Name: CAMBA, RACHELLE S.
1. Make a drug study on the individual drugs discussed in this course unit. Type them in word and compile them.
2. Search for 2 new drugs for each classification of Cardiovascular drugs not discussed in this course unit and include them in the drug study.
ANTIHYPERTENSIVE MEDICATIONS
A. Inhibitors (…pril)
DRUG DOSAGE
Captopril Hypertension
Adult: Initial dose: PO
12.5-25 mg bid-tid; may
increase to 50 mg bid-tid
at 1-2 wk intervals; usual
range 25-150 mg bid-tid;
max 450 mg/day
Child: PO 0.3-0.5
mg/kg/dose, titrate up to 6
mg/kg/day in 1-4 divided
doses
Neonate:
PO 0.05-0.1 mg/kg bid-
tid, may  increase as
needed.
THERAPEUTIC
ACTION
Inhibits ACE, preventing
conversion of angiotensin
I to angiotensin II, a potent
vaso-constrictor. Less
angiotensin II decreases
peripheral arterial
resistance, decreasing
aldosterone secretion,
which reduces sodium and
water retention and lowers
BP.
ADVERSE REACTION
CNS: dizziness, fainting,
headache, malaise, fatigue,
fever, insomnia,
paresthesia. cv;
tachycardia, hypotension,
chest pain, angina
pectoris, palpitations.
Gl: abdominal pain,
anorexia, constipation,
diarrhea, dry mouth,
dysgeusia, nausea,
vomiting.
Hematologic: leukopenia,
agranulocytosis,
thrombocytopenia,
pancytopenia, anemia.
Metabolic hyperkalemia.
Respiratory: dry,
persistent, nonproductive
cough; dyspnea.
Skin: urticarial rash,
maculopapular rash,
pruritus, alopecia. Other:
angioedema.
NURSING
CONTRAINDICATION
CONSIDERATIONS
Breastfeeding, children,  Monitor BP
hypersensitivity, heart closely following
block, potassium-sparing the first dose. A
diuretics, bilateral renal sudden
artery stenosis, exaggerated
angioedema 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.
 encourage patient
to implement
lifestyle changes,
including weight
loss, smoking
cessation,
decreased alcohol
and salt in the diet,
and increased
exercise
 administer on an
empty stomach 1
hour before or 2
hours after meals
 alert the surgeon
and mark the
patient’s chart
prominently if the
patient is to
 undergo surgery
 consult with the
prescriber to
reduce the dose in
patients with renal
failure to account
further
 monitor patient
carefully for signs
of a drop in fluid
volume which
may lead to
hypotension and
other adverse
effects.

Enalapril Hypertension Inhibits ACE, preventing CNS: asthenia, headache, Hypersensitivity, history  monitor B/P,
Adult: PO 2.5-5 mg/day, conversion of obesa dizziness, fatigue, vertigo, of angioedema orthostatic
may increase or decrease angiotensin I to syncope, weakness. hypotension,
to desired response, range angiotensin II, a potent Precautions: syncope; if
10-40 mg/ day; IV 0.625- vasoconstrictor. Less CV; hypotension, chest Breastfeeding, renal changes occur,
1.25 mg q6hr over 5 min angiotensin II decreases pain, angina. disease, hyperkalemia, dosage change
peripheral arterial hepatic failure, may be required;
Child: PO 0.08 mg/kg/day resistance, decreasing Gl: anorexia, diarrhea, dehydration, bilateral renal obtain peak/trough
in 1-2 divided doses, max aldosterone secretion, nausea, abdominal pain, artery/aortic stenosis levels, maintain
0.58 mg/kg/day in 1-2 reducing sodium and water vomiting. adequate
divided doses; IV 5-10 retention, and lowering hydration
mcg/kg/dose q8-24hr BP. GU: decreased renal  encourage patient
function (especially in to implement
patients with bilateral lifestyle changes,
renal artery stenosis or including weight
HF). loss, smoking
cessation,
Hematologic: bone decreased alcohol
marrow depression. and salt in the diet,
and increased
Respiratory: bronchitis; exercise
dry, persistent, tickling,  administer on an
nonproductive cough empty stomach 1
dyspnea.
 hour before or 2
Skin: rash. hours after meals
 alert the surgeon
Other: angioedema, and mark the
anaphylaxis patient’s chart
prominently if the
patient is to
undergo surgery
 consult with the
prescriber to
reduce the dose in
patients with renal
failure to account
further
 monitor patient
carefully for signs
of a drop in fluid
volume which
may lead to
hypotension and
other adverse
effects.

Lisinopril Adult: PO 10-40 mg/day; Selectively suppresses  CNS: Vertigo, depression, Contraindicated in patients  Monitor B/P,
may increase to 80 mg/day renin-angiotensin- stroke, insomnia, hypersensitive to either check for
if required. aldosterone system;  paresthesias, headache, drug or sulfonamides and orthostatic
inhibits ACE;  fatigue, asthenia, dizziness in those with a history of hypotension,
Child >6 yr: PO 0.7 prevents the conversion of angioedema related to syncope; if
mg/kg/day, up to 5 mg/ angiotensin I to CV: Chest pain,   previous treatment with an changes occur,
day; titrate q1-2wk up to angiotensin II hypotension, sinus ACE inhibitor, hereditary dosage change
0.6 mg/kg/day or 40 tachycardia or idiopathic angioedema, may be required
mg/day or anuria.  Establish baselines
EENT: Blurred vision, in renal/liver
Geriatric: PO 2.5-5 nasal congestion function tests
mg/day, increase q7day before therapy
GI: Nausea, vomiting,   begins
anorexia,    Monitor
constipation,  flatulence, renal/liver
GI irritation, diarrhea, function tests:
 hepatic failure, hepatic protein, BUN,
necrosis creatinine; watch
for increased
GU: Proteinuria, renal levels that may
insufficiency, sexual indicate nephrotic
dysfunction, impotence syndrome and
renal failure;
HEMA: Neutropenia, monitor renal
agranulocytosis symptoms:
polyuria, oliguria,
INTEG: Rash, pruritus frequency, dysuria
 Check potassium
MISC: Muscle  levels throughout
cramps, hyperkalemia treatment,
although
RESP: Dry cough,  hyperkalemia
dyspnea rarely occurs

SYST: Angioedema,
anaphylaxis, toxic
epidermal necrolysis

Perindopril Adult: PO 4 mg/day, may Lowers BP by inhibition CNS: Insomnia, dizziness, Hypersensitivity to  Monitor B/P,
increase or decrease to of ACE. Reduced paresthesias, headache, perindopril or any other orthostatic
desired response; range 4- aldosterone is associated fatigue, anxiety, ACE inhibitor; history of hypotension,
8 mg/day may give in 2 with the potassium-sparing depression angioedema induced by an syncope; if
divided doses or as a effect. In addition, ACE inhibitor, pregnancy changes occur
single dose; max 16 decreases systemic CV: Hypotension, chest [category C (first dosage change
mg/day vascular resistance pain, tachycardia, trimester), category D may be required
(afterload) and pulmonary dysrhythmias, syncope, (second and third  Monitor blood
capillary wedge pressure cardiac arrest trimester)]; patients with studies:
(PCWP), a measure of hypertrophic neutrophils,
preload, and improves EENT: Tinnitus, visual cardiomyopathy, renal decreased
cardiac output as well as changes, sore throat, artery stenosis. platelets.
activity tolerance. double vision, dry burning  encourage patient
eyes to implement
lifestyle changes,
GI: Nausea, vomiting, including weight
colitis, cramps, diarrhea, loss, smoking
constipation, flatulence, cessation,
dry mouth, loss of taste, decreased alcohol
 liver failure and salt in the diet,
and increased
GU: Proteinuria, renal exercise
failure, increased  administer on an
frequency of polyuria or empty stomach 1
oliguria hour before or 2
hours after meals
HEMA: Agranulocytosis,  alert the surgeon
neutropenia, bone marrow and mark the
suppression patient’s chart
prominently if the
INTEG: Rash, purpura, patient is to
alopecia, hyperhidrosis undergo surgery
 consult with the
META: Hyperkalemia prescriber to
reduce the dose in
RESP: Dyspnea, dry patients with renal
cough, crackles failure to account
further
SYST: Angioedema  monitor patient
carefully for signs
of a drop in fluid
volume which
may lead to
hypotension and
other adverse
effects.

B. Angiotensin II- Receptor Blockers (…sartan)

THERAPEUTIC CONTRAINDICATION NURSING

DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Losartan (P) Adult: PO 50 mg/day Selectively blocks the CNS: Dizziness, Hypersensitivity to  Assess B/P with
alone or 25 mg/day when binding of angiotensin II insomnia, anxiety, losartan position changes,
used in combination with to the AT1 receptors found confusion, abnormal pulse q4hr; note
diuretic; maintenance 25- in many tissues (e.g., dreams, migraine, tremor, Precautions: rate, rhythm,
100 mg/day vascular smooth muscle, vertigo, headache, Pregnancy C (1st quality
adrenal glands). malaise, depression, trimester),  Monitor
Child >6 yr: PO 0.7 Antihypertensive effect fatigue electrolytes:
mg/kg/day, max 50 mg/ results from blocking the potassium,
day vasoconstricting and CV: Angina pectoris,  breastfeeding, children, sodium, chloride
aldosterone-secreting 2nd-degree AV  geriatric,  Obtain baselines
effects of angiotensin II. block,  CVA, hypersensitivity to ACE for renal,
hypotension, MI, electrolyte, liver
inhibitors, hepatic
dysrhythmias function tests
disease, angioedema,
before therapy
EENT: Blurred vision,  renal artery stenosis, begins
burning eyes,  African descent,  Encourage patient
conjunctivitis hyperkalemia, to implement
hypotension lifestyle changes
GI: Diarrhea, dyspepsia,  Administer
anorexia, constipation, dry without regard to
mouth, flatulence, meals
gastritis, vomiting  Alert the surgeon
and mark the
GU: Impotence, patient’s chart
nocturia, urinary  prominently if the
frequency,  urinary tract patient is to
infection, renal failure undergo surgery
 Ensure that the
HEMA: Anemia,  female patient is
thrombocytopenia not pregnant
before beginning
INTEG: Alopecia,  therapy, and
dermatitis, dry skin,  suggest the use of
flushing, photosensitivity, barrier
rash, pruritus, sweating contraceptives
angioedema while she is
taking these drugs
META: Gout,   Find an
hyperkalemia,  alternative
hypoglycemia method of feeding
the baby if the
MS: Cramps,  patient is nursing
myalgia, pain, 
 Monitor the
stiffness
patient carefully
in any situation
RESP: Cough, upper
that might lead to
respiratory infection,
a drop in fluid
congestion, dyspnea,
 bronchitis volume
Candesartan Adult: PO (single agent) Inhibits vasoconstrictive CNS: dizziness, fatigue, Known sensitivity to  Serious
16 mg daily initially in action of angiotensin headache. candesartan or any other hypersensitivity
patients who are not Il by blocking angiotensin angiotensin II (AT1) reactions: Assess
volume depleted, range 8- II receptor on the surface CV: chest pain, peripheral receptor antagonist (e.g., for angioedema,
32 mg/day; with diuretic of vascular smooth edema. losartan, valsartan); anaphylaxis;
or volume depletion, 2-32 muscle and other tissue primary facial swelling,
mg/day as a single dose or cells. EENT: pharyngitis, hyperaldosteronism; difficulty
divided bid rhinitis, sinusitis. bilateral renal artery breathing (rare).
stenosis; pregnancy  Encourage patient
Adult and child >6 yr Gl: abdominal pain, (category C, first to implement
and weight >50 kg: PO diarrhea, nausea, trimester; category D, lifestyle changes
8-16 mg/day or divided vomiting. second and third  Administer
bid, adjust to B/P, usual trimesters); lactation. without regard to
range 4-32 mg/day max GU: albuminuria. meals
30 mg/day  Alert the surgeon
Musculoskeletal: and mark the
Child >6 yr and weight arthralgia, back pain. patient’s chart
<50 kg: PO 4-8 mg/ day prominently if the
or divided bid, adjust to Respiratory: coughing, patient is to
B/P bronchitis, URI. undergo surgery
 Ensure that the
Child >1 yr and <6 yr: Other: angioedema female patient is
PO 0.2 mg/kg/day in 1 not pregnant
dose or divided in 2 before beginning
doses/day, adjust B/P, therapy, and
max 0.4 mg/kg/day suggest the use of
barrier
contraceptives
while she is
taking these drugs
 Find an
alternative
method of feeding
the baby if the
patient is nursing
 Monitor the
patient carefully
in any situation
that might lead to
 a drop in fluid
volume.
Irbesartan Adult: PO 150 mg/day; Binding to the receptors CNS: Dizziness, Hypersensitivity to  Hypotension: For
may be increased to 300 results in blocking the anxiety, headache, irbesartan, losartan, or severe
mg/day; volume-depleted vasoconstricting and fatigue, syncope valsartan; pregnancy hypotension,
patients: start with 75 aldosterone-secreting [(category C first place in supine
mg/day. effects of angiotensin II, CV: Hypotension trimester), category D position and give
thus resulting in an (second and third IV infusion of
antihypertensive effect. GI: Diarrhea, dyspepsia, trimesters)], lactation. NS; drug may be
hepatitis, cholestasis continued after
B/P is restored
HEMA:  Encourage patient
Thrombocytopenia to implement
lifestyle changes
MISC: Edema, chest   Administer
pain, rash,  without regard to
tachycardia,  UTI, meals
angioedema,  Alert the surgeon
hyperkalemia and mark the
patient’s chart
RESP: Cough, upper prominently if the
respiratory infection, patient is to
rhinitis, pharyngitis, sinus undergo surgery
disorder  Ensure that the
female patient is
not pregnant
before beginning
therapy, and
suggest the use of
barrier
contraceptives
while she is
taking these drugs
 Find an
alternative
method of feeding
the baby if the
patient is nursing
 Monitor the
patient carefully
 in any situation
that might lead to
a drop in fluid
volume.
Valsartan Adult: PO 80 or 160 Blocks angiotensin II, CNS: dizziness, Hypersensitivity to  Assess B/P (lying,
mg/day alone or in which results in headache, fatigue, vertigo, valsartan or losartan; sitting, standing),
combination with other vasodilation and blocking syncope. pregnancy [(category C) pulse q4hr; note
antihypertensives, may of the aldosterone- first trimester, (category rate, rhythm,
increase to 320 mg CHF secreting effects of CV: edema, hypotension, D) second and third quality
angiotensin II, thus orthostatic hypotension. trimesters], lactation; periodically
Geriatric: PO Adjust resulting in an severe heart failure with  Monitor
based on clinical antihypertensive effect. EENT: blurred vision, gin compromised renal electrolytes:
response; may start with rhinitis, sinusitis, function. potassium,
lower dose pharyngitis. sodium, chloride;
total CO2
Child/adolescent 6-16 Gl: abdominal pain,  Assess for
yr: PO 1.3 mg/kg/day, diarrhea, nausea. angioedema:
max 40 mg/day facial swelling,
GU: renal impairment. shortness of
breath
Hematologic:  Obtain baselines
neutropenia. in renal, liver
function tests
Metabolic: hyperkalemia. before therapy
Musculoskeletal: begins
arthralgia, back pain.  Assess blood
tests: BUN,
Respiratory: URI, cough. creatinine, before
Other: viral infection. treatment
 Monitor for
edema in feet,
legs daily
 Assess for skin
turgor, dryness of
mucous
membranes for
hydration status;
correct volume
depletion before
initiating therapy
 Overdose
symptoms:
bradycardia or
tachycardia,
circulatory
collapse
 Encourage patient
to implement
lifestyle changes
 Administer
without regard to
meals
 Alert the surgeon
and mark the
patient’s chart
prominently if the
patient is to
undergo surgery
 Ensure that the
female patient is
not pregnant
before beginning
therapy, and
suggest the use of
barrier
contraceptives
while she is
taking these drugs
 Find an
alternative
method of feeding
the baby if the
patient is nursing
 Monitor the
patient carefully
in any situation
that might lead to
a drop in fluid
volume.
C. Calcium Channel Blockers (CCB)
THERAPEUTIC
DRUG DOSAGE ADVERSE EFFECTS
ACTION
Diltiazem (P) Adult: PO 60-120 mg bid Inhibits calcium ion CNS: abnormal dreams,
(SUS REL) (Cardizem influx across cell anxiety, confusion,
SR), max 540 mg/day, or membrane during cardiac dizziness, drowsiness,
120-240 mg (EXT REL) depolarization, produces headache, nervousness,
daily relaxation of coronary psychiatric disturbances,
vascular smooth muscle, weakness.
dilates coronary arteries,
slows SA/AV node EENT: blurred vision,
conduction times, dilates disturbed equilibrium,
peripheral arteries. epistaxis, tinnitus.
Decreased angina
pectoris, dysrhythmias, Resp: cough, dyspnea.
B/P.
CV: ARRHYTHMIAS,
HF, peripheral edema,
bradycardia, chest pain,
hypotension, palpitations,
syncope, tachycardia.
GI: increase liver
enzymes, anorexia,
constipation, diarrhea, dry
mouth, dysgeusia,
dyspepsia, nausea,
vomiting.
GU: dysuria, nocturia,
polyuria, sexual
dysfunction, urinary
frequency.
Derm: STEVENS-
JOHNSON
SYNDROME, dermatitis,
erythema multiforme,
flushing, sweating,
photosensitivity,
NURSING
CONTRAINDICATIONS
CONSIDERATIONS
Known hypersensitivity to  encourage
drug; sick sinus syndrome lifestyle changes
(unless pacemaker is in  do not cut, crush,
place and functioning); or chew this tablet
second- or third-degree AV  give with food if
block; severe hypotension GI upset occurs.
(systolic <90 mm Hg or  provide comfort
diastolic <60 mm Hg); and safety
patients undergoing measures.
intracranial surgery;  reduce dosage if
bleeding aneurysms. Safe patient has renal
use during pregnancy failure.
(category C), lactation, or  monitor for any
in children is not situation that
established. might lead to a
drop in blood
pressure.
 provide support
and reassurance
to deal with drug
effects.
 provide patient
teaching
regarding drug,
dosage, adverse
effects, signs and
symptoms of
problems to
report, and safety
precautions.
 pruritus/urticaria, rash.

