GENERIC NAME
(BRAND NAME)
CLASSIFICATION
ACTION
USES
SIDE EFFECTS
NURSING IMPLICATIONS
Slows conduction through
AV node, can interrupt
reentry pathways through
AV node, and can restore
normal sinus rhythm in
patients with paroxysmal
supraventricular
tachycardia (PVST)
SVT, Wolfe-ParkinsonWhite (WPW) syndrome,
diagnostic aid to assess
myocardial perfusion
defects in CAD, widecomplex tachycardia
diagnosis
Light-headedness, arm tingling,
numbness, blurred vision, facial
flushing, dyspnea, chest pressure,
nausea, metallic taste, groin pressure
Assess I & O ratio, electrolytes (K, Na, Cl).
Assess cardiopulmonary status: B/P, pulse,
respiration, ECG intervals. Monitor
respiratory status: watch for bilateral
crackles, respiratory depression. If
increased respirations/pulse, product may
need to be discontinued. Monitor CNS
effects (confusion, psychosis, parasthesias,
convulsions)
Prolongs duration of
action potential and
effective refractory
period, noncompetitive
alpha and beta adrenergic
inhibitation; increases QT
and PR intervals.
Decreases sinus rate,
decreases peripheral
vascular resistance
Severe ventricular
tachycardia,
supraventricular
tachycardia, ventricular
fibrillation, A-fib, atrial
flutter, cardiac arrest,
cardiac surgery, heart
failure, PSVT
Headache, dizziness, hypotension,
bradycardia, tremors, malaise, halos,
hyperthyroidism, hypothyroidism,
nausea, vomiting, diarrhea,
constipation, rash, blue-gray skin
discoloration, spontaneous
ecchymosis, flushing, abnormal
salivation, pain in extremities,
pulmonary inflammation
Assess pulmonary toxicity: dyspnea,
fatigue, fever, chest pain. Monitor ECG
continuously to determine effectiveness.
Assess B/P for hypotension/hypertension.
Monitor I & O ratio, electrolytes (K Na, Cl).
Hepatic studies (AST, ALT, bilirubin, alk
phos). Chest x-ray and thyroid function
tests. Assess for dehydration or
hypovolemia. Watch for rebound
hypertension after 1 – 2 hrs. Monitor
cardiac status and CNS symptoms
Blocks acetylcholine at
parasympathetic
neuroeffector sites;
increases cardiac output,
heart rate by blocking
vagal stimulation in heart;
dries secretions by
blocking vagus
Bradycardia < 40 – 50
bpm, brady-dysrhythmia,
reversal of
anticholinesterase agents,
insecticide poisoning,
decreasing secretions
before surgery,
antispasmodic with GU,
biliary surgery,
bronchodilator, cardiac
arrest, pulseless electrical
activity, ventricular
asystole
Headache, dizziness, flushing,
insomnia, delirium, hypotension,
paradoxical bradycardia, blurred
vision, photophobia, pupil dilation,
nasal congestion, dry mouth, nausea,
vomiting, constipation, retention
hesitancy, impotence, rash,
decreased sweating, suppression of
lactation
Monitor I & O; check for urinary retention.
Monitor ECG. Monitor bowel sounds for
constipation. Monitor for increased
intraocular pressure. Watch for allergic
reactions. Monitor cardiac and respiratory
status
DRUGS FOR DYSRHYTHMIAS (CHAPTER 37)
adenosine
(Adenocard)
amiodarone
(Cordarone)
atropine
(Sal-Tropine)
Antidysrhythmic—
High alert drug
Antidysrhythmic (Class
III)—High alert drug
Antidysrhythmic,
anticholinergic
parasympatholytic,
antimuscarinic
digoxin
Cardiac glycoside,
inotropic,
antidysrhythmic
Inhibits sodium-potassium
ATPase, which makes
more calcium available
for contractile proteins,
resulting in increased
cardiac output. Inc force
of contraction, dec. HR
Antiarrhythmic Class
IV, Calcium Channel
Blocker—high alert
drug
Inhibits calcium ion influx
across cell membrane
during cardiac
depolarization. Produces
relaxation of coronary
vascular smooth muscle,
dilates coronary arteries,
slows SA/AV node
conduction times, dilates
peripheral arteries
(Lanoxin)
diltaizem
(Cardizem)
lidocaine
Antidysrhythmic
(Xylocaine)
propranolol
(Inderal)
Antihypertensive,
antianginal,
antidysrhythmic
Heart failure, A-Fib, atrial
flutter, atrial tachycardia,
cardiogenic shock,
paroxysmal atrial
tachycardia, rapid
digitalization in these
disorders
Headache, hypotension, drowsiness,
depression, bradycardia, blurred
vision, yellow-green halos, nausea,
vomiting, diarrhea
PO: Angina pectoris due
to coronary artery spasm,
hypertension.
