Medications M/S III

Spring 2010

Medication Aldomet Altace Atenolol Verapamil

Brand Name Methyldopa Ramipril Atenolol Calan
Drug Class Antihypertensive Antihypertensive Antihypertensive Calcium channel blocker, Anti-
Antianginal Hypertensive,Anti-
Anginal, Anti-
Dysrhythmic
Chem. Class Adrenergic Inhibitor ACE Inhibitor Beta Blocker Diphenylalkylamine
Action Reduce Arterial Pressure Pre vents conversion of Angiotensin I to II Blocks B-adrenergic receptor Inhibits calcium across cell in
depolarization, relaxes smooth muscle of
heart, dilates artery of heart, decreases
sa/av node conduction, dilates perif.
arteries
Uses Hypertension Hypertension Hypertension Unstable angina
CHF (post MI) Angina Dysrhythmias,HTN,supraventricular
Reduce risk for MI, stroke tachycardia, a-fib/flutter
Nursing If giving IV dilute in 100 ml Assess neutrophils if less than 1000/mm3 PO peak is 2-4 hrs, IV rapid onset peak is 5 PO peak is 3-4 hrs
Considerations D5W over ½ -1 hour. discontinue,decreased platelets, WBC’s min IV Onset 3 min., peak 3-5 min, duration
Monitor BP prior to Monitor BP prior to administration. Monitor I&O, daily wt.,BP, HR. 10-20 min
administration. Orthostatic Precautions Monitor Bp,HR,resp,ECG
Orthostatic Precautions I&O, daily wt.,JVD,Lung sounds
HA, dizzy, anxiety, seizure, (GI)
Proteinuria, (Bld)Leukopenia

