Cardiovascular Medications (162) Flashcards
METOLAZONE: Nursing Considerations
- Diuresis onset 1 hour, peak 2 hours, duration 12–24 hours
- Take with meals or just after to decrease gastric symptoms, slightly decreased absorption
- Avoid changing positions (sitting/standing/lying) rapidly
- Take in morning to avoid interference with sleep
- Rx; Preg Cat B
METOLAZONE: Side Effects
- Dizziness, weakness, fatigue
- Nausea, vomiting, anorexia
- Rash
- Hyperglycemia
- Hypokalemia
- Photosensitivity
- Headache
- Aplastic anemia
- Impotence
- Muscle cramps
METOLAZONE: Purpose
Treatment of edema and hypertension
INDAPAMIDE: Nursing Considerations
- Diuresis onset 1–2 hours, peak 2 hours, duration 36 hours
- Take with meals or just after to decrease gastric symptoms, slightly decreased absorption
- Avoid changing positions (sitting/standing/lying) rapidly
- Take in morning to avoid interference with sleep
- Monitor electrolytes
- Rx; Preg Cat B
INDAPAMIDE: Side Effects
- Headache, dizziness
- Electrolyte changes
- Orthostatic hypotension
- Muscle cramps
- Vision disturbances
- Nausea, diarrhea
- Rash, pruritus
- Increased intraocular pressure
- Hyperglycemia
- Impotence
INDAPAMIDE: Purpose
Treatment of edema and hypertension
HYDROCHLOROTHIAZIDE: Nursing Considerations
- Diuresis onset 2 hours, peak 4 hours, duration 6–12 hours
- Take with meals or just after to decrease gastric symptoms
- Take in morning to avoid interference with sleep
- Hypersensitivity to sulfonamide
- Monitor electrolytes
- Rx; Preg Cat B
HYDROCHLOROTHIAZIDE: Side Effects
- Hypokalemia
- Hyperglycemia
- Nausea, vomiting, anorexia
- Blurred vision
- Fatigue, weakness
- Confusion, esp. in elderly
- Photosensitivity
- Orthostatic hypotension
- Electrolyte changes
- Renal failure
- Aplastic anemia
- Rash, urticaria
- Erectile dysfunction
HYDROCHLOROTHIAZIDE: Purpose
Treatment of edema and hypertension
CHLORTHALIDONE: Nursing Considerations
- Diuresis onset 2 hours, peak 6 hours, duration 24–72 hours
- Take with meals or just after to decrease gastric symptoms
- Take in the morning to avoid interference with sleep
- Weigh daily to determine fluid loss; effect of drug may be decreased if used daily
- Avoid changing positions (sitting/standing/lying) rapidly
- Rx; Preg Cat B
CHLORTHALIDONE: Side Effects
- Aplastic anemia
- Orthostatic hypotension
- Nausea, vomiting, anorexia
- Urinary frequency
- Electrolyte changes
- Headache, dizziness
- Hyperglycemia
- Photosensitivity
- Rash
- Impotence
- Hypokalemia
CHLORTHALIDONE: Purpose
Treatment of edema and hypertension
SPIRONOLACTONE: Nursing Considerations
- Diuresis onset 24–48 hours, peak 48–72 hours
- Take in the morning to avoid interference with sleep
- Take with meals or just after to decrease gastric symptoms
- Avoid food high in potassium: oranges, bananas, salt substitutes, dried apricots, dates
- Weigh daily to determine fluid loss; effect of drug may be decreased if used daily
- Contact provider if cramps, lethargy, menstrual abnormalities, deepening voice, breast enlargement
- Avoid potassium supplements
- Monitor electrolytes
- Rx; Preg Cat C
SPIRONOLACTONE: Side Effects
- Hyperkalemia
- Hyponatremia
- Vomiting, diarrhea
- Bleeding
- Rash, pruritus
- Gynecomastia
- Headache, confusion
- Impotence
- Agranulocytosis
SPIRONOLACTONE: Purpose
Treatment of edema and hypertension and of primary hyperaldosteronism
HYDROCHLOROTHIAZIDE/TRIAMTERENE: Nursing Considerations
- Diuresis onset 2 hours
- Take with meals or just after to decrease gastric symptoms
- Take early in the day to prevent nocturia and sleeplessness