Endo: gynecomastia,
hyperglycemia.

Hemat: anemia,
leukopenia,
thrombocytopenia.

Metab: weight gain.

MS: joint stiffness,

muscle cramps.

Neuro: paresthesia,
tremor.

Misc: gingival
hyperplasia
Amlodipine Adult: PO 5 mg daily Amlodipine is a calcium CNS: Headache,  Hypersensitivity to this  encourage
initially, max 10 mg/day channel blocking agent fatigue, dizziness,  product, severe aortic lifestyle changes
that selectively blocks asthenia,  anxiety, stenosis, severe obstructive  do not cut, crush,
Geriatric: PO 2.5 calcium ion reflux across depression, insomnia, CAD. or chew this tablet
mg/day; may increase to cell membranes of cardiac paresthesia, somnolence  give with food if
5 mg/day, max 10 mg/day and vascular smooth Precautions: Pregnancy  GI upset occurs.
muscle without changing CV: Peripheral  C, breastfeeding, children,  provide comfort
serum calcium edema, bradycardia,  geriatric, CHF, and safety
concentrations. It hypotension, palpitations, hypotension, hepatic measures.
predominantly acts on the syncope, chest pain injury, GERD  reduce dosage if
peripheral circulation, patient has renal
decreasing peripheral GI: Nausea,  failure.
vascular resistance, and vomiting, diarrhea,   monitor for any
increases cardiac output. gastric upset,  situation that
Amlodipine reduces constipation, flatulence, might lead to a
systolic, diastolic, and anorexia, gingival drop in blood
mean arterial blood hyperplasia, dyspepsia pressure.
pressure.
 provide support
GU: Nocturia, 
and reassurance
polyuria, sexual 
to deal with drug
difficulties
effects.

Felodipine Adult: PO 5 mg/day
initially, usual range 2.5-
10 mg/day; max 10
mg/day; do not adjust
dosage at intervals of ,2
wk
Geriatric: PO 2.5 mg/day
BP reduction is due to a
reduction in peripheral
vascular resistance (after-
load) against which the
heart works. This reduces
oxygen demand by the
heart and consequently
may account for its
effectiveness in chronic
stable angina.
INTEG: Rash,  
pruritus, urticaria,  teaching
alopecia
MISC: Flushing,  effects, signs and
muscle cramps,  symptoms of
cough,  weight gain,
tinnitus, epistaxis
CNS: Headache, fatigue,
drowsiness, dizziness,
anxiety, depression,
nervousness, insomnia,
light-headedness,
paresthesia, tinnitus,
psychosis, somnolence
CV: Dysrhythmias,
edema, CHF,
hypotension, palpitations,
MI, pulmonary edema,
tachycardia, syncope, AV
block, angina
GI: Nausea, vomiting,
diarrhea, gastric upset,
constipation, increased
liver function studies, dry
mouth
GU: Nocturia, polyuria
HEMA: Anemia
INTEG: Rash, pruritus,
peripheral edema
MISC: Flushing, sexual
difficulties, cough, nasal
congestion, shortness of
breath, wheezing,
provide patient
regarding drug,
dosage, adverse
problems to
report, and safety
precautions
Hypersensitivity to  encourage
felodipine and sick sinus lifestyle changes
rhythm or second- or third-  do not cut, crush,
degree heart block except or chew this tablet
with the use of a  give with food if
pacemaker. Safety and GI upset occurs.
efficacy in children are not  provide comfort
established. and safety
measures.
 reduce dosage if
patient has renal
failure.
 monitor for any
situation that
might lead to a
drop in blood
pressure.
 provide support
and reassurance
to deal with drug
effects.
 provide patient
teaching
regarding drug,
dosage, adverse
effects, signs and
symptoms of
problems to
report, and safety
precautions

Adult: PO ext rel 30-60 Reduces myocardial
mg qd, titrate upward as oxygen utilization and
needed; max 90 mg/day supply and relaxes and
(Adalat CC); 120 mg/ day prevents coronary artery
(Procardia XL) spasm; has little or no
effect on SA and AV
Adolescent/child nodal conduction with
(unlabeled): PO ext rel therapeutic dosing.
0.25-0.5 mg/kg/day, max Decreases peripheral
3 mg/kg/day vascular resistance and
increases cardiac output.
Vasodilation of both
coronary and peripheral
vessels is greater than that
produced by verapamil or
diltiazem and frequently
results in reflex
Nifedipine tachycardia. Decreased
peripheral vascular
resistance also leads to a
rise in peripheral blood
flow, the basis for use of
this drug in treatment of
Raynaud's phenomenon.
Minimal effect on
myocardial contractility.
Nicardipine Adult: PO 20 mg tid Calcium entry blocker
initially; may increase that inhibits the
epistaxis, respiratory
infection, chest pain,
Angioedema, gingival
hyperplasia.
CNS: Headache, fatigue,
drowsiness, dizziness,
anxiety, depression,
weakness, insomnia,
light-headedness,
paresthesia, tinnitus,
blurred vision,
nervousness, tremor,
flushing
CV: Dysrhythmias,
edema, hypotension,
palpitations, tachycardia
GI: Nausea, vomiting,
diarrhea, gastric upset,
constipation, increased
LFTs, dry mouth,
flatulence, gingival
hyperplasia
GU: Nocturia, polyuria
HEMA: Bruising,
bleeding, petechiae
INTEG: Rash, pruritus,
flushing, hair loss,
Stevens-Johnson
syndrome, toxic
epidermal necrolysis,
exfoliative dermatitis
MISC: Sexual
difficulties, cough, fever,
chills
CNS: Headache,
dizziness, anxiety,
Hypersensitivity to this  encourage
product or dihydropyridine, lifestyle changes
cardiogenic shock  do not cut, crush,
or chew this tablet
Precautions: Pregnancy   give with food if
C, breastfeeding, children, GI upset occurs.
hypotension, sick sinus  provide comfort
syndrome, 2nd- or 3rd- and safety
degree heart block, measures.
hypotension less than 90  reduce dosage if
mm Hg systolic, hepatic patient has renal
injury, renal disease, acute failure.
MI, aortic stenosis, GERD,  monitor for any
heart failure. situation that
might lead to a
drop in blood
pressure.
 provide support
and reassurance
to deal with drug
effects.
 provide patient
teaching
regarding drug,
dosage, adverse
effects, signs and
symptoms of
problems to
report, and safety
precautions
Sick sinus syndrome, 2nd-  Hypertension:
or 3rd-degree heart block, assess for
 after 3 days (range 20-40 transmembrane influx of depression, confusion, hypersensitivity to this decreasing B/P;
mg tid) or SUS REL 30 calcium ions into cardiac paresthesia, somnolence, product or dihydropyridine, salt in diet,
mg bid; may increase to muscle and smooth flushing advanced aortic stenosis smoking,
60 mg bid IV 5 mg/hr; muscle, thus affecting exercise, diet,
may increase by 2.5 contractility. More CV: Edema, bradycardia, Precautions: Pregnancy  weight, monitor
mg/hr q15min; max 15 selectively affects hypotension, palpitations, C, breastfeeding, children, B/P often
mg/hr vascular smooth muscle pulmonary edema, chest geriatric, CHF,  encourage
than cardiac muscle; pain, tachycardia, hypotension, hepatic lifestyle changes
relaxes coronary vascular increased angina, injury, renal disease  do not cut, crush,
smooth muscle with little arrhythmias, CHF or chew this tablet
or no negative inotropic  give with food if
effect. Significantly GI: Nausea, vomiting, GI upset occurs.
decreases systemic gastric upset,  provide comfort
vascular resistance. It constipation, hepatitis, and safety
reduces BP at rest and abdominal cramps, dry measures.
during isometric and mouth, sore throat  reduce dosage if
dynamic exercise. patient has renal
GU: Nocturia, polyuria failure.
 monitor for any
INTEG: Rash,  situation that
infusion site  might lead to a
discomfort,  Stevens- drop in blood
Johnson syndrome pressure.
MISC: Blurred 
 provide support
vision, flushing, 
and reassurance
sweating, SOB, 
to deal with drug
impotence.
effects.
 provide patient
teaching
regarding drug,
dosage, adverse
effects, signs and
symptoms of
problems to
report, and safety
precautions
Verapamil Adult: PO 80 mg tid, Inhibits calcium ion CNS: Headache, Sick sinus syndrome, 2nd-  encourage
may titrate upward; EXT influx through slow drowsiness, dizziness, or 3rd-degree heart block, lifestyle changes
REL 120-240 mg/day as a channels into cells of anxiety, depression, hypotension ,90 mm Hg  do not cut, crush,
single dose, may increase myocardial and arterial weakness, asthenia, systolic, cardiogenic shock, or chew this tablet
 to 240-480 mg/day smooth muscle. Dilates
coronary arteries and
arterioles and inhibits
coronary artery spasm.
Decreases and slows SA
and AV node conduction
without affecting normal
arterial action potential or
intraventricular
conduction. Associated
vasodilation of arterioles
decreases total peripheral
vascular resistance and
reduces arterial BP at rest.
May slightly decrease
heart rate. Dilates
coronary arteries and
inhibits coronary artery
spasm, which increases
myocardial oxygen
delivery and produces an
antianginal effect. Also
decreases nodal
conduction, which results
in an antiarrhythmic
effect.
D. Vasodilators
THERAPEUTIC
DRUG DOSAGE
ACTION
Nitroprusside (P) Adult and child: IV INF Acts directly on vascular
0.25-1.0 mcg/kg/min; smooth muscle to produce
max 10 mcg/kg/min peripheral vasodilation,
with consequent marked
lowering of arterial BP,
associated with slight
increase in heart rate,
mild decrease in cardiac
output, and moderate
fatigue, insomnia, severe CHF, Lown-Ganong  give with food if
confusion, light- Levine syndrome, Wolff- GI upset occurs.
headedness. Parkinson-White syndrome  provide comfort
and safety
CV: Edema, CHF, Precautions: Pregnancy  measures.
bradycardia, hypotension, C, breastfeeding, children,  reduce dosage if
palpitations, AV block, geriatric, CHF, patient has renal
dysrhythmias hypotension, hepatic failure.
injury, renal disease,  monitor for any
GI: Nausea, diarrhea, concomitant b-blocker situation that
gastric upset, therapy might lead to a
constipation, elevated drop in blood
liver function tests GU: pressure.
Impotence, nocturia,   provide support
polyuria, gynecomastia and reassurance
to deal with drug
HEMA: Bruising,  effects.
petechiae, bleeding  provide patient
teaching
INTEG: Rash, bruising regarding drug,
dosage, adverse
MISC: Gingival  effects, signs and
hyperplasia symptoms of
problems to
SYST: Stevens-Johnson report, and safety
syndrome precautions
NURSING
ADVERSE EFFECTS CONTRAINDICATIONS
CONSIDERATIONS
CNS: Dizziness, Compensatory  encourage
headache, agitation, hypertension, as in lifestyle changes
twitching, decreased atriovenous shunt or  monitor BP
reflexes, restlessness coarctation of aorta, and closely during
for control of hypotension administration
CV: Bradycardia, ECG in patients with inadequate  monitor blood
changes, tachycardia, cerebral circulation. Safety glucose and
hypotension during pregnancy (category serum electrolytes
C) or lactation is not  monitor for any
 lowering of peripheral GI: Nausea,  established situation that
vascular resistance. vomiting, abdominal  might lead to a
pain drop in blood
pressure.
INTEG: Pain,   provide support
irritation at inj  and reassurance
site, sweating to deal with drug
effects.
MISC: Cyanide,  provide patient
thiocyanate toxicity, teaching
flushing, hypothyroidism regarding drug,
dosage, adverse
effects, signs and
symptoms of
problems to
report, and safety
precautions.
Hydralazine Adult: PO 10 mg qid 2-4 Vasodilates arterioles  CNS: Headache, tremors, Coronary artery disease,  encourage
days, then 25 mg qid for in smooth  muscle  dizziness, anxiety, mitral valvular rheumatic lifestyle changes
rest of 1st wk, then 50 mg by direct relaxation;  peripheral neuritis, heart disease, MI,  monitor BP
qid individualized to reduces B/P with  depression, fever, chills tachycardia, SLE. Safe use closely during
desired response; max reflex increases in heart during pregnancy (category administration
300 mg/day rate, stroke volume, CV: Palpitations, reflex C) or lactation is  monitor blood
Child: PO 0.75-1 cardiac output tachycardia, angina, established. glucose and
mg/kg/day in 2-4 divided shock, rebound serum electrolytes
doses; max 25 mg/dose, hypertension, orthostatic  monitor for any
increase over 3-4 wk to hypotension situation that
max 7.5 mg/kg/day or might lead to a
200 mg, whichever is less GI: Nausea, vomiting, drop in blood
anorexia, diarrhea, pressure.
constipation, paralytic  provide support
ileus, hepatotoxicity and reassurance
to deal with drug
GU: Urinary  effects.
retention,   provide patient
glomerulonephritis,  teaching
hematuria regarding drug,
dosage, adverse
HEMA: Leukopenia, effects, signs and
agranulocytosis, anemia, symptoms of
thrombocytopenia
 problems to
INTEG: Rash,  report, and safety
pruritus, urticaria precautions.