Drowsy,weak, dizzy,(CV) Insomnia, fatigue, dizzy,(CV)hypotension,

Side Effects myocarditis,(GI) hepatic
dysfunction,pancreatitis,
(Bld)Leukopenia,
thrombocytopenia
Teaching Don’t stop taking med abruptly
due to withdrawl.
No OTC (cough, cold, allergy)
meds
Don’t stop taking med abruptly due to
withdrawl.
No OTC (cough, cold, allergy) meds
bradycardia, CHF. (GI) ischemic colitis,
(BLD) thrombocytopenia.(RESP) HA,drowsy,dizzy
bronchospasm (CV)CHF, dysrhythmias
(system)Stevens-Johnson Syndrome
Don’t stop taking med abruptly, take at Teach pt. how to check pulse, BP before
same time, report changes in HR (teach to taking med, no grapefruit, increase fluids
take pulse), decrease ETOH,NA,smoking for constipation,decrease caffeine, no
ETOH
Mosby/Elsevier 23rd Edition, Mosby’s Nursing Drug Reference 2010
Drug/Use
Captopril: Capoten
Used for HTN, CHF,
↓progretion of diabetic
nephropathy.
Diltiazem: Cardizem
Used for: HTN, Angina
pectoris, supraventricular
tachyarrhythmias and rapid
ventricular rates in atrial
flutter or fibrillation.
Carvedilol: Coreg
Used for: HTN, CHF, L
ventricucar disfunc. After
MI( used with digoxin,
diuretics, and ACE
inhibitors)
Digoxin: Digitek,
Lanoxicaps, Lanoxin
Used for: CHF,
tachyarrhythmias, atrial
fibrillation and atrial flutter
( slows ventricular rate),
paroximal atrial tachycardia.
Action/ Classification
ACE inhibitor: block conversion of
angiotensin I to angiotensin II, a
potent vasoconstrictor. Increase
plasma rennin levels and reduce
aldosterone levels.
Antianginals, antiarrhythmics,
antihypertensives.
Calcium channel blocker. Inhibits
transport of calcium into
myocardial and vascular smooth
muscle cells, resulting in inhibition
of excitation/contraction.
Systemic vasodialator, coronary
vasodilator, suppression of
arrythmias.
Antihypertensive, beta blocker.
Blocks stimulation of
beta1(myocardial) and
beta(pulmonary, vascular and
uterine) adrenergic receptor sites.
Also has alpha1 blocking activity,
which may result in orthostatic
hypotention. ↓HR and BP,
Improves cardiac output, slowing
the progression of CHF and ↓ risk
of dead.
Antiarrhythmics, inotropics.
Digitalis glycosides, increases the
force of myocardial contraction,
prolongs refractory period of the
AV node, decreases conduction
through the SA and AV nodes.
Increases cardiac output(positive
inotropic effect) and slowing of the
heart rate( negative chronotropic
effect).
Contraindications
Use cautiously in renal and hepatic
impairment, hypovolemia, elderly pts,
diuretic therapy, cardiac insufficiency,
angioedema, pregnancy, hypersensitivity.
Hypersensativity, 2nd or 3rd degree AV
block, BP<90, recent MI,pulmonary
congestion, hepatic impairment, geriatric
pt, renal impairment, CHF, ventricular
arrhytmias,preg., lactation, children.
Pulmonary edema, cardiogenic shock,
bradycardia, heart block, severe hepatic
impairment, asthma, renal impairment,
PVD, DM(↑BS)
Hypersensativity, uncontrol ventricular
arrhythmias, AV block, known alcohol
intolerance, constrictive pericarditis,
electrolyte abnormalities(↓K,↓Mg,↓Ca may
predispose to toxicity). Mi , geriatric pts,
renal, obese pt.
SE &Adverse reactions
Dizziness, fatique, headache, insomnia,
weakness, cough, hypotension, taste
disturbances,proteinuria,rashes,
hyperkalemia, agranulocytosis,
neutropenia, angioedema.
Anxiety, dizziness, nervousness, blurred
vision, cough, arrhythmias, CHF,
peripheral edema, bradycardia,
palpitations, hypotension, N/V, flushing,
increased sweating, polyurea, nocturia,
disurea, stevens-johnson syndrome.
Dizziness, fatique, weakness,
anxiety,blirred vision, dry eyes,
bronchospasm, wheezing, bradycardia,
CHF, pulmonary edema, diarrhea,
impotence, hyperglycemia.
Fatigue, headache, weakness, blurred
vision, yellow vision, arrhythmias,
bradycardia, ECG changes, anorexia,
N/V/D, thrombocytopenia.
Recommended doses
Half life: <2h(↑in renal
impairment)
Tabs: 12.5mg, 25mg,
50mg,100mg.
Nursing considerations:
Administeron empty stomach,
√BP &HR, monitor for ↓ fluid
overload.
PO 30-120mg 3-4x daily. 60-
120mg twice daily as SR caps.
180-240mg once daily as CD or
XR capsulesor LA tabs (up to
360mg a day.)
IV 0.25mg/kg; may repeat in 15
minutes a dose of 0.35mg/kg.
May follow with cont. infusion
of 10mg/hr( range 5-15mg/hr)
for up to 24 hrs.
Tabs: 3.125mg, 6.25mg, 12.5mg,
25mg.
√BP & HR, I&O, BS.
IV digitalizing dose 0.6-1mg(10-
15mcg/kg)
PO digitalizing dose 0.75-
1.25mg (10-15mg/kg)
PO maintenance dose: 0.063-0.5
mg/day.
 MEDICATION DOSAGE/ Recommended TIMETIME PERTINENT ACTION/CLASSIFICATION ADMINISTRATION
BRAND/ ROUTE/ DOSAGE SCHEDULE LAB PRECAUTIONS/ADVERSE
GENERIC FREQUENCY APPLIED REACTIONS
& CLIENT EDUCATION
aspirin (ASA) salicylate levels. Classification- antipyretcs, nonopiod analgesics, Use cautiously with history of Gi bleeding or ulcer
PT,PTT, INR salicylates disease, ETOH use, severe renal and hepatic disease.

Action- It decreases platelet aggregation. Adv. reactions/SE: Gi bleeding, dyspepsia, nausea,

Produces analgesic affects. It reduces fever and
inflammation by inhibiting production of
prostaglandins.
anaphylaxis, epigastric distress. Patients who have
asthma, allergies, nasal polyps, or allergic to tartrazine
have in increase risk of becoming hypersensitive and
develop reactions. Assess pain and fever before and
after administration. Administer with food, or after
meals to minimize gastric irritation. Do not crush
enteric coated tablets. Do not take antacids within 1-2
hours of enteric coated tablets.

