CACAPIT, LOVELY ROSE S.
NCENH06- NDA
ESSENTIAL DRUGS FOR THE PATIENT WITH CARDIOVASCULAR DISEASES
DRUG
GENERIC NAME: METHYLDOPA
BRAND NAME: Aldomet
CLASSIFICATION: CARDIOVASCULAR
AGENT; CENTRAL-ACTING,
ANTIHYPERTENSIVE; AUTONOMIC
NERVOUS SYSTEM AGENT; ALPHA-
ADRENERGIC AGONIST
(SYMPATHOMIMETIC)
DOSAGE: 125 mg, 250 mg, 500 mg
tablets; 50 mg/mL oral suspension; 50
mg/mL injection
FREQUENCY: PO 250 mg b.i.d. or t.i.d.,
may be increased up to 3 g/d in divided
doses  Lab tests: Schedule baseline and periodic blood counts and
IV 250–500 mg q6h, may be increased up
to 1 g q6h
ROUTE: PO, IV
MODE OF ACTION
Structurally related to catecholamines and
their precursors. Has weak
neurotransmitter properties; inhibits
decarboxylation of dopa, thereby reducing
concentration of dopamine, a precursor of
norepinephrine. It also inhibits the
precursor of serotonin.
Lowers standing and supine BP, and
unlike adrenergic blockers, is not so prone dosage reduction.
to produce orthostatic hypotension,
diurnal BP variations, or exercise
hypertension. Reduces renal vascular
resistance; maintains cardiac output
without acceleration, but may slow heart
rate; tends to support sodium and water
retention.
NURSING CONSIDERATIONS
Check BP and pulse at least q30min until stabilized during IV
infusion and observe for adequacy of urinary output.
Take BP taken at regular intervals in lying, sitting, and standing
positions during period of dosage adjustment if physician
requests.
Be aware that transient sedation, drowsiness, mental
depression, weakness, and headache commonly occur during
first 24–72 h of therapy or whenever dosage is increased.
Symptoms tend to disappear with continuation of therapy or
Supervision of ambulation in older adults and patients with
impaired kidney function; both are particularly likely to manifest
orthostatic hypotension with dizziness and light-headedness
during period of dosage adjustment.
Monitor fluid and electrolyte balance and I&O. Report oliguria
and changes in I&O ratio. Weigh patient daily, and check for
edema because methyldopa favors sodium and water retention.
liver function tests especially during first 6–12 wk of therapy or if
patient develops unexplained fever; periodic serum electrolytes.
Be alert to and report symptoms of mental depression (e.g.,
anorexia, insomnia, inattention to personal hygiene, withdrawal).
Drug-induced depression may persist after drug is withdrawn.
Be alert that rising BP indicating tolerance to drug effect may
occur during week 2 or 3 of therapy.
 DRUG MODE OF ACTION
GENERIC NAME: HYDRALAZINE Reduces BP mainly by direct effect on vascular
HYDROCHLORIDE smooth muscles of arterial-resistance vessels,
resulting in vasodilation. Has little effect on
BRAND NAME: Apresoline venous-capacitance vessels. Hypotensive effect
may be limited by sympathetic reflexes, which
CLASSIFICATIONS: CARDIOVASCULAR increase heart rate, stroke volume, and cardiac
AGENT; NONNITRATE VASODILATOR; output.
ANTIHYPERTENSIVE
Diastolic response is often greater than systolic
DOSAGE: 10 mg, 25 mg, 50 mg, 100 mg tablets; response. Vasodilation reduces peripheral
20 mg/mL vial resistance and substantially improves cardiac
output, and renal and cerebral blood flow.
FREQUENCY & ROUTE: Postural hypotensive effect is reportedly less
Adult: PO 10–50 mg q.i.d. IM 10–50 mg q4–6h IV than that produced by ganglionic blocking agents
10–20 mg q4–6h
Geriatric: PO Start with 10 mg 2–3 times/d
NURSING CONSIDERATIONS
 Lab tests: Determine antinuclear antibody
titer before initiation of therapy and
periodically during prolonged therapy.
 Make baseline and periodic determinations
of BUN, creatinine clearance, uric acid,
serum potassium, blood glucose, and ECG.