IV: A-fib, atrial flutter,
paroxysmal
supraventricular
tachycardia (PVST), rapid
ventricular rate in children
Assess apical pulse for 1 min before
giving. If < 60 in adult, <90 in infant; take
again in 1 hr. Monitor electrolytes (K, Na,
Cl, Mg, Ca). Monitor Renal studies (BUN,
creatinine); blood studies (ALT, AST,
bilirubin, Hct, Hgb. Monitor I & O ratio,
daily weights. Monitor therapeutic level 0.5
– 2 ng/ml. K supplements if level < 3;
bananas and OJ. Do not stop taking
abruptly.
Headache, fatigue, drowsiness,
edema, nausea, constipation, rash,
rhinitis, photosensitivity, burning
Assess cardiac status: B/P, pulse,
respiration, ECG and intervals (PR, QRS,
QT). If systolic < 90 mm Hg or < 50 bpm,
hold dose. Limit caffeine consumption,
avoid grapefruit juice. Do not discontinue
abruptly
Increases electrical
stimulation threshold of
ventricle, His-Purkinje
system, which stabilizes
cardiac membrane,
decreased automaticity
Ventricular tachycardia,
ventricular dysrhythmias
during cardiac surgery,
MI, digoxin toxicity,
cardiac catheterization
Headache, dizziness, hypotension,
bradycardia, blurred vision,
confusion, nausea, vomiting,
anorexia, rash, swelling, edema,
phlebitis at inj site, dyspnea
Assess ECG continuously to determine
increased PR or QRS segments. IV inf
rate using inf pump; run at < 4 mg/min.
Assess blood levels (1.5 - 5 mcg/ml)
Assess I & O, electrolytes (K, Na, Cl).
Assess for malignant hyperthermia:
tachypnea, tachycardia, changes in B/P, ↑
temp. Assess respiratory status (crackles,
respiratory ↓). CNS effects: psychosis,
dizziness, convulsions. Administer IM in
deltoid.
Nonselective beta-blocker
with negative inotropic,
chronotropic, dromotropic
properties
Chronic stable angina
pectoris, hypertension,
supraventricular
dysrhythmias, migraine,
prophylaxis, anxiety, acute
MI, unstable angina
fatigue, bronchospasm, depression,
hallucinations, bizarre dreams, sore
throat, dry eyes, nausea, vomiting,
diarrhea, UTIs, ↓ libido,
hyperglycemia, hypoglycemia,
facial swelling, Raynaud’s
phenomenon
Assess B/P, pulse. If < 50 bpm or systolic
<90 mm Hg call prescriber. Monitor I &
O; watch for fluid overload if kidney
damage exist. Assess ECG continuously.
Assess hepatic enzymes: AST, ALT,
bilirubin. Assess for angina pain.
Antidysrhythmic
Slows conduction
velocity; reduces
membrane
responsiveness; inhibits
automaticity; betablocking activity
Life-threatening
dysrhythmias, sustained
ventricular tachycardia;
also atrial fibrillation
(single dose)
Nausea, vomiting, dizziness,
headache, hypotension, chest pain,
altered taste, tinnitus, constipation,
dry mouth, bruising, rash, dyspnea
Assess GI status. Assess cardiac studies:
ECG for PR, QT prolongation. Do chest
x-ray and pulmonary function test. Assess I
& O for decreased output; daily weights.
