1.

3.4.
7. monitor intake and output

8. client teaching
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1. take medication as prescribed
4@
2. teach client how to take and record pulse daily
*x

3. identify and report signs of toxicity

*x

*6
for atrial fibrillation: take pulse and report if below 60 or above 100 or changes in rhythm
$B,

*7
daily weights: report two pound increase
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2.
3.4.

Cardiac

glycosides
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1. action: makes heart beat slower but stronger
4@*x

1. improves pumping ability of heart

*x

2. increases force of heart's contraction

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3. decreases rate of contraction
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4. increases cardiac output

Antihyperten
2. examples
sives
1. digitoxin (Crystodigin)
9. action: dilates peripheral blood vessels
2. digoxin (Lanoxin)
10. examples
3. use
1. hydralazine HCL (Apresoline)
1. congestive heart failure
2. enalapril maleate (Vasotec)
2. atrial flutter
3. reserpine (Serpasil)
3. atrial fibrillation
4. prazosin HCL (Minipress)
4. contraindications
5. methyldopa (Aldomet)
1. ventricular tachycardia
6. clonidine (Catapres)
2. ventricular fibrillation
11. use: hypertension
3. second and third degree heart block
12. contraindications
5. adverse side effects
1. heart block
1. gastrointestinal effects such as nausea and vomiting,
2. children
diarrhea, and anorexia
13. adverse side effects
2. bradycardia
1. orthostatic hypotension
3. xanthopsia
2. dizziness
4. muscle weakness
3. bradycardia
5. dysrhythmia
4. tachycardia
6. nursing interventions
5. sexual dysfunction
1. before giving glycoside, check apical pulse and heart
6. deterioration in renal function
rhythm. Report if < 60 bpm
7. agranulosis
2. establish baseline data such as vital signs, electrolytes,
14. nursing interventions
clinical symptoms, creatinine clearance test
1. monitor vital signs and blood pressure, sitting and
3. monitor for drug toxicity
standing
*0
in children - cardiac arrhythmias
2. monitor for hearing changes, renal functioning
*1
in adults - visual disturbances, nausea and vomiting, anorexia
3. if hypotension, closely monitor client
*2
older clients more prone to toxicity
4. encourage intake of foods high in vitamin B
4. monitor drug levels
5. teach client
*3
therapeutic range 0.8 to 2.0 ng/ml
*8
low sodium diet
*4
toxic range > two ng/ml
*9
change positions slowly
*5
diuretics may increase chance of toxicity
*10
take medication as instructed

*11
*12

4.
3.4.

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3.
3.4.
4@*x

*x

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*x

Lipid$B,
lowering agents (antilipemic)
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21. action and use: lower LDL levels by reducing the synthesis of

Thrombolyti
cholesterol and/or triglycerides. Use: primary
cs
hypercholesterolemia
15. action: binds with plasminogen to dissolve thrombi (clots) in
22. examples
coronary arteries within four to six hours of myocardial infarction.
1. cholestyramine (Questran)
Activates conversion of plasminogen to plasmin. Plasmin is able to
2. atorvastatin (Lipitor)
break down clots (fibrin).
3. colestipol (Colestid)
16. examples
4. nicotinic acid (Niacin)
1. streptokinase (Streptase)
23. contraindications:
2. urokinase (Abbokinase)
1. hypersensitivity
17. uses
2. pregnancy/lactation
1. myocardial infarction
3. active liver disease
2. deep venous thrombosis
24. adverse side effects
3. pulmonary emboli
1. skin flushing
18. contraindications
2. gastric upset
1. active bleeding
3. niacin: temporary, intense flushing of face, neck and ears
2. cerebral embolism/thrombosis/hemorrhage
4. reduced absorption of fat-soluble vitamins
3. recent intraarterial diagnostic procedure or surgery
5. disruption of liver function
4. recent major surgery
6. muscle tenderness or weakness (rhabdomyolysis)
5. neoplasms of the CNS
25. nursing interventions
6. severe hypertension
1. monitor cholesterol levels
19. adverse side effects
2. monitor liver function tests
1. bleeding
3. teach client
2. allergic reactions:urticaria, itching, flushing, headache
*13
blood work and eye exams will be necessary during treatment
(illustration )
*14
to report blurred vision, severe GI symptoms, or headache
20. nursing interventions
*15
about low-cholesterol high-fiber diet
1. monitor for bleeding
*16
to report muscle weakness or tenderness
2. monitor coagulation studies
4. with cholestyramine, colestipol: Give other medications
3. monitor for allergic reactions
(e.g., such as thiazide diuretics, digoxin, warfarin, and
4. keep available: aminocaproic acid (fibrinolysis inhibitor)
certain antibiotics) one hour before or four hours after
administration of cholestryramine and colestipol, so that
they will not react with bile-acid-binding resins

