How it works “ Action” Nursing management

To divert blood to the important organs ❖ Monitor BP, heart rate, ECG,
stimulates the sympathetic nervous system via cardiac output, CVP, and urinary
vasoconstriction. This will also increase BP and output continuously.
perfusion. ❖ Report significant changes in vital
signs or arrhythmias.
Why do we give it? “Reason” ❖ Palpate peripheral pulses and
❖ Hypovolemic shock assess appearance of extremities
❖ Severe hypotension routinely.
❖ Superficial bleeding ❖ Notify physician if quality of pulse
❖ Cardiac decomp/ arrest deteriorates or if extremities
❖ Allergic reactions become cold or mottled.
❖ Ventricular arrhythmia ❖ Lab Test Considerations:
❖ Respiratory distress Monitor potassium
❖ Glaucoma concentrations during therapy;
❖ Adjunct to local anesthetic may cause hypokalemia.
❖ Bronchodilators ❖ Monitor electrolytes, BUN,
creatinine, and prothrombin time
Adverse Effects weekly during prolonged therapy.
CV: increase blood pressure to dangerously
high levels. Interactions
Derm: dopamine can cause necrosis of the ❖ Antidepressants: increase
vein. adrenergic effects.
❖ Oxytocin: increases the risk for
hypertension.
Contraindications
Dopamine: pheochromocytoma, v fib ,
arrhythmia.
Simple nursing Brain Bits
Epinephrine: narrow angle glaucoma,
❖ These are the drugs you will mostly see
anesthetic for fingers and toes (no no) in a CODE situation.
Norepinephrine: hypotension from blood loss, ❖ When giving epi do not administer in
Midodrine: causes severe hypertension when fingers and toes it can cause severe
the patient is lying down. vasoconstriction and cause the area to
become ischemic.

Generic Trade Safe dose Route

Dopamine Intropin 1– 5 mcg/kg/min. IV titration

Epinephrine Adrenalin 0.1– 0.5 mg (single dose) IM, sub Q ,IV push

Norepinephrine Levophed 0.5– 1 mcg/min initially. IV

maintenance of 2– 12 mcg/min

Midodrine ProAmatine 10 mg three times daily PO

 Nursing management
How it works “ Action” ❖ Monitor BP, heart rate, ECG, cardiac output,
Block beta receptors in the heart to decrease CVP, and urinary output continuously
cardiac workload to decrease HR and dilate ❖ Abrupt withdrawal of propranolol may
blood vessels, provides membrane stabilizing precipitate life-threatening arrhythmias,
effects. Timolol treats glaucoma. hypertension, or myocardial ischemia
❖ Take HR and BP immediately prior to
Why do we give it? “Reason” administering medication and 30 minutes
❖ Hypertension after. Observe provider’s parameters to hold
❖ Cardiac arrhythmia drug if BP and/or HR are low.
❖ Heart failure ❖ Advise patient to notify health care
❖ Angina professional if slow pulse, difficulty breathing,
❖ Glaucoma wheezing, cold hands and feet, dizziness,
❖ Prevention of MI lightheadedness, confusion, depression, rash,
fever, sore throat, unusual bleeding, or
bruising occur. If diabetic monitor for
Adverse Effects hypoglycemia. Teach not to stop taking
CV: Orthostatic hypotension, bradycardia, abruptly
PULMONARY EDEMA, Interactions
ENDO: May cause ^ BUN, serum lipoprotein, ❖ Antidepressants: bradycardia and increase
potassium, triglyceride, and uric acid levels. beta blocker effects
May cause ^ blood glucose levels. In labile ❖ NSAID: decrease beta blocker effects
diabetic patients, hypoglycemia may be ❖ Diuretics: increase beta blocker
accompanied by precipitous ^ of BP. effects/hypotension
RESP: bronchospasm (hx of asthma) ❖ Clonidine: paradoxical hypertensive effects
❖ Cimetidine: beta blocker toxicity
❖ Lidocaine: beta blocker toxicity
Contraindications
❖ Sinus bradycardia Simple Nursing Brain Bits
❖ Heart block
❖ Never give a beta blocker to a client with a
❖ Heart Failure history of asthma because it can cause
❖ Asthma bronchospasm.
❖ Emphysema ❖ Beta Blockers end in -OLOL
❖ Hypotension 4 B'S
❖ Bradycardia
❖ Blood pressure decrease
❖ Bronchial constriction (relief)
❖ Blood sugar masking

Generic Trade Safe dose Route

Propranolol Inderal, Inderal LA, 80– 320 mg/day in 2– 4 divided PO, IV , PO-ER
InnoPran XL doses

Metoprolol: lopressor lopressor 25– 100 mg/day as a single dose PO, IV , PO-ER

Sotalol Betapace, Betapace 80 mg twice daily PO

Give on an empty AF
stomach

Timolol Novo-Timol One drop of 0.25% eye drops into Ophthalmic

Ophthalmic each affected eye(s) twice daily,
approximately 12 hours apart.
 How it works “ Action” Nursing management
Block Alpha receptors causing vasodilation by ❖ Monitor BP, pulse, and ECG every 2
relaxing the smooth muscle of the blood min until stable during IV
vessels. administration. If hypotensive crisis
In ophthalmic preps they constrict the pupil occurs, epinephrine is
contraindicated and may cause
Why do we give it? “Reason” paradoxical further decrease in BP.
❖ Hypertension caused by ❖ norepinephrine may be used
pheochromocytoma ❖ Instruct client to change positions
❖ Hypertension caused by pre op prep. slowly to minimize orthostatic
❖ Treat tissue damage caused by hypotension.
dopamine injection. ❖ Instruct patient to notify health care
professional if chest pain occurs
during IV infusion.
Adverse Effects
CNS: CEREBROVASCULAR SPASM,
dizziness, weakness. Interactions
EENT: nasal stuffiness. ❖ Epinephrine or methoxamine:
CV: HYPOTENSION, MI, angina, arrhythmias, Severe hypotension
tachycardia. ❖ Ephedrine or phenylephrine.:
GI: abdominal pain, diarrhea, nausea, vomiting, decreased pressor response
aggravation of peptic ulcer.
Derm: flushing. Local: injection site pain (local).
Interactions
Contraindications

