ACE inhibitor Indication:

Prevention of cardiovascular disorders Congestive heart failure Hypertension Left ventricular dysfunction Prevention of nephropathy in diabetes mellitus

SI: cough,elevated blood potassium levels,low blood pressure, dizziness,

headache, drowsiness, weakness, abnormal taste (metallic or salty taste), and rash.

AV: Renal impairment. Angio-oedema. - Pancreatitis. - Upper respiratory tract symptoms. - Gastrointestinal effects. - Altered liver function, jaundice and hepatitis. Blood disorders. Nsg reponsi In patients taking diuretics, close supervision is needed when commencing treatment. The initial dose of ACE has a risk of first-dose hypotension, therefore patients should be advised to sit or lie down for 2-4 hours after this. Advise patients to avoid driving and other hazardous work until they are confident that they have no dizziness or fainting from possible hypotensive side-effects. Avoid excess intake of alcohol since this can enhance hypotensive effect. Advise patients to rise slowly in order to avoid postural hypotension.

Angiotensin II antagonist Indication: controlling high blood pressure, treating heart failure, and preventing kidney failure in people with diabetes or high blood pressure ARBs may also prevent the recurrence of atrial fibrillation Si: cough, elevated potassium levels in the blood (hyperkalemia), low blood pressure, dizziness, headache, drowsiness, diarrhea, abnormal taste sensation (metallic or salty taste), and rash AV: ide effects are kidney failure, liver failure, allergic reactions, a decrease in white blood cells, and swelling of tissues (angioedema). Nsg repsom: Monitor patients blood pressure> symptomatic hypotension may occur If hypotension occurs have the patient lie down and give fluid volume expanders Monitor patient for s/sx of angio edema In patient with intravascular volume depletion, correct the depletion before starting the treatment Teach the patient and his caregiver about the drug Calcium channel blocker Indi: high blood pressure, angina, and abnormal heart rhythms Si: constipation, nausea, headache, rash, edema (swelling of the legs with fluid), low blood pressure, drowsiness, and dizziness. AV: Liver dysfunction and over growth of gums may also occur, sexual dysfunction. Nsg r: Tell patients to report dizziness and symptoms of an irregular heart rate. Teach your patients to avoid grapefruit juice because it inhibits the hepatic metabolism of calcium channel blockers and may lead to increased blood drug levels and increased pharmacologic effects. All calcium channel blockers should be used cautiously in patients with heart failure. Drugs that inhibit cytochrome P450 isoenzymes, such as erythromycin, inhibit the metabolism of amlodipine and may result in a stronger antihypertensive effect. -monitor bp

Centrally acting adrenergics

Ind: High blood pressure Hot flashes Alcohol or drug withdrawal Attention-deficit/hyperactivity disorder (ADHD) Tourette syndrome

Si: Drowsiness or sedation Dizziness C onstipation Dry mouth HeadacheWeight gain av: Extreme fatigueImpotencePsychological problems, such as depression nsg r: 2. Watch for orthostatic hypotension especially in elderly. 1. Monitoring a. Monitor B/P closely b. Weight daily 3-4 days as Na++/H2O retention may be a problem.
3. Instruct client to take last dose before bedtime to ensure continuous blood pressure control during night and reduce daytime drowsiness if taking oral form of drug. 4. Avoid alcohol, prolonged standing, and exercising loop diuretics ind: to Hypertension,

CHF (in the presence of renal insufficiency or for immediate effect). ARF, CRF, ascites, and nephrotic syndrometreat water imbalances associated with congestive
heart failure and kidney failure.

Si: low blood volume which leads to dehydration and low blood pressure. The levels of sodium, potassium and magnesium in the blood decrease and the pH of the blood increase above the normal range. Av: hearing loss. Taking loop diuretics over a long period of time reduces the ability of arterial walls to resist blood flow Nsg r: Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs ,, Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.,, Monitor for S&S of hypokalemia,, Ingest potassium-rich foods daily,, Ingest potassium-rich foods daily

Potassium sparing diuretics Indication: CHF. CLD Si: Frequent urination Arrhythmia Extreme tiredness or weaknessMuscle cramps or weaknessDizziness, lightheadednessFever, sore throat, cough, ringing in the ears, Av: Hyperkalemia is a common side effect of these medications. GI disturbances, including nausea, vomiting, diarrhea, anorexia can occur. Nsg r: Weigh patient under standard conditions before therapy begins and daily throughout therapy. . For patients with ascites, physician may want measurements of abdominal girth. Observe for and report immediately the onset of mental changes, lethargy, or stupor in patients with liver disease. Adverse reactions are generally reversible with discontinuation of drug. Be aware that the maximal diuretic effect may not occur until third day of therapy and that diuresis may continue for 23 d after drug is withdrawn. Report signs of hyponatremia or hyperkalemia Carbonic anhydrase Inhibitors Indi: Acetazolamide is used to decrease intraocular pressure in the treatment of glaucoma. It is also used as a diuretic. Acetazolamide can be used as an andjunct in the treatment of refractory seizure disorders and can also prevent altitude sickness.

Si Weakness,Diarrhea Increased urinary frequency Decreased appetite Decreaseweight Metallic taste Nausea and vomiting Paresthesia Headache Photosensitivity Confusion Tinnitus

Av: Nephrotoxicity or HepatotoxicityBone marrow depression Nsg r: Obtain history of seizure disorder.May increases digoxin levels.