avoid hazardous activities

protect medication from heat and light

Antianginals
2. nitrates
1. examples: nitroglycerin, isosorbide dinitrate (Isordil)
2. action: dilate arterioles which lowers peripheral vascular resistance (afterload)

3.
4.
5.

*26
*27
*28
*29
*30
*31
*32
*33

uses: treatment and prevention of acute chest pain caused by myocardial ischemia
adverse effects: postural hypotension, headache, flushing, dizziness
contraindications
*17
hypersensitivity
*18
severe anemia
*19
hypotension
*20
hypovolemia
6. nursing Interventions
*21
monitor for orthostatic hypotension
*22
monitor for tolerance with long term use
*23
administer every five minutes but not more than three tablets in 15
minutes
*24
if pain not relieved after 15 minutes and three tablets, notify
physician immediately
*25
instruct client
take pulse before taking medication
take oral preparations without food
when to seek medical attention
not to chew or swallow sublingual tabs
make position changes slowly
carry drug so that it is always within reach but avoid exposure to body heat and light
replace drug approximately every six months
avoid alcohol ingestion
1. beta-adrenergic blocking agents
1. examples: propranolol (Inderal), metoprolol (Lopressor)
2. action: inhibit sympathetic stimulation of beta receptors in the heart
decreases heart rate and force of myocardial contraction thus decreasing
myocardial oxygen consumption
3. uses: reduces frequency and severity of acute anginal attacks, dysrhythmias
4. side effects: blood dyscrasias, hypotension, GI disturbances, flushing of the
skin
5. contraindications
*34
hypersensitivity
*35
cardiogenic shock
*36
cardiac failure
6. nursing interventions
*37
weigh daily. Report weight gain of five pounds or greater
*38
monitor ECG if using for dysrhythmia
*39
administer on an empty stomach
*40
protect injectable solution from light
*41
instruct client
*42
take pulse before taking drug
*43
not to discontinue medication abruptly
*44
avoid hazardous activities if drowsiness occurs
*45
make position changes slowly
*46
take drug at same time each day

2.

calcium channel blockers

1. examples: verapamil (Isoptin), nifedipine (Adalat), diltiazem (Cardizem)
2. action: prevent the movement of extracellular calcium into the cell resulting
in coronary and peripheral artery dilation
3. uses: stable angina, dysrhythmias, hypertension
4. side effects: headache, drowsiness, dizziness, GI disturbances, flushing of
the skin
5. contraindications: hypersensitivity
6. nursing interventions
*47
monitor chest pain
*48
monitor ECG if used for dysrhythmia
*49
administer with food
*50
instruct client
*51
increase fluids to counteract constipation
*52
take pulse before taking drug
*53
avoid hazardous activities until stabilized on
drug
*54
limit caffeine consumption
*55
avoid alcohol
*56
change position slowly
Hypotension and shock
3. natural and synthetic catecholamines
4. examples: epinephrine, dopamine (Intropin), dobutamine (Dobutrex)
5. actions: increase cardiac output, (+) inotrope, (+) chronotrope
6. uses: dopamine and dobutamine: hypovolemic and cardiogenic shock, epinephrine:
anaphylactic shock
7. adverse effects: dysrhythmias, hypotension, tissue necrosis if extravasation occurs. Tremors,
anxiety, dizziness with epinephrine
8. contraindications
1. hypersensitivity
2. ventricular fibrillation
3. tachydysrhythmias
4. safety in children not known
9. nursing interventions
1. correct hypokalemia before administering
2. monitor vital signs frequently
3. monitor ECG continuously during administration
4. administer with infusion pump
5. start drug slowly and increase according to health care provider's orders
6. monitor injection site for extravasation
7. protect solution from light
8. do not use discolored solution
9. stop the drug gradually