❖ Coronary artery disease Simple Nursing Brain bits

If you are giving multiple meds remember, If it makes
you hyper or shaky check the drug book before
administering it with Alpha Adrenergic blockers

Generic trade Safe dose Route

phentolamine Oraverse, Regitine 5 mg given 1– 2 hr pre IM, IV, Local

op, repeated PRN. can
infuse at 0.5– 1 mg/min
during surgery.
 How it works “ Action” Contraindications
Block Alpha receptors causing vasodilation by ❖ History of serious hypersensitivity
relaxing the smooth muscle of the blood reaction.
vessels in ophthalmic preps they constrict the ❖ Stevens-Johnson syndrome,
pupil angioedema, anaphylaxis
❖ Pulmonary edema
Why do we give it? “Reason” ❖ Cardiogenic shock
❖ Carvedilol: essential HTN, HF to reduce ❖ Bradycardia, heart block or sick
progression sinus syndrome
❖ Labetalol: HTN usually as an adjunct to ❖ Uncompensated HF requiring IV
a Diuretic inotropic agents (wean before
starting carvedilol); Severe hepatic
Adverse Effects impairment; Asthma or other
CNS: Dizziness, fatigue, weakness, anxiety, bronchospastic disorders.
depression, drowsiness, insomnia, memory
loss, mental status changes, nervousness, Nursing management
nightmares. ❖ Monitor BP, pulse, and ECG every
EENT: Blurred vision, dry eyes, intraoperative 2 min until stable during IV
floppy iris syndrome, nasal stuffiness. administration. If hypotensive crisis
Resp: bronchospasm, wheezing. occurs, epinephrine is
CV: BRADYCARDIA, HF, PULMONARY EDEMA contraindicated and may cause
GI: diarrhea, constipation, nausea. GU: erectile paradoxical further decrease in BP.
dysfunction,plibido. Norepinephrine may be used
Derm: STEVENS-JOHNSON SYNDROME, ❖ Instruct client to change positions
TOXIC EPIDERMAL NECROLYSIS, itching, slowly to minimize orthostatic
rashes, urticaria. Endo: hyperglycemia, hypotension.
hypoglycemia. ❖ Instruct patient to notify health
MS: arthralgia, back pain, muscle cramps. care professional if chest pain
Neuro: paresthesia. occurs during IV infusion
Misc: ANAPHYLAXIS, ANGIOEDEMA,
drug-induced lupus syndrome. Interactions
❖ Antidepressants: tremors
❖ Cimetidine: increased adrenergic
blocker effect
❖ Clonidine: increase clonidine
effects
❖ Digoxin: digoxin toxicity

Generic Trade Safe dose Route

Carvedilol Coreg, Coreg CR 6.25 mg twice daily PO

Labetalol Trandate 100 mg twice daily PO, IV

 How it works “ Action” Nursing management
Peripherally acting: inhibits norepinephrine in ❖ Monitor intake and output ratios
the PNS ( treats BPH, HTN) and daily weight
Centrally acting: decreases CNS activity (HTN) ❖ Assess for edema daily,
especially at beginning of
Why do we give it? “Reason” therapy.
❖ Certain cardiac arrhythmias ❖ Monitor BP and pulse prior to
❖ BAH starting, frequently during initial
❖ HTN dose adjustment and dose
increases and periodically
Adverse Effects throughout therapy.
EENT: dry eyes. ❖ Titrate slowly in patients with
CV: AV block, bradycardia, hypotension (with cardiac conditions or those taking
epidural), palpitations. other sympatholytic drugs.
GI: dry mouth, constipation, nausea, vomiting. Report significant changes.
GU: erectile dysfunction. ❖ Transdermal: Instruct patient on
Derm: rash, sweating. proper application of transdermal
F&E: sodium retention, hyperkalemia system. Do not cut or trim unit.
Metab: weight gain. Transdermal system can remain
Neuro: paresthesia. in place during bathing or
Misc: withdrawal phenomenon swimming.

Contraindications Interactions
❖ Central:Hepatic disease ( active ) , MAOI ❖ Adrenergic: risk of HTN
antidepressant therapy ❖ Levodopa: hypotension,
❖ Peripheral: ulcerative colitis , peptic ulcer decrease levodopa
❖ Anesthetic agents: increase
anesthetic
❖ Beta blockers: hypertension
❖ Lithium: lithium toxicity
❖ Haloperidol: psychotic behavior