Assess B/P and lung sounds (bilateral
crackles). Toxicity: fine tremors,
dizziness, hypotension, drowsiness,
abnormal heart rate. Monitor cardiac
function.
Antidysrhythmic Group
III
Blockade of Beta 1 and
Beta 2 receptors leads to
antidysrhythmic effect,
prolongs action potential
in myocardial fibers
without affecting
conduction, prolongs QT
interval
Life-threatening
ventricular dysrhythmias;
betapace AF: to maintain
sinus rhythm in
symptomatic atrial
fibrillation/flutter, cardiac
surgery, PSVT /
Dizziness, anxiety, nightmares,
insomnia, bradycardia, chest pain,
tinnitus, vision changes, double
vision, nausea, vomiting, diarrhea,
dry mouth, constipation, impotence,
urinary retention, rash, fever, facial
swelling, joint pain, nasal stuffiness,
orthostatic hypotension
Apical/radial pulse before
administration. Baseline QT must be <=
450 msec. Assess I & O ratio, weigh daily,
edema in feet and legs. Assess pulse q4hr.
Obtain baseline renal studies. Assess skin
turgor and hydration status. Give PO at
bedtime. Do not stop abruptly, taper over 2
weeks. Wear support hose to minimize
orthostatic hypotension
propafenone
(Rhythmol)
sotalol
(Betapace)
DRUGS FOR CARDIAC ARREST (CHAPTER 37)
GENERIC NAME
(BRAND NAME)
dobutamine
CLASSIFICATION
ACTION
USES
SIDE EFFECTS
NURSING IMPLICATIONS
Adrenergic direct
acting Beta 1 agonist,
cardiac stimulant
Causes increased
contractility increased
cardiac output without
marked increase in HR by
acting on Beta 1 receptors
in heart. Minor alpha and
beta 2 effects
Cardiac decompensation
due to organic heart
disease or cardiac surgery.
Cardiogenic shock in
children, congenital heart
disease in children
undergoing cardiac cath
Anxiety, headache, dizziness,
tachycardia, hyper/hypotension,
angina, PVCs, heartburn, nausea,
vomiting, muscle cramps (legs),
dyspnea
Assess for hypovolemia. Assess
oxygenation/perfusion deficit. Monitor for
heart failure. Monitor ECG during
administration, if B/P increases, dosage is
decreased. Monitor serum electrolytes and
urine output. Monitor for sulfite
sensitivity—may be life threatening
Adrenergic
Causes increased cardiac
output; acts on Beta 1 and
Alpha receptors, causing
vasoconstriction in blood
vessels; low dose causes
renal and mesenteric
vasodilation. Beta 1
stimulation produces
intropic effects with
increased cardiac output
Headache, palpitations, tachycardia,
hypertension, ectopic beats, angina,
wide QRS complex, nausea,
vomiting, diarrhea, anxiety
Assess hypovolemia. Assess
oxygenation/perfusion deficit. Monitor for
heart failure. Monitor ECG during
administration. Monitor I & O ratio: urine
decrease. Monitor B/P and pulse q5 min
during administration. Monitor for
parasthesias and coldness of extremities.
Monitor inj site for tissue sloughing
(Dobutrex)
dopamine
(Intropin)
Shock, increased
perfusion, hypotension,
bradycardia, cardiac arrest
epinephrine
norepinephrine
Bronchodilator
nonselective adrenergic
agonist, vasopressor—
high alert drug
Beta 1 and Beta 2 agonist
causing increased levels
of cAMP producing
bronchodilation, cardiac,
and CNS stimulation; high
doses cause
vasoconstriction via alpha
receptors, low doses
causes vasodilation via
Beta 2 vascular receptors
Adrenergic—high alert
drug
Causes increased
contractility and HR by
acting on Beta receptors in
heart; also acts on Alpha
receptors causing
vasoconstriction in blood
vessels; B/P is elevated,
coronary blood flow
improves, cardiac output
increases
Pituitary hormone
Promotes reabsorption of
water by action on renal
tubular epithelium; causes
vasodilation
(Levophed)
vasopressin
(Pitressin)
Acute asthmatic attacks,
hemostasis,
bronchospasm,
anaphylaxis, allergic
reactions, cardiac arrest,
adjunct in anesthesia,
shock, bradycardia,
chloroquine overdose
Tremors, anxiety, dizziness,
palpitations, tachycardia,
dysrhythmias, anorexia, nausea,
vomiting, dyspnea, hallucinations,
increased T wave, sweating, dry
eyes
Assess ECG during administration. Monitor
inj site for tissue sloughing, Monitor for
sulfite sensitivity—life threatening
situation.