 Monitor for S&S of SLE, especially with
prolonged therapy.
 Monitor BP and HR closely. Check every 5
min until it is stabilized at desired level,
then every 15 min thereafter throughout
hypertensive crisis.
 Monitor I&O when drug is given
parenterally and in those with renal
dysfunction.

Child: PO 3–7.5 mg/kg/d in 4 divided doses IV/IM

1.7–3.5 mg/kg/d in 4 divided doses
 DRUG
GENERIC NAME: ASPIRIN
(ACETYLSALICYLIC ACID)
BRAND NAME: A.S.A
CLASSIFICATIONS: CENTRAL
NERVOUS SYSTEM AGENT;
ANALGESIC, SALICYLATE;
ANTIPYRETIC; ANTIPLATELET
DOSAGE: 81 mg chewable tablets; 325
mg, 500 mg tablets; 81 mg, 165 mg, 325
mg, 500 mg, 650 mg, 975 mg enteric-
coated tablets; 650 mg, 800 mg sustained
release tablets; 120 mg, 200 mg, 300 mg,
600 mg suppositories
FREQUENCY & ROUTE:
Adult: PO/PR 350–650 mg q4h (max: 4
g/d)
Child: PO/PR 10–15 mg/kg in 4–6 h (max:
3.6 g/d)
MODE OF ACTION NURSING INTERVENTION
Major actions appear to be associated  Monitor for loss of tolerance to aspirin. The reaction is
primarily with inhibiting the formation of nonimmunologic; symptoms usually occur 15 min to 3 h
prostaglandins involved in the production after ingestion: profuse rhinorrhea, erythema, nausea,
of inflammation, pain, and fever.  vomiting, intestinal cramps, diarrhea.
Anti-inflammatory action: Inhibits
prostaglandin synthesis. As an anti-  Monitor for salicylate toxicity. In adults, a sensation of
inflammatory agent, aspirin appears to be fullness in the ears, tinnitus, and decreased or muffled
involved in enhancing antigen removal hearing are the most frequent symptoms associated with
and in reducing the spread of chronic salicylate overdosage.
inflammation in ground substances.
These anti-inflammatory actions also  Monitor children closely because salicylate toxicity is
contribute to analgesic effects.  enhanced by the dehydration that frequently accompanies
Analgesic action: Principally peripheral fever or illness. Children tend to manifest salicylate toxicity
with limited action in the CNS, possibly on by hyperventilation, agitation, mental confusion, or other
the hypothalamus; results in relief of mild behavioral changes, drowsiness, lethargy, sweating, and
to moderate pain.  constipation.
Antipyretic action: In addition to
inhibiting prostaglandin synthesis, aspirin  Note: Potential for toxicity is high in older adults and
lowers body temperature in fever by patients with asthma, nasal polyps, perennial vasomotor
indirectly causing centrally mediated rhinitis, hay fever, or chronic urticaria.
peripheral vasodilation and sweating
 Discontinue aspirin use with onset of ringing or buzzing in
the ears, impaired hearing, dizziness, GI discomfort or
bleeding, and report to physician.
 Maintain adequate fluid intake when taking repeated doses of
aspirin.
 Do not breast feed while taking this drug.
DRUG
GENERIC NAME: LOSARTAN
POTASSIUM
BRAND NAME: COZAAR
CLASSIFICATION: CARDIOVASCULAR
AGENT; ANGIOTENSIN II RECEPTOR
ANTAGONIST; ANTIHYPERTENSIVE
DOSAGE: 25 mg, 50 mg tablet
FREQUENCY & ROUTE:
Adult: PO 25–50 mg in 1–2 divided doses
(max: 100 mg/d); start with 25 mg/d if
volume depleted (i.e., on diuretics)
MODE OF ACTION
Angiotensin II receptor (type AT1)
antagonist acts as a potent
vasoconstrictor and primary vasoactive
hormone of the renin–angiotensin–
aldosterone system.
Selectively blocks the binding of
angiotensin II to the AT1 receptors found
in many tissues (e.g., vascular smooth
muscle, adrenal glands). Antihypertensive
effect results from blocking the
vasoconstricting and aldosterone-
secreting effects of angiotensin II.