Generic Trade Central / Safe dose Route

peripheral

Clonidine Catapres Central 100 mcg (0.1 mg) PO, TD

BID

Methyldopa N/A Central 250– 500 mg 2– 3 PO

times daily

Doxazosin Cardura, Cardura Peripheral 1 mg once daily PO

XL

Prazosin Minipress Peripheral 1 mg 2– 3 times PO

daily
 How it works “ Action” Nursing management
Suppress the renin-angiotensin-aldosterone ❖ Monitor BP and pulse frequently
system and prevent the activity of ACE which ❖ Assess patient for signs of
converts angiotensin 1 to angiotensin 2 angioedema (dyspnea, facial
(vasoconstrictor). Inhibiting the conversion swelling).
causes Na+ and H2O to not be retained thus ❖ Heart Failure: Monitor weight and
sodium and BP will decrease. assess patient routinely for
resolution of fluid overload
Why do we give it? “Reason” (peripheral edema, rales/crackles,
❖ Treatment of hypertension dyspnea, weight gain, jugular
venous distention).
Adverse Effects ❖ May cause hyperkalemia.
CV: Orthostatic hypotension, syncope ❖ Instruct your clients to get up
tachycardia, hypotension, chest pain slowly and avoid salt substitutes.
CNS: Dizziness, fatigue, headache, weakness.
GI: Abdominal pain, diarrhea, nausea, vomiting Interactions
❖ NSAIDS: Reduced hypotensive effects
GU: Erectile dysfunction, impaired renal ❖ Rifampin: Decreased ace1 effects
function.proteinuria ❖ Allopurinol: Increased risk of hypersensitivity
Derm: Rashes. F and E: hyperkalemia.Misc: ❖ Digoxin: Decreased dig levels
❖ Loop diuretics: Decrease diuretic effects
ANGIOEDEMA ❖ Lithium: Possible lithium toxicity
RESP: Upper respiratory infections and cough, ❖ Hypoglycemics(insulin) : Increase risk of
HEMAT: Neutropenia hypoglycemia
❖ Potassium sparing diuretics: Elevated
potassium levels ( hyperkalemia )
Contraindications
❖ ACE1/Angiotensin receptor blockers: HF,
salt or volume depletion, bilateral Simple Nursing Brain bits
stenosis, angioedema, pregnancy
2nd/3rd trimester due to neonatal death. Be mindful of suffixes! All ACE inhibitors end in
april
Use caution with African American population
as drugs may not be effective and/or may
cause extremely uncomfortable side effects

Generic Trade with/without food Safe dose Route

Captopril Capoten Without food 12.5– 25 mg 2– 3 PO

times daily

Lisinopril Prinivil With food 10 mg once daily PO

Enalapril Vasotec with/ without 2.5– 5 mg once PO , IV

daily

Ramipril Altace with/without 2.5 mg once daily PO

 How it works “ Action” Nursing management
Block the binding of angiotensin 2 at various sites ❖ Monitor BP and pulse frequently
on smooth muscle, blocking the vasoconstriction ❖ Assess patient for signs of
effects of the renin-angiotensin-aldosterone system angioedema (dyspnea, facial
thus causing a decrease in blood pressure. swelling).
❖ Heart Failure: Monitor weight and
assess patient routinely for
Why do we give it? “Reason” resolution of fluid overload
❖ Treatment of hypertension (peripheral edema, rales/crackles,
dyspnea, weight gain, jugular
Adverse Effects venous distention).
CNS: dizziness, fatigue, headache, insomnia, weakness. ❖ May cause hyperkalemia.
CV: chest pain, edema, hypotension. ❖ Instruct your clients to get up
EENT: nasal congestion. slowly and avoid salt substitutes.
Endo: hypoglycemia, weight gain.
GI: diarrhea, abdominal pain, dyspepsia, nausea. Interactions
GU: impaired renal function. ❖ NSAIDS: reduced hypotensive effects
❖ Rifampin: decreased ace1 effects
F and E: hyperkalemia. ❖ Allopurinol: increased risk of hypersensitivity
MS: back pain, myalgia. ❖ Digoxin: decreased dig levels
Misc: ANGIOEDEMA, fever. ❖ Loop diuretics: Decrease diuretic effects
❖ Lithium: possible lithium toxicity
Contraindications ❖ Hypoglycemics(insulin) : increase risk of
❖ ACE1/Angiotensin receptor blockers: HF, hypoglycemia
❖ Potassium sparing diuretics: elevated
salt or volume depletion, bilateral stenosis,
potassium levels ( hyperkalemia )
angioedema, pregnancy 2nd/3rd trimester
due to neonatal death.

Simple Nursing Brain bits

Be mindful of suffixes! All ARBS end in
TAN
These replace ACE in african american
population and when the side effects of
ace become too much the client.

Generic Trade Safe dose Route

Irbesartan Apravo 150 mg once daily PO

Losartan Cozaar 50 mg once daily PO

Valsartan Diovan 80 mg or 160 mg once PO

daily
 How it works “ Action”
-LOOP DIURETICS Nursing management
❖ Diuretics work by altering the reabsorption or ❖ Monitor BP and pulse frequently
excretion of electrolytes and alter fluid volume . ❖ Monitor intake and output ratios and daily
weight.
Loop diuretics: inhibit the reabsorption of sodium ❖ Do not stop the drugs abruptly unless you
chloride in the proximal and distal convoluted tubules speak with the HCP.
and the loop of henle . This site increase their ❖ If GI upset occurs then take the med with
effectiveness . food or milk.
❖ Take early in the morning.
Why do we give it? “Reason” ❖ Do not reduce fluid intake.
❖ Hypertension ❖ Avoid alcohol and non prescription drugs.
❖ Used with antihypertensives ❖ Notify the healthcare provider if: muscle
❖ To reduce edema cramps , weakness, dizziness, diarrhea,
❖ Glaucoma restlessness, excessive thirst, general
❖ Seizures weakness, rapid pulse, increased heart rate
❖ Renal disease. or pulse, gi distress.
❖ Weigh yourself weekly.
❖ These drugs may cause hypokalemia,
Adverse Effects monitor serum potassium levels
Neuro: dizziness, headache, encephalopathy,
lightheadedness,weakness, fatigue
EENT: hearing loss, tinnitus Interactions
CV: orthostatic hypotension ❖ Cisplatin/aminoglycosides: increased risk
GU: electrolyte imbalances, glycosuria of ototoxicity
GI: anorexia, nausea, vomiting ❖ Anticoagulant/thrombotic: increased risk of
Derm: rash, photosensitivity bleeding
Endo: hyperglycemia, hyperuricemia. ❖ Digitalis: increase risk of arrhythmia
F & E: dehydration, hypocalcemia, hypochloremia, ❖ Lithium: increased risk of lithium toxicity
hypokalemia, hypomagnesemia, hyponatremia, ❖ Hydantoins: decreased diuretic effect
hypokalemia, metabolic alkalosis ❖ Nsaid: decreased Diuretics effect
MS:arthralgia, muscle cramps, myalgia.