Prinivil, Zestril
(lisinopril)
Angiotensin-Converting
Enzyme (ACE) Inhibitor
HTN- 10 mg BUN, Crt, Classification- antihypertensives, ACE inhibitor Use cautiously in patients with or family history of
once daily and electrolytes, K, angioedema. Monitor BP and pulse frequently
increased to 20- CBC, urine Action- Blocks the conversion of angiotensin I to monitor weight for fluid overload.
40 mg/day. protein angiotensin II (vasoconstrictor). Prevents
CHF- 5 mg/day degradation of vasodilatory prosotglandins and Adverse. reaction/SE: dizziness, cough, hypotension,
and increased to bradykinin. taste disturbances, drowsiness, HA
40 mg/day
Patient teaching: avoid salt substitutes or foods with high
potassium levels. change position slowly to minimize
hypotension. may cause impairment of taste but will
resolve in about 12 weeks. Notify MD. of any rash,
mouth sores, sore throat, irregular heart beat,, swelling
of face, eyes, lips, hands and feet, and difficulty
swallowing or breathing.
Glucophage Start with 500 Serum glucose, Classification-Antidiabetic Use cautiously in patients that have renal disease and
mg q.d. to t.i.d. Hgb, folic acid, avoid if they are over 80 years old unless renal
(metformin) or 850 mg q.d. to Vit. B-12 Action-Decreases hepatic and intestinal glucose function is normal, chronis ETOH use, metabolic
b.i.d with meals, absorption. Increases insulin sensitivity. acidosis, renal dysfunction, and CHF. With hold for
may increase by patients undergoing radiographic studies requiring
500-850 mg/d I.V. iodinated contrast and 48 hours afterwards.- risk
every 1-3 wk for lactic acidosis.

Adverse reactions/side effects: Administer with meals to

minimize effects. Abdominal bloating, N/V/D,
unpleasant metallic taste, when combined with oral
sulfonylureas observe for s/s of hypoglycemia.

Patient teaching: take at same time everyday, teach s/s of

hypo and hyperglycemia and proper blood testing.
 MEDICATIONS

MEDICATION DOSAGE/ TIME MINIMUM RATE OF MINIMUM/MAXIMU RELEVANT LAB NURSING CONSIDERATION BEFORE AND
SAFE ADMINISTRATION M EFFECTIVE AFTER ADMINISTRATION
CLASS & ACTION ROUTE/ SCHEDULE DILUTION FOR IV DRUGS CONCENTRATION FINDINGS

FREQUENCY

K-Dur/ KCL(potassium 40mEq/ Infuse at a rate not 1-4 mEq/kg/24h Serum electrolytes and Patient should be monitored with
chloride) to exceed 10 mEq/h acid base balance: continuous or serial ECG during infusion.
1000 ml Not to exceed 40 to Potassium, sodium,
Class: Electrolytic and 80 mEq/24h chloride, bicarbonate, pH Direct injection of any concentrated
water balance agent solution can be instantly fatal; Rapid
Monitor I &O infusion may cause fatal hyperkalemia
Action: Principal (cardiac arrest).
intracellular cation;
essential for maintenance Observe for signs and symptoms of
of intracellular hyperkalemia: cardiac arrest, cardiac
isotonicity; essential for dysrhythmias, and areflexia.
acid-base metabolic
balance Side effects: abd pain, N/V, diarrhea.

(Shannon & Wilson, Monitor urinary output

2009, pg.1259)
Monitor IV site for signs of phlebitis or
extravasation.

Precaution: renal insufficiency can lead to

hyperkalemia.

Antidote: IV sodium bicarbonate 40 to

160 mEq over 5 mins to correct acidosis.

Lasix/ furosemide/ Uritol 20-80 mg PO; May be 20 mg over 1 80 mg/Qd- 1Gm/Qd Electrolytes, BUN, CO2, Check serum potassium level
20-40 mg IV given minute blood sugar, uric acid, I &
Class: electrolyte & undiluted O Contraindicated with CRF with azotemia,
water balance agent; and oliguria & anuria
loop diuretic;
antihypertensive Monitor I & O, weight, and BP

Action: inhibits Side effects: anemia, anorexia, blurred

reabsorption of sodium vision, deafness, diarrhea, dizziness,
and and chloride hyperglycemia, hyperurecemia,
primarily in the loop of hypokalemia, leg cramps, lethargy,
Henle and also in the leucopenia, mental confusion, parasthesia,
proximal and distal renal postural hypotension, pruritus, urinary
tubules. Decreases frequency, urticaria, vomiting, weakness
edema and intravascular
volume thereby
decreasing blood
pressure

