Nitroglycerin Beta-Adrenergic Blockers (Antagonist) Blockade of Beta1 receptors in the heart cause o Decreased heart rate o Decreased force

e of contraction o Decreased rate of AV conduction Naldolo (Corgard) Bradycardia (common), CHF, hypotension, depression, lethargy . fatigue Propanolo (Inderal) Metoprolol (Lopressor) Atenolol (Tenormin) 1. 2. 3. 4. 5. 6. 7. Evaluate for increase in CHF, or dysrhythmias involving heart block may decrease action of calcium channel blockers uses: angina, hypertension, and cardiac dysrhythmias teach client how to decrease effects of postural hypotension teach client to continue to take medication regardless of feeling better check pulse before administering if client has DM, monitor blood glucose levels carefully

CALCIUM CHANNEL BLOCKERS: Blockade of calcium channel receptors in the heart causes decreased cardiac contractility and a decreased rate of sinus and AV node conduction Diltiazem (Cardizem) Verapamil (Calan, Isopt) Nifedipine (Procardia) constipation, exacerbation, of CHF, hypotension, bradycardia, peripheral edema Reflex tachycardia, hypotension, dizziness, HA

1.USES- Chronic stable angina, hypertension, and supraventricular dysrhythmias 2. May intensify cardiosuppressant effects of beta blocker medication 3. Assess for bradycardia Nifedipine1.less likely to exacerbate preexisting cardiac conditions 2. Is not effective in treating dysrhythmias

ANTIDYSRHYTMIC MEDICATION: Decrease cardiac excitability; delay cardiac conduction either in the atrium or in the ventricle. Atropine is cardiac stimulant for bradycardia General Nursing Implications Assess client of changes in cardiac rhythm and impact on cardiac output Evaluate effect of medication on dysrhythmia and resulting effects on cardiac output Patient on cardiac monitor when given IV Atropine available for cardiac depression (bradycardia) All cardiac depressants are contraindicated in patients with sinus node or AV node block Digitalis will enhance cardiac depressant effects Closely monitor for dysrhytmias that are precipitated by the treatment All of these medications can make existing dysrhytmias worse and can create new ones RN or physician will administer IV medication. LPN may assist Medication Quinidine Sulfate (Quindex) Bretylium IV Amiodarone (Cardarone) PO, IV Lidocaine Hydrochloride (Xylocaine) Tocainide (Tonocard) Procainamide (Pronestyl) PO,IV Side effects Vertigo, N/V, and diarrhea, progressive AV block, cinchonism- tinnitus, visual problems HA Hypotension Hypotension, bradycardia Nursing Implications 1.Use: supraventricular dysrhythmias and to convert client to sinus rhythm Use: ventricular dysrhythmia that do not respond to other therapy 1. Asses for severe bradycardia 2. monitor for dyspnea, cough, and fever Use: ventricular dysrythmias Only use preparations labeled for IV use Use: to prevent/ control dysrhythmias 1.Uses: treatment of atrial and ventricular dysrhythmias 2.hypotension is not uncommon 3.Autoimmune problems Lupus symptoms

Drowsiness, confusion, seizures, severe depression of cardiac conduction Nausea, tremors N/V, blood dyscrasia, Hypotension

Propanolo Hydrochloride (Inderal) Atropine Sulfate IV, PO, SubQ, IM

Dry Mouth, blurred vision, dilated pupils

1. increased heart rate. Used to treat bradycardia that causes symptoms 2.carefully asses patients cardiac output in response to the bradycardic episode

Thrombolytic Medication: Bind to fibrin and initiate fibrinolysis to break up a clot. Convert circulating plasminogen to plasmin to begin fibrinolysis General Nursing Implications: Used to treat acute coronary thrombosis (MI) DVT, and massive pulmonary emboli Therapy started as soon as condition identified Follow bleeding precautions Administer by RN or Dr

Streptokinase (Streptase) IV Bleeding, Hypotension Alteplase (tPA, Activase) IV Tenectaplse (TNKase)

1.Moniotor for hypotension not related to bleeding 2.Monitor for development of intracranial bleeding 3. Contraindicated in client with HX of stroke or presence of internal bleeding

ANTIPLATELETS (PLATELET AGGREGATION INHIBITORS) Inhibit aggregation of and clumping of platelets which reduce risk of stroke, or MI or peripheral vascular occlusion in clients with peripheral vascular disease Clopidrogel (Plavix) PO Aspirin PO GI bleeding, dyspepsia, epistaxia, blood dyscrasia Irreversible suppression of platelets, GI hemorrhage, hemorrhagic stroke 1. May be taken with or without food 2. teach client to watch for bleeding problems 3. A low dose of aspirin (81 mg) is as effective as higher dose 4. take aspirin with food

CARDIAC GLYCOSIDE: INCREASE MYOCARIDAL CONTRACTILITY AND CARDIAC OUTPUT: DECREASES CONDUCTION OF IMPULSE THROUGH AV NODE Nursing Implications: take apical pulse before administering Digoxin (Lanoxin) PO, IV Anorexia, N/V, visual disturbances, fatigue, drug induced dysrhythmias 1.therapuetic plasma levels of Digoxin are 0.5- 2 ng/ml 2.First sign of toxicity is usually GI symptoms 3.Uses: Supraventricular tachycardia, CHF