Contraindications
❖ Hypersensitivity
❖ Electrolyte imbalances
❖ severe kidney or liver dysfunction
❖ Anuria.
❖ Mannitol: active intracranial bleeding except
during craniotomy Simple Nursing Brain bits
Taking this medication early in the day
can prevent injury r/t getting out of bed
at night for the client.

Generic Trade Safe dose Route

Bumetanide Bumex 0.5– 2 mg/day given in PO

1– 2 doses

Furosemide: Lasix 20– 80 mg/day as a PO, IM, IV

single dose

Torsemide Demadex 2.5– 5 mg once daily PO

 -THIAZIDES
How it works “ Action” Nursing management
❖ Diuretics work by altering the reabsorption ❖ Monitor BP and pulse frequently .
or excretion of electrolytes and alter fluid ❖ Monitor intake and output ratios and
volume . daily weight.
Thiazide Diuretics: Inhibit reabsorption in the ❖ Do not stop the drugs abruptly
ascending portion of the loop of henle and early unless you speak with the DR.
distal tubule. Excrete sodium, chloride, and H2O ❖ If GI upset occurs then take the med
with food or milk.
Why do we give it? “Reason” ❖ Take early in the morning.
❖ Hypertension ❖ Do not reduce fluid intake.
❖ Used with antihypertensives ❖ Avoid alcohol and non prescription
❖ To reduce edema drugs.
❖ Glaucoma ❖ Notify the healthcare provider if:
❖ Seizures muscle cramps , weakness,
❖ Renal disease. dizziness, diarrhea, restlessness,
excessive thirst, general weakness,
rapid pulse, increased heart rate or
Adverse Effects pulse, gi distress.
Neuro: Dizziness, headache, encephalopathy,
❖ Weigh yourself weekly
lightheadedness,weakness, fatigue
❖ These drugs may cause
EENT: Hearing loss, tinnitus
hypokalemia, monitor serum
CV: Orthostatic hypotension
potassium levels.
GU: Electrolyte imbalances, glycosuria
❖ May cause in serum and urine
GI: Anorexia, nausea, vomiting
glucose in diabetic patients. May
Derm: Rash, photosensitivity
cause anqin serum bilirubin, calcium,
Endo: Hyperglycemia, hyperuricemia.
creatinine, and uric acid.
F & E: Dehydration, hypocalcemia, hypochloremia,
hypokalemia, hypomagnesemia, hyponatremia, Interactions
hypokalemia, metabolic alkalosis ❖ Allopurinol: increased risk of
MS: Arthralgia, muscle cramps, myalgia. hypersensitivity to allopurinol
❖ Anesthetics: increased anesthetic
effects
Contraindications ❖ Antineoplastic drugs: extended
❖ Hypersensitivity leukopenia
❖ Electrolyte imbalances ❖ Antidiabetic drugs: hyperglycemia
❖ Severe kidney or liver dysfunction
❖ Anuria.
❖ Mannitol: active intracranial bleeding except
during craniotomy
Simple Nursing Brain bits

❖ Thiazide and Loop: liver disease, lupus,

diabetes, a cross sensitivity may occurs
with thiazides and sulfonamides
❖ Yellow dye may cause allergic reactions
or bronchial asthma with thiazides.

Generic Trade Safe dose Route

Hydrochlorothiazide Microzide 12.5– 100 mg/day in 1– PO

2 doses

Metolazone Zaroxolyn 2.5– 5 mg/day PO

 -POTASSIUM SPARING
How it works “ Action” Nursing management
❖ Diuretics work by altering the ❖ Monitor BP and pulse frequently
reabsorption or excretion of electrolytes ❖ Monitor intake and output ratios
and alter fluid volume . and daily weight.
Potassium Sparing Diuretics: reduce the ❖ Do not stop the drugs abruptly
excretion of potassium, block the reabsorption unless you speak with the HCP.
of sodium into the kidney. And thereby ❖ If GI upset occurs then take the
increasing sodium and h20 in the urine and med with food or milk.
reduces excretion of K+ ❖ Take early in the morning
❖ Do not reduce fluid intake
Why do we give it? “Reason” ❖ Avoid alcohol and non
❖ Hypertension prescription drugs.
❖ Used with antihypertensives ❖ Notify the healthcare provider if:
❖ To reduce edema muscle cramps , weakness,
❖ Glaucoma dizziness, diarrhea, restlessness,
❖ Seizures excessive thirst, general
❖ weakness, rapid pulse, increased
Adverse Effects heart rate or pulse, GI distress.
Neuro: Dizziness, headache, encephalopathy, ❖ Weigh yourself weekly.
lightheadedness,weakness, fatigue ❖ These drugs may cause
EENT: Hearing loss, tinnitus hyperkalemia, monitor serum
CV: Orthostatic hypotension potassium levels.
GU: Electrolyte imbalances, glycosuria
GI: Anorexia, nausea, vomiting Interactions
Derm: Rash, photosensitivity ❖ Angiotensin converting
Endo: Hyperglycemia, hyperuricemia. enzyme/potassium supplement:
F & E: Dehydration, hypocalcemia, Increased risk of hyperkalemia
hypochloremia, hyperkalemia, ❖ Nsaids/anticoagulants:
hypomagnesemia, hyponatremia, hypokalemia, decreased diuretic effect
metabolic alkalosis
MS: Arthralgia, muscle cramps, myalgia.
Simple Nursing Brain bits
Contraindications
❖ Hypersensitivity Avoid foods high in potassium
❖ Electrolyte imbalances, hyperkalemia Avocado, Acorn squash, Spinach,
❖ Severe kidney or liver dysfunction Sweet potato,Wild-caught salmon, Dried
❖ Anuria. apricots, Pomegranate Coconut water,
❖ Mannitol: active intracranial bleeding White beans, Banana
except during craniotomy