(Shannon & Wilson,

2009, pg. 695)

Lipitor/ atorvastin 10 mg, 20 Monitor lipid levels within If given concurrently with digoxin
calcium mg, and 40 2-4 wks after initiation of monitor for digoxin toxicity.
mg tabs therapy
Class: Antilipemic agent; Caution use with liver and renal disease.
reductase inhibitor PO/Qd Digoxin level
Side effects: back pain, myalgia,
Action: reduces LDL and Liver function tests headache, abdominal pain, constipation,
total triglyceride diarrhea, dyspepsia, flatulence, sinusitis,
production as well as pharyngitis, and rash.
increases the plasma
level of HDL

(Shannon & Wilson,

2009, pg. 131)

Lorpressor/ metoprolol 25 mg, 50 Administer Give at a rate of 50-100 mg/Qd CBC, Blood Glucose, Check patient’s apical pulse and BP
tartrate mg, 100mg undiluted 5mg over 60 secs liver function tests, kidney before administration.
tab/ PO function tests(BUN and
Class; Beta-adrenergic serum creatinine), I & O, Monitor ECG when giving IV route
antagonist; 1 mg/mL
antihypertensive; injection Expect maximum effect on BP after 1 wk
antianginal of therapy

Action: blocks beta 1 Caution use with hepatic or renal

receptor cites located impairment, AV conduction defects;
primarily on cardiac bronchial asthma; DM; peripheral
muscle, reducing heart vascular disease.
rate and cardiac output;
lowers blood pressure, Ensure that sustained release capsules are
slows sinus rate and swallowed whole and not chewed or
decreases myocardial crushed.
automaticity (Shannon &
May cause elevated: BUN, creatinine,
Wilson, 2009, pg 1007)
serum transaminase, alkaline phosphate,
lactate dehydrogenase, and serum uric
acid
 DRUG DOSE; TIME MINIMUM RATE OF MINIMUM/ RELEVANT LAB NURSING CONSIDERATIONS
DRUG CLASS & ROUTE;& SAFE ADMINISTRATION MAXIMUM FINDINGS BEFORE AND AFTER
ACTIONS FREQUENC DILUTION FOR IV DRUGS EFFECTIVE ADMINISTRATION
Y CONSENTRATION
Epoetin Alfa/Epogen: SC/IV N/A Bolus- give over 1 Give undiluted. Baseline Control blood pressure prior to initiation
Blood former minute transferring and of therapy. Hypertension is an adverse
serum ferritin. effect that must be controlled. Monitor
Epoetin stimulates the PTT & INR, Hct, closely for thrombotic events, especially
production of RBC’s in CBC, platelet of the patient has CRF. Be aware that
the bone marrow. For anemia: start IV count, BUN, the blood pressure may rise during the
creatinine, therapy as the Hct increases. Do not
50-100 U/kg/dose
phosphorus, shake the solution Use only one dose
until target Hct range
potassium. per vial.
of 30-33% is reached.

Dalteparin Sodium/ SC CBC with platelet Patient should be sitting or lying supine
Fragmin: count, UA, stool for injection. Carefully monitor patient
for occult blood for hemorrhage. May cause nausea,
Low molecular weight vomiting, hemorrhage, CVA. Use
heparin caution in patients with uncontrolled
hypertension, cerebral aneurysm,
Used in the prevention bleeding disorders, severe liver or renal
and treatment of DVT disease, diabetic retinopathy or
following surgery. pregnancy.

Isosorbide Mononitrate/ PO N/A Serum electrolytes Monitor cardiac status and blood
Ismo: Vasodilator pressure. Watch for signs and
symptoms of toxicity such as orthostatic
It decreases preload hypotension, dizziness headache and
and LVEDV. dyspnea. Do not crush or chew
sustained release tablets.

Clopidogrel PO N/A N/A N/A Periodic platelet Carefully monitor for Gi bleeding,
Bisulfate/Plavix count and lipid especially if the patient is taking aspirin,
profile heparin, or warfarin. May cause adverse
Anticoagulant effects such as chest pain, edema,
nausea, headache, dizziness, bronchitis,
This medication and dyspnea. Inform patient that taking
inhibits platelet Feverfew, garlic, ginger or ginkgo with
aggregation by these medications may increase the risk
selectively preventing of bleeding.
the binding of
adenosine diphosphate
to its platelet receptor.
It prolongs the bleeding
time, and thus reduces
atherosclerotic events
in patients that are
considered high risk.