Report presence of tingling or tremors in the hands or feet. Report for unusual bleeding or bruising. Inform physician of Unexplained fever, sore throat, or flank pain.

Osmotic diuretics Indication: acute renal failure, glaucoma, post-traumatic intracranial hypertension,
and non-traumatic encephalopathies such as Reyes syndrome.

SI: Increased urination; nausea; runny nose; vomiting. Av: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; chest pain; chills or fever; confusion;difficulty urinating; extreme dizziness; extreme thirst or dry mouth; fast or irregular heartbeatmuscle cramps Nsg r: . Vital signs 2. Intake and output 3. Central venous pressure Pulmonary artery pressure Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst)Signs of electrolyte imbalance/deficit antianginal/nitrates indi: treatment of angina pectoris si: Headache, dizziness, flushing, rapid heartbeat or restlessness av: rash, itching, swelling, dizziness, trouble breathing nsg r: Monitor ECG and vital signs closely, especially blood pressure.

In suspected overdose, assess for signs and symptoms of increased intracranial

pressure. Inform patient that drug may cause headache. Advise him to treat headache as usual and not to alter drug schedule. If headache persists, tell him to contact prescriber. Instruct patient to move slowly when sitting up or standing, to avoid dizziness or lightheadedness from sudden blood pressure decrease. As appropriate, review all other significant adverse reactions and interaction

Beta adrenergic blockers Beta blockers are used for treating: abnormal heart rhythm, high blood pressure, heart failure, angina (chest pain), tremor, pheochromocytoma, and prevention of migraines. SI: Decreased sexual ability; dizziness or lightheadedness; drowsiness (slight); trouble in sleeping; unusual tiredness or weakness Av: Breathing difficulty and/or wheezing; cold hands and feet; mental depression; shortness of breath; slow heartbeat (especially less than 50 beats per minute); swelling of ankles, feet, and/or lower Antiarrhytmics Indi: Preventing or treatment of atrial or ventricular arrhythmias including those secondary to MI or digitalis toxicity Si: dry mouth and throat, diarrhea, and loss of appetite Av: fever and chills difficult urination swollen or painful joints pain when breathing skin rash or itching cardiac glycoside indi: treatment of congestive heart failure and cardiac arrhythmia si: Diarrhea; nausea. Av: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision, yellow vision, or other vision changes; confusion; fast, slow, or irregular heartbeat; hallucinations; mood or mental changes (eg, depression) Nsg r: blood samples are best taken 6-8 hours after dose or just before next dose. May be given without regard to meals. Tablets may be crushed. Monitor pulse for bradycardia, EKG for arrhythmias for 1-2 hours after administration (excessive slowing of pulse may be a first clinical sign of toxicity). Assess for GI disturbances, neurologic abnormalities (signs of toxicity) every 2-4 hours during digitalization (daily during maintenance).

Antihyperlipidemia Indi: hypercholesterolemia hyperlipoproteinemia hypertriglyceridemia myocardial infarction prophylaxis si: ou have muscle problems like weakness, tenderness, or pain that happen without a good reason, especially if you also have a fever or feel more tired than usual You have allergic reactions including swelling of the face, lips, tongue, and/or throat that may cause difficulty in breathing or swallowing, which may require treatment right away You experience nausea and vomiting You pass brown or dark-colored urine You feel more tired than usual Your skin and whites of your eyes get yellow You have stomach pain You have an allergic skin reaction av: Muscle problems. Liver problems nsg r: Advise patient to notify prescriber immediately if he develops unexplained muscle pain, tenderness, or weakness, especially if accompanied by fatigue or fever. - Instruct patient to consult prescriber before taking OTC niacin because of increased risk of rhabdomyolysis. - Instruct patient to take a missed dose as soon as possible. If its almost time for his next dose, he should skip the missed dose. Tell him not to double the dose. - - Expect to measure lipid levels 2 to 4 weeks after therapy starts - - Also expect drug to be used in patients with type 2 diabetes who have no obvious CAD but multiple risk factors anticoagulant indi- - Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation, and following heart valve insertion. - Prophylaxis and treatment of venous thromboembolism and transient ischaemic attacks. si: Bleedingpain in the side or lower back,Coughing, having a hoarse voice and being short of breath excessive gas, diarrhea, cramping, less appetite, nausea and vomiting av: blisters, itching, toes turning purple and hurting, red skin sores, urinating changes, swelling in the face, legs and feet, and a jaundiced appearance to the skin or eyes

thrombo indi: ST elevation myocardial infarction.Arterial thrombosis. Deep vein thrombosis. Pulmonary embolism. Intra-arterial or intravenous catheter occlusion. Nsg r: Initial care is determined by the complications of
both thrombolytic therapy and MI. monitor bp Hypotension may occur due to release of bradykinin. Rigors, rash, flushing, dyspnoea and occasionally bronchospasm may be reported. Rigors, rash, flushing, dyspnoea and occasionally bronchospasm may be reported. Respiration rate and oxygen saturation should be monitored and oxygen therapy given to maintain oxyhaemoglobin saturation levels at 95 per cent positive inotropic agents