Generic Trade Safe dose Route

Spironolactone Aldactone 25– 400 mg/day PO

as a single dose
 -CARBONIC ANHYDRASE INHIBITORS
How it works “ Action” Nursing management
❖ Diuretics work by altering the ❖ Monitor BP and pulse frequently
reabsorption or excretion of electrolytes ❖ Assess for allergy to sulfonamides
and alter fluid volume. ❖ Monitor intake and output ratios
Carbonic anhydrase inhibitors: sulfonamides and daily weight.
without bacteriostatic action, inhibit CAH ❖ Do not stop the drugs abruptly
enzyme thus results in excretion of Na+ K+ HC03 unless you speak with the DR.
and H20 ❖ If GI upset occurs then take the
med with food or milk
Why do we give it? “Reason” ❖ Take early in the morning
❖ Hypertension ❖ Do not reduce fluid intake
❖ Used with antihypertensives ❖ Avoid alcohol and non
❖ To reduce edema prescription drugs
❖ Glaucoma ❖ Notify the healthcare provider if:
❖ Seizures muscle cramps , weakness,
❖ Renal disease dizziness, diarrhea, restlessness,
excessive thirst, general
Adverse Effects weakness, rapid pulse, increased
Neuro: dizziness, headache, encephalopathy, heart rate or pulse, gi distress.
lightheadedness,weakness, fatigue ❖ Weigh yourself weekly
EENT: hearing loss, tinnitus ❖ These drugs may cause
CV: orthostatic hypotension hypokalemia, monitor serum
GU: electrolyte imbalances, glycosuria potassium levels and electrolytes.
GI: anorexia, nausea, vomiting ❖
Derm: rash, photosensitivity Interactions
Endo: Hyperglycemia, hyperuricemia. ❖ Primidone: decreased
F & E: Dehydration, hypocalcemia, effectiveness of primidone
hypochloremia, hypokalemia, ❖ Barbiturates & aspirin:
hypomagnesemia, hyponatremia, hypokalemia, decrease diuretic effectiveness
metabolic alkalosis ❖ tricyclic antidepressants: can
MS: Arthralgia, muscle cramps, myalgia. lead to toxicity

Contraindications Simple Nursing Brain bits

❖ Hypersensitivity to sulfonamides
❖ Electrolyte imbalances ❖ If a client has an allergy to
❖ severe kidney or liver dysfunction sulfonamides this drug should
❖ Anuria. not be given.
❖ Mannitol: active intracranial bleeding .
except during craniotomy

Generic Trade Safe dose Route

Acetazolamide Diamox 250– 1000 mg/day in PO

1– 4 divided doses

Methazolamide Neptazane 50– 100 mg 2– 3 times PO

daily.
 -OSMOTIC
How it works “ Action” Nursing management
❖ Diuretics work by altering the ❖ Monitor BP and pulse frequently
reabsorption or excretion of electrolytes ❖ Monitor intake and output ratios
and alter fluid volume . and daily weight
Osmotic Diuretics: increase the density of the ❖ Assess patient for anorexia,
filtrate in the glomerulus preventing selective muscle weakness, numbness,
reabsorption of h20 and it passes as urine. tingling, paresthesia, confusion,
and excessive thirst. Report signs
Why do we give it? “Reason” of electrolyte imbalance.
❖ Adjunct in the treatment of: ❖ Avoid alcohol
❖ Acute oliguric renal failure ❖ Hypokalemia, monitor serum
❖ Edema potassium levels and electrolyte
❖ Increased intracranial or intraocular levels
pressure
❖ Toxic overdose. Interactions
❖ GU irrigant During transurethral ❖ Digoxin: Hypokalemia increases
procedures (2.5– 5% solution only). the risk of dig toxicity

Adverse Effects
CNS:confusion, headache.
EENT: blurred vision, rhinitis.
CV: transient volume expansion, chest pain,
HF, pulmonary edema, tachycardia.
GI: nausea, thirst, vomiting.
GU: renal failure, urinary retention.
F and E: dehydration, hyperkalemia, Simple Nursing Brain Bits
hypernatremia, hypokalemia, hyponatremia.
Local: phlebitis at IV site. Symptoms of fluid and electrolyte
imbalance include dry mouth, thirst,
Contraindications weakness, lethargy, drowsiness,
❖ Mannitol: active intracranial bleeding restlessness confusion, muscle pain or
except during craniotomy cramps, confusion, gastrointestinal
❖ Hypersensitivity disturbances, hypotension, oliguria,
❖ Anuria tachycardia, and seizures.
❖ Dehydration
❖ Severe pulmonary edema or congestion.

