Side Effects CNS: amnesia, confusion, dizziness, HA, insomnia, memory loss, weakness; EENT: blurred vision, GI: abd cramps, constipation,
diarrhea, flatus, heartburn, altered taste DRUG INDUCED HEPATITIS, increased liver enzymes, nausea, pancreatitis ENDO: HYPERGLYCEMIA GU:
erectile dysfunction, DERM: rashes, MS: RHABDOMYLOSIS, immune mediated necrotizing myopathy, myopathy, myotis HYPERSENSTITIVITY
Administration guidelines obtain diet history especially regarding fat consumption GOAL: decrease in serum LDL levels,
Medication concerns Increased risk of rhabdomylosis if taken with gemfibrozil or niacin; cyclosporin (transplant immunosuppresent) increases
risk for severe side effects; Grapefruit juice increase release of other drugs; CONTRAINDICATED in pts with unaccountable muscle aches or pains
pt teaching points Take as directed, not to skip doses or double up on missed doses, avoid grapefruit juice, should be used in conjunction w/ diet
restrictions, exercise and cessation of smoking, notify for symptoms such as muscle pain, tenderness or weakness occur; female pts need to
notify healthcare preofesional promptly if pregnancy planned or suspected; importance of follow up exam
gemfibrozil (Lopid) fibric acid derivative
Why is pt receiving this? managmenet of type II b hyperlipedeia (increased LDL and triglycerides, decreased HDL) in pts who do not yet have
clinical coronary artery disease and have failed therapy with diet, exercise, weight loss, or other agents. Inhibits synthesis of VLDL, the biggest
carrier of triglycerides
Dosage PO 600 mg twice daily 30 min before breakfast and dinner
Side Effects CNS: dizziness, HA; EENT: blurred vision, GI: abd cramps, diarrhea, epigastric pain, flatulence, gallstones, heartburn,
nausea/vomiting DERM: alopecia, urticaria rashes, MS: myotis
Administration guidelines obtain diet history especially regarding fat consumption and alcohol GOAL: decrease in serum triglyceride and
cholesterol levels and improved HDL to LDL ratios If no response is seen w/in 3 mo, medication is usually discontinued
Medication concerns Increased risk of rhabdomylosis if taken with statins; cyclosporin (transplant immunosuppresent) may have dereased
effect;
pt teaching points Take as directed, not to skip doses or double up on missed doses, should be used in conjunction w/ diet restrictions, exercise
and cessation of smoking, notify for symptoms
nitroglycerin antianginals Translingual spray “Nitrolingual, Nitromist”, Ointment “Nitro-Bid” Sublingual tablets “Nitrostat”
Why is pt receiving this? Acute mgmt. of angina pectoris; treatment of HF assoc. w/ acute MI
PO: adjunct treatment of HF
IV: adjunct treatment of acute MI
SL:works in minutes
ointment: works in 30-60 min, messy
Vasodilates vessels of periphery to decrease cardiac workload; Dilates NONATHEROSCLEROTIC coronary arteries to improve blood flow and
oxygenation
Dosage SL: 0.3-0.6 mg; may repeat q 5 min for 2 additional doses for acute attack
Translingual spray: 1-2 sprays, may be repeated q 5 min for 2 additional doses for acute attack; both may also be used prophylactically 5-10 min before
activites that may precipitate acute attack
IV: 5 mcg/min, increase by 5 mcg/min q 3-5 min to 20 mcg/min; if no response increase by 10-20 mcg/min q 3-5 min (dosind determined by
hemodynamic perameters; max: 200 mcg/min)
Ointment: 1-2 in. q 6-8 hrs
Side Effects CNS: dizziness, headache, apprehension, restlessness, weakness, EENT: blurred vision, CV: hypotension (dose dependent), reflex
tachycardia, syncope , GI: abd pain, n/v MISC: alcohol intoxication (large IV doses), cross tolerance, flushing, tolerance DERM: contact dermatitis
(transdermal only)
Administration guidelines SL tablet administered, pt should feel “tingling sensation”, wait 5 minutes, if pain continues, can repeat with second and
third dose (AFTER SECOND CALL 911) ; Assess location, duration, intensity, and precipitating factors of pts angina pain; Monitor BP and pulse before
and after administration. Pts receiving IV nitro require continuous ECG and BP monitoring; additional hemodynamic testing PRN GOAL: decrease in
frequency and severity of angina attacks, increase in activity tolerance, treatment of HF associated with acute MI
Medication concerns RISK OF REFLEX TACHYCARDIA
SL: Allow SL to dissolve, DO NOT EAT, DRINK OR SMOKE;
IV: NTG binds with PVC need to use special tubing (with vented spike) and glass tubing; MUST be ran through pump
Store in airtight, light resistant glass;; HA is normal as well as orthostatic hypotension
pt teaching points Take as directed, take missed doses ASAP unless next dose is w/in 2 hr, reduce risk of falls from orthostatic hypotension,
educate that HA is normal, monitor for reflex tachycardia, avoid concurrent use w/ alcohol, sit down and use medication at first sign of
acute angina attack, dose may be repated if pain not relieved in 5-10 min; CALL HCP or go to hospital if not relieved by 3 tablets in 15 min ,
pts should have multiple bottles at easy ready access, be warned expiration is 6 months from when bottle opened (look for fizzing on
tongue)
nitroglycerin antianginals , PO and Transdermal patch “Minitran, Nitro-Dur”
Why is pt receiving this?