NURSING CONSIDERATIONS
 Monitor BP at drug trough (prior to a scheduled dose).
 Inadequate response may be improved by splitting the
daily dose into twice-daily dose.
 Lab tests: Monitor CBC, electrolytes, liver & kidney
function with long-term therapy.
 Inadequate response may be improved by splitting the
daily dose into twice-daily dose.
 Lab tests: Monitor CBC, electrolytes, liver & kidney
function with long-term therapy.
DRUG
GENERIC NAME: CAPTOPRIL
BRAND NAME: CAPOTEN
CLASSIFICATION: CARDIOVASCULAR
AGENT; ANGIOTENSIN-CONVERTING
ENZYME (ACE) INHIBITOR;
ANTIHYPERTENSIVE AGENT
DOSAGE: 12.5 mg, 25 mg, 50 mg, 100
mg tablets
FREQUENCY AND ROUTE:
Adult: PO 6.25–12.5 mg t.i.d., may
increase to 100 mg t.i.d. (max: 450 mg/d)
MODE OF ACTION
Lowers blood pressure by specific
inhibition of the angiotensin-converting
enzyme (ACE). This interrupts conversion
sequences initiated by renin that lead to
formation of angiotensin II, a potent
endogenous vasoconstrictor. ACE
inhibition alters hemodynamics without
compensatory reflex tachycardia or
changes in cardiac output (except in
patients with CHF). Peripheral vascular
resistance is lowered by vasodilation.
Inhibition of ACE also leads to decreased
circulating aldosterone. Reduced
circulating aldosterone is associated with
a potassium-sparing effect. In heart
failure, captopril administration is followed
by a fall in CVP and pulmonary wedge
pressure; hypotensive action appears to
be unrelated to plasma renin levels.
NURSING CONSIDERATIONS
 Monitor BP closely following the first dose. A sudden
exaggerated hypotensive response may occur within 1–3 h
of first dose, especially in those with high BP or on a
diuretic and restricted salt intake.
 Advise bed rest and BP monitoring for the first 3 h after the
initial dose.
 Monitor therapeutic effectiveness. At least 2 wk of therapy
may be required before full therapeutic effects are
achieved.
 Lab tests: Establish baseline urinary protein levels before
initiation of therapy and check at monthly intervals for the
first 8 months of treatment and then periodically thereafter.
Perform WBC and differential counts before therapy is
begun and at approximately 2-wk intervals for the first 3
months of therapy and then periodically thereafter.
 Monitor BP closely following the first dose. A sudden
exaggerated hypotensive response may occur within 1–3 h
of first dose, especially in those with high BP or on a
diuretic and restricted salt intake.
 Advise bed rest and BP monitoring for the first 3 h after the
initial dose.
 Monitor therapeutic effectiveness. At least 2 wk of therapy
may be required before full therapeutic effects are
achieved.
 Lab tests: Establish baseline urinary protein levels before
initiation of therapy and check at monthly intervals for the
first 8 mo of treatment and then periodically thereafter.
Perform WBC and differential counts before therapy is
begun and at approximately 2-wk intervals for the first 3 mo
of therapy and then periodically thereafter.
DRUG
GENERIC NAME: CLONIDINE
HYDROCHLORIE
BRAND NAME: CATAPRES
CLASSIFICATIONS: CARDIOVASCULAR decreases systolic and diastolic BP and
AGENT; CENTRAL-ACTING
ANTIHYPERTENSIVE; ANALGESIC
DOSAGE: 0.1 mg, 0.2 mg, 0.3 mg tablets;
0.1 mg/24 h, 0.2 mg/24 h, 0.3 mg/24 h
transdermal patch; 100 mcg/mL, 500
mcg/mL injection
FREQUENCY & ROUTE:
Adult: PO 0.1 mg b.i.d. or t.i.d., may
increase by 0.1–0.2 mg/d until desired
response is achieved (max: 2.4 mg/d)
Transdermal 0.1 mg patch once q7d, may
increase by 0.1 mg q1–2 wk
Geriatric: PO Start with 0.1 mg once daily
Child: PO 5–10 mcg/kg/d divided q8–12h,
may increase to 5–25 mcg/kg/d divided
q6h (max: 0.9 mg/d)
MODE OF ACTION
Centrally acting antiadrenergic derivative.
