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NUR 393 Fall 2015

Cardiac Drug List


Digitalis (digoxin)
Desired action increase the force of myocardial contraction
Prolongs refractory period of the AV node
Decreases conduction through SA and AV node
Therapeutic effect- increase cardiac output, slow heart rate
Indications- heart failure, a fib/a flutter (slow ventricular rate), paroxysmal a. tach
( inc filling time and CO)
Side effects dizzy, n/v/d, headache, rash, weak, anxiety
Adverse effects- change in heart rhythm, blurry vision, halos
Lab values (V/S, electrolytes) therapeutic range 0.5 -2.0
Drug Drug interaction avoid antacid and laxative, bb, anticholinergics
EKG changes shortens QR and down slope ST segment
Patient teaching take pulse hold < 60 < bp 100
Diet k+ rich foods
Antidote- digibind digifab
Nursing care: take apical pulse 1 min , monitor labs / patient /

Furosemide (Lasix)
Action inhibits reabsorption of sodium and chloride from LOH and distal renal
tubules
Therapeutic effect : diuresis and lowers bp
Indications :edema from heart failure , renal disease, high bp
s/e: dizzy lighthead, a/v/n
adverse: skin rash , ear ringing muscle weakness cramps
lab values (v/s , electrolytes) losing k+ less than 3.5, low bp
interactions: dig. Lithium inc their toxicity, nsaids decrease action

patient teaching/ diet: change position slowly (OH) potass rich diet (banana, oj,
avocado). Take in the am. report weight gain,
nursing care : monitor I& Os daily take bp and pulse listen to lungs
outcome: decrease in edema, weight, bp, increase urine

Spironolactone (Aldactone)
Therapeutic effect- same as Lasix but potassium sparing
Indications- edema chf patient on dig

Side effects Fluid or electrolyte imbalance, gynecomastia, GI upset,


drowsiness, headache, hyponatremia; tachycardia, hypotension, oliguria,
hyperkalemia; confusion, weakness, paresthesia, hirsutism, mental disturbances,
menstrual irregularities, loss of libido and impotence.

Adverse effectsLab values (V/S, electrolytes) k+ levels bun serum,.,


EKG changes
Patient teaching
Diet less k+ foods
AntidoteNursing care: check bp. Hr prior and after. report weight gain weakness cramps ios

Metoprolol (Lopressor) same as carvedilol (coreg)


Desired action block beta receptor stimulation
Therapeutic effect- decrease hr , bp , frequency of angina
Indications- hypertension, angina , mi prevention, manage stable heart failure
Side effects bronchospasm , hyper/hypoglycemia fatigue weakness anxiety dizzy
nervous nightmares c/n/v, dec libido
Adverse effects- bradycardia , hf, p. edema
Lab values (V/S, electrolytes)

Drug int: dec eff dopamine and dobutamine


EKG changes
Patient teaching pulse
Diet
AntidoteNursing care: Monitor BP, ECG, and pulse frequently. Monitor vital signs and ECG
Monitor intake and output ratios and daily weights. Assess routinely for signs and
symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular
venous distention).

Coumadin (Warfarin sodium)


Desired action anticoagulant, long term use takes few days to work
Therapeutic effect- prevent thromboembolism
Indications- preventative DVT, MI, valve replacement, PE, a fib
Side effects cramps nausea red orange urine
Adverse effects- bleeding
Lab values (V/S, electrolytes) monitor PT . INR (2-3)
Drug no Tylenol
EKG changes
Patient teaching s/s bleeding soft bristle brush
Diet no high vit k foods dark green veg
Antidote- vit k.. serious plasma whole blood
Nursing care: Assess for signs of bleeding and hemorrhage (bleeding gums;
nosebleed; unusual bruising; tarry, black stools; hematuria; fall in hematocrit or BP;
guaiac-positive stools, urine, or nasogastric aspirate).
Assess for evidence of additional or increased thrombosis. Symptoms depend on
area of involvement.