MISC: Nasal 
congestion, muscle 
cramps,  lupuslike
symptoms, flushing,
edema, dyspnea
Adult: PO 2.5-5 mg/day Directly relaxes arteriolar CNS: Headache, fatigue Pheochro-mocytoma; acute  encourage
in 1-2 divided doses, max smooth muscle, causing MI, dissecting aortic lifestyle changes
100 mg/day; usual range vasodilatation; reduces CV: Severe rebound aneurysm, valvular  monitor BP
10-40 mg/day in single peripheral vascular hypertension (on dysfunction, heart failure. closely during
doses resistance, decreases B/P; withdrawal in children), Safety during pregnancy administration
increased cutaneous blood tachycardia, angina, (category C) or lactation is  monitor blood
Geriatric: PO 2.5 flow; stimulation of hair increased T-wave, CHF, not established. glucose and
mg/day, may be increased follicles. Decreased B/P pulmonary edema, serum electrolytes
gradually in hypertension; hair pericardial effusion,  monitor for any
growth. edema, sodium retention, situation that
Child <12 yr: PO initial water retention, might lead to a
0.1-0.2 mg/kg/day; hypotension drop in blood
effective range, 0.25-1 pressure.
Minoxidil mg/kg/day; max, 50 mg/ GI: Nausea, vomiting  provide support
day GU: Breast tenderness and reassurance
to deal with drug
HEMA: Hct, Hgb, effects.
erythrocyte count may  provide patient
decrease initially, teaching
leukopenia regarding drug,
dosage, adverse
INTEG: Pruritus, effects, signs and
Stevens-Johnson symptoms of
syndrome, rash, hirsutism, problems to
contact dermatitis report, and safety
precautions.

OTHERS:
I. Diuretics
 THERAPEUTIC CONTRAINDICATION NURSING
DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Hydrochlorothiazide Adult/adolescent: PO Acts on the distal tubule CNS: Drowsiness,  Hypersensitivity to  monitor Vital
12.5-25 mg/day, may in the kidney, increasing paresthesia,  thiazides or sulfonamides, signs
increase to 50 mg/day in excretion of sodium, depression,  headache, anuria, renal  monitor input and
1-2 divided doses water, chloride, and dizziness, fatigue, decompensation, output
potassium. Decreased weakness, fever pregnancy (D)  weigh the patient
Child >6 mo: PO 1-2 B/P, decreased edema in preeclampsia daily
mg/kg/day in divided lung tissues peripherally. CV: Irregular pulse,   monitor for
doses; max 37.5 mg/day orthostatic hypotension, Precautions: adverse effects
for 6 mo-2 yr; max 100 palpitations, volume Pregnancy B,  Monitor glucose in
mg/day for 2-12 yr depletion, allergic breastfeeding, urine if patient is
myocarditis hypokalemia, diabetic
Child <6 mo: PO up to 2- renal/hepatic disease,  Assess
3.3 mg/kg/day in divided EENT: Blurred vision gout, COPD, lupus improvement in
doses erythematosus, diabetes CVP q8hr
ELECT: Hypokalemia, mellitus, hyperlipidemia,
 Check for rashes,
hypercalcemia, CCr ,30 ml/min,
temp elevation
hyponatremia, hypomagnesemia
daily
hypochloremia,
 Assess for
hypomagnesemia
confusion,
especially in
GI: Nausea, vomiting,
geriatric patients;
anorexia, constipation,
take safety
diarrhea, cramps,
precautions if
pancreatitis, GI irritation,
needed
hepatitis
 Monitor for acidic
GU: Frequency, polyuria, urine, reduced
uremia, glucosuria, urine, osmolality,
hyperuricemia, jaundice nocturia;
hypotension, broad
HEMA: Aplastic anemia, T-wave, U-wave,
hemolytic anemia, ectopy,
leukopenia, tachycardia, weak
agranulocytosis, pulse; muscle
thrombocytopenia, weakness, altered
neutropenia LOC, drowsiness,
apathy, lethargy,
INTEG: Rash, urticaria, confusion,
purpura, photosensitivity, depression;
alopecia, erythema anorexia, nausea,
multiforme cramps,
constipation,
META: Hyperglycemia, distention,
hyperuricemia, renal paralytic ileus;
failure, increased hypoventilation,
creatinine, BUN respiratory muscle
weakness
SYST: Stevens-Johnson  Assess fluid
syndrome volume status:
I&O ratios, record,
count, or weigh
diapers as
appropriate;
weight; H 507
Canada only
Adverse effects:
italics = common;
bold = life-
threatening
HYDROcodone
distended red
veins; crackles in
lungs; color,
quality, and
specific gravity of
urine; skin turgor;
adequacy of
pulses; moist
mucous
membranes;
bilateral lung
sounds; peripheral
pitting edema;
assess for
dehydration:
symptoms of
decreasing output,
thirst,
hypotension; dry
mouth and mucous
 membranes should
be reported
 Monitor
electrolytes:
potassium,
sodium, calcium,
magnesium; also
include BUN,
blood pH, ABGs,
uric acid, CBC,
blood glucose,
renal function
 Assess B/P before,
during therapy
with patient lying,
standing, and
sitting as
appropriate;
orthostatic
hypotension can
occur rapidly.
Indapamide Adult: PO 1.25-5 mg/day; Hypotensive activity in CNS: Depression,  Acts on proximal   Check for rashes,
may increase to 5 mg/day the hypertensive patient headache, dizziness, section of  distal  temp elevation
over 8 wk appears to result from a fatigue, weakness, renal tubule by  daily • Monitor
decrease in plasma and nervousness, agitation, inhibiting  patients that
extracellular fluid extremity numbness reabsorption of  receive cardiac
volume, decreased sodium, may act by direct glycosides for
peripheral vascular CV: Orthostatic  vasodilatation caused by increased
resistance, direct hypotension,  blocking of calcium hypokalemia,
arteriolar dilation, and palpitations,  volume channels. Decreased  toxicity
calcium channel depletion, PVCs, B/P;  decreased edema  Monitor for
blockade. Augments the dysrhythmias, vaculitis in lung tissues, hypokalemia:
action of other peripherally. acidic or reduced
hypotensive agents. EENT: Blurred  urine, osmolality,
vision, nasal  nocturia;
congestion,  increased hypotension, broad
intraocular pressure T-wave, U-wave,
ectopy,
ELECT: Hypokalemia, tachycardia, weak
hypercalcemia, pulse; muscle
hyponatremia,
hypochloremic alkalosis,
hypomagnesemia,
hyperuricemia,
hyperglycemia
GI: Nausea, vomiting,
anorexia, constipation,
diarrhea, cramps,
abdominal pain, dry
mouth,
hypercholesterolemia
GU: Frequency, polyuria,
nocturia, impotence  Monitor for
HEMA: Agranulocytosis,
anemia
INTEG: Rash, pruritus,
Stevens-Johnson
syndrome
MS: Cramps
 Monitor for
weakness, altered
LOC, drowsiness,
apathy, lethargy,
confusion,
depression;
anorexia, nausea,
cramps,
constipation,
distention,
paralytic ileus;
hypoventilation,
respiratory muscle
weakness
hypomagnesemia:
agitation, muscle
twitching,
paresthesias,
hyperactive
reflexes, positive
Babinski reflex,
dysphagia,
nystagmus,
seizures, tetany;
nausea, vomiting,
diarrhea, anorexia,
abdominal
distention; ectopy,
tachycardia, broad,
flat- or inverted T-
waves, depressed
ST segment,
prolonged QT
interval, decreased
cardiac output,
hypotension
hyponatremia:
increased B/P,
cold, clammy skin,
hypo/hypervolemi
 a; anorexia,
nausea, vomiting,
diarrhea,
abdominal cramps;
lethargy, increased
ICP, confusion,
headache,
seizures, coma,
fatigue, tremors,
hyperreflexia
 Monitor for
manifestations of
hyperchloremia:
weakness,
lethargy, coma,
deep rapid
breathing
 Assess fluid
volume status:
I&O ratios and
record, weight,
distended red
veins, crackles in
lung, color, quality
and specific
gravity of urine,
skin turgor,
adequacy of
pulses, moist
mucous
membranes,
bilateral lung
sounds, peripheral
pitting edema;
dehydration
symptoms of
decreasing output,
thirst,
hypotension, dry
mouth and mucous
membranes should
 be reported.
 Monitor
electrolytes:
potassium,
sodium, calcium,
magnesium; also
include BUN,
blood pH, ABGs,
uric acid, CBC,
blood glucose
 Assess B/P before,
during therapy
with patient lying,
standing, and
sitting as
appropriate;
orthostatic
hypotension can
occur rapidly
Amiloride Adult: PO 5-10 mg daily Inhibits sodium,  CNS: Headache, Elevated serum potassium  Monitor for
in 1-2 divided doses; may potassium  ATPase  dizziness, fatigue, (>5.5 mEq/L), hyperkalemia:
be increased to 10-20 mg ion exchange in  weakness, paresthesias, concomitant use of other MS: fatigue,
daily if needed the distal tubule,  tremor, depression, potassium-sparing muscle weakness;
cortical collecting duct anxiety, encephalopathy diuretics; anuria, acute or CARDIAC:
Infant/child (6-20 kg): resulting in inhibition of chronic renal dysrhythmias,
PO 0.625 mg/kg/day sodium reabsorption and CV: Orthostatic  insufficiency; evidence of hypotension;
decreasing potassium hypotension,  diabetic nephropathy; NEURO:
secretion. Induces dysrhythmias,  angina type 1 diabetes mellitus; paresthesias,
urinary excretion of metabolic or respiratory confusion; RESP:
sodium and reduces EENT: Blurred  acidosis; hepatic function dyspnea
excretion of potassium vision, increased  impairment. Safety during  Monitor for
and hydrogen ions by intraocular  pressure pregnancy (category B), hypokalemia:
direct action on distal lactation, or in children is weakness,
renal tubules. ELECT: not established. polyuria,
Hyperkalemia,  polydipsia,
dehydration,  fatigue, ECG U
hyponatremia, wave
hypochloremia  Assess fluid
volume status:
GI: Nausea, diarrhea, dry distended red
mouth, vomiting,
 anorexia, cramps, veins, crackles in
constipation, abdominal lung, color,
pain, jaundice quality, and
specific gravity of
GU: Polyuria, dysuria, urine, skin turgor,
frequency, impotence adequacy of
pulses, moist
HEMA: Aplastic anemia, mucous
neutropenia membranes,
bilateral lung
INTEG: Rash, pruritus, sounds, peripheral
alopecia, urticaria pitting edema;
dehydration
MS: Cramps symptoms of
decreasing output,
RESP: Cough, dyspnea, thirst,
shortness of breath hypotension, dry
mouth and mucous
membranes should
be reported
 Monitor
electrolytes:
potassium,
sodium, calcium,
magnesium; also
include BUN,
ABGs, uric acid,
CBC, blood
glucose
 Assess B/P before,
during therapy
with patient lying,
standing, and
sitting as
appropriate;
orthostatic
hypotension can
occur rapidly
Spironolactone Adult: PO 25-200 mg/day A diuretic agent that CNS: Headache, Pregnancy D,  Assess fluid
in 1-2 divided doses promotes sodium and confusion, drowsiness, hypersensitivity, anuria, volume status:
chloride excretion without lethargy, ataxia severe renal disease, I&O ratios and
Child (unlabeled): PO concomitant loss of hyperkalemia record, count or
1.5-3.3 mg/kg in divided potassium. Lowers ELECT: Hyperchloremic weigh diapers as
doses systolic and diastolic metabolic acidosis, Precautions: appropriate,
pressures in hypertensive hyperkalemia, Breastfeeding, weight, distended
patients. hyponatremia dehydration, renal/hepatic red veins, crackles
disease, electrolyte in lung, color,
ENDO: Impotence, imbalances, metabolic quality, and
gynecomastia, irregular acidosis, gynecomast specific gravity of
menses, amenorrhea, urine, skin turgor,
postmenopausal bleeding, adequacy of
hirsutism, deepening pulses, moist
voice, breast pain mucous
membranes,
GI: Diarrhea, cramps, bilateral lung
bleeding, gastritis, sounds, peripheral
vomiting, anorexia, pitting edema;
nausea, hepatocellular dehydration
toxicity symptoms of
decreasing output,
HEMA: Agranulocytosis thirst,
hypotension, dry
INTEG: Rash, pruritus, mouth and mucous
urticaria membranes should
be reported
 Monitor
electrolytes:
potassium,
sodium, calcium,
magnesium; also
include BUN,
ABGs, uric acid,
CBC, blood
glucose
Patient/family education
 Teach patient to
take medication
early in day to
prevent nocturia
 Instruct patient to
take with food or
milk if GI
 symptoms of
nausea and
anorexia occur
 Teach patient to
maintain a record
of weight on a
weekly basis and
notify prescriber
of weight loss
of .5 lb
 Caution patient
that this product
causes an increase
in potassium
levels, that foods
high in potassium
should be avoided:
oranges, bananas,
salt substitutes,
dried apricots,
dates; avoid
potassium salt
substitutes; refer to
dietitian for
assistance
planning
 Teach patient to
take in am, to
prevent
sleeplessness
 Teach patient to
avoid hazardous
activities until
reaction is known
 Teach patient to
notify prescriber if
pregnancy is
planned or
suspected,
pregnancy (C), do
 not breastfeed
 Teach patient not
to use alcohol or
any OTC
medications
without
prescriber’s
approval; serious
product reactions
may occur
 Emphasize the
need to contact
prescriber
immediately if
muscle cramps,
weakness, nausea,
dizziness, or
numbness occur
 Teach patient to
take own B/P and
pulse and record
 Teach patient to
notify prescriber
of cramps,
diarrhea, lethargy,
thirst, headache,
skin rash,
menstrual
abnormalities,
deepening voice,
breast enlargement
 Advise patient that
dizziness and
confusion may
occur; avoid
driving or other
hazardous
activities if
alertness is
decreased
  Teach patient to
continue taking
medication even if
feeling better; this
product controls
symptoms but
does not cure the
condition
 Advise patient
with hypertension
to continue other
treatment
(exercise, weight
loss, relaxation
techniques,
cessation of
smoking)

II. Renin Inhibitor

THERAPEUTIC CONTRAINDICATION NURSING

DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Aliskiren Adult: PO 150 mg/day, Renin inhibitor that  CNS: Headache,  Hypersensitivity  avoid in the
may increase to 300 acts on the  renin- dizziness, torsades de second and third
mg/day if needed, max angiotensin system  pointes, seizures Precautions: trimesters of
300 mg/day (RAS). Decrease in  Breastfeeding,  pregnancy and
B/P CV: Orthostatic  children, geriatric, used only in the
hypotension,  angioedema, aortic/renal first trimester if
hypotension  artery stenosis, cirrhosis, the benefit clearly
CAD, dialysis, out weights the
GI: Diarrhea hyper/hypokalemia, risk
hyponatremia,  advise to use
GU: Renal stones,  hypotension, contraceptive
increased uric acid  hypovolemia, renal/ while on this drug
hepatic disease, surgery,  advise
INTEG: Rash  diabetes breastfeeding
mothers to find
META: Hyperkalemia  another method of
feeding the baby
MISC: Angioedema,   monitor serum
 cough potassium level
for risk of
hyperkalemia
 monitor closely if
taken with
furosemide
 advise to report
any signs of
difficulty in
breathing or
swelling of lips,
face or tongue