Stimulates alpha2-adrenergic receptors in
CNS to inhibit sympathetic vasomotor
centers. Central actions reduce plasma
concentrations of norepinephrine. It
heart rate. Orthostatic effects tend to be
mild and occur infrequently. Also inhibits
renin release from kidneys.
NURSING CONSIDERATION
 Monitor BR closely. Determine positional changes (supine,
sitting, standing).
 Monitor BP closely whenever a drug is added to or
withdrawn from therapeutic regimen.
 Monitor I&O during period of dosage adjustment. Report
change in I&O ratio or change in voiding pattern.
 Determine weight daily. Patients not receiving a
concomitant diuretic agent may gain weight, particularly
during first 3 or 4 d of therapy, because of marked sodium
and water retention.
 Supervise closely patients with history of mental
depression, as they may be subject to further depressive
episodes.
 Although postural hypotension occurs infrequently, make
position changes slowly, and in stages, particularly from
recumbent to upright position, and dangle and move legs a
few minutes before standing. Lie down immediately if
faintness or dizziness occurs.
 Avoid potentially hazardous activities until reaction to drug
has been determined due to possible sedative effects.
 Although postural hypotension occurs infrequently, make
position changes slowly, and in stages, particularly from
recumbent to upright position, and dangle and move legs a
few minutes before standing. Lie down immediately if
faintness or dizziness occurs.
 Avoid potentially hazardous activities until reaction to drug
has been determined due to possible sedative effects.
DRUG
GENERIC NAME: WARFARIN SODIUM
BRAND NAME: COUMADIN SODIUM
CLASSIFICATIONS: BLOOD FORMERS,
COAGULATORS, AND
ANTICOAGULANTS; ORAL
ANTICOAGULANT
DOSAGE: 1 mg, 2 mg, 2.5 mg, 3 mg, 4
mg, 5 mg, 6 mg, 7.5 mg, 10 mg tablets; 2
mg injection
FREQUENCY AND ROUTE:
Adult: PO/IV 10–15 mg/d for 2–5 d, then
2–10 mg once/d with dose adjusted to
maintain a PT 1.2–2 times control or INR
of 2–3
Child: PO 0.1–0.3 mg/kg/d, adjust to
maintain INR of 2–3
MODE OF ACTION
Indirectly interferes with blood clotting by
depressing hepatic synthesis of vitamin K-
dependent coagulation factors: II, VII, IX,
and X.
Prophylaxis and treatment of deep vein
thrombosis and its extension, pulmonary
embolism; treatment of atrial fibrillation
with embolization. Also used as adjunct in
treatment of coronary occlusion, cerebral
transient ischemic attacks (TIAs), and as
a prophylactic in patients with prosthetic
cardiac valves. Used extensively as
rodenticide.
NURSING CONSIDERATIONS
 Determine PT/INP prior to initiation of therapy and then daily
until maintenance dosage is established.
 Obtain a CAREFUL medication history prior to start of
therapy and whenever altered responses to therapy require
interpretation; extremely IMPORTANT since many drugs
interfere with the activity of anticoagulant drugs
 Monitor closely older adult, psychotic, or alcoholic patients
because they present serious noncompliance problems.
 Note: Patients at greatest risk of hemorrhage include those
whose PT/INR are difficult to regulate, who have an aortic
valve prosthesis, who are receiving long-term anticoagulant
therapy, and older adult and debilitated patients.
 Stop drug and notify physician immediately if bleeding or
signs of bleeding appear: Blood in urine, bright red or black
tarry stools, vomiting of blood, bleeding with tooth brushing,
blue or purple spots on skin or mucous membrane, round
pinpoint purplish red spots (often occur in ankle areas),
nosebleed, bloody sputum; chest pain; abdominal or lumbar
pain or swelling, profuse menstrual bleeding, pelvic pain;
severe or continuous headache, faintness or dizziness;
prolonged oozing from any minor injury (e.g., nicks from
shaving).
 Maintain a well-balanced diet and avoid excess intake of
alcohol.
 Do not breast feed while taking this drug without consulting
physician.