- Diabetes mellitus may become manifest during thiazide treatment
- May increase BUN and serum creatinine
- Rx; Preg Cat C
HYDROCHLOROTHIAZIDE/TRIAMTERENE: Side Effects
- Nausea, vomiting, diarrhea
- Anemia
- Renal stones
- Hyperkalemia
- Hyperglycemia
- Muscle cramps
- Dizziness, headache
- Photosensitivity
HYDROCHLOROTHIAZIDE/ TRIAMTERENE: Purpose
Treatment of edema and hypertension
TICLOPIDINE: Nursing Considerations
- Monitor blood studies in long-term therapy
- Take with meals or just after to decrease gastric symptoms
- Monitor for signs of cholestasis (jaundice, dark urine, light-colored stools)
- Avoid all OTC products unless approved by provider
- Discontinue 10–14 days before surgery
- Rx; Preg Cat B
TICLOPIDINE: Side Effects
- Rash
- Diarrhea
- Bleeding
- Decrease in WBCs
- Thrombocytopenia
- Nausea
- GI distress
- Purpura, rash
- Headache, dizziness
- Tinnitus
- Hypercholesterolemia
TICLOPIDINE: Puspose
Prevention of stroke in high-risk patients
CLOPIDOGREL: Nursing Considerations
- Monitor blood studies in long-term therapy
- Report signs of unusual bruising, bleeding; it may take longer to stop bleeding
- Discontinue 5 days before elective surgery
- Take without regard to food
- Rx
CLOPIDOGREL: Side Effects
- GI bleeding
- Nausea, vomiting, diarrhea, GI discomfort
- Depression
- Bleeding, including life-threatening bleeding
- Rash
- Headache, dizziness
- Edema
- Chest pain
- Glomerulonephritis
- Hepatic failure
- URI, bronchospasms
- Arthralgia
CLOPIDOGREL: Purpose
Risk reduction for stroke, MI, peripheral arterial disease in high-risk patients, acute coronary syndrome, TIA, and angina
FUROSEMIDE: Nursing Considerations
- PO: diuresis onset 60 minutes, peak 1–2 hours, duration 6–8 hours
- IV: diuresis onset 5 minutes, peak 30 minutes, duration 2 hours
- PO: take with food or milk to prevent GI upset, slightly lessened absorption, tablets may be crushed
- Take early in the day to prevent nocturia and sleeplessness
- Avoid changing positions (sitting/standing/lying) rapidly
- Do not give IV faster than 4 mg/min; may cause ototoxicity
- Rx; Preg Cat C
FUROSEMIDE: Side Effects
- Orthostatic hypotension
- Hypokalemia
- Hyperglycemia
- Nausea, diarrhea
- Polyuria
- Rash, pruritus
- Muscle spasm
- Headache, fatigue
- Ototoxicity
- Renal failure
- Electrolyte imbalances
- Thrombocytopenia
- Photosensitivity
FUROSEMIDE: Purpose
Treatment of pulmonary edema, edema in CHF and other conditions, and hypertension
BUMETANIDE: Nursing Considerations
- PO: diuresis onset 30–60 minutes, peak 1–2 hours, duration 3–6 hours
- IM: diuresis onset 40 minutes, peak 1–2 hours, duration 4–6 hours
- IV: diuresis onset 5 minutes, peak 15–30 minutes, duration 3–6 hours
- Weigh daily
- Do not take at bedtime to prevent nocturia
- Encourage potassium-containing foods
- Monitor BUN, CBC, calcium, and uric acid
- Rx; Preg Cat C
BUMETANIDE: Side Effects
- Electrolyte imbalance
- Hypovolemia
- Ototoxicity
- Hyperglycemia
- Hypotension
- Chest pain
- Rash, pruritus
- Muscle weakness
- Tinnitus
- Headache, dizziness
- Nausea, diarrhea
- Increased cholesterol levels
- Hypokalemia
- Renal failure
- Thrombocytopenia
- Polyuria
BUMETANIDE: Purpose
Treatment of edema in CHF
DIGOXIN: Nursing Considerations
- Check pulse; if less than 60 beats per minute (adult) or 90 beats per minute (infant), hold the med and contact provider
- PO: with or without food; may crush tablets and mix with food/fluids
- Do not open, chew, or crush capsule
- Contact provider if loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression
- Eat a sodium-restricted and potassium-rich (bananas, orange juice) diet to keep potassium level normal