Generic Trade Safe dose Route

Mannitol Osmitrol 50– 100 g as a 5– 25% IV

solution
 How it works “ Action” Nursing management
❖ Oral and parenteral anticoagulants ❖ Assess for signs of bleeding and
Are used to prevent the formation and extension of hemorrhage (bleeding gums; nose
a thrombus but do not help with an active clot or bleeds; unusual bruising; tarry, black
stools; hematuria; fall in hematocrit or
embolus .
BP; guaiac-positive stools, urine, or
Warfarin : Most commonly prescribed nasogastric aspirate)
Anticoagulant. Interferes with clotting mechanisms ❖ Monitor stool and urine for occult blood
of the blood, causing the depletion of prothrombin. before and periodically
❖ Lab Test Considerations: Monitor PT/
INR and other clotting factors frequently
during therapy. Therapeutic PT ranges
Why do we give it? “Reason” 1.3– 1.5 times greater than control.
❖ Prevention of DVT Normal INR (not on anticoagulants) is
❖ Prevention of A-FIB with embolization 0.8– 1.2. An INR of 2.5– 3.5 is
❖ Prevention of clotting in arterial heart surgery recommended.
❖ Prevention and treatment of PE, prevention ❖ Review foods high in vitamin K. Patient
should have consistent limited intake of
of repeat cerebral thrombosis
these foods, as vitamin K is the antidote
❖ Adjuvant treatment of MI for warfarin, and alternating intake of
❖ Treatment of coronary occlusion,acute MI, these foods will cause PT levels to
peripheral arterial embolism fluctuate. Advise patient to avoid
❖ Prevention of thrombus formation after valve cranberry juice or products during
replacement therapy.
❖ Diagnosis of disseminated intravascular
coagulation Interactions
❖ Nsaids/aspirin: increased risk for
bleeding
❖ PCN/aminoglycoside/increased risk for
Adverse Effects bleeding
GI: Cramps, nausea ❖ Beta blocker/loop diuretics : increased
Derm: Dermal necrosis, alopecia risk for bleeding
Hemat: BLEEDING, thrombocytopenia ❖ Disulfiram/cimetidine; increased risk
Misc: Fever, hepatitis for bleeding
❖ Oral contraceptive/
barbiturates/diuretics: decreased
Contraindications effects of anticoagulant
❖ Uncontrolled bleeding
❖ Open wounds
❖ Active ulcer disease
❖ Recent brain, eye, or spinal cord injury or Simple Nursing Brain Bits
surgery
❖ Severe liver or kidney disease Warfarin Crosses placenta and may cause fatal
❖ uncontrolled hypertension hemorrhage in the fetus. May also cause
congenital malformation.
Labs: PT / INR

Generic Trade Safe dose Route

Warfarin Coumadin 2– 5 mg/day for 2– 4 PO

days; then adjust daily
dose by results of INR.

Simplenursing.com
 How it works “ Action”
Oral and parenteral anticoagulants Nursing management
Are used to prevent the formation and extension of a ❖ Assess for signs of bleeding and hemorrhage
thrombus but do not help with an active clot or embolus (bleeding gums; nose bleed; unusual
bruising; black, tarry stools; hematuria; fall
in hematocrit or BP; guaiac-positive stools).
❖ Heparin inhibits the formation of fibrin clots, Notify health care professional if these occur.
inhibits conversion of fibrinogen to fibrin and ❖ SQ: Observe injection sites for hematomas,
inactivated several clotting factors. ecchymosis, or inflammation.
❖ Lab Test Considerations: Monitor activated
partial thromboplastin time (aPTT) and
hematocrit before and after and periodically.
Why do we give it? “Reason” When intermittent IV therapy is used, draw
❖ Prevention of DVT, aPTT levels 30 min before each dose during
❖ Prevention of A-FIB with embolization initial therapy and then periodically.
❖ prevention of clotting in arterial heart surgery ❖ During continuous administration, monitor
aPTT levels every 4 hr during early therapy.
❖ Prevention and treatment of PE, prevention of
❖ SQ therapy: Draw blood 4– 6 hr after
repeat cerebral thrombosis injection. Monitor platelet count every 2– 3
❖ Adjuvant treatment of MI days throughout therapy.
❖ treatment of coronary occlusion,acute MI,
peripheral arterial embolism
❖ Prevention of thrombus formation after valve
Interactions
❖ Nsaids/aspirin: increased risk for
replacement bleeding
❖ Diagnosis of disseminated intravascular ❖ PCN/aminoglycoside/increased risk for
coagulation bleeding
❖ Maintain patency of iv catheter ❖ Beta blocker/loop Diuretics : increased
risk for bleeding
❖ Disulfiram/cimetidine; increased risk
Adverse Effects for bleeding
GI: Drug-induced hepatitis ❖ Oral contraceptive/
Derm: alopecia (long-term use), rashes, urticaria barbiturates/diuretics: decreased
Hemat: BLEEDING, HEPARIN-INDUCED effects of anticoagulant
THROMBOCYTOPENIA (HIT) (WITH OR WITHOUT
THROMBOSIS), anemia.
Local: Pain at injection site.
MS: Osteoporosis (long-term use)
.Misc: Fever, hypersensitivity

Contraindications

❖ Uncontrolled bleeding
❖ Severe thrombocytopenia; hemorrhagic disease
❖ Open wounds (full dose). Simple Nursing Brain bits
❖ Pork allergy ❖ Heparin can’t be taken orally,
❖ TB gastric acids inactive it, given
❖ Hemorrhagic disease injection only!
❖ Leukemia

