ATI Flashcards
Hydralazine
Available in oral, IM, or IV forms
Give oral dose with food to enhance effectiveness
Oral dosage usually begins low and is gradually increased
Administer IV form undiluted; do not add to other solutions
Adverse effects: Headache, dizziness, weakness and fatigue
Reflex Tachycardia
A systemic lupus erythematosus (SLE)-like syndrome can occur (facial rash, joint pain, fever, nephritis, pericarditis) – most likely with high doses
Fluid retention, edema
Abrupt withdrawal can cause hypertensive crisis and heart failure
hydrochlorothiazide
Available orally alone and in fixed-dose combination with multiple other drugs, such as potassium-sparing diuretics, ACE inhibitors, ARBs, beta blockers and other antihypertensive drugs
Chlorothiazide is available in IV form
Give with food to minimize GI effects
Give last dose of day by 3 p.m. to prevent nocturia and sleep loss
Adverse effects: Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss (dehydration), and hypokalemia (most common)
Hyperglycemia (especially in clients who are diabetic)
Increased uric acid levels (hyperuricemia) with possible gouty arthritis in susceptible clients
Furosemide
Available for oral, IM, or IV use
Give oral form with food to prevent GI symptoms
If prescribed more than once daily, give second dose by early afternoon to prevent nocturia and sleep loss
Give IV form undiluted; administer slowly to prevent ototoxicity
Protect all forms from light; store oral solution in refrigerator and other forms at controlled room temperature
Adverse effects: Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss (dehydration), and hypokalemia
Hypotension
Ototoxicity (all loop diuretics can be temporary or permanent depending on the specific drug)
Hyperglycemia (especially in clients who have diabetes mellitus)
Increased uric acid levels (hyperuricemia) with possible gouty arthritis in susceptible clients
Digoxin
Available as oral tablets, capsules, and elixir, as well as for IV use
Give oral form with or without food
Tablets may be crushed and mixed with food if necessary
IV form may be administered directly over at least 5 min; monitor site carefully for infiltration, which can cause tissue damage
Adverse effects: Cardiac dysrhythmias, especially likely with digoxin toxicity
Any dysrhythmia may occur, with AV block being most common
GI symptoms – early signs of toxicity
Nausea, vomiting, anorexia
CNS symptoms
Fatigue, visual disturbances, such as yellow vision and blurred vision
Increased mortality in women
Dobutamine
Available for IV infusion only
Dose based on client’s weight and titrated based on continuous monitoring of vital signs, ECG, urine output, and (if available) cardiac output and pulmonary wedge pressures
Peak effect obtained about 10 minutes after infusion begins
Multiple infusion incompatibilities exist; use dedicated IV line for infusion
Correct any fluid volume deficits before administering dobutamine
Adverse effects: Tachycardia, cardiac dysrhythmias, and possible angina pain
Milrinone
Available for IV infusion only
Give a loading dose over
10 minutes and then administer a dose based on client’s weight by continuous infusion
Some solution incompatibilities exist; use dedicated IV line if possible
Adverse effects: Hypokalemia
Cardiac dysrhythmias, hypotension
Anginal chest pain
Atorvastatin
Available orally only
For greatest effectiveness, take in the evening with or without food (take one statin, lovastatin [Mevacor], with food for better absorption)
Adverse effects: Myopathy (pain in muscles, which can progress to rhabdomyolysis [breakdown of muscle protein causing kidney damage])
Hepatotoxicity
Gemfibrozil
Available oral use only
Usually taken twice daily, 30 minutes before breakfast and evening meals
Monitor periodic LDL, HDL, triglyceride, and total cholesterol levels for improvement
Adverse effects: GI symptoms: nausea, abdominal pain, diarrhea
Gallstones
Myopathy (pain in muscles)
Liver toxicity
Nitroglycerin and Isosorbide
Nitroglycerin available as sublingual tablets, sustained-release capsules or tablets, a translingual spray or transmucosal tablets, transdermal ointment or patch, and IV form
Two types of isosorbide are available
isosorbide dinitrate (Isordil) available in regular, chewable, sublingual or sustained release tablets.
isosorbide mononitrate (Ismo, Imdur) available in sustained release and immediate release tablets or capsules
Place sublingual tablets under tongue to dissolve when chest pain starts; if not relieved in 5 minutes, call 911, take a second tablet; take a third tablet 5 minutes later if no relief
Sublingual sprays: Dose equals 1 or 2 sprays; as for sublingual tablets, no more than 3 doses in a 15-minute period
Client should not swallow transdermal or transmucosal tablets; may need to moisten mouth to help tablet dissolve
Store tablets in a dark tightly closed container for no more than 24 months after opening.
Transdermal patches are for prevention only; apply to a hairless area and rotate sites.
Remove patches for 10–12 hours daily to prevent tolerance; apply patch in morning, remove at night.