- Avoid OTC meds and herbal meds; many adverse interactions may occur
- Do not stop product abruptly
- Rx; Preg Cat C
DIGOXIN: Side Effects
- Headache
- Fatigue
- Bradycardia
- Nausea
- Atrial tachycardia (in children)
- Blurred vision
- Mental disturbances
- Vomiting
- Dysrhythmias
DIGOXIN: Purpose
Treatment of heart failure and atrial fibrillation
VERAPAMIL: Nursing Considerations
- PO: take before meals, except sustained-release which is to be taken with food
- Do not open, chew, or crush sustained- or extended-release capsule
- Teach patient how to take radial pulse and keep record of pulse rate
- Avoid hazardous activities until stabilized on drug
- Do not use OTC products or alcohol unless directed by provider; limit caffeine
- Avoid grapefruit juice
- Rx; Preg Cat C
VERAPAMIL: Side Effects
- Edema
- Nausea, constipation
- Headache
- Drowsiness
- Fatigue
- CHF
- Dizziness
- Bruising
- Dysrhythmias
- Impotence
- Nocturia
- Rash
VERAPAMIL: Purpose
treatment of angina, dysrhythmias, hypertension, supraventricular tachycardia, and atrial flutter/fibrillation
NIFEDIPINE: Nursing Considerations
- Avoid changing positions (sitting/standing/lying) rapidly
- Take without regard to meals; onset 20 minute, peak 6 hours, duration 6–8 hours
- PO, extended-release capsule: do not open, chew, or crush
- Do not use OTC products or alcohol unless directed by provider; limit caffeine
- Monitor BP when used with beta blockers
- Do not drink grapefruit juice; stop grapefruit juice at least 3 days prior to initiating nifedipine therapy
- Protect med from light and store in dry area
- Rx; Preg Cat C
NIFEDIPINE: Side Effects
- Orthostatic hypotension
- Gingival hyperplasia
- Peripheral edema
- Palpitations
- Headache, dizziness
- Fatigue
- Nausea, vomiting
- Rash
- Blurred vision
- Flushing
- Dysrhythmias
- Sexual difficulties
- Cough, fever, chills
NIFEDIPINE: Purpose
Treatment of hypertension and angina
FELODIPINE: Nursing Considerations
- Do not adjust dosage at intervals of less than 2 weeks
- PO: take without regard to meals
- Do not open, chew, or crush extended-release capsule
- Do not use OTC products or alcohol unless directed by provider; limit caffeine
- Avoid grapefruit juice
- Contact provider if pulse is less than 50 beats per minute
- Rx; Preg Cat C
FELODIPINE: Side effects
- Dysrhythmia
- Headache
- Fatigue, dizziness
- Edema, CHF
- Flushing
- Nausea, vomiting, diarrhea
- Increased liver function tests
- Sexual dysfunction
- Nocturia
- SOB, wheezing
FELODIPINE: Purpose
Treatment of essential hypertension
METOLAZONE: Nursing Considerations
- Diuresis onset 1 hour, peak 2 hours, duration 12–24 hours
- Take with meals or just after to decrease gastric symptoms, slightly decreased absorption
- Avoid changing positions (sitting/standing/lying) rapidly
- Take in morning to avoid interference with sleep
- Rx; Preg Cat B
METOLAZONE: Side Effects
- Dizziness, weakness, fatigue
- Nausea, vomiting, anorexia
- Rash
- Hyperglycemia
- Hypokalemia
- Photosensitivity
- Headache
- Aplastic anemia
- Impotence
- Muscle cramps
METOLAZONE: Purpose
Treatment of edema and hypertension
INDAPAMIDE: Nursing Considerations
- Diuresis onset 1–2 hours, peak 2 hours, duration 36 hours
- Take with meals or just after to decrease gastric symptoms, slightly decreased absorption
- Avoid changing positions (sitting/standing/lying) rapidly
- Take in morning to avoid interference with sleep
- Monitor electrolytes
- Rx; Preg Cat B
INDAPAMIDE: Side Effects
- Headache, dizziness
- Electrolyte changes
- Orthostatic hypotension
- Muscle cramps
- Vision disturbances