III. Symphathetic Nervous System Blockers

THERAPEUTIC CONTRAINDICATION NURSING

DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Metoprolol (Beta Adult: PO 50 mg bid, or Lowers B/P by b-blocking CNS: Insomnia, dizziness, Hypersensitivity to b-  monitor vital
Blockers) 100 mg/day; may give effects; reduces elevated mental changes, blockers, cardiogenic signs especially
200-450 mg in divided renin plasma levels; hallucinations, depression, shock, heart block (2nd HR and BP before
doses; ext rel 25-100 mg blocks b2-adrenergic anxiety, headaches, and 3rd degree), sinus administration
qd, titrate at weekly receptors in bronchial, nightmares, confusion, bradycardia,  avoid if BP is less
intervals, max 400 mg/day vascular smooth muscle fatigue pheochromocytoma, sick than 90/60 mmHg
only at high doses, sinus syndrome  avoid if HR is less
Child/adolescent 6-16 negative chronotropic CV: CHF, palpitations, than 60 beats per
yr: PO ext rel 1 mg/kg up effect dysrhythmias, cardiac Precautions: Pregnancy minute
to 50 mg qd arrest, AV block, C, breastfeeding, geriatric,  monitor for
hypotension, bradycardia, major surgery, diabetes adverse effects
Geriatric: PO 25 mg/day pulmonary/peripheral mellitus,  caution in patients
initially, increase weekly edema, chest pain thyroid/renal/hepatic with
as needed disease, COPD, CAD, hyperglycemia
EENT: Sore throat, dry nonallergic
burning eyes bronchospasm, CHF,
bronchial asthma, CVA,
GI: Nausea, vomiting, children, depression,
colitis, cramps, diarrhea, vasospastic angina
constipation, flatulence,
dry mouth, hiccups

GU: Impotence

Carvedilol (Alpha-Beta Adult: PO 6.25 mg bid 3
Blockers) 7-14 days if tolerated
well, then increase to 12.5
mg bid 3 7-14 days if
tolerated well, may be
increased if needed to 25
mg bid, max 50 mg daily;
ext rel cap 20 mg/ day,
may increase after 7-14
days to 40 mg/day, max
80 mg/day
HEMA: Agranulocytosis,
eosinophilia,
thrombocytopenic purpura
INTEG: Rash, purpura,
alopecia, dry skin,
urticaria, pruritus
RESP: Bronchospasm,
dyspnea, wheezing
A mixture of  CNS: Dizziness, Hypersensitivity, asthma,  Monitor I&O,
nonselective blocking and somnolence, insomnia, class IV decompensated weight daily
a-blocking activity; ataxia, hyperesthesia, cardiac failure, 2nd- or  Hypertension:
decreases cardiac output, paresthesia, vertigo, 3rd-degree heart block, Monitor B/P
exercise-induced depression, fatigue, cardiogenic shock, severe during beginning
tachycardia, reflex weakness, headache bradycardia, pulmonary treatment and
orthostatic tachycardia; edema, severe hepatic periodically
causes reduction in CV: Bradycardia, postural disease. thereafter; pulse
peripheral vascular hypotension, dependent q4hr, note rate,
resistance and edema, peripheral edema, Precautions: rhythm, quality.
vasodilatation. AV block, extrasystoles, Pregnancy C,  Monitor for
Decreased B/P in  hypo/hypertension, breastfeeding, children, adverse effects
hypertension palpitations, peripheral geriatric, cardiac failure, complain of
ischemia, CHF, hepatic injury, peripheral fatigue, loss of
pulmonary edema vascular disease, libido, inability to
anesthesia, major surgery, sleep, and GI and
GI: Diarrhea, abdominal diabetes mellitus, genitourinary
pain, increased alkaline thyrotoxicosis, disturbances
phosphatase, increased emphysema, chronic
ALT/AST bronchitis, renal disease
GU: Decreased libido,
impotence, UTI.
INTEG: Rash, Stevens-
Johnson syndrome
MISC: Injury, back 
pain, viral infection, 
hypertriglyceridemia,

Phentolamine ( Alpha- Adult: IV/IM 5 mg; Causes vasodilation and
Adrenergiic Blockers) repeat if necessary decreases general vascular
resistance and pulmonary
Child: IV 0.05-0.1 mg/kg; arterial pressure, primarily
repeat if necessary, max 5 by direct action on
mg vascular smooth muscle.
Through stimulation of
beta-adrenergic receptors,
produces positive
inotropic and chronotropic
cardiac effects and
increases cardiac output.
thrombocytopenia,
hyperglycemia, abnormal
weight gain, aplastic
anemia
RESP: Rhinitis, 
pharyngitis, dyspnea, 
bronchospasm, cough,
lung edema
CNS: Dizziness, flushing, Hypersensitivity, MI,  not recommended
weakness, cerebrovascular coronary insufficiency, for essential
spasm, paresthesias, CVA angina, hypotension hypertension due
Precautions: Pregnancy C, to the side effects
CV: Hypotension, breastfeeding,  monitor vital
tachycardia, angina, dysrhythmia, peptic ulcer signs especially
dysrhythmias, MI disease BP
 monitor for signs
EENT: Nasal congestion of adverse effects
Patient/family education
GI: Dry mouth, nausea,  Caution patient
vomiting, diarrhea, not to discontinue
abdominal pain product abruptly
 Teach patient not
INTEG: Pruritus, to use OTC
injection site pain products (cough,
cold, allergy)
RESP: Nasal congestion unless directed by
prescriber
 Teach patient the
importance of
complying with
dosage schedule,
even if feeling
better
 Emphasize the
need to rise
slowly to sitting
or standing
position to
minimize
orthostatic
 hypotension
 Teach patient to
notify prescriber
of mouth sores,
sore throat, fever,
swelling of hands
or feet, irregular
heartbeat, chest
pain
 Caution patient to
report excessive
perspiration,
dehydration,
vomiting,
diarrhea; may
lead to fall in B/P
 Caution patient
that product may
cause dizziness,
fainting, light-
headedness; may
occur during 1st
few days of
therapy
 Teach patient how
to take B/P, teach
normal readings
for age group
Prazosin (Alpha -1 Adult: PO 1 mg bid or Lowers blood pressure in CNS: Dizziness, Hypersensitivity  Hypertension/
Adrenergic Blockers) tid, increasing to 20 mg/ supine and standing headache, drowsiness, CHF: Monitor
day in divided doses if positions with most anxiety, depression, Precautions: Pregnancy B/P, orthostatic
required, usual range 6-15 pronounced effect on vertigo, weakness, C, breastfeeding, children, hypotension,
mg/day; max 1 mg diastolic pressure. Minor fatigue, syncope geriatric patients, prostate syncope; check
initially, max 20-40 effect on heart rate and cancer, ocular surgery, for edema in feet,
mg/day cardiac output in the CV: Palpitations, orthostatic hypotension legs daily;
supine position and does orthostatic hypotension, monitor I&O,
Child: PO 5 mcg/kg q6hr; not increase plasma renin tachycardia, edema, weight daily;
max 400 mcg/kg/day or activity. Tolerance to rebound hypertension notify prescriber
15 mg/day antihypertensive effect of changes
rarely occurs. Effective EENT: Blurred vision,  Assess for allergic
when used concomitantly epistaxis, tinnitus, dry reactions: rash,
with a beta-adrenergic mouth, red sclera fever, pruritus,
blocking agent and a urticaria; product
thiazide diuretic. GI: Nausea, vomiting, should be
Infrequently used in diarrhea, constipation, discontinued if
monotherapy because of abdominal pain, antihistamines fail
tendency to support pancreatitis to help
sodium and water  Assess for
retention resulting in GU: Urinary frequency, orthostatic
increased plasma volume. incontinence, impotence, hypotension; tell
priapism, water and patient to rise
sodium retention slowly from
sitting or lying
position
Patient Teaching
 Instruct patient
not to discontinue
product abruptly;
stress the
importance of
complying with
dosage schedule,
even if feeling
better; if dose is
missed, take as
soon as
remembered; take
at same time each
day
 Advise patient not
to use OTC
products (cough,
cold, allergy)
unless directed by
prescriber; also to
avoid large
amounts of
caffeine, alcohol
 Emphasize the
need to rise
slowly to sitting
 or standing
position to
minimize
orthostatic
hypotension
 Teach patient to
notify prescriber
of mouth sores,
sore throat, fever,
swelling of hands
or feet, irregular
heartbeat, chest
pain
 Caution patient to
report excessive
perspiration,
dehydration,
vomiting,
diarrhea; may
lead to fall in B/P
 Caution patient
that product may
cause dizziness,
fainting, light-
headedness; may
occur during 1st
few days of
therapy; to avoid
hazardous
activities
 Teach patient how
to take B/P and
normal readings
for age group;
instruct to take
B/P q7day
Guanfacine (Alpha-2 PO (Adults): 1 mg daily Results in decreased CNS: drowsiness, Treatment of acute  Hypertension:
Adrenergic Agonist) given at bedtime, may be peripheral vascular headache, weakness, hypertension associated Monitor BP (lying
increases if necessary at resistance and a slightly depression, dizziness, with toxemia of and standing) and
3– 4 wk intervals up to 2 reduced (5 bpm) heart fatigue, insomnia, pregnancy; pregnancy pulse frequently
mg/day; may also be rate. Cardiac output is not irritability. (category B); children <12 during initial dose
given in 2 divided doses. altered by this agent. y. adjustment and
EENT: tinnitus. periodically
Use Cautiously in: Severe during therapy.
Resp: dyspnea. coronary artery disease or Report significant
recent myocardial changes.
CV: bradycardia, chest infarction; Geri: May  Monitor
pain, hypotension, have increased sensitivity, frequency of
palpitations, rebound especially those with prescription refills
hypertension, syncope. hepatic, cardiac, or renal determine
dysfunction; adherence.
GI: constipation, dry Cerebrovascular disease;  monitor for signs
mouth, abdominal pain, Severe renal or liver of reflex
nausea. disease; History of hypertension.
hypotension, heart block,  Hypertension:
GU: erectile dysfunction. bradycardia, or Emphasize the
cardiovascular disease; importance of
OB, Lactation, Pedi: continuing to take
Pregnancy, lactation, or medication as
children <6 yr (safety not directed, even if
established). feeling well.
Medication
controls but does
not cure
hypertension.
Instruct patient to
take medication at
the same time
each day. Take
missed doses as
soon as
remembered; do
not double doses.
If 2 or more doses
are missed,
consult health
care professional.
Do not
discontinue
abruptly; may
cause sympathetic
 overstimulation
(nervousness,
anxiety, rebound
hypertension,
chest pain,
tachycardia,
increased
salivation, nausea,
trembling,
stomach cramps,
sweating,
difficulty
sleeping). These
effects may occur
2– 7 days after
discontinuation,
although rebound
hypertension is
rare and more
likely to occur
with high doses.

DRUGS USED FOR ANGINA:

A. Nitrates

THERAPEUTIC NURSING
DRUG DOSAGE ADVERSE EFFECTS CONTRAINDICATIONS
ACTION CONSIDERATIONS
Nitroglycerine (P) Adult: Sublingual 1–2 Decreases preload  CNS: Headache, apprehen Hypersensitivity to this  Give sublingual
sprays (0.4–0.8 mg) or a and afterload,  sion, blurred vision, product or nitrites, severe preparations under
0.3–0.6-mg tablet q3– which thus  weakness, vertigo, anemia, increased ICP, the tongue or in
5min as needed (max: 3 decreases left  dizziness, faintness.  cerebral hemorrhage the buccal pouch,
doses in 15 min) PO 1.3– ventricular end-  closed-angle glaucoma, and encourage the
9 mg q8–12h IV Start diastolic pressure and CV: Postural cardiac tamponade patient not to
with 5 mcg/min and systemic vascular hypotension, palpitations, ardiomyopathy, constrictive swallow
titrate q3–5min until resistance; dilates tachycardia (sometimes pericarditis  Ask the patient if
desired coronary arteries and with paradoxical the tablet “fizzles”
response Transdermal improves blood flow bradycardia), increase in Precautions: Pregnancy  or burns, which
Unit Apply once q24h or through coronary angina, syncope, C, breastfeeding, children, indicates potency
leave on for 10–12 h, vasculature, dilates and circulatory collapse.  postural hypotension,  Always check the
then remove and have a arterial, venous beds severe renal/ hepatic
10–12 h nitrate-free systemically. GI: Nausea, vomiting,
interval Topical Apply Therapeutic doses may involuntary passing of
1.5–5 cm (½–2 in) of reduce systolic, urine and feces, abdominal
ointment q4–6h diastolic, and mean BP; pain, dry mouth.  medication from
heart rate is usually
Child: IV 0.25–0.5 slightly increased. Hematologic: Methemogl
mcg/kg/min, titrate by Produces antianginal, obinemia (high doses).  that a sublingual
0.5–1 mcg/kg/min q3–5 antiischemic, and
min antihypertensive effects. Skin: Cutaneous
vasodilation with flushing,
rash, exfoliative
dermatitis, contact
dermatitis with
transdermal patch; topical
allergic reactions with
ointment: pruritic
eczematous
eruptions, anaphylactoid
reaction characterized by
oral mucosal and
conjunctival edema.  chew or crush
Body as a Whole: Muscle
twitching, pallor,
perspiration, cold sweat;
local sensation in oral
cavity at point of
dissolution of sublingual
forms.
disease, acute MI, abrupt expiration date on
discontinuation, the bottle and
hyperthyroidism protect the
heat and light
 Instruct the patient
dose may be
repeated in 5
minutes if relief is
not felt, for a total
of three doses; if
pain persists, the
patient should go
to an emergency
room
 Give sustained-
release forms with
water, and caution
the patient not to
them.
 Rotate the sites of
topical forms to
decrease the risk
of skin abrasion
and breakdown;
monitor for signs
of skin breakdown
to arrange for
appropriate skin
care as needed.
 Make sure that
translingual spray
is used under the
tongue and not
inhaled
 Break an amyl
nitrate capsule and
wave it under the