Generic Trade Safe dose Route

Heparin Hepalean, Hep-Lock, 10,000 units, followed by IV, Sub Q

Hep-Lock UP 5000– 10,000 units q 4– 6
hr. Continuous
infusion—5000 units

Simplenursing.com
 How it works “ Action”
These drugs work by decreasing the platelets’ ability to stick together Nursing management
(aggregate ) in the blood, thus forming a clot. ❖ Assess for signs of bleeding and hemorrhage
Aspirin works by prohibiting the aggregation of the platelets for the
(bleeding gums; nose bleed; unusual
lifetime of the platelet. The ADP blockers alter the platelet cell
membrane, preventing aggregation. Glycoprotein receptor blockers bruising; black, tarry stools; hematuria; fall
work to prevent enzyme production, again inhibiting platelet in hematocrit or BP; guaiac-positive stools).
aggregation. Notify health care professional if these occur.
❖ SQ: Observe injection sites for hematomas,
ecchymosis, or inflammation.
Why do we give it? “Reason” ❖ Lab Test Considerations: Monitor activated
❖ Antiplatelet drug therapy is designed primarily to treat partial thromboplastin time (aPTT) and
patients at risk for acute coronary syndrome, MI, stroke, and hematocrit before and after and periodically.
intermittent claudication. When intermittent IV therapy is used, draw
aPTT levels 30 min before each dose during
initial therapy and then periodically.
Adverse Effects ❖ During continuous administration, monitor
❖ Heart palpitations aPTT levels every 4 hr during early therapy.
❖ Bleeding
❖ Dizziness and headache
❖ SQ therapy: Draw blood 4– 6 hr after
❖ Nausea, diarrhea, constipation, dyspepsia injection. Monitor platelet count every 2– 3
days throughout therapy.

Interactions
Contraindications ❖ Aspirin and NSAID: Increased risk of
bleeding
❖ Pregnancy ❖ Macrolide antibiotics: Increased
❖ Lactation effectiveness of anti-infective
❖ Congestive heart failure ❖ Digoxin: Decreased digoxin serum levels
❖ Active bleeding ❖ Phenytoin: Increased phenytoin serum levels
❖ Thrombotic thrombocytopenic purpura

Generic Trade Use Dose

Clopidogrel plavix Recent MI, stroke, and Single loading dose: 300
acute coronary syndrome mg; 75 mg/day orally

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 How it works “ Action”
these drugs break down fibrin clots by converting plasminogen to Nursing management
plasmin. Plasmin is an enzyme that breaks down the fibrin of a blood ❖ Must administer within 4-6 hours post
clot. This reopens blood vessels after their occlusion and prevents thrombus formation
tissue necrosis. ❖ Assess the patient for bleeding every 15
minutes during the first 60 minutes of
therapy, every 15 to 30 minutes for the next 8
Why do we give it? “Reason” hours, and at least every 4 hours until therapy
❖ Acute stroke or MI by lysis (breaking up) of blood clots in the is completed. Vital signs are monitored
coronary arteries continuously. If pain is present, the primary
❖ Blood clots causing pulmonary emboli and DVT health care provider may order an opioid
analgesic. Once the clot dissolves and blood
❖ Suspected occlusions in central venous catheters (Ford 394)
flows freely through the obstructed blood
vessel, severe pain usually decreases. (Ford
396)
Adverse Effects
❖ Bleeding ❖ Lab Test Considerations: Monitor activated
partial thromboplastin time (aPTT) and
hematocrit before and after and periodically.
When intermittent IV therapy is used, draw
Contraindications aPTT levels 30 min before each dose during
❖ Active bleeding initial therapy and then periodically.
❖ History of stroke ❖ During continuous administration, monitor
❖ History of aneurysm aPTT levels every 4 hr during early therapy.
❖ Recent intracranial surgery

Interactions
❖ When a thrombolytic is administered with
medications that prevent blood clots, such
as aspirin, dipyridamole, or an anticoagulant,
the patient is at increased risk for bleeding.

Generic Trade Use Dose

alteplase Activase, Cathflo Activase (for IV Acute MI, acute ischemic stroke, Total dose of 90–100 mg IV,
catheter occlusions only) PE, IV catheter clearance given as a 2- to 3-hr infusion

Simplenursing.com
 Nursing management
How it works “ Action” ❖ The dose of sublingual nitroglycerin may be repeated every 5
minutes until pain is relieved or until the patient has received
The nitrates act by relaxing the smooth muscle layer
three doses in a 15-minute period. One to two sprays of
of blood vessels, increasing the lumen of the artery
translingual nitroglycerin may be used to relieve angina, but no
or arteriole, and increasing the amount of blood
more than three metered doses are recommended within a
flowing through the vessels. (Ford 382)
15-minute period.
❖ Do not rub the nitroglycerin ointment into the patient’s skin,
because this will immediately deliver a large amount of the
drug through the skin. Exercise care in applying topical
nitroglycerin and do not allow the ointment to come in contact
with your fingers or hands while measuring or applying the
Why do we give it? “Reason” ointment, because the drug will be absorbed through your skin,
causing a severe headache.
❖ Relieve pain of acute anginal attacks
❖ The primary health care provider is notified if any of the
❖ Prevent angina attacks (prophylaxis )
following occur:
❖ Treat chronic stable angina pectoris (Ford
❖ Heart rate of 20 bpm or more above the normal rate
382)
❖ Rapid weight gain of 5 lb or more
❖ Unusual swelling of the extremities, face, or abdomen
Adverse Effects ❖ Dyspnea, angina, severe indigestion, or fainting
❖ Central nervous system (CNS) reactions, such as ❖ Avoid the use of alcohol unless use has been permitted by the
headache (may be severe and persistent), primary health care provider.
dizziness, weakness, and restlessness ❖ Notify your emergency response providers if the drug does not
❖ Other body system reactions, such as relieve pain or if pain becomes more intense despite use of this
hypotension, flushing (caused by dilation of small
drug.
capillaries near the surface of the skin), and rash
(Ford 382) ❖ Follow the recommendations of the primary health care
❖ provider regarding frequency of use.
❖ Keep an adequate supply of the drug on hand for events, such
as vacations, bad weather conditions, and holidays.
❖ Keep a record of the frequency of acute anginal attacks (date,
Contraindications time of the attack, drug, and dose used to relieve the acute
pain), and bring this record to each primary health care
❖ hypersensitivity to the drugs, severe anemia, provider or clinic visit.
closed-angle glaucoma, postural hypertension, early
myocardial infarction (sublingual form), head trauma,
cerebral hemorrhage (may increase intracranial
hemorrhage), allergy to adhesive (transdermal system), Interactions
or constrictive pericarditis. Patients taking
phosphodiesterase inhibitors (drugs for erectile
dysfunction) should not use nitrates. (Ford 382)
❖ Aspirin: Increased nitrate plasma concentrations and action may
occur
❖ calcium channel blockers:Increased symptomatic orthostatic
hypotension
❖ Dihydroergotamine: Increased risk of hypertension and decreased
antianginal effect
❖ Heparin: Decreased effect of heparin
❖ phosphodiesterase inhibitors: Severe hypotension and
cardiovascular collapse may occur
❖ Alcohol: Severe hypotension and cardiovascular collapse may occur