- Nausea, diarrhea
- Rash, pruritus
- Increased intraocular pressure
- Hyperglycemia
- Impotence
INDAPAMIDE: Purpose
Treatment of edema and hypertension
DILTIAZEM: Nursing Considerations
- Monitor blood pressure during dosage adjustments
- PO: take on an empty stomach with a full glass of water
- Teach patient how to take radial pulse and keep records of pulse rate; if less than 50 beats per minute, hold dose and notify provider
- Avoid hazardous activities until stabilized on drug
- Do not crush, chew, or break
- Do not stop abruptly
- Avoid grapefruit juice
- Rx; Preg Cat C
DILTIAZEM: Side Effects
- Edema
- Nausea, constipation
- Rash
- Photosensitivity
- Headache, dizziness
- Fatigue, drowsiness
- Bradycardia, palpitations
- Increased liver enzymes
- Renal failure
- Nocturia
- CHF, dysrhythmias
DILTIAZEM: Purpose
Management of angina, vasospasms, hypertension, atrial fibrillation/flutter, and supraventricular tachycardia
AMLODIPINE: Nursing Considerations
- May be taken without regard to meals
- Consult provider before taking nonprescription cough remedies
- Check pulse; if less than 50 beats per minute, hold med and contact provider
- Change positions slowly
- Avoid grapefruit juice
- Rx; Preg Cat C
AMLODIPINE: Side Effects
- Flushing
- Headache, fatigue
- Nausea, vomiting
- Abdominal pain
- Somnolence
- Peripheral edema
- Nocturia
- Sexual difficulties
- Palpitations, bradycardia
- Cough, dyspnea
AMLODIPINE: Purpose
Treatment of chronic stable angina, hypertension, and variant angina
PROPRANOLOL: Nursing Considerations
- Check pulse; if less than 50 beats per minute, hold the med and contact provider
- PO: take with full glass of water at the same time each day
- Do not open, chew, or crush extended-release capsule
- Do not stop abruptly; taper over 2 weeks; may precipitate life-threatening dysrhythmias
- Do not use aluminum-containing antacid; may decrease absorption
- Rx; Preg Cat C
PROPRANOLOL: Side Effects
- Weakness, fatigue
- Hypotension, dizziness
- Impotence
- Bronchospasm
- Bradycardia
- Nausea, vomiting
- Depression
- Blurred vision
- Hyper/hypoglycemia
- Dysrhythmias
- Thrombocytopenia
- Arthralgia
PROPRANOLOL: Purpose
Treatment of stable angina, hypertension, supraventricular dysrhythmias, and acute MI; prophylaxis of migraine
METOPROLOL: Nursing Considerations
- Check pulse; if less than 60 beats per minute, hold med and contact provider
- PO: may be taken with food, take at same time each day
- XL tablet must be swallowed whole
- Do not stop abruptly; taper over 2 weeks; may precipitate angina
- Do not use OTC products (nasal decongestants, cold preparations) unless directed by provider
- May worsen heart failure
- Rx; Preg Cat C
METOPROLOL: Side Effects
- Bradycardia, palpitations
- Nausea, vomiting, diarrhea
- Hypotension, dizziness
- CHF
- Depression
- Insomnia
- Confusion, headache
- Impotence
- Bronchospasms
- Rash, urticaria
- Hypoglycemia
METOPROLOL: Purpose
Treatment of hypertension, acute MI, angina, heart failure, and cardiomyopathy
CARVEDILOL: Nursing Considerations
- PO: take with food
- Tablet may be crushed or swallowed whole
- Do not stop abruptly; taper over 1–2 weeks
- Rx; Preg Cat C
CARVEDILOL: Side Effects
- Dizziness, fatigue
- Diarrhea
- Postural hypotension
- Impotence
- Hyperglycemia
- CHF worsening
- Paresthesia
- Bradycardia
- Peripheral edema
- Headache, insomnia
- Increased liver enzymes
- Thrombocytopenia
- Bronchospasm
CARVEDILOL: Purpose
Treatment of hypertension, CHF, LV dysfunction after MI, and cardiomyopathy
ATENOLOL: Nursing Considerations
- Masks signs of hypoglycemia in diabetics