Isosorbide dinitrate Adult: PO 5-20 mg bid-
tid, initially, maintenance
10-40 mg bid-tid; SL
buccal tab 2.5-5 mg; may
repeat q5-10min 3 3
doses; ext rel 40-80 mg
q8-12hr, max 160 mg/day
nose of the angina
patient to provide
rapid relief using
the inhalation
form of the drug;
this may be
repeated with
another capsule in
3 to 5 minutes if
needed.
 Keep a record of
the number of
sprays used if a
trans- lingual
spray form is used
to prevent running
out of medication
and episodes of
untreated angina.
 Have emergency
life support
equipment readily
available in case
of severe reaction
to the drug or
myocardial
infarction.
 Taper the dose
gradually (over 4
to 6 weeks) after
long-term therapy
Relaxes vascular smooth Body as a Hypersensitivity to nitrates  Give sublingual
muscle with resulting Whole: Hypersensitivity or nitrites; severe anemia; preparations under
vasodilation. Dilation of reaction, paradoxical head trauma; increased the tongue or in
peripheral blood vessels increase in anginal pain, intracranial pressure. Safe the buccal pouch,
tends to cause peripheral methemoglobinemia use during pregnancy and encourage the
pooling of blood, (overdose).  (category C) or lactation is patient not to
decreased venous return not established. swallow
to heart, and decreased CNS: Headache,  Ask the patient if
left ventricular end- dizziness, the tablet “fizzles”
diastolic pressure, with weakness, lightheadedness
consequent reduction in , restlessness.  or burns, which
myocardial oxygen indicates potency
consumption. Has an CV: Palpitation, postural  Always check the
antianginal effect by hypotension, tachycardia.  expiration date on
causing vasodilation of the bottle and
the coronary arteries. GI: Nausea, vomiting.  protect the
medication from
Skin: Flushing, pallor, heat and light
perspiration, rash,  Instruct the patient
exfoliative dermatitis that a sublingual
dose may be
repeated in 5
minutes if relief is
not felt, for a total
of three doses; if
pain persists, the
patient should go
to an emergency
room
 Give sustained-
release forms with
water, and caution
the patient not to
chew or crush
them.
 Rotate the sites of
topical forms to
decrease the risk
of skin abrasion
and breakdown;
monitor for signs
of skin breakdown
to arrange for
appropriate skin
care as needed.
 Make sure that
translingual spray
is used under the
tongue and not
inhaled
  Break an amyl
nitrate capsule and
wave it under the
nose of the angina
patient to provide
rapid relief using
the inhalation
form of the drug;
this may be
repeated with
another capsule in
3 to 5 minutes if
needed.
 Keep a record of
the number of
sprays used if a
trans- lingual
spray form is used
to prevent running
out of medication
and episodes of
untreated angina.
 Have emergency
life support
equipment readily
available in case
of severe reaction
to the drug or
myocardial
infarction.
 Taper the dose
gradually (over 4
to 6 weeks) after
long-term therapy
Isosorbide mononitrate Adult: PO (Monoket) 10- Relaxation of  CNS: Vascular headache, Hypersensitivity to this  Assess for pain:
20 mg bid, 7 hr apart; vascular smooth  flushing, dizziness, product or nitrates, severe duration, time
(Imdur) initiate at 30-60 muscle, which  weakness anemia, closed-angle started, activity
mg/day as a single dose, leads to decreased  glaucoma being performed,
increase q3day as needed; preload,  afterload, CV: Orthostatic character,
may increase to 120 thus decreasing left hypotension, tachycardia, Precautions: Pregnancy C, intensity.
mg/day; max 240 mg/day ventricular end-diastolic collapse, syncope breastfeeding, children,  Monitor for
pressure, and systemic orthostatic hypotension, orthostatic B/P,
vascular resistance and GI: Nausea, vomiting MI, CHF, severe pulse at baseline,
reducing cardiac O2 renal/hepatic disease, during treatment
demand. Relief and  INTEG: Pallor,  increased ICP, cerebral and periodically
prevention of angina sweating, rash hemorrhage, acute MI, thereafter
pectoris. geriatrics, GI disease,  Give sublingual
MISC: Twitching,  syncope. preparations under
hemolytic anemia,  the tongue or in
methemoglobinemia, the buccal pouch,
tolerance, xerostomia and encourage the
patient not to
swallow
 Ask the patient if
the tablet “fizzles”
or burns, which
indicates potency
 Always check the
expiration date on
the bottle and
protect the
medication from
heat and light
 Instruct the patient
that a sublingual
dose may be
repeated in 5
minutes if relief is
not felt, for a total
of three doses; if
pain persists, the
patient should go
to an emergency
room
 Give sustained-
release forms with
water, and caution
the patient not to
chew or crush
them.
 Rotate the sites of
topical forms to
decrease the risk
of skin abrasion
and breakdown;
monitor for signs
of skin breakdown
to arrange for
appropriate skin
care as needed.
 Make sure that
translingual spray
is used under the
tongue and not
inhaled
 Break an amyl
nitrate capsule and
wave it under the
nose of the angina
patient to provide
rapid relief using
the inhalation
form of the drug;
this may be
repeated with
another capsule in
3 to 5 minutes if
needed.
 Keep a record of
the number of
sprays used if a
trans- lingual
spray form is used
to prevent running
out of medication
and episodes of
untreated angina.
 Have emergency
life support
equipment readily
 available in case
of severe reaction
to the drug or
myocardial
infarction.
 Taper the dose
gradually (over 4
to 6 weeks) after
long-term therapy

B. Beta-Blockers

THERAPEUTIC NURSING
DRUG DOSAGE ADVERSE EFFECTS CONTRAINDICATIONS
ACTION CONSIDERATIONS
Metoprolol (P) Adult: PO 100 mg/day as Reduces heart rate and Body as a Hypersensitivity to b-  Hypertension/
a single dose or in 2 cardiac output at rest and Whole: Hypersensitivity blockers, cardiogenic angina: monitor
divided doses, increase during exercise; lowers (erythematous rash, fever, shock, heart block (2nd and ECG directly
qwk as needed, or 100 mg both supine and standing headache, muscle aches, 3rd degree), sinus when giving IV
ext rel tab daily, max 400 BP, slows sinus rate and sore bradycardia, during initial
mg/day ext rel decreases myocardial throat, laryngospasm, pheochromocytoma, sick treatment
automaticity. Antianginal respiratory distress).  sinus syndrome  Monitor B/P
effect is like that of during beginning
propranolol. CNS: Dizziness, fatigue, Precautions: Pregnancy C, treatment,
insomnia, increased breastfeeding, geriatric, periodically
dreaming, mental major surgery, diabetes thereafter; pulse
depression.  mellitus, q4hr; note rate,
thyroid/renal/hepatic rhythm, quality;
CV: Bradycardia, palpitat disease, COPD, CAD,non- check
ion, cold extremities, allergic bronchospasm, apical/radial
Raynaud's phenomenon, CHF, bronchial asthma, pulse before
intermittent claudication, CVA, children, depression, administration;
angina pectoris, CHF, vasospastic angina notify prescriber
intensification of AV of any significant
block, AV changes (pulse
dissociation, complete <60 bpm).
heart block, cardiac  Check for
arrest.  baselines in renal,

Nadolol Adult: PO 40 mg/day; Reduces heart rate and
increase by 40-80 mg q2- cardiac output at rest and
14 days; maintenance 40- during exercise, and also
240 mg/day for angina, decreases conduction
40-320 mg/day for velocity through AV
hypertension node and myocardial
Geriatric: PO 20 mg/day, automaticity. Decreases
may increase by 20 mg both systolic and diastolic
until desired dose BP at rest and during
exercise. Suppression of
beta2-adrenergic receptors
in bronchial and vascular
smooth muscle can cause
bronchospasm and a
Raynaud's-like
phenomenon.
liver function
GI: Nausea, heartburn, ga tests before
stric pain, diarrhea or therapy begins
constipation, flatulence.  and periodically
thereafter
Hematologic: Eosinophil  Assess for edema
ia, thrombocytopenic and in feet, legs daily;
non-thrombocytopenic monitor I&O,
purpura, agranulocytosis ( daily weight;
rare).  check for jugular
vein distention,
Skin: Dry skin, pruritus, crackles
skin eruptions.  bilaterally,
dyspnea (CHF)
Special Senses: Dry
mouth and mucous
membranes. 
Metabolic: 
Hypoglycemia. 
Respiratory: Bronchospa
sm (with high
doses), shortness of
breath.
CNS: Depression,  Bronchial asthma, severe  Pain: assess for
dizziness, fatigue, COPD, inadequate duration, time
lethargy, paresthesia, myocardial function, sinus started, activity
headache, weakness, bradycardia, greater than being performed,
insomnia, memory loss, first-degree conduction location,
nightmares block, overt cardiac failure, character
cardiogenic shock. Safety  Monitor B/P at
CV: Bradycardia, during pregnancy (category beginning of
hypotension, CHF, C), lactation, and in treatment,
palpitations, AV block, children <18 y is not periodically
chest pain, peripheral established. thereafter; note
ischemia, flushing, rate, rhythm,
edema, vasodilatation, Cautious use: CHF; quality of
conduction disturbances diabetes mellitus; apical/radial
hyperthyroidism; renal pulse before
EENT: Blurred  impairment. administration;
vision, dry eyes,  notify prescriber
nasal congestion of any significant
changes
ENDO: (pulse ,60 bpm),
Hyperglycemia,  orthostatic
hypoglycemia hypotension
 Check for
GI: Nausea,  baselines in renal,
vomiting, diarrhea,  liver function
colitis, constipation, tests before
cramps, dry mouth, therapy begins
flatulence, hepatomegaly,  Headache, light-
pancreatitis, taste headedness,
distortion decreased B/P;
may indicate a
GU: Impotence, need for
decreased libido decreased dosage
 Hypertension:
HEMA: Agranulocytosis, instruct patient to
thrombocytopenia comply with
weight control,
INTEG: Rash,  dietary
pruritus, fever,  adjustments,
alopecia modified exercise
program; to
RESP: Dyspnea,  report weight
respiratory  gain .5 lb,
dysfunction,  swelling, unusual
bronchospasm, cough, bruising,
wheezing, pharyngitis, bleeding
laryngospasm, pulmonary  Advise patient to
edema carry/wear
emergency ID to
identify product
being taken,
allergies; teach
patient product
controls
symptoms but
does not cure
condition.
Propranolol Adult: PO 10-20 mg bid- Blocks cardiac effects of CNS: Depression, Hypersensitivity to this  Monitor B/P
qid, increase at 3-7 day beta-adrenergic hallucinations, dizziness, product, cardiogenic shock, during beginning
intervals up to 160-320 stimulation; as a result, fatigue, lethargy, AV heart block, treatment,
mg/day, or 80 mg/ day, reduces heart rate, paresthesia, bizarre bronchospastic disease, periodically
increase at 3-7 day myocardial irritability dreams, disorientation sinus bradycardia, thereafter; pulse
intervals up to 160-320 (Class II antiarrhythmic) bronchospasm, asthma q4hr; note rate,
mg/day and force of contraction, CV: Bradycardia, rhythm, quality;
depresses automaticity of hypotension, CHF, Precautions: Pregnancy C, check
sinus node and ectopic palpitations, AV block, breastfeeding, children, apical/radial
pacemaker, and decreases peripheral vascular diabetes mellitus, pulse before
AV and intraventricular insufficiency, renal/hepatic disease, administration;
conduction velocity. vasodilatation, pulmonary hyperthyroidism, COPD, notify prescriber
Hypotensive effect is edema, dysrhythmias, myasthenia gravis, of any significant
associated with decreased cold extremities peripheral vascular disease, changes (pulse
cardiac output, hypotension, cardiac <50 bpm or
suppressed renin activity, EENT: Sore throat, failure, Raynaud’s disease, systolic B/P <90
as well as beta-blockade. laryngospasm, blurred sick sinus syndrome, mm Hg)
Also decreases platelet vision, dry eyes vasospastic angina,  Check for
aggregability. smoking, Wolff Parkinson- baselines in renal,
GI: Nausea, vomiting, White syndrome, liver function
diarrhea, colitis, thyrotoxicosis. tests before
constipation, cramps, dry therapy begins
mouth, hepatomegaly, and periodically
gastric pain, acute thereafter
pancreatitis  Assess for edema
in feet, legs daily;
GU: Impotence, monitor I&O,
decreased libido, UTIs weight daily;
check for jugular
HEMA: Agranulocytosis, vein distention,
thrombocytopenia crackles
bilaterally;
INTEG: Rash, pruritus, dyspnea (CHF)
fever, Stevens-Johnson  Monitor skin
syndrome, toxic turgor, dryness of
epidermal necrolysis mucous
membranes for
META: Hyperglycemia, hydration status,
hypoglycemia especially
geriatric
MISC: Facial swelling,

C. Calcium Channel Blockers (CCB)
THERAPEUTIC
DRUG DOSAGE
ACTION
Diltiazem Adult: PO 30 mg qid, Dilates coronary arteries
increasing dose gradually and arterioles and inhibits
to 180-360 mg/day in coronary artery spasm;
divided doses or (SR) 60- thus myocardial oxygen
120 mg bid; may increase delivery is increased
to 240-360 mg/ day or (antianginal effect). By
120 or 180 mg EXT REL vasodilation of peripheral
(LA, CD, XT, XR arterioles, drug decreases
products) PO daily total peripheral vascular
resistance and reduces
arterial BP at rest
(antihypertensive effect).
weight change,  Assess for
Raynaud’s phenomenon headache, light-
headedness,
MS: Joint pain, decreased B/P;
arthralgia, muscle may indicate
cramps, pain need for
decreased dose;
RESP: Dyspnea, may aggravate
respiratory dysfunction, symptoms of
bronchospasm, cough arterial
insufficiency.
NURSING
ADVERSE EFFECTS CONTRAINDICATIONS
CONSIDERATIONS
CNS: Headache, fatigue, Sick sinus syndrome, 2nd-  Angina: location,
drowsiness, dizziness, or 3rd-degree heart block, duration,
depression, weakness, hypotension less than 90 alleviating
insomnia, tremor, mm Hg systolic, acute MI, factors, activity
paresthesia pulmonary congestion, when pain starts.
cardiogenic shock  Caution patient to
CV: Dysrhythmia, edema, avoid hazardous
CHF, bradycardia, Precautions: Pregnancy C, activities until
hypotension, palpitations, breastfeeding, children, stabilized on
heart block CHF, aortic stenosis, product and
bradycardia, GERD, dizziness is no
GI: Nausea, vomiting, hepatic disease, hiatal longer a problem
diarrhea, gastric upset, hernia, ventricular  Instruct patient to
constipation, increased dysfunction, elderly limit caffeine
LFTs consumption; to
avoid grapefruit
GU: Nocturia, polyuria, juice; to avoid
acute renal failure alcohol and OTC
products unless
INTEG: Rash, pruritus at directed by
inj site, flushing, prescriber.
photosensitivity, burning  Teach patient to
 use as directed
RESP: Rhinitis, dyspnea, even if feeling
pharyngitis better; may be
taken with other
cardiovascular
products (nitrates,
b-blockers); how
to take pulse, B/P
before taking
product; to
change position
slowly
 Teach patient not
to discontinue
abruptly

D. Piperazineacetamide

THERAPEUTIC CONTRAINDICATION NURSING

DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Adult: PO 500 mg bid Antianginal, CNS: Headache, Preexisting QT  Angina: characteristics
and increased to 1000 antiischemic; dizziness, hallucinations prolongation, hepatic of pain (intensity,
mg bid based on unknown, may work disease (Child-Pugh class location, duration,
response; max 1000 mg by inhibiting portal fatty- CV: Palpitations, QT A, B, C), hypersensitivity, alleviating/precipitatin
bid acid oxidation. prolongation, orthostatic hypokalemia, renal failure, g factors)
Decreased anginal pain hypotension torsades de pointes,  contraindicated for use
and number of episodes. ventricular dysrhythmia, with any known
EENT: Tinnitus ventricular tachycardia, sensitivity to the drug
hepatic cirrhosis with preexisting
Ranolazine GI: Nausea,  prolonged QT interval
vomiting,  Precautions: Pregnancy  or in combination with
constipation, dry  C, breastfeeding, children, drugs that would
mouth geriatric, renal disease, prolong QT intervals;
hypotension, females at and with hepatic
MISC: Peripheral  risk for torsades de pointes impairment and
edema lactation
 caution should be used
RESP: Dyspnea with pregnancy or
renal impairment.
DRUG USED FOR ARRHYTHMIA
A. Class I Antiarrhythmic Drugs