Acute hypotension, shock
Headache, palpitations, tachycardia,
hypertension, ectopic beats, angina,
nausea, vomiting, restlessness,
decreased urine output, necrosis in
tissue, tissue sloughing with
extravasation
Assess I & O ratio: < 30 ml/hr call doctor.
Monitor ECG during administration.
Monitor B/P and pulse after parenteral route
admin. CVP or PWP during inf possible.
Assess for parasthesias and coldness of
extremities: peripheral blood flow may
decrease. Watch inj site for tissue
sloughing. Watch for sulfite sensitivity,
can be life-threatening
Diabetes insipidus,
abdominal distention
postoperatively, bleeding
esophageal varices
Drowsiness, lethargy, vertigo,
increased B/P, dysrhythmias, nasal
irritation, nausea, cramps, vomiting,
vulval pain, tremor, sweating,
bronchial constriction
Monitor nasal mucosa for irritation.
Monitor B/P and pulse when giving IM/IV.
Monitor I & O ratio, daily weight,
fluid/electrolyte balance. check for edema
in extremities, Monitor for H2O
intoxication./
USES
SIDE EFFECTS
NURSING IMPLICATIONS
Chronic stable angina
pectoris, hypertension,
vasospastic angina, may
coadminister with other
antihypertensives and
antianginals
Headache, fatigue, dizziness,
anxiety, hypotension, nausea,
vomiting, diarrhea, polyuria, rash,
pruritus, sexual difficulties, cough,
weight gain, tinnitus
Monitor Cardiac Status: B/P, pulse,
respirations, ECG. Monitor I & O ratio,
daily weight, jugular vein distension,
crackles. Give w/o regards to meals. Avoid
OTC drugs and grapefruit.
DRUGS FOR HYPERTENSION (CHAPTER 39)
GENERIC NAME
(BRAND NAME)
amlodipine besylate
(Norvasc)
CLASSIFICATION
ACTION
Antianginal,
Antihypertensive,
Calcium Channel
Blocker
Inhibits calcium ion influx
across the cell membrane
during cardiac
polarization; produces
relaxation of coronary
vascular smooth muscle
forosemide
Loop diuretic
Inhibits reabsorption of
sodium and chloride at
proximal and distal tubule
and in the loop of Henle
Antihypertensive (ACE
inhibitor)
Selectively suppresses
renin-angiotensinaldosterone system;
inhibits ACE, prevents
conversion of angiotensin
I to angiotensin II; results
in dilation of arterial,
venous vessels
(Lasix)
fosinopril
(Monopril)
lisinopril
(Prinivil, Zestril)
losartan
(Lopressor)
Hypokalemia, hypochloremic
alkalosis, hypomagnesaemia,
hyperuricemia, hypocalcemia,
hyponatremia, metabolic alkalosis,
hyperglycemia, polyuria, rash,
pruritus, nausea
Assess for metabolic alkalosis and
hypokalemia. Watch for rashes and
temperature elevations. Monitor I & O,
daily weights. Assess for confusion, hearing
issues, electrolyte levels, skin turgor and
hydration status. Look for allergies to
sulfonamides and thiazides. Monitor
respirations
Hypertension, alone or in
combination with thiazide
diuretics, systolic CHF
Insomnia, parasthesia, headache,
dizziness, hypotension, nausea,
memory disturbance, orthostatic
hypotension, diarrhea, increased
BUN, creatinine, decreased libido,
decreased Hct, Hgb, hyperkalemia
Assess blood studies: neutrophils and
decreased platelets. Monitor B/P, watch for
orthostatic hypotension, Monitor renal
studies. Monitor K levels. Watch for edema
in feet and legs; daily weights. Look for
allergic reaction. Do not discontinue
abruptly
Antihypertensive,
ACE inhibitor
Selectively suppresses
renin-angiotensinaldosterone system;
inhibits ACE
Mild to Moderate
Hypertension, adjunctive
therapy of systolic CHF,
Acute MI
Vertigo, fatigue, hypotension,
headache, blurred vision, nausea,
vomiting, anorexia, sexual
dysfunction, rash, muscle cramps,
dyspnea
Assess blood studies, platelets: WBC with
differential. If neutrophils <1000/mm3,
Assess apical/pedal pulse before
administration. Assess B/P, pulse q4hr.