long term prophylactic management of angina pectoris; Vasodilates vessels of periphery to decrease cardiac workload; Dilates
NONATHEROSCLEROTIC coronary arteries to improve blood flow and oxygenation
Dosage Transdermal patch .2-.4 mg/hr initially, may titrate up to .4-.8 mg/hr; patch should be worn 12- 14 hr day and taken off 10-12 hr/day
PO 2.5-9 mg q8-12 hrs
Side Effects CNS: dizziness, headache, apprehension, restlessness, weakness, EENT: blurred vision, CV: hypotension (dose dependent), reflex
tachycardia, syncope , GI: abd pain, n/v MISC: alcohol intoxication (large IV doses), cross tolerance, flushing, tolerance DERM: contact dermatitis
(transdermal only)
Administration guidelines administer dose 1 hr before or 2 hrs after meal w/ full glass of water
Patches should be rotated to different spots on body, ONLY 1 per body, HANDLE W/GLOVES (should be applied to hairless spot on body)
Medication concerns RISK OF REFLEX TACHYCARDIA; HA and orthostatic hypotension are normal
pt teaching points Take as directed, take missed doses ASAP unless next dose is w/in 2 hr, reduce risk of falls from orthostatic hypotension,
educate that HA is normal, monitor for reflex tachycardia, avoid concurrent use w/ alcohol, sit down and use medication at first sign
of acute angina attack, dose may be repated if pain not relieved in 5-10 min; CALL HCP or go to hospital if not relieved by 3 tablets in
15 min , pts should have multiple bottles at easy ready access, be warned expiration is 6 months from when bottle opened (look for
fizzing on tongue)
dopamine (Intropin) adrenergics HIGH ALERT
Why is pt receiving this?
Adjunct to standard measures to improve BP, CO, Urine output in treatment of shock unresponsive to fluid replacement larger doses stimulate
dopaminergic and beta1 adrinergic receptors to produce cardiac stimulation
USED TO THINK ACTED AT KINDEY, NOW UNDERSTOOD IF CO IMPROVED, YOU CAN INCREASE RENAL BLOOD FLOW, HOWEVER CAN
RESULT IN OBSTR KINDY FLOW DUE TO ALPHA STIMULATION
Dosage IV: 5-15 mcg/kg/min; infusion rate titrated as needed
Side Effects CNS: HA, EENT: mydriasis, RESP: dyspnea, CV: arrhythmias, hypotension, angina, ECG change, palpitations, vasoconstrictions, GI:
nausea/vomiting, DERM: piloerection, LOCAL: VERY TOXIC IF INFILTRATES TISSUE
Administration guidelines pt CONSTANTLY monitored for BP, HR, pulse pressure, ECG, pulmonary capillary wedge pressure, CO, CVP, and
urinary output throughout administration; Monitor for infiltration at IV siteGOAL: increase in BP (peripheral circulation and urine output)
Medication concerns Beta blockrs may antagonize effects
pt teaching points Explain rationale for instituting medication and need for frequent monitoring; advise pt to inform nurse immediately if chest
pain, dyspnea, numbness, tingling, or burning of extremities occurs; notify IMMEDIATELY of pain or discomfort at site of extremity
dobutamine (Dobutrex) adrenergics HIGH ALERT
Why is pt receiving this?
Short term (under 48 hr) mgmt. of HF caused by depressed contractility from organic heart disease or surgical procedures; Stimulates B1 ONLY
w/ minor effects on HR or peripheral blood vessels (INCREASES CO ONLY); this is a catecholamine
Dosage IV: 2.5-15 mcg/kg/min; infusion rate titrated as needed
Side Effects CNS: HA, RESP: SOB, CV: hypertension, increased HR, premature ventricular contractions, angina pectoris, arrhythmias, hypotension,
palpitations GI: n/v Local: phlebitis MISC: hypersensitivity rxns including skin rash, fever, bronchospasm
Administration guidelines pt CONSTANTLY monitored for BP, HR, pulse pressure, ECG, pulmonary capillary wedge pressure, CO, CVP, and
urinary output throughout administration; Monitor for infiltration at IV siteGOAL: increase in CO (improved hemodynamic perameters and urine
output)
Medication concerns Beta blockrs may antagonize effects
pt teaching points Explain rationale for instituting medication and need for frequent monitoring; advise pt to inform nurse immediately if chest
pain, dyspnea, numbness, tingling, or burning of extremities occurs; notify IMMEDIATELY of pain or discomfort at site of extremity; Instruct home
caregiver proper care of IV equipment, to report sings ofworsening HF, abd pain or n/v