THERAPEUTIC CONTRAINDICATION NURSING

DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Adult: PO 1 g followed Produces slight change in CNS: Headache, Myasthenia gravis;  Titrate the dose to
by 250–500 mg q3h or contractility of cardiac dizziness, confusion, hypersensitivity to the smallest
500 mg–1 g q6h muscle and cardiac psychosis, restlessness, procainamide or procaine; amount needed to
sustained release (b.i.d. output; suppresses irritability, weakness, blood dyscrasias; complete achieve control of
for Procanbid) IM 0.5–1 automaticity of His- depression AV block, second and third the arrhythmia
g q4–6h until able to take Purkinje ventricular degree AV block  continually
PO IV 100 mg q5min at a muscle. Produces CV: Hypotension, heart unassisted by pacemaker. monitor cardiac
rate of 25–50 mg/min peripheral vasodilation block, cardiovascular rhythm when
until arrhythmia is and hypotension, collapse, arrest, torsades initiating or
controlled or 1 g given, especially with IV use. de pointes changing dose
then 2–6 mg/min Cautious Use: Patient who  ensure that
GI: Nausea, vomiting, has undergone electrical emergency life
Child: PO 40–60 anorexia, diarrhea, conversion to sinus support equipment
mg/kg/d divided q4– hepatomegaly, pain, bitter rhythm; hypotension, is readily available
6h IV 3–6 mg/kg q 10–30 taste cardiac enlargement, CHF,  administer
min (max: 100 mg/dose), MI, coronary occlusion, parenteral forms as
then 0.02–0.08 HEMA: Systemic lupus ventricular dysrhythmia ordered only if the
Procainamide (Class Ia) mg/kg/min erythematosus syndrome, from digitalis intoxication; oral form is not
agranulocytosis, hepatic or renal feasible; expect to
thrombocytopenia, insufficiency; electrolyte switch to the oral
neutropenia, hemolytic imbalance; bronchial form as soon as
anemia asthma; history of SLE. possible
Safety during pregnancy  consult with the
INTEG: Rash, urticaria, (category C) or lactation is prescriber to
edema, swelling (rare), not established. reduce the dose in
pruritus, flushing, patients with renal
angioedema or hepatic
dysfunction
SYST: SLE  offer support and
encouragement to
help the patient
deal with the
diagnosis and the
drug regimen.
 provide thorough
 patient teaching
 establish safety
precautions,
including side rails,
lighting, and noise
control, if CNS
effects occur to
ensure patient
safety
 arrange for
periodic
monitoring of
cardiac rhythm
when the patient is
receiving long-
term therapy
Quinidine (Class Ia) Adult: PO 400–600 mg Prolongs action  CNS: Headache, Hypersensitivity or  Titrate the dose to
q2–3h until arrhythmia potential duration  dizziness, involuntary idiosyncrasy to quinine the smallest
terminates, then 200–300 and effective  movement, confusion, or Cinchona derivatives; amount needed to
mg 3–4 times/day refractory period,  psychosis, restlessness, pregnancy (category C), achieve control of
thus decreasing  irritability, syncope, lactation. the arrhythmia
myocardial excitability; excitement, depression, Thrombocytopenic purpura  continually
anticholinergic ataxia resulting from prior use of monitor cardiac
properties. Treatment  quinidine; intraventricular rhythm when
of  dysrhythmias. CV: Hypotension, conduction defects, initiating or
bradycardia, PVCs, heart complete AV block, changing dose
block, cardiovascular ectopic impulses and  ensure that
collapse, arrest, torsades rhythms due to escape emergency life
de pointes, widening QRS mechanisms; support equipment
complex, ventricular thyrotoxicosis; acute is readily available
tachycardia rheumatic fever; subacute  administer
bacterial endocarditis, parenteral forms as
EENT: Cinchonism: extensive myocardial ordered only if the
tinnitus, blurred vision, damage, frank CHF, oral form is not
hearing loss, mydriasis, hypotensive states; feasible; expect to
disturbed color vision myasthenia gravis; digitalis switch to the oral
intoxication. form as soon as
GI: Nausea, vomiting, possible
anorexia, diarrhea,  consult with the
hepatotoxicity, abdominal prescriber to
pain

Flecainide (Class Ic) Adult: PO 100 mg q12h, Decreases conduction in
may increase by 50 mg all parts of the heart, with
b.i.d. q4d (max: 400 greatest effect on the His-
mg/d) Purkinje system, which
stabilizes the cardiac
Child: PO 1–3 mg/kg/d membrane. Clinically,
in 3 divided doses (max: causes both hypotension
8 mg/kg/d) and negative entropy (in
higher dose ranges) and
is an effective
suppressant of PVCs and
a variety of atrial and
ventricular arrhythmias.
HEMA:
Thrombocytopenia,
hemolytic anemia,
agranulocytosis,
hypoprothrombinemia
INTEG: Rash, urticaria,
angioedema, swelling,
photosensitivity, flushing
with severe pruritus
RESP: Dyspnea,
respiratory depression
CNS: Headache,
dizziness, involuntary
movement, confusion,
psychosis, restlessness,
irritability, paresthesias,
ataxia, flushing,
somnolence, depression,
anxiety, malaise, fatigue,
asthenia, tremors
CV: Hypotension,
bradycardia, angina,
PVCs, heart block,
reduce the dose in
patients with renal
or hepatic
dysfunction
 offer support and
encouragement to
help the patient
deal with the
diagnosis and the
drug regimen.
 provide thorough
patient teaching
 establish safety
precautions,
including side rails,
lighting, and noise
control, if CNS
effects occur to
ensure patient
safety
 arrange for
periodic
monitoring of
cardiac rhythm
when the patient is
receiving long-
term therapy
Hypersensitivity to  Monitor I&O ratio;
flecainide; preexisting electrolytes prior to
second- or third-degree AV use: potassium,
block, right bundle branch sodium, chloride;
block when associated with check weight daily
a left hemiblock unless a and for signs of
pacemaker is present; CHF or pulmonary
cardiogenic shock, toxicity: dyspnea,
significant hepatic fatigue, cough,
impairment. Safety during fever, chest pain,
pregnancy (category C), jugular vein
lactation, or in children distention,
<18 y is not established. crackles; if these
 cardiovascular collapse/
arrest, dysrhythmias,
CHF, fatal ventricular
tachycardia, palpitations,
QT prolongation, torsades
de pointes
EENT: Tinnitus, blurred
vision, hearing loss,
corneal deposits, dry eyes
GI: Nausea, vomiting,
anorexia, constipation,
abdominal pain,
flatulence, change in
taste, diarrhea
GU: Impotence,
decreased libido,
polyuria, urinary retention
HEMA: Leukopenia,
thrombocytopenia
INTEG: Rash, urticaria,
edema, swelling
RESP: Dyspnea,
respiratory depression
Propafenone (Class Ic) Adult: PO Initiate with Slows conduction CNS: Headache,
150 mg q8h, may be velocity; reduces dizziness, abnormal
increased at 3–4 d membrane dreams, syncope,
intervals (max: 300 mg responsiveness; inhibits confusion, seizures,
q8h) automaticity; increases insomnia, tremor, anxiety,
ratio of effective fatigue
occur, product
Cautious Use: CHF, sick should be
sinus syndrome, renal discontinued
impairment  Monitor liver
function studies:
AST, ALT,
bilirubin, alkaline
phosphatase
 Assess patient for
CNS symptoms:
confusion,
psychosis,
numbness,
depression,
involuntary
movements; if
these occur,
product should be
discontinued
 Monitor cardiac
rate, respiration:
rate, rhythm,
character, chest
pain; watch for
ventricular
tachycardia,
supraventricular
tachycardia, or
fibrillation.
 Flecainide level:
Monitor level in
those with CHF or
renal failure, peak,
trough
2nd-, 3rd-degree AV  Monitor GI status:
block, right bundle branch bowel pattern,
block, cardiogenic shock, number of stools
hypersensitivity,  Monitor chest x-
bradycardia, uncontrolled ray film,
CHF, sick sinus syndrome, pulmonary

Lidocaine (P) (Class Ib) Adult: IV 50–100 mg
bolus at a rate of 20–50
mg/min, may repeat in 5
min, then start infusion of
1–4 mg/min immediately
after first
bolus IM/SC 200–300
mg IM,  may repeat once
after 60–90 min
Child: IV 0.5–1 mg/kg
bolus dose, then 10–50
refractory period to marked hypotension, function test during
action potential duration; CV: Supraventricular bronchospastic disorders, treatment
beta-blocking activity. dysrhythmia, ventricular electrolyte imbalance,  Monitor I&O ratio;
Appropriate dose and dysrhythmia, bradycardia, Brugada syndrome check for
concentration decreases prodysrhythmia, decreasing output;
rate of single and palpitations, AV block, Precautions: Pregnancy C, daily weight
multiple PVCs. In intraventricular breastfeeding, children,  Monitor B/P for
addition, suppresses conduction delay, AV geriatric, CHF, fluctuations
ventricular tachycardia. dissociation, hypotension, hypo/hyperkalemia, non-  Advise patient to
Exerts a negative chest pain, asystole allergic bronchospasm, report fever, chills,
inotropic effect on the renal/hepatic disease, sore throat,
myocardium. EENT: Blurred vision, hematologic disorders, bleeding, shortness
altered taste, tinnitus myasthenia gravis, COPD of breath, chest
pain, palpitations,
GI: Nausea, vomiting, blurred vision
constipation, dyspepsia,  Advise patient to
cholestasis, abnormal take medication
hepatic studies, dry with food
mouth, diarrhea, anorexia  Instruct patient not
to use with
HEMA: Leukopenia, grapefruit juice or
agranulocytosis, St. John’s wort
granulocytopenia,
thrombocytopenia,
anemia, bruising
INTEG: Rash
RESP: Dyspnea
Increases electrical  CNS: Headache History of hypersensitivity  Monitor blood
stimulation threshold  to amide-type local glucose, A1c,
of ventricle and  EENT: Nasopharyngitis anesthetics; application or during treatment to
His-Purkinje  system, injection of lidocaine determine diabetes
which stabilizes cardiac ENDO: Hyperuricemia, anesthetic in presence of control
membrane and decreases hypoglycemia severe trauma or sepsis,  Monitor CBC
automaticity. blood dyscrasias, baseline and
Decreased  ventricular GI: Body weight loss, supraventricular periodically during
dysrhythmia. pancreatitis arrhythmias, Stokes- treatment, report
Adams syndrome, decreased blood
INTEG: Angioedema, untreated sinus counts
exfoliative dermatitis, bradycardia, severe Patient/family education
 mcg/kg/min infusion hypersensitivity reactions,
urticaria
MISC: Arthralgia, back
pain
RESP: Bronchial
hyperreactivity (with
bronchospasm), cough,
nasopharyngitis.
Mexiletine (Class Ib) Adult: PO 200–300 mg Has little or no effect on CNS: Dizziness, tremor,
q8h (max: 1200 mg/d) atrial tissue and produces nervousness,
Child: PO 1.4–5 mg/kg modest suppression of incoordination, headache,
q8h sinus node automatically blurred vision,
and AV nodal paresthesias, numbness.  third-degree heart block;
conduction. Prolongs the
His-to-ventricular CV: Exacerbated
interval (HQ) only if arrhythmias, palpitations,
patient has preexisting chest pain, syncope,
conduction disturbance. hypotension.  
GI: Nausea, vomiting,
heartburn, diarrhea,
constipation, dry mouth,
abdominal pain.  weak, debilitated
degrees of sinoatrial,  Teach patient the
atrioventricular, and symptoms of
intraventricular heart hypo/hyperglycemi
block. Safe use during a and what to do
pregnancy (category B), about each; to have
lactation, or in children is glucagon
not established. emergency kit
available, carry
sugar packets
 Advise patient that
Cautious Use: Liver or product must be
kidney disease, CHF, continued on a
marked hypoxia, daily basis, explain
respiratory depression, consequences of
hypovolemia, shock; discontinuing
myasthenia gravis; product abruptly;
debilitated patients, older to take only as
adults; family history of directed
malignant hyperthermia
(fulminant
hypermetabolism). Topical
use in eyes, over large
body areas, over prolonged
periods, in severe or
extensive trauma or skin
disorders.
Severe left ventricular  Check pulse and
failure, cardiogenic shock, BP before
severe bradyarrhythmias. administration;
Preexisting second- or make sure both are
stabilized.
pregnancy (category C),  Effective serum
lactation; concurrent concentration
administration of drugs range is 0.5–2
which alter urinary pH mcg/mL.
Lab tests: Baseline
and periodic liver
function tests.
 Supervise
ambulation in the
 patient or the older
Skin: Rash.  adult during drug
stabilization
Body as a period. CNS
Whole: Dyspnea, edema, adverse reactions
arthralgia, fever, malaise, predominate (e.g.,
hiccups.  intention tremors,
nystagmus, blurred
Urogenital: Impotence, vision, dizziness,
urinary retention. ataxia, confusion,
nausea).
 Encourage drug
compliance;
affected
particularly by the
distressing adverse
effects of tremor,
ataxia, and eye
symptoms.
 Check frequently
with patient about
adherence to drug
regimen. If adverse
effects are
increasing, consult
physician. Dose
adjustment or
discontinuation
may be needed.

Patient & Family

Education

 Learn about pulse

parameters to be
reported: Changes
in rhythm and rate
(bradycardia =
pulse below 60);
symptomatic
bradycardia (light-
 headedness,
syncope,
dizziness), and
postural
hypotension.
 Do not breast feed
while taking this
drug.

B. Class II Antiarrhythmic Drugs

THERAPEUTIC NURSING
DRUG DOSAGE ADVERSE EFFECTS CONTRAINDICATIONS
ACTION CONSIDERATIONS
Acebutolol Adult: PO 200 mg Decreases both systolic Body as a Overt CHF, second- or third-  Monitor renal
b.i.d. increased to 600– and diastolic BP at rest Whole: Fatigue.  degree AV block, severe function tests:
1200 mg/day and during exercise. CNS: Dizziness, bradycardia, cardiogenic protein, BUN,
insomnia, drowsiness, shock; lactation; children creatinine; watch for
confusion, fainting.  <12 y. increased levels that
CV: Bradycardia, may indicate
hypotension, CHF.  Cautious Use: Impaired nephrotic syndrome;
GI: Nausea, diarrhea, cardiac function, well- obtain baselines in
constipation, flatulence.  compensated CHF, renal/hepatic
Hematologic: Agranulo mesenteric or peripheral function tests before
cytosis, antinuclear vascular disease; patients beginning treatment
antibodies (ANA).  undergoing major surgery  Monitor I&O ratio,
Metabolic: hypoglycemi involving general anesthesia; weight daily
a (may mask symptoms renal or hepatic impairment;  Monitor B/P during
of a hypoglycemic labile diabetes mellitus; beginning of
reaction).  hyperthyroidism; treatment and
Respiratory: Bronchosp bronchospastic disease periodically
asm, pulmonary edema, (asthma, emphysema); avoid thereafter, pulse
dyspnea. Urogenital: De abrupt withdrawal; q4hr; note rate,
creased libido; pregnancy (category B) rhythm, quality
impotence.  Monitor
apical/radial pulse
before
administration;
 notify prescriber of
significant changes
 Check for edema in
feet and legs daily
Adult: IV 500 mcg/kg Blocks sympathetically CNS: Confusion, light- Cardiac failure, heart block  Dysrhythmias:
loading dose followed mediated increases in headedness, paresthesia, greater than first degree, Monitor B/P during
by 50 mcg/kg/min, may cardiac rate and BP since somnolence, fever, sinus bradycardia, beginning treatment,
increase dose q5– it binds predominantly to dizziness, fatigue, cardiogenic shock; periodically
10min prn (max: 200 beta1-receptors in cardiac headache, depression, pregnancy (category C), thereafter; pulse
mcg/kg/min) tissue. anxiety, seizures lactation. Safety in children q4hr; note rate,
is not established. rhythm, quality;
CV: Hypotension, apical/radial pulse
bradycardia, chest pain, Cautious Use: History of before
peripheral ischemia, allergy or bronchial asthma, administration;
shortness of breath, bronchospasm, emphysema; notify prescriber of
CHF, conduction CHF; diabetes mellitus; any significant
disturbances 1st-, 2nd-, kidney function impairment. changes (pulse <50
3rd-degree heart block bpm); if severe,
slow or stop infusion
GI: Nausea, vomiting,  Check for baselines
anorexia, gastric pain, in renal, liver
flatulence, constipation, function tests before
Esmolol
heartburn, bloating therapy begins
 Caution patient to
GU: Urinary retention, rise slowly to
impotence, dysuria prevent orthostatic
hypotension
INTEG: Induration,  Advise patient to
inflammation at inj site, notify if pain,
discoloration, edema, swelling occurs at
erythema, burning, IV site
pallor, flushing, rash,
pruritus, dry skin,
alopecia