Nitrobid Vials must IV: 5mcg/min, Should not exceed 400 Urine Monitor blood pressure and pulse before
be diluted in increase by mcg/mL catecholamine: and after administration. Patients
(nitroglycerin) D5W or 5mcg/min q 3-5 min receiving IV form require continuous
0.9% NaCl. to 20 mcg/min, then Urine ECG and blood pressure monitoring.
increase by 10-20 vanillylmandelic Additional hemodynamic parameters
mcg/min q 3-5 min acid concentration may be monitored.
Nitrates, antianginals may be increased

Administer via infusion pump to ensure

Increases coronary
accurate rate.
blood flow by dilating
coronary arteries and
improving collateral
flow to ischemic
regions. Produces
vasodilation.

Dilaudid Dilute with Administer slowly Amylase: Opioid antagonist: Narcan

at least 5 mL not to exceed 2 mg
(Hydromorphone) of sterile over 3-5 min Lipase: Assess blood pressure, pulse, and
water or respirations before and periodically
Opioid analgesics 0.9% NaCl during administration.
for injection
(May be

Binds to opiate Increased)

receptors in the CNS.
Alters the perception of
and response to painful
stimuli while producing
generalized CNS
depression. Supresses
the cough reflex via a
direct central action.
 Diovan/Cozaar Serum K: Assess blood pressure (lying,
sitting,standing) and pulse periodically
(Valsartan/ losartan) BUN: during therapy.

Anti HTN Serum Creatinine: CHF: Daily weights assess routinely for
resolution of fluid overload.
Angiotensin II receptor (may all be
antagonist increased) Monitor renal function and electrolyte
levels periodically.
Blocks vasoconstrictor
and aldosterone
producing effects of
angiotensin II at
receptor sites.

Norvasc N/A N/A N/A Total serum Monitor blood pressure and pulse before
calcium therapy, during dose titration, and
(amplodipine) concentration is periodically during therapy.
not affected by
calcium channel Monitor ECG periodically during
blockers prolonged therapy.
Anti HTN
Monitor I&O’s and daily wts.
Ca channel blocker
Assess for signs of CHF (edema, rales,
crackles, dyspnea, wt gain, jugular
venous distention.)
Inhibits the transport of
calcium into
myocardial & Vascular
sm. Muscle cells,
resulting in inhibition
of excitation-
contraction coupling.

NIFEDIPINE Assessment & Drug Effects

Adalat CC, Procardia,
Procardia XL Monitor BP carefully during titration period.
Patient may become severely hypotensive,
especially if also taking other drugs known to
lower BP. Withhold drug and notify physician
if systolic BP <90.
 Monitor blood sugar in diabetic patients.
Nifedipine has diabetogenic properties.

Monitor for gingival hyperplasia and report

promptly. This is a rare but serious adverse
effect (similar to phenytoin-induced
hyperplasia).

SEVELAMER Assessment & Drug Effects

HYDROCHLORIDE
Renagel Lab tests: Obtain frequent serum phosphate
levels.

CALCIUM CARBONATE Assessment & Drug Effects

Note number and consistency of stools. If

constipation is a problem, physician may
Tums
prescribe alternate or combination therapy with
a magnesium antacid or advise patient to take a
laxative or stool softener as necessary.

Lab tests: Determine serum and urine calcium

weekly in patients receiving prolonged therapy
and in patients with renal dysfunction.

Record amelioration of symptoms of

hypocalcemia (see Signs & Symptoms,
Appendix F).

Observe for S&S of hypercalcemia in patients

receiving frequent or high doses, or who have
impaired renal function (see Appendix F).

BENAZEPRIL Assessment & Drug Effects

HYDROCHLORIDE
Assess for hypotension, especially in patients
Lotensin
who may be volume depleted (e.g., prolonged
diuretic therapy, recent vomiting or diarrhea,
salt restriction) or who have CHF.

Lab tests: Monitor serum potassium levels for

hyperkalemia (see Appendix F).