Assess electrolytes (K, Na, Cl). Assess
edema in feet, legs daily. Weigh daily.
Assess skin turgor/hydration. Assess for
CHF: edema, dyspnea, wet crackles.
Baselines in hepatic, renal studies.
Antihypertensive
Blocks the vasoconstrictor
and aldosterone-secreting
effects of angiotensin II;
selectively blocks the
binding of angiotensin II
to the AT1 receptor found
in tissues
Hypertension, alone or in
combination, nephropathy
in type 2 diabetes,
hypertension with left
ventricular hypertrophy
Dizziness, insomnia, dysrhythmias,
diarrhea, dyspepsia, cough, upper
respiratory infection, gout,
dermatitis, dry skin, urinary
frequency, UTI, abnormal dreams,
vertigo, migraine
Assess B/P with position changes. Monitor
electrolytes (K, Na, Cl). Baselines in renal,
hepatic studies. Assess for edema in legs,
feet and daily weights. Monitor skin turgor
and hydration status. Photosensitivity may
occur, avoid sunlight. Use contraception
while taking this drug.
Insomnia, dizziness, confusion,
fatigue, hypotension, palpitations,
nausea, vomiting, diarrhea,
impotence, rash, pruritus, dyspnea,
wheezing
Assess ECG directly when giving IV.
Monitor I & O, weigh daily. Apical/radial
pulse before administration. Notify
prescribed in < 50. Have baselines in renal,
hepatic studies. Assess for edema in feet,
legs daily. Assess skin turgor and mucous
membranes for hydration status. Take at
bedtime; take tablet same time each day
(Cozaar)
metoprolol
Pulmonary edema, edema
in CHF, hepatic disease,
nephrotic syndrome,
ascites, hypertension,
hypertensive
emergency/urgency
Antihypertensive,
antianginal
Lowers B/P by beta
blocking effects; reduces
elevated renin plasma
levels; blocks beta 2
adrenergic receptors in
bronchial
Mild to Moderate
Hypertension, acute MI,
angina pectoris, NYHA
class II, III heart failure
spironolactone
Competes with
aldosterone at receptor
sites in distal tubule,
resulting in excretion of
sodium chloride, water,
retention of potassium,
phosphate
Edema in CHF,
hypertension, diureticinduced hypokalemia,
primary
hyperaldosteronism,
edema of nephrotic
syndrome, cirrhosis of the
liver with ascites, CHF,
bronchopulmonary
dysplasia, PMS
Diarrhea, vomiting, rash, pruritus,
drowsiness, headache,
hyperchloremic metabolic acidosis,
hyponatremia, impotence,
amenorrhea, deepening voice, breast
pain, cramps, nausea
Monitor electrolytes (K, Na, Cl), BUN,
serum creatinine, ABGs, CBC, signs of
hyperkalemia. Assess daily weight and
I & O ratio. Watch for signs of metabolic
acidosis (drowsiness, restlessness). Look for
rashes. Monitor for confusion. Monitor
hydration status and skin turgor.