RESP: Bronchospasm,
dyspnea, cough,
wheezing, nasal
stuffiness, pulmonary
edema
Propranolol Adult: PO 10–30 mg Blocks cardiac effects of CNS: Depression, Hypersensitivity to this  Monitor B/P during
t.i.d. or q.i.d. IV 0.5–3 beta-adrenergic hallucinations, dizziness, product, cardiogenic shock, beginning treatment,
mg q4h prn stimulation; as a result, fatigue, lethargy, AV heart block, periodically
reduces heart rate, paresthesia, bizarre bronchospastic disease, sinus thereafter; pulse
Child: PO 1–4 mg/kg/d myocardial irritability dreams, disorientation bradycardia, bronchospasm, q4hr; note rate,
in 4 divided doses (Class II antiarrhythmic) asthma rhythm, quality;
(max: 16 and force of contraction, CV: Bradycardia, check apical/radial
mg/kg/d) IV 10–20 depresses automaticity of hypotension, CHF, Precautions: Pregnancy C, pulse before
mcg/kg/min over 10 sinus node and ectopic palpitations, AV block, breastfeeding, children, administration;
min pacemaker, and decreases peripheral vascular diabetes mellitus, notify prescriber of
AV and intraventricular insufficiency, renal/hepatic disease, any significant
conduction velocity. vasodilatation, hyperthyroidism, COPD, changes (pulse <50
Hypotensive effect is pulmonary edema, myasthenia gravis, bpm or systolic B/P
associated with decreased dysrhythmias, cold peripheral vascular disease, <90 mm Hg).
cardiac output, suppressed extremities hypotension, cardiac failure,  Check for baselines
renin activity, as well as Raynaud’s disease, sick in renal, liver
beta-blockade. Also EENT: Sore throat, sinus syndrome, vasospastic function tests before
decreases platelet laryngospasm, blurred angina, smoking, Wolff- therapy begins and
aggregability. vision, dry eyes Parkinson-White syndrome, periodically
thyrotoxicosis. thereafter
GI: Nausea, vomiting,  Assess for edema in
diarrhea, colitis, feet, legs daily;
constipation, cramps, monitor I&O,
dry mouth, weight daily; check
hepatomegaly, gastric for jugular vein
pain, acute pancreatitis distention, crackles
bilaterally; dyspnea
GU: Impotence, (CHF)
decreased libido, UTIs  Monitor skin turgor,
dryness of mucous
HEMA: membranes for
Agranulocytosis, hydration status,
thrombocytopenia especially geriatric
 Assess for headache,
INTEG: Rash, pruritus, light-headedness,
fever, Stevens-Johnson decreased B/P; may
syndrome, toxic indicate need for
epidermal necrolysis decreased dose; may
aggravate symptoms
META: Hyperglycemia, of arterial
hypoglycemia insufficiency.
 MISC: Facial swelling,
weight change,
Raynaud’s phenomenon

MS: Joint pain,

arthralgia, muscle
cramps, pain

RESP: Dyspnea,
respiratory dysfunction,
bronchospasm, cough

C. Class III Antiarrhythmic Drugs

DRUG DOSAGE
Adult: PO loading dose
800-1600 mg/day for 1-3
wk; then 600-800 mg/day
3 1 mo; maintenance 400
mg/day; IV loading dose
(first rapid) 150 mg over
the first 10 min then slow
360 mg over the next 6
hr; maintenance 540 mg
given over the remaining
18 hr, decrease rate of the
slow infusion to 0.5
Amiodarone (P) mg/min
Child (unlabeled): PO
loading dose 10-15 mg/
kg/day in 1-2 divided
doses for 4-14 days then 5
mg/kg/day
Child and infant:
IV/INTRAOSSEOUS
during CPR 5 mg/kg as a
bolus (PALS guidelines)
THERAPEUTIC
ACTION
By direct action on
smooth muscle, decreases
peripheral resistance and
increases coronary blood
flow. Blocks effects of
sympathetic stimulation.
NURSING
ADVERSE EFFECTS CONTRAINDICATIONS
CONSIDERATIONS
CNS: Headache, Hypersensitivity to  Monitor
dizziness, involuntary amiodarone, or benzyl electrolytes:
movement, tremors, alcohol; cardiogenic shock, potassium,
peripheral neuropathy, severe sinus bradycardia, sodium, chloride
malaise, fatigue, ataxia, advanced AV block unless  Monitor chest x-
paresthesias, insomnia a pacemaker is available, ray, thyroid
severe sinus-node function tests
CV: Hypotension, dysfunction or sick sinus  Monitor liver
bradycardia, sinus arrest, syndrome, bradycardia, function studies:
CHF, dysrhythmias, SA congenital or acquired QR AST, ALT,
node dysfunction, AV prolongation syndromes, or bilirubin, alkaline
block, increased history of torsade de phosphatase
defibrillation energy pointes; severe liver  Monitor for
requirement disease, children. Safety dehydration or
during pregnancy (category hypovolemia,
EENT: Blurred vision, D) or lactation is not monitor PT, INR
halos, photophobia, established. if using warfarin
corneal microdeposits,  Assess for CNS
dry eyes Cautious Use: Hepatic symptoms:
disease, cirrhosis; confusion,
ENDO: Hashimoto's thyroiditis, psychosis,
Hyper/hypothyroidism goiter, thyrotoxicosis, or numbness,
history of other thyroid depression,
GI: Nausea, vomiting, dysfunction; CHF, left involuntary
diarrhea, abdominal pain, movements; if
anorexia, constipation, ventricular dysfunction; these occur,
hepatotoxicity hypersensitivity to iodine; product should be
older adults; Fabry disease, discontinued
GU: Epididymitis, ED especially with visual  Assess for
disturbances; electrolyte hypothyroidism:
INTEG: Rash, imbalance, hypokalemia, lethargy,
photosensitivity, blue- hypomagnesemia, dizziness,
gray skin discoloration, hypovolemia; preexisting constipation,
alopecia, spontaneous lung disease, COPD; open enlarged thyroid
ecchymosis, toxic heart surgery. gland, edema of
epidermal necrolysis, extremities, cool,
urticaria, pancreatitis, pale skin
phlebitis (IV)  Monitor
hyperthyroidism:
MISC: Flushing, restlessness,
abnormal taste or smell, tachycardia,
edema, abnormal eyelid puffiness,
salivation, coagulation weight loss,
abnormalities frequent
urination,
MS: Weakness, pain in menstrual
extremities. irregularities,
dyspnea, warm,
RESP: Pulmonary moist skin
fibrosis/toxicity,  Monitor cardiac
pulmonary inflammation, rate, respiration:
ARDS, gasping syndrome rate, rhythm,
in neonates character, chest
pain, ventricular
tachycardia,
supraventricular
tachycardia or
fibrillation
 Assess sight and
vision before
treatment and
throughout
therapy;
microdeposits on
the cornea may
 cause blurred
vision, halos, and
photophobia, to
prevent corneal
deposits use
methylcellulose
 Instruct patient
that skin
discoloration is
usually reversible,
but skin may turn
bluish on neck,
face, arms when
used for long
periods.
 Advise patient
that dark glasses
may be needed
for photophobia
 Instruct patient to
use sunscreen and
protective
clothing to
prevent burning
associated with
photosensitivity
 Instruct patient to
take medication
as prescribed, not
to double doses,
do not
discontinue
abruptly
 Instruct patient to
complete follow-
up appointment
with health care
provider
including
pulmonary

Adult: PO Based on
creatinine clearance
(Clcr) and QTc interval, if
QTc increases by >15%
from baseline or is >500
msec 2–3 h after initial
dose. Decrease
subsequent doses by 50%
Dofetilide
D. Class IV Antiarrhythmic Drugs
DRUG DOSAGE
Diltiazem (P) Adult: IV 0.25 mg/kg IV
bolus over 2 min, if
inadequate response, may
repeat in 15 min with
0.35 mg/kg, followed by
a continuous infusion of
5–10 mg/h (max: 15 mg/h
for 24 h)
Blocks cardiac ion
channel carrying the rapid
component of delayed
potassium current, no
effect on sodium
channels. Effectiveness
indicated by correction of
cardiac arrhythmias.
Action results in
suppression of
arrhythmias dependent
upon re-entry of
potassium ions. It also
prolongs the atrial and
ventricular refractory
period.
THERAPEUTIC
ACTION
Dilates coronary arteries
and arterioles and inhibits
coronary artery spasm;
thus myocardial oxygen
delivery is increased
(antianginal effect). By
vasodilation of peripheral
arterioles, drug decreases
total peripheral vascular
resistance and reduces
function studies,
chest x-ray,
ophthalmic
examinations
CNS: Syncope, dizziness, Hypersensitivity, digoxin  do not use for
headache, stroke toxicity, aortic stenosis, mild to moderate
pulmonary hypertension, renal disease,
CV: Hypotension, children, severe renal  monitor BUN/
postural hypotension, disease. creatinine; adjust
bradycardia, angina, dose based on
PVCs, substernal Precautions: Pregnancy C, creatinine
pressure, precipitation of breastfeeding, AV block, clearance.
angina, transient bradycardia, electrolyte  • Instruct patient
hypertension, QT imbalance to notify
prolongation, torsades de prescriber if fast
pointes, ventricular heartbeats with
dysrhythmias, chest pain fainting or
dizziness occur.
GI: Nausea, vomiting,  Teach patient that
severe diarrhea, anorexia if a dose is
missed, do not
MISC: Angioedema double, take next
dose at usual time
RESP: Dyspnea,
respiratory infections
NURSING
ADVERSE EFFECTS CONTRAINDICATIONS
CONSIDERATIONS
CNS: Headache, fatigue, Known hypersensitivity to  Dysrhythmias:
drowsiness, dizziness, drug; sick sinus syndrome monitor B/P and
depression, weakness, (unless pacemaker is in pulse, respiration,
insomnia, tremor, place and functioning); ECG and
paresthesia second- or third-degree AV intervals (PR,
block; severe hypotension QRS, QT);
CV: Dysrhythmia, edema, (systolic <90 mm Hg or PCWP, CVP
CHF, bradycardia, diastolic <60 mm Hg); often during
hypotension, palpitations, patients undergoing infusion; if B/P
heart block intracranial surgery; drops 30 mm Hg,
 arterial BP at rest bleeding aneurysms. Safe stop infusion and
(antihypertensive effect). GI: Nausea, vomiting, use during pregnancy call prescriber
diarrhea, gastric upset, (category C), lactation, or Patient/family
constipation, increased in children is not education
LFTs established.  Caution patient to
avoid hazardous
GU: Nocturia, polyuria, Cautious Use: CHF activities until
acute renal failure (especially if patient is also stabilized on
receiving beta blocker), product and
INTEG: Rash, pruritus at conduction abnormalities; dizziness is no
inj site, flushing, renal or hepatic longer a problem
photosensitivity, burning impairment; older adults.  Instruct patient to
limit caffeine
RESP: Rhinitis, dyspnea, consumption; to
pharyngitis avoid grapefruit
juice; to avoid
alcohol and OTC
products unless
directed by
prescriber
 Teach patient to
use as directed
even if feeling
better; may be
taken with other
cardiovascular
products (nitrates,
b-blockers); how
to take pulse, B/P
before taking
product; to
change position
slowly
 Teach patient not
to discontinue
abruptly
Verapamil Adult: PO 240–480 mg/d Dilates coronary arteries CNS: Headache, Sick sinus syndrome, 2nd-  Monitor B/P and
in divided doses IV 5–10 and inhibits coronary drowsiness, dizziness, or 3rd-degree heart block, pulse, pulmonary
mg IV direct, may repeat artery spasm, which anxiety, depression, hypotension ,90 mm Hg capillary wedge
in 15–30 min if needed increases myocardial weakness, asthenia, systolic, cardiogenic shock, pressure (PCWP),
 oxygen delivery and fatigue, insomnia, severe CHF, Lown-Ganong central venous
Child: IV <1 y, 0.1–0.2 produces an antianginal confusion, light- Levine syndrome, Wolff- pressure, index,
mg/kg; 1–15 y, 0.1–0.3 effect. Also decreases headedness Parkinson-White syndrome often during inf;
mg/kg (2–5 mg) nodal conduction, which notify prescriber
results in an CV: Edema, CHF, Precautions: Pregnancy  if <50 bpm,
antiarrhythmic effect. bradycardia, hypotension, C, breastfeeding, children, systolic B/P <90
palpitations, AV block, geriatric, CHF, mm Hg
dysrhythmias hypotension, hepatic  Monitor ALT,
injury, renal disease, AST, bilirubin
GI: Nausea, diarrhea, concomitant b-blocker daily; if these are
gastric upset, therapy elevated,
constipation, elevated hepatotoxicity is
liver function tests suspected
 Monitor platelets;
GU: Impotence, nocturia, if
polyuria, gynecomastia <150,000/mm3 ,
product is usually
HEMA: Bruising,  discontinued and
petechiae, bleeding another product
started
INTEG: Rash, bruising  Assess for
extravasation;
MISC: Gingival  change site q48hr
hyperplasia  Monitor cardiac
status: B/P, pulse,
SYST: Stevens-Johnson respiration, ECG
syndrome  Monitor
renal/hepatic
function tests
during long-term
treatment, serum
potassium,
periodically.
 Advise patient to
increase
fluids/fiber to
counteract
constipation
 Caution patient to
avoid hazardous
 activities until
stabilized on
product and
dizziness is no
longer a problem
 Instruct patient to
limit caffeine
consumption; to
avoid alcohol,
grapefruit, and
OTC products
unless directed by
prescriber
 Advise patient to
comply with
medical regimen:
diet, exercise,
stress reduction,
product therapy;
to notify
prescriber of
irregular
heartbeat,
shortness of
breath, swelling
of feet and hands,
pronounced
dizziness,
constipation,
nausea,
hypotension, IV
calcium.
 Caution patient
not to discontinue
abruptly; chest
pain may occur
 Advise to report
chest pain,
palpitations,
irregular
heartbeat,
 swelling of
extremities, skin
irritation, rash,
tremors,
weakness.