Generic Trade Use Dose

isosorbide Isordil, Dilatate SR, Monoket Treatment and prevention of angina Initial dose 5–20 mg orally;
maintenance dose 10–40 mg BID, TID
orally
Sublingually: 2.5–5 mg
Prevention: 5–10 mg sublingually, 5
mg chewable

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 How it works “ Action” Nursing management
Systemic and coronary arteries are influenced ❖ Monitor BP and pulse frequently
by Ca++ moving across cell membranes. ❖ Monitor intake and output ratios
CCB act by inhibiting the movement of calcium and daily weight. Assess for signs
across the cell membrane of cardiac and of HF (peripheral edema,
arterial muscles. Resulting in less calcium rales/crackles, dyspnea, weight
available for nerve impulse transmission and gain, jugular venous distention).
relax blood vessels to increase 02 supply to ❖ Angina: Assess location,
decrease cardiac workload duration, intensity, and
precipitating factors of patient’s
Why do we give it? “Reason” anginal pain
❖ Hypertension ❖ Avoid large amounts (6– 8
❖ Angina pectoris glasses of grapefruit juice/day)
❖ Vasospastic (Prinzmetal’s) angina ❖ Have the client check pulse and
report any sudden changes
Adverse Effects
CNS: dizziness, fatigue. Interactions
CV: peripheral edema, angina, bradycardia, ❖ Cimetidine: increase effects of
hypotension, palpitations. CCB
GI: gingival hyperplasia, nausea. ❖ Theophylline: toxic effects of
Derm: flushing theophylline
Contraindications ❖ Digoxin: Dig toxicity
❖ Calcium channel blockers: sick sinus ❖ Rifampin: decreased CCB effects
syndrome, 2nd/3rd degree
atrioventricular block, ventricular
dysfunction, cardiogenic shock.

Generic Trade Safe dose Route

Amlodipine Norvasc 5– 10 mg once PO

daily

Diltiazem Cardizem 30– 120 mg 3– 4 PO

times daily o

Verapamil Calan 80– 120 mg 3 PO, IV

times daily
 How it works “ Action” Nursing management
Cardiotonics such as digoxin increase cardiac output through positive The physical assessment should include the following:
inotropic activity (an increase in the force of the contraction). They slow ❖ Taking blood pressure, apical-radial pulse rate, respiratory
the conduction velocity through the atrioventricular (AV) node in the rate
heart and decrease the heart rate through a negative chronotropic ❖ Auscultating the lungs, noting any unusual sounds during
effect. inspiration and expiration
Milrinone has inotropic action and is used in the short-term ❖ Examining the extremities for edema
management of severe heart failure that is not controlled by the digitalis ❖ Checking the jugular veins for distention
preparation. (Ford 403) ❖ Measuring weight
❖ Inspecting sputum raised (if any) and noting the appearance
(e.g., frothy, pink tinged, clear, yellow)
❖ Looking for evidence of other problems such as cyanosis,
shortness of breath on exertion (if the patient is allowed out of
bed) or when lying flat, and mental changes (Ford 405)
❖ Pediatric
❖
Why do we give it? “Reason” ❖ The drug is withheld and the primary health care provider
❖ Heart failure notified before administration of the drug if the apical pulse
❖ Atrial fibrillation rate in a child is below 70 bpm, or below 90 bpm in an infant.
❖ Daily weights
❖
Adverse Effects
❖ Headache
❖ Weakness, drowsiness Interactions
❖ Visual disturbances (blurring or yellow halo) ❖ thyroid hormone: Decreased effects of digoxin
❖ Arrhythmias ❖ Thiazide and loop diuretics: increased diuretic electrolyte
❖ Nausea and anorexia disturbances, especially hypokalemia

Contraindications
❖ digitalis toxicity
❖ known hypersensitivity
❖ ventricular failure, ventricular tachycardia, cardiac
tamponade, restrictive cardiomyopathy, or AV block. (Ford
Digoxin toxicity & electrolyte imbalances
Plasma digoxin levels are monitored closely. Blood for plasma level
404)
measurements should be drawn immediately before the next dose or 6 to 8
hours after the last dose regardless of route. Therapeutic drug levels are
between 0.8 and 2 nanograms/mL. Plasma digoxin levels greater than 2
nanograms/mL are considered toxic and are reported to the primary health
care provider
Hypokalemia makes the heart muscle more sensitive to digitalis, thereby
increasing the possibility of developing digitalis toxicity. At frequent intervals,
observe patients with hypokalemia closely for signs of digitalis toxicity. (Ford
405)

Generic Trade Use Dose

digoxin Lanoxin Heart failure, atrial fibrillation Loading dose:* 0.75–1.25 mg orally or 0.6–1
mg IV
Maintenance: 0.125–0.25 mg/day orally
Lanoxicaps: 0.1–0.3 mg/day orally

milrinone. Short-term management of Short-term management of heart Loading dose: 50 mcg/kg IV

heart failure failure IV: Up to 1.13 mg/kg/day