Nitroglycerin
Desired action direct vasodilator
Therapeutic effect- incr blood flow more oxygen less pain
Indications- angina , CHF,MI
Side effects headache, dizzy, hypotension, tachycardia
Adverse effects-
Lab values (V/S, electrolytes) bp/ hr
Drug
EKG changes may be tachy
Patient teaching 1t q5 for 3 doses still pain emergency call
Take before activity, rest before you take in, keep in container
Diet
AntidoteNursing care: hr/bp

Enoxaprin (Lovenox)
Desired action anticoag. Low mole hep, predictable response

Therapeutic effect- prevent thrombi


Indications- dvt ,pe, unstable angina no q wave mi
Side effects same as warfarin
Adverse effectsLab values (V/S, electrolytes) cbc platelet occult blood no PTT
Drug asa, nsaids othrr anticoag
EKG changes
Patient teaching same as warf blood dark urine
Diet

Antidote- prot,sulfate
Nursing care:same as warf

Heparin
Desired action inhibits antithrobin factors fibrinogen and platelet
Therapeutic effect- prevent clot
Indications- dvt, a fib,
Side effects fever, chills, n/v
Adverse effects- bleeding
Lab values (V/S, electrolytes)
Drug recent surgery dont use
EKG changes
Patient teaching s/s bleeding
Diet
Antidote- p. sulfate
Nursing care: frequent testing

Dalteparin (Fragmin)
Desired action same as other anticoag

Clopidogrel (Plavix)
Desired action prevent clumping
Therapeutic effect prevent platelet aggragation
Indications- acute coronary disease history of MI
Side effects h/a dizzy weakness syncope flushing rash edema hpt

Adverse effectsLab values (V/S, electrolytes)


Drug nsaids
EKG changes
Patient teaching
Diet with meals
AntidoteNursing care :report s/s

Dopamine (Dobutrex)

Desired action stimulates alpha beta

Therapeutic effect- positive inotropic increase cardiac output inc bp (systolic) and
pulse pressure
Indications- MI, traua, open heart surgery CHF
Side effects hypotension, angina , headache
Adverse effectsLab values (V/S, electrolytes)
Drug dont use tach or v fib
EKG changes may see widen qrs not good
Patient teaching
Diet
Antidote- regitine (phentolamine)
Nursing care: get ekg..cont cardiac monitor .foley cath Monitor blood pressure,
pulse, peripheral pulses, and urinary output at intervals prescribed by physician.
Precise measurements are essential for accurate titration of dosage.

Report the following indicators promptly to physician for use in decreasing or


temporarily suspending dose: Reduced urine flow rate in absence of hypotension;
ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure
(marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis,
mottling, coldness, complaints of tenderness, pain, numbness, or burning
sensation).
Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine
flow, other indices of adequate dosage and perfusion of vital organs include loss of
pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal
of confusion or comatose state.

Dobutamine
Desired action same as dopamine.Renal protective
Therapeutic effect- inc HR
IndicationsSide effects
Adverse effectsLab values (V/S, electrolytes)
Drug
EKG changes
Patient teaching Monitor ECG, HR, BP, Cardiac output, and pulmonary wedge
pressure continuously
Caution should be used to prevent infiltration at injection site
Hypovolemia should be corrected before administrating drug w/ plasma expanders
Complete physical assessment and focused cardiac assessment prior to
administration
Hypersensitivity Rxn: skin rash, fever, eosinophilia, and bronchospasm
Digitalis preparation prior to admin in patients with a fib w/ rapid ventricular
response d/t AV conduction
Diet
AntidoteNursing care:

Adenocard (Adenosine) emergency drug

Desired action antidys slows entry av

Therapeutic effectIndications- SVT


Side effects /adverse: chest pain hypotension palp dizzy
Lab values (V/S, electrolytes)
Contraind 2nd 3rd block asthma
EKG changes
Patient teaching
Diet avoide caffeine alcohol
AntidoteNursing care: ecg . bp.lung sounds,k+, ios

Amiodarone (Cordarone)
Desired action antiarr
Therapeutic effect- normal RR
Indications- v fib pulseless v tach
Side effects
Adverse effectsLab values (V/S, electrolytes)
EKG changes inc pr interval
Patient teaching same as adenosine
Nursing care:

Epinepherine emergency drug


Desired action vasoconstricter bronchodilator
Therapeutic effect- restore rhythm in cardiac arrest inc bp
Indications- cardiac arrest
Side effects h/a, tremors insomnia
Lab values (V/S, electrolytes) hr bp
Nursing care: auscultate breath sounds

Amlodipine/Diltiazem (Cardizem) check bp/hr


Desired action calcium channel blocker
Indications- stable angina . a fib , flutter
Side effects headache, dizz, n/v axiety