CARDITONIC DRUGS
I. Cardiac Glycosides

THERAPEUTIC NURSING
DRUG DOSAGE ADVERSE EFFECTS CONTRAINDICATIONS
ACTION CONSIDERATIONS
Digoxin (Lanoxin) Digitalizing Dose Inhibits sodium- CNS: Headache, Hypersensitivity to  Assess and
Adult: PO 10–15 mcg/kg potassium ATPase, which drowsiness, apathy, digoxin, ventricular document apical
(1 mg) in divided doses makes more calcium confusion, disorientation, fibrillation, ventricular pulse for 1 min
over 24–48 h IV 10–15 available for contractile fatigue, depression, tachycardia, carotid sinus before giving
mcg/kg (1 mg) in divided proteins, resulting in hallucinations syndrome, 2nd- or 3rd- product; if pulse
doses over 24 h increased cardiac output; degree heart block <60 in adult or
increases force of CV: Dysrhythmias, <90 in an infant
Child: PO/IV <2 y, 40– contraction (positive hypotension, bradycardia, Precautions: Pregnancy C, or is significantly
60 mcg/kg; 2–10 y, 20–40 inotropic effect); AV block breastfeeding, geriatric, different, take
mcg/kg; >10 y, 10–15 decreases heart rate renal disease, acute MI, again in 1 hr; if
mcg/kg (1.5–2 mg) (negative chronotropic EENT: Blurred vision, AV block, severe <60 in adult, call
effect); decreases AV yellow-green halos, respiratory disease, prescriber; note
Neonate: PO/IV 30–50 conduction speed. photophobia, diplopia hypothyroidism, sinus rate, rhythm,
mcg/kg Decreased edema, pulse, nodal disease, character
respiration, crackles. GI: Nausea, vomiting, hypokalemia, electrolyte  Monitor
Premature anorexia, abdominal pain, disturbances, hypertension, electrolytes:
neonate: PO/IV 20 diarrhea cor pulmonale, Wolff- potassium,
mcg/kg Parkinson-White syndrome sodium, chloride,
magnesium,
calcium; renal
Maintenance Dose function studies:
Adult: PO/IV 0.1–0.375 BUN, creatinine;
mg/d other blood
studies: ALT,
Child: PO/IV <2 y, 7.5– AST, bilirubin,
9 mcg/kg/d; 2–10 y, 6– Hct, Hgb, product
7.5 mcg/kg/d; >10 y, levels (therapeutic
0.125–0.25 mg/d level 0.5-2 ng/ml)
Neonate: 6–7.5 mcg/kg/d before initiating
treatment and
Premature neonate: 3.75 periodically
mcg/kg/d thereafter
 Monitor
resolution of
atrial
dysrhythmias by
ECG; if
tachydysrhythmia
develops, hold
product; delay
cardioversion
while product
levels are
determined
 Monitor ECG
continuously
during parenteral
loading doses and
for patients with
suspected
toxicity; provide
hemodynamic
monitoring for
patients with
heart failure or
administer
multiple cardiac
products
 Caution patient to
avoid OTC
medications
including cough,
cold, allergy
preparations,
antacids, since
many adverse
product
interactions may
occur; do not take
 antacid at same
time.
 Instruct patient to
notify prescriber
of any loss of
appetite, lower
stomach pain,
diarrhea,
weakness,
drowsiness,
headache, blurred
or yellow-green
vision, rash,
depression; teach
toxic symptoms
of this product
and when to
notify prescriber
 Advise patient to
maintain a
sodium-restricted
diet as ordered; to
take potassium
supplements as
ordered to prevent
toxicity
 Instruct patient to
report shortness
of breath,
difficulty
breathing, weight
gain, edema,
persistent cough
 Teach patient
purpose of
product is to
regulate the
heart’s
functioning
 Teach patient as
 outpatient to
check and record
pulse for 1 min
before taking
dose; if there is a
change of >15
bpm from usual
pulse, prescriber
should be notified
 Teach patient to
take medication at
the same time
each day, take
missed doses
within 12 hr; do
not double doses;
notify prescriber
if doses are
missed for 2 days
or more; how to
monitor heart rate
 Teach patient
toxic symptoms
and when to
notify prescriber

II. Phosphodiesterase Inhibitors

THERAPEUTIC NURSING
DRUG DOSAGE ADVERSE EFFECTS CONTRAINDICATIONS
ACTION CONSIDERATIONS
Milrinone Adult: IV BOL 50 In therapeutic dose, CV: Dysrhythmias, Hypersensitivity to this  Monitor for
mcg/kg given over 10 increases myocardial hypotension, chest pain, product, severe aortic hypokalemia:
min; start INF of 0.375- contractility. Therefore, PVCs disease, severe pulmonic acidic urine,
0.75 mcg/kg/min; reduce increases cardiac output valvular disease, acute MI. reduced urine,
dosage in renal and decreases pulmonary GI: Nausea, vomiting, osmolality,
impairment wedge pressure and anorexia, abdominal pain, Precautions: Pregnancy C, nocturia;
vascular resistance, hepatotoxicity, jaundice breastfeeding, children, hypotension,
without increasing geriatric, renal/hepatic broad T-wave, U-
myocardial oxygen HEMA: disease, atrial wave, ectopy,
demand or significantly Thrombocytopenia flutter/fibrillation tachycardia, weak
increasing heart rate. pulse; muscle
MISC: Headache, weakness, altered
hypokalemia, tremor, LOC, drowsiness,
injection site reactions apathy, lethargy,
confusion,
depression;
anorexia, nausea,
cramps,
constipation,
distention,
paralytic ileus;
hypoventilation,
respiratory
muscle weakness
 Assess fluid
volume status:
complete I&O
ratio and record;
note weight,
distended red
veins, crackles in
lung; color,
quality, and
specific gravity of
urine; skin turgor,
adequacy of
pulses, moist
mucous
membranes,
bilateral lung
sounds, peripheral
pitting edema;
dehydration
symptoms of
decreasing output,
thirst,
hypotension, dry
mouth and
 mucous
membranes
should be
reported
 Monitor
electrolytes:
potassium,
sodium, calcium,
magnesium; also
include BUN,
blood pH, ABGs
 Monitor ALT,
AST, bilirubin
daily; if these are
elevated,
hepatotoxicity is
suspected
 Monitor platelets;
if
<150,000/mm3 ,
product is usually
discontinued and
another product
started
 Assess for
extravasation:
change site q48hr

VASODILATORS
I. ACE Inhibitors (…pril)

THERAPEUTIC NURSING
DRUG DOSAGE ADVERSE EFFECTS CONTRAINDICATIONS
ACTION CONSIDERATIONS
Captopril Adult: PO 25 mg tid; Effective in stepped CNS: Fever, chills Breastfeeding, children,  Hypertension:
may increase to 50 mg protocol management of hypersensitivity, heart Monitor B/P,
bid-tid; after 14 days may hypertension to convert to CV: Hypotension, block, potassium-sparing check for
increase to 150 mg tid if normotensive range, and postural hypotension, diuretics, bilateral renal orthostatic
needed in congestive heart failure tachycardia, angina artery stenosis,
with resulting decreases angioedema. hypotension,
in dyspnea and improved GI: Loss of taste, syncope; if
exercise tolerance. increased liver function Precautions: Dialysis  changes occur,
tests patients, hypovolemia,  dosage change
leukemia, scleroderma, LE, may be required
GU: Impotence, dysuria, blood dyscrasias, CHF,  Monitor renal
nocturia, proteinuria, diabetes mellitus, studies: protein,
nephrotic syndrome, renal/hepatic disease, BUN, creatinine;
acute reversible renal thyroid disease, African watch for
failure, polyuria, oliguria, descent, pregnancy (C) 1st increased levels
frequency trimester, collagen-vascular that may indicate
disease, hyperkalemia, nephrotic
HEMA: Neutropenia, hyponatremia syndrome and
agranulocytosis, renal failure;
pancytopenia, monitor renal
thrombocytopenia, symptoms:
anemia polyuria, oliguria,
frequency,
INTEG: Rash, pruritus dysuria,
MISC: Angioedema, potassium
hyperkalemia  Establish
baselines in renal,
RESP: Bronchospasm, liver function
dyspnea, cough tests before
therapy begins
and check
periodically;
monitor for
increased liver
function studies;
watch for
increased uric
acid, glucose
 Check potassium
levels throughout
treatment,
although
hyperkalemia
rarely occurs
 CHE: Assess for
edema, dyspnea,
 wet crackles,
increased B/P,
weight gain
 Assess for
allergic reactions:
rash, fever,
pruritus, urticaria;
product should be
discontinued if
antihistamines fail
to help
Adult: PO 2.5 mg 1–2 Antihypertensive effect CNS: Insomnia, Hypersensitivity to  CHF: monitor for
times/d, may increase up related to suppression of dizziness, paresthesias, enalapril or captopril. increased weight,
to 5–20 mg/d in 1–2 the renin-angiotensin- headache, fatigue, anxiety There has been evidence of rales, jugular vein
divided doses (max: 40 aldosterone system causes fetotoxicity and kidney distention, edema,
mg/d) vasodilation and, CV: Hypotension, chest damage in newborns difficulty
therefore, lower blood pain, tachycardia, exposed to ACE inhibitors breathing
pressure. Improvement in dysrhythmias, syncope, during pregnancy (category  Monitor
cardiac output results in angina, MI, orthostatic D). Safety during lactation electrolytes: K,
increased exercise hypotension or in children is not Na, Cl during 1st
tolerance. EENT: Tinnitus, visual established. 2 wk of therapy
changes, sore throat,  Monitor renal
double vision, dry Cautious Use: Renal studies: protein,
burning eyes impairment, renal artery BUN, creatinine;
stenosis; patients with increased levels
GI: Nausea, vomiting, hypovolemia, receiving may indicate
Enalapril
colitis, cramps, diarrhea, diuretics, undergoing nephrotic
constipation, flatulence, dialysis; patients in whom syndrome and
dry mouth, loss of taste, excessive hypotension renal failure
hepatotoxicity would present a hazard  Monitor renal
(e.g., cerebrovascular symptoms:
GU: Proteinuria, renal insufficiency); CHF; polyuria, oliguria,
failure, increased hepatic impairment; frequency,
frequency of polyuria or diabetes mellitus. dysuria
oliguria  Establish
baselines in renal,
HEMA: Agranulocytosis, liver function
neutropenia tests before
therapy begins
INTEG: Rash, purpura, and 1 wk into
alopecia, hyperhidrosis,
photosensitivity therapy, avoid
activities
META: Hyperkalemia requiring
coordination
RESP: Dyspnea, dry  Check potassium
cough, crackles levels throughout
treatment,
SYST: Toxic epidermal although
necrolysis, Stevens- hyperkalemia
Johnson syndrome, rarely occurs
angioedema  Check for edema
in feet, legs daily
 Assess for
allergic reactions:
rash, fever,
pruritus, urticaria;
product should be
discontinued if
antihistamines fail
to help
 Teach patient not
to use OTC
products (cough,
cold, allergy
medications)
unless directed by
physician, to
avoid potassium,
salt substitutes;
serious side
effects can occur;
xanthines, such as
coffee, tea,
chocolate, cola,
can prevent action
of product
 Emphasize the
need to rise
slowly to sitting
or standing
 position to
minimize
orthostatic
hypotension; not
to exercise in hot
weather, which
can cause
increased
hypotension
 Advise patient to
notify prescriber
of mouth sores,
sore throat, fever,
swelling of hands
or feet, irregular
heartbeat, chest
pain, coughing,
shortness of
breath
 Caution patient to
report excessive
perspiration,
dehydration,
vomiting,
diarrhea; may
lead to fall in B/P
 Caution patient
that product may
cause skin rash or
impaired
perspiration; that
angioedema may
occur and to
discontinue if it
occurs
 Caution patient
that product may
cause dizziness,
fainting, light-
headedness; may
occur during 1st
 few days of
therapy; to avoid
activities that may
be hazardous

II. Nitrates

THERAPEUTIC CONTRAINDICATION NURSING

DRUG DOSAGE ADVERSE EFFECTS
ACTION S CONSIDERATIONS
Nitroglycerine Adult: Sublingual 1–2 Therapeutic doses may CNS: Headache, apprehension, Hypersensitivity,  Administer IV
sprays (0.4–0.8 mg) or a reduce systolic, blurred vision, weakness, idiosyncrasy, or tolerance nitroglycerin
0.3–0.6-mg tablet q3– diastolic, and mean BP; vertigo, dizziness, faintness.  to nitrates; severe anemia; with extreme
5min as needed (max: 3 heart rate is usually head trauma, increased caution to
doses in 15 slightly increased. CV: Postural ICP; glaucoma patients with
min) PO 1.3–9 mg q8– Produces antianginal, hypotension, palpitations, (sustained-release forms).
hypotension or
12h IV Start with 5 antiischemic, and tachycardia (sometimes with Also (IV nitroglycerin):
mcg/min and titrate q3– antihypertensive effects. paradoxical bradycardia), hypotension, uncorrected hypovolemia
5min until desired increase in angina, syncope, hypovolemia, constrictive since the IV
response Transdermal and circulatory collapse.  pericarditis, pericardial drug may
Unit Apply once q24h or tamponade; pregnancy precipitate a
leave on for 10–12 h, GI: Nausea, vomiting, (category C), lactation. severe
then remove and have a involuntary passing of urine and hypotensive
10–12 h nitrate free feces, abdominal pain, dry Cautious Use state.
interval Topical Apply mouth.   Monitor patient
1.5–5 cm (½–2 in) of Severe liver or kidney closely for
ointment q4–6h Hematologic: Methemoglobine disease, conditions that change in levels
mia (high doses).  cause dry mouth, early of
Child: IV 0.25–0.5 MI.
mcg/kg/min, titrate by Skin: Cutaneous vasodilation consciousness
0.5–1 mcg/kg/min q3–5 with flushing, rash, exfoliative and for
min dermatitis, contact dermatitis dysrhythmias.
with transdermal patch; topical IV nitroglycerin
allergic reactions with ointment: solution
pruritic eczematous contains a
eruptions, anaphylactoid substantial
reaction characterized by oral amount of
mucosal and conjunctival ethanol as
edema.  diluent. Ethanol
intoxication can
Body as a Whole: Muscle
develop with
twitching, pallor, perspiration, high doses of IV
cold sweat; local sensation in nitroglycerin
oral cavity at point of (vomiting,
dissolution of sublingual forms. lethargy, coma,
breath smells of
alcohol). If
intoxication
occurs, infusion
should be
stopped
promptly;
patient recovers
immediately
with
discontinuation
of drug
administration.
 Be aware that
moisture on
sublingual
tissue is
required for
dissolution of
sublingual
tablet. However,
because chest
pain typically
leads to dry
mouth, a patient
may be
unresponsive to
sublingual
nitroglycerin.
 Assess for
headaches.
Approximately
50% of all
 patients
experience mild
to severe
headaches
following
nitroglycerin.
Transient
headache
usually lasts
about 5 min
after sublingual
administration
and seldom
longer than 20
min. Assess
degree of
severity and
consult as
needed with
physician about
analgesics and
dosage
adjustment.
 Supervise
ambulation as
needed,
especially with
older adult or
debilitated
patients.
Postural
hypotension
may occur even
with small doses
of nitroglycerin.
Patients may
complain of
 dizziness or
weakness due to
postural
hypotension.
 Take baseline
BP and heart
rate with patient
in sitting
position before
initiation of
treatment with
transdermal
preparations.
 One hour after
transdermal
(ointment or
unit) medication
has been
applied, check
BP and pulse
again with
patient in sitting
position. Report
measurements
to physician.
 Assess for and
report blurred
vision or dry
mouth.
 Assess for and
report the
following
topical
reactions.
Contact
dermatitis from
the transdermal
 patch; pruritus
and erythema
from the
ointment.
 Be aware that
local burning or
tingling from
the sublingual
form has no
clinical
significance.
 Be alert for
overdose
symptoms:
Hypotension,
tachycardia;
warm, flushed
skin becoming
cold and
cyanotic;
headache,
palpitations,
confusion,
nausea,
vomiting,
moderate fever,
and paralysis.
Tissue hypoxia
leads to coma,
convulsions,
cardiovascular
collapse. Death
can occur from
asphyxia.
 Spit out the rest
of your
sublingual tablet
 as soon as pain
is completely
relieved,
especially if you
are experiencing
unpleasant
adverse effects
such as
headache. Relax
for 15–20 min
after taking
tablet to prevent
dizziness or
faintness.
 Be aware that
pain not
relieved by 3
sublingual
tablets over a
15-min period
may indicate
acute MI or
severe coronary
insufficiency.
Contact
physician
immediately or
go directly to
emergency
room.
 Note:
Sublingual
tablets may be
taken
prophylactically
5–10 min prior
to exercise or
 other stimulus
known to trigger
angina (drug
effect lasts 30–
60 min).
 Keep record for
physician of
number of
angina attacks,
amount of
medication
required for
relief of each
attack, and
possible
precipitating
factors.
 Be aware that
contact with
water
(swimming,
bathing) does
not affect your
transdermal
unit.
 Remove
transdermal unit
or ointment
immediately
from skin and
notify physician
if faintness,
dizziness, or
flushing occurs
following
application.
 You can use a
 sublingual
formulation
while
transdermal unit
or ointment is in
place.
 Report blurred
vision or dry
mouth. Both
warrant
withdrawal of
drug.
 Change position
slowly and
avoid prolonged
standing.
Dizziness, light-
headedness, and
syncope (due to
postural
hypotension)
occur most
frequently in
older adults.
 Do not drink
alcohol too soon
after taking
nitroglycerin. It
may cause
severe postural
hypotension
(sharp drop in
BP), vertigo,
flushing, or
pallor if you
drink alcohol
too soon after
 taking
nitroglycerin.
 Report any
increase in
frequency,
duration, or
severity of
anginal attack.
 Withdraw
gradually after
prolonged use to
prevent
precipitating
anginal attack.
 Do not breast
feed while
taking this drug
without
consulting
physician.