Topical ointment: dosage measured as amount squeezed from tube (e.g. 2 inches = 30 mg); apply to dry skin and cover area with plastic wrap.
When discontinuing long-acting forms, taper doses to prevent increased chest pain (vasospasm)
IV form is infused continuously in a glass bottle with special tubing only
Adverse effects: Headache (severe at first, reduced with treatment)
Orthostatic hypotension
Tachycardia
Tolerance develops quickly to all forms (decreased effectiveness)
Quinidine and Procainamide
Available in oral, IM and IV forms
IM administration is painful and has poor absorption
Oral dosing is preferred – Give oral dose 1 hr before or 2 hr after meals for best absorption; give with food if GI symptoms occur
Do not crush or chew extended-release tablets
If giving IV procainamide, wait 4 hr before administering an oral dose
For IV doses, use an IV pump and infuse at recommended rate and dilution
Multiple IV solution incompatibilities exist; avoid infusing with other drugs or solutions
Adverse effects: GI symptoms: nausea, vomiting, diarrhea
Tachycardia (more frequent with quinidine due to anticholinergic effects)
Hypotension (less severe with oral administration than IV)
Widen the QRS complex and prolongs QT interval
Ventricular dysrhythmias occur due to toxicity; oral or IV therapy (QRS too wide or QT interval too long)
Arterial embolism (caused by dislodging small clots) if treating atrial fibrillation
Speed shock with too rapid IV infusion (flushing, headache, irregular heart rate, severe hypotension, loss of consciousness, cardiac arrest)
Quinidine: cinchonism (tinnitus, visual disturbances, headache, nausea, vomiting)
Procainamide: systemic lupus erythematosus-like syndrome (SLE) seen in 70% of clients after 1 year of oral therapy)
Blood dyscrasias (procainamide with continued use)
Lidocaine
Available for IV infusion (IV preferred for dysrhythmias; local administration for anesthesia only)
IM administration is for emergency use only
Add 2 g lidocaine to 250 or 500 mL D5W and infuse at 1 to 4 mg/minute (per prescription) using an IV pump
Assure that the correct lidocaine preparation is used for the specific type of therapy (e.g. labeled for IV use only)
Incompatible in solution or tubing with other drugs, such as some antibiotics, phenytoin
Adverse effects: CNS effects (toxicity): confusion, drowsiness, restlessness, paresthesias, muscle twitching or tremors, seizures, respiratory arrest
Hypotension, bradycardia, heart block with high doses
Flecainde and Propafenone
Available for oral use only
Begin with low dose and increase gradually no more frequently than every 4 days until maximum or desired dose has been reached
Adverse effects: Dizziness, dyspnea, and visual disturbances
Worsening of heart failure; edema
Widen QRS complex; prolongs QT and PR intervals
Potential for 1st degree AV block; multiple dysrhythmias may occur
Instruct on temporary use of Holter monitor if necessary
Propranolol
Available for oral or IV use
Use the IV route to treat life-threatening dysrhythmias
Take either with or without food at consistent times during the day to minimize adverse effects
Take client’s BP and pulse before administering propranolol; withhold drug and notify provider if BP is below 90 mm/Hg systolic or if pulse is slower than 60 beats/min
Give IV dose either directly by IV bolus over 1 minute or give an intermittent infusion over 15 to 20 minutes
Adverse effects: Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output
Heart failure
Rebound excitation causing angina pain or MI with sudden withdrawal of beta blocker in client with CHD
Peripheral arterial insufficiency (similar to Raynaud’s disease)
CNS effects: confusion, fatigue, drowsiness
Amiodarone
Available for oral and IV use
Give oral amiodarone with or without food, but at consistent times during the day
Infuse IV dose through central line catheter to prevent thrombophlebitis of peripheral IV sites
Begin oral dosing with hospitalized client
Correct low potassium or magnesium levels before beginning therapy
Adverse effects: GI symptoms: anorexia, nausea, vomiting, constipation
ARDS, Pulmonary toxicity with pneumonitis (causing fever, cough, shortness of breath) – occur most frequently with long-term and/or high dose use and may lead to pulmonary fibrosis
Dizziness, fatigue, malaise, ataxia, paresthesia and corneal microdeposits Cardiac effects: Bradycardia and hypotension (common with IV dose)
Heart failure may be worsened by amiodarone therapy
Blue-grey discoloration of skin
Verapamil
Available for oral or IV use
Give oral dose with food to prevent GI upset
IV form: give dose using recommended dilution over 2 to 3 minutes; monitor cardiac rhythm and vital signs continuously
Adverse effects: Hypotension, especially with IV dose or overdose
Bradycardia, especially with IV dose, but also with oral therapy
Heart failure, peripheral edema of feet and legs
Lightheadedness, dizziness (caused by vasodilation)