DRUG
GENERIC NAME: VERAPAMIL
HYDROCHLORIDE
BRAND NAME: ISOPTIN
CLASSIFICATIONS: CARDIOVASCULAR slows SA and AV node conduction without
AGENT; CALCIUM CHANNEL
BLOCKER; ANTIARRHYTHMIC,
MISCELLANEOUS
DOSAGE: 40 mg, 80 mg, 120 mg tablets; reduces arterial BP at rest. May slightly
120 mg, 180 mg, 240 mg sustained-
release tablets; 100 mg, 120 mg, 180 mg,
200 mg, 240 mg, 300 mg sustained-
release capsules; 5 mg/2 mL injection
FREQUENCY AND ROUTE:
Angina
Adult: PO 80 mg q6–8h, may increase up
to 320–480 mg/d in divided doses (Note:
Covera-HS must be given once daily h.s.)
MODE OF ACTION
Inhibits calcium ion influx through slow
channels into cells of myocardial and
arterial smooth muscle. Dilates coronary
arteries and arterioles and inhibits
coronary artery spasm. Decreases and
affecting normal arterial action potential or
intraventricular conduction. Associated
vasodilation of arterioles decreases total
peripheral vascular resistance and
decrease heart rate.
NURSING CONSIDERATIONS
 Monitor therapeutic effectiveness. Drug should
decrease angina frequency, nitroglycerin consumption,
and episodes of ST segment deviation.
 Establish baseline data and periodically monitor: BP
and pulse.
 Instruct patient to remain in recumbent position for at
least 1 h after dose is given to diminish subjective
effects of transient asymptomatic hypotension that may
accompany infusion.
 Monitor I&O ratio during IV and early oral maintenance
therapy. Renal impairment prolongs duration of action,
increasing potential for toxicity and incidence of
adverse effects. Advise patient to report gradual weight
gain and evidence of edema.
 Monitor ECG continuously during IV administration.
Essential because drug action may be prolonged and
incidence of adverse reactions is highest during IV
administration in older adults, patients with impaired
kidney function, and patients of small stature.
 Check BP shortly before administration of next dose to
evaluate degree of control during early treatment for
hypertension.
DRUG MODE OF ACTION NURSING CONSIDERATIONS
GENERIC NAME: MORPHINE SULFATE Natural opium alkaloid  Obtain baseline respiratory rate, depth, and rhythm and size of pupils
with agonist activity by before administering the drug. Respirations of 12/min or below and
BRAND NAME: AVINZA binding with the same miosis are signs of toxicity. Withhold drug and report to physician.
receptors as endogenous  Observe patient closely to be certain pain relief is achieved. Record
CLASSIFICATIONS: CENTRAL opioid peptides. Narcotic relief of pain and duration of analgesia.
NERVOUS SYSTEM (CNS) AGENT; agonist effects are  Be alert to elevated pulse or respiratory rate, restlessness, anorexia, or
ANALGESIC; NARCOTIC (OPIATE) identified with 3 types of drawn facial expression that may indicate need for analgesia.
AGONIST receptors: Analgesia at  Differentiate among restlessness as a sign of pain and the need for
supraspinal level, medication, restlessness associated with hypoxia, and restlessness
DOSAGE: 10 mg, 15 mg, 30 mg euphoria, respiratory caused by morphine-induced CNS stimulation (a paradoxic reaction that
tablets/capsules; 15 mg, 20 mg, 30 mg, depression and physical is particularly common in women and older adult patients).
60 mg, 100 mg, 120 mg, 200 mg dependence; analgesia  Monitor for respiratory depression; it can be severe for as long as 24 h
controlled release tablets/capsules; 10 at spinal level, sedation after epidural or intrathecal administration.
mg/2.5 mL, 10 mg/5 ml, 20 mg/mL, 20 and miosis; and  Monitor carefully those at risk for severe respiratory depression after
mg/5 mL, 30 mg/1.5 mL, 100 mg/5 mL dysphoric, hallucinogenic epidural or intrathecal injection: Older adult or debilitated patients or
oral solution; 0.5 mg/mL, 1 mg/mL, 2 and cardiac stimulant those with decreased respiratory reserve (e.g., emphysema, severe
mg/mL, 4 mg/mL, 5 mg/mL, 8 mg/mL, 10 effects. obesity, kyphoscoliosis).