CLASSIFICATION
ACTION
USES
SIDE EFFECTS
NURSING IMPLICATIONS
Antiplatelet,
antipyretic, nonopioid
analgesic, NSAID
Blocks pain impulses in
CNS, reduces
inflammation by
inhibition of prostaglandin
synthesis; antipyretic
action on results from
vasodilation of peripheral
vessels; decreases platelet
aggregation
Mild to moderate pain or
fever including RA,
osteoarthritis,
thromboembolic disorders,
TIAs, rheumatic fever,
postmyocardial infarction,
prophylaxis of MI,
ischemic stroke, angina
Nausea, vomiting, rash, stimulation,
headache, hallucinations, rapid
pulse, pulmonary edema, tinnitus,
hypoglycemia, hyponatremia,
hypokalemia, increased bleeding
time, bruising, hyperpnea. Reye’s
syndrome (children)
Assess pain before and after administration.
Assess hepatic, blood, and renal studies.
Watch for hepatotoxicity if on long term
use. Watch for allergic reaction. Watch for
ototoxicity if on long term use. Monitor for
edema in feet, ankles, legs. Assess salicylate
level: 150 – 300 mcg/ml for chronic
inflammation.
Platelet aggregation
inhibitor
Inhibits first and second
phases of ADP-induced
effects in platelet
aggregation.
Reducing risk of stroke,
MI, peripheral arterial
disease in high-risk
patients, acute coronary
syndrome, transient
ischemic attack (TIA),
unstable angina
headache, syncope, edema,
hypertension, nausea, vomiting,
diarrhea, epistaxis, rash, pruritus,
UTI, hypercholesterolemia, chest
pain, fatigue, back pain, upper
respiratory tract infection,
bronchitis, cough
Assess for thrombotic/thrombocytic
purpura: (fever, thrombocytopenia,
neurolytic anemia). Assess for symptoms of
stroke and MI during treatment. Assess
hepatic and blood studies during long term
use. Monitor for unusual bleeding.
Antianginal,
vasodilator
Relaxation of vascular
smooth muscle, which
leads to decreased
preload, after-load, which
is responsible for
decreasing left ventricular
end-diastolic pressure,
systemic vascular
resistance and reducing
cardiac O2 demand
Vascular headache, flushing,
dizziness, postural hypotension,
twitching, pallor, sweating, nausea,
vomiting, diarrhea, syncope,
tachycardia, faintness
Assess pain characteristics. Monitor B/P,
pulse, respirations. Clients develop
tolerance over long term use. Side effects
may indicate a lower dosage is needed.
Give PO with 8 oz of water on empty
stomach. SL tabs placed under tongue to
dissolve. Avoid alcohol. SL product may
produce “stinging” effect.
Potassium sparing
diuretic
(Aldactone)
DRUGS FOR CAD (CHAPTER 41)
GENERIC NAME
(BRAND NAME)
aspirin
(acetylsalicylic acid)
clopidogrel
(Plavix)
isosorbide
mononitrate
(Imdur)
Treatment, prevention of
chronic stable angina
pectoris, diffuse
esophageal spasm
nitroglycerin
Coronary vasodilator,
antianginal
Decreases preload,
afterload, which is
responsible for decreasing
left ventricular enddiastolic pressure, system
vascular resistance; dilates
coronary arteries,
improves blood flow
through coronary
vasculature, dilates
arterial, venous beds
systemically
Chronic stable angina
pectoris, prophylaxis of
angina pain, CHF
associated with acute MI,
controlled hypotension in
surgical procedures
Headache, flushing, dizziness,
postural hypotension, syncope,
nausea, vomiting, pallor, sweating,
rash, tachycardia
Medication Source: Roth-Skidmore, L. (2008). 2008 Mosby’s nursing drug reference. St. Louis: Mosby Elsevier
Assess pain characteristics. Monitor for
orthostatic hypotension. Take B/P and pulse
before and after administration. Can
develop tolerance over long term use.
Watch for side effects, may require lowered
dosage. Take PO with 8 oz of water on
empty stomach. SL tablets should be
dissolved under the tongue. Keep tablets in
original container, replace every 6 months.
Can take (3) SL tablets in 15 minute period
(1 every 5 minutes). If no relief of
symptoms, seek immediate medical care.
SL may cause stinging sensation under
tongue. NEVER take with erectile
dysfunction products (sildenafil, tadalafil,
vardenafil), may cause hypotension, death