*57
*58
*59
*60
*61
*62

5.
3.4.
8. teach client

*63
take medication at same time every day
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wear medical alert jewelry: wearer takes anticoagulants (illustration )
4@*x

*65

use

a
soft

toothbrush

*x

*66

do not use a straight razor; use an electric razor

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*67
avoid alcohol and smoking
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*68
report any signs of bleeding, red or black bowel movements, headaches, rashes, red or pink

tinged urine, sputum
Anticoagulants
*69
avoid trauma
1. action: disrupt the blood coagulation process, thereby suppressing
*70
blood levels of the anticoagulant may be monitored
the production of fibrin
*71
do not take over-the-counter (OTC) medications without
2. examples
1. heparin: parenteral administration
Bronchodilators
2. coumadin (Warfarin): oral administration
10. action:
3. use
1. dilate air passages in the lungs, specific action dependent on type of drug.
1. pulmonary embolism
2. increase heart rate
2. deep vein thrombosis
3. act on the autonomic nervous system
3. myocardial infarction
11. examples
4. atrial fibrillation
1. beta-adrenergic: abuterol (Proventil, Ventolin), metaproterenol (Alupent)
4. adverse side effects
2. xanthines: aminophylline, theophylline (Theo-Dur) acts on bronchial smooth muscle
1. allergic responses such as chills, fever and urticaria
3. epinephrine HCL (Adrenalin) - increases the rate and strength of cardiac contraction
2. use cautiously if client tends to bleed (hemophilia, peptic
through the sympathetic nervous system
ulcer)
4. isoproterenol HCL (Isuprel) - increases the heart rate by stimulating the beta3. GI disturbances- nausea and vomiting, diarrhea,
adrenergic blocking agent of the sympathetic nervous system
abdominal cramps
12. use
5. contraindications
1. bronchospasms
1. hemophilia
2. asthma
2. leukemia
13. adverse effects
3. peptic ulcer
1. dizziness
4. blood dyscrasias
2. tremors
6. nursing interventions
3. anxiety
1. heparin: monitor APTT (activated partial thromboplastin
4. palpitations
time)
5. gastric disturbances
normal 40 seconds
6. headache
at therapeutic levels, APTT increases by a factor of 1.5 to 2
7. tachycardia
2. coumadin - monitor PT (prothrombin time)
8. dysrhythmias
normal 12 seconds
14. contraindications
INR (International normalized ratio) two to three
1. hypersensitivity
3. do baseline blood studies before therapy
2. narrow angle glaucoma
4. have antidote ready
3. tachydysrhythmias
heparin: protamine sulfate
4. severe cardiac disease
coumadin: vitamin K
15. nursing interventions
5. monitor client for symptoms of hemorrhage such as
1. monitor theophylline levels (normal ten to 20 mcg/dl)
increased pulse, decreased BP
2. monitor intake and output, and vital signs
6. avoid salicylates (such as aspirin)
3. monitor EKG, vital signs during therapy
7. avoid IM injections
4. teach clients

*72
take medication as prescribed only
*73
report adverse effects
*74
stop smoking during therapy
*75
take with meals
*76
avoid OTC drugs
*77
The dosage of medication needed for a therapeutic effect can vary with age, weight,
gender, health status and environmental factors.
*78
Most drugs produce a mixture of therapeutic and adverse effects.
*79
Medications require a written order from a physician or a nurse practitioner legally
permitted to prescribe them.
*80
Because most drugs are metabolized in the liver, it is especially susceptible to drug
induced injury.
*81
The nurse is responsible to judge independently before giving a prescribed
medication.
*82
The route of administration will be chosen to achieve a certain therapeutic action, at
a certain speed.
*83
Medications interact with foods, and that interaction can block or slow therapeutic
action
*84
People metabolize medications differently, depending on age, gender, body size,
health status, drug tolerance, cumulative effect of medication, and genetics.
*85
Inhalers are most effective when their users know the right technique. Teach the
technique and then test how well the client uses it.
*86
Medications are especially likely to cause hypotension in elderly people.
*87
There are two types of drug dependence: psychic and physical. Psychic dependence
implies a craving to use the drug periodically. Physical dependence implies physical
symptoms when the drug is withheld.