mg/mL, 15 mg/mL, 25 mg/mL, 50 mg/mL
 Continue monitoring for respiratory depression for at least 24 h after
injection; 10 mg/mL, 15 mg/1.5 mL, 20 Symptomatic relief of
each epidural or intrathecal dose.
mg/2 mL extended-release lysosomal severe acute and chronic
 Assess vital signs at regular intervals. Morphine-induced respiratory
injection; 5 mg, 10 mg, 20 mg, 30 mg pain after nonnarcotic
depression may occur even with small doses, and it increases
suppositories analgesics have failed
progressively with higher doses (generally max: 90 min after SC, 30 min
and as preanesthetic
after IM, and 7 min after IV).
FREQUENCY AND ROUTE: medication; also used to
Adult: PO 10–30 mg q4h prn or 15–30 mg relieve dyspnea of acute  Encourage changes in position, deep breathing, and coughing (unless
sustained release q8–12h; (Avinza) dose left ventricular failure and contraindicated) at regularly scheduled intervals. Narcotic analgesics
q24h IV 2.5–15 mg q4h or 0.8–10 mg/h by pulmonary edema and also depress cough and sigh reflexes and thus may induce atelectasis,
continuous infusion, may increase prn to pain of MI. especially in postoperative patients.
control pain or 5–10 mg given epidurally  Be alert for nausea and orthostatic hypotension (with light-headedness
q24h and dizziness) in ambulatory patients or when a supine patient assumes
the head-up position or in patients not experiencing severe pain.
 Monitor I&O ratio and pattern. Report oliguria or urinary retention.
Morphine may dull perception of bladder stimuli; therefore, encourage
the patient to void at least q4h. Palpate lower abdomen to detect bladder
distention.
DRUG MODE OF ACTION NURSING CONSIDERATIONS
GENERIC NAME: NITROGLYCERIN Organic nitrate and potent vasodilator that  Administer IV nitroglycerin with extreme caution to
relaxes vascular smooth muscle by patients with hypotension or hypovolemia since the IV
BRAND NAME: NITROSTAT unknown mechanism, resulting in dose- drug may precipitate a severe hypotensive state.
related dilation of both venous and arterial  Monitor patient closely for change in levels of
CLASSIFICATIONS: CARDIOVASCULAR blood vessels. Promotes peripheral consciousness and for dysrhythmias. IV nitroglycerin
AGENT; NITRATE VASODILATOR pooling of blood, reduction of peripheral solution contains a substantial amount of ethanol as
resistance, and decreased venous return diluent. Ethanol intoxication can develop with high
DOSAGE: 0.5 mg/mL, 5 mg/mL, 10 to the heart. Both left ventricular preload doses of IV nitroglycerin (vomiting, lethargy, coma,
mg/mL injection; 0.3 mg, 0.4 mg, 0.6 mg and afterload are reduced and myocardial breath smells of alcohol). If intoxication occurs, infusion
sublingual tablets; 0.4 mg/spray oxygen consumption or demand is should be stopped promptly; patient recovers
translingual spray; 2 mg, 3 mg buccal decreased. immediately with discontinuation of drug administration.
tablets; 2.5 mg, 6.5 mg, 9 mg, 13 mg  Be aware that moisture on sublingual tissue is required
sustained-release tablets, capsules; 0.1 for dissolution of sublingual tablet. However, because
mg/h, 0.2 mg/h, 0.3 mg/h, 0.4 mg/h, 0.6 chest pain typically leads to dry mouth, a patient may
mg/h, 0.8 mg/h transdermal patch; 2% be unresponsive to sublingual nitroglycerin.
ointment  Assess for headaches.
 Supervise ambulation as needed, especially with older
FREQUENCY & ROUTE: adult or debilitated patients. Postural hypotension may
Adult: Sublingual 1–2 sprays (0.4–0.8 mg) occur even with small doses of nitroglycerin. Patients
or a 0.3–0.6-mg tablet q3–5min as may complain of dizziness or weakness due to postural
needed (max: 3 doses in 15 min) PO 1.3– hypotension.
9 mg q8–12h IV Start with 5 mcg/min and  Take baseline BP and heart rate with patient in sitting
titrate q3–5min until desired response position before initiation of treatment with transdermal
Transdermal Unit Apply once q24h or preparations.
leave on for 10–12 h, then remove and
have a 10–12 h nitrate free interval
Topical Apply 1.5–5 cm (½–2 in) of
ointment q4–6h
Child: IV 0.25–0.5 mcg/kg/min, titrate by
0.5–1 mcg/kg/min q3–5 min
DRUG
GENERIC NAME:
STREPTOKINASE
BRAND NAME: STREPTASE
CLASSIFICATIONS: BLOOD
FORMERS, COAGULATORS,
AND ANTICOAGULANTS;
THROMBOLYTIC ENZYME
DOSAGE: 250,000 IU, 750,000
IU, 1,500,000 IU vials
FREQUENCY & ROUTE:
Coronary Artery Thrombosis, MI
Adult: IV 1.5 million IU infused
over 60 min Intracoronary
15,000–20,000 IU bolus,
followed by 2000–4000 IU/min
for 60 min
Deep Vein Thrombosis,
Pulmonary Embolism, Arterial
Embolism
Adult: IV 250,000 IU over 30
min loading dose, then 100,000
IU/h for 48–72 h
MODE OF ACTION NURSING CONSIDERATIONS
Derivative of the beta-  Monitor for excessive bleeding q15min for the first hour of therapy, q30min for second
hemolytic streptococci. to eighth hour, then q8h.
Promotes thrombolysis  Be aware that patient is at risk for postthrombolytic bleeding for 2–4 d after
by activating the intracoronary SK treatment. Continue monitoring vital signs until laboratory tests
conversion of confirm anticoagulant control.
plasminogen to plasmin,  Report signs of potential serious bleeding; gum bleeding, epistaxis, hematoma,
the enzyme that spontaneous ecchymoses, oozing at catheter site, increased pulse, pain from internal
degrades fibrin, bleeding. SK infusion should be interrupted, then resumed when bleeding stops.
fibrinogen, and other  Report promptly symptoms of a major allergic reaction; therapy will be discontinued
procoagulant proteins and emergency treatment instituted. Minor symptoms (e.g., itching, nausea) respond
into soluble fragments. to concurrent antihistamine or corticosteroid treatment or both without interruption of
Decreases blood and SK administration.
plasma viscosity and  Check cardiac monitor frequently. Be alert to changes in cardiac rhythm, especially
erythrocyte aggregation during intracoronary instillation. Dysrhythmias signal need to stop therapy at once.
tendency, thus  Monitor BP. Mild changes can be expected, but report substantial changes (greater
increasing perfusion of than ±25 mm Hg). Therapy may be discontinued.
collateral blood vessels.
 Monitor for excessive bleeding q15min for the first hour of therapy, q30min for second
to eighth hour, then q8h.
Acute extensive deep
 Be aware that patient is at risk for postthrombolytic bleeding for 2–4 d after
venous thrombosis,
intracoronary SK treatment. Continue monitoring vital signs until laboratory tests
acute arterial
confirm anticoagulant control.
thrombosis or embolism,
acute pulmonary  Report signs of potential serious bleeding; gum bleeding, epistaxis, hematoma,
embolus, coronary spontaneous ecchymoses, oozing at catheter site, increased pulse, pain from internal
artery thrombosis, MI, bleeding. SK infusion should be interrupted, then resumed when bleeding stops.
and arteriovenous  Report promptly symptoms of a major allergic reaction; therapy will be discontinued
cannula occlusion. and emergency treatment instituted. Minor symptoms (e.g., itching, nausea) respond
to concurrent antihistamine or corticosteroid treatment or both without interruption of
SK administration.
 Check cardiac monitor frequently. Be alert to changes in cardiac rhythm, especially
during intracoronary instillation. Dysrhythmias signal need to stop therapy at once.
 Monitor BP. Mild changes can be expected, but report substantial changes (greater
than ±25 mm Hg). Therapy may be discontinued.
References
Wilson, S. &. (2007). Prentice Hall Nurse's Drug Guide. Retrieved from www.robholland.com: http://www.robholland.com/Nursing/Drug_Guide/