- Check pulse; if less than 50 beats per minute, hold the med and contact provider
- PO: take before meals, at bedtime
- Do not stop abruptly; taper over 2 weeks
- Limit alcohol, smoking, sodium intake
- Rx; Preg Cat D
ATENOLOL: Side Effects
- Bradycardia, cold extremities
- Postural hypotension
- Bronchospasm in overdose
- 2nd- or 3rd-degree heart block
- Cold extremities
- Insomnia, fatigue
- Dizziness
- Mental changes
- Nausea, diarrhea
- Hypoglycemia
- Impotence
- Thrombocytopenia
ATENOLOL: Purpose
Treatment of mild to moderate hypertension and MI, prophylaxis of angina
SIMVASTATIN: Nursing Considerations
- Take without regard to food
- Contact provider if unexplained muscle pain, tenderness, or weakness; in rare cases can cause breakdown of skeletal muscle tissue leading to kidney failure
- Asian patients should not take niacin while taking simvastatin
- May require lower dose at initiation of therapy
- Rx; Preg Cat X
SIMVASTATIN: Side Effects
- Liver dysfunction
- URI
- Headache
- Abdominal pain
- Constipation
- Nausea
- Muscle cramps, myalgia
- Hyperglycemia
SIMVASTATIN: Purpose
Reduction of cholesterol, triglyceride, and lipoprotein levels; prophylaxis of MI and stroke
ROSUVASTATIN CALCIUM: Nursing Considerations
- Patient should keep tight control of diet during therapy
- Contact provider if unexplained muscle pain, tenderness, or weakness; in rare cases can cause breakdown of skeletal muscle tissue leading to kidney failure
- Asian patients may require lower dose at initiation of therapy
- Take without regard to meals
- Rx; Preg Cat X
ROSUVASTATIN CALCIUM: Side Effects
- Myalgia
- Constipation, heartburn
- Abdominal pain
- Rash, pruritus
- Nausea
- Thrombocytopenia
- Muscle cramps, arthralgia
- Headache, dizziness
- Kidney failure
- Liver dysfunction
ROSUVASTATIN CALCIUM: Purpose
Reduction of cholesterol levels and progression of atherosclerosis, prophylaxis of cardiovascular disease and stroke
PRAVASTATIN: Nursing Considerations
- Take without regard to food
- Contact provider if unexplained muscle pain, tenderness, or weakness; in rare cases can cause breakdown of skeletal muscle tissue leading to kidney failure
- Peak 1–1.5 hours
- Rx; Preg Cat X
PRAVASTATIN: Side Effects
- Abdominal cramps, flatus
- Heartburn
- Constipation, diarrhea
- Headache, dizziness, fatigue
- Lens opacities
- Renal failure
- Muscle cramps
- Hepatic dysfunction
PRAVASTATIN: Purpose
Reduction of cholesterol levels and risk of recurrent MI, treatment of atherosclerosis
NIACIN: Nursing Considerations
- Take with meals to reduce GI upset, can add 325 mg ASA 30 minutes before dose to reduce flushing
- Flushing will occur several hours after med taken, will decrease over 2 weeks
- Avoid changing positions (sitting/standing/lying) rapidly
- May be used in combination with simvastatin or lovastatin
- OTC, Rx; Preg Cat C
NIACIN: Side Effects
- Headache
- Nausea, vomiting
- Postural hypotension
- Myopathy
- Flushing
- Pruritus
- Abnormalities of liver function tests
- Hyperglycemia
NIACIN: Purpose
Treatment of pellagra, hyperlipidemia, and peripheral vascular disease
LOVASTATIN: Nursing Considerations
- Onset 2 weeks, peak 4–6 weeks, duration 6 weeks
- Take with food, absorption is reduced by 30% on an empty stomach
- Contact provider if unexplained muscle pain, tenderness, or weakness; in rare cases can cause breakdown of skeletal muscle tissue leading to kidney failure
- Avoid grapefruit products
- Rx; Preg Cat X
LOVASTATIN: Side Effects
- Flatus, constipation
- Abdominal pain, nausea, diarrhea, GI upset
- Heartburn
- Muscle cramps
- Dizziness
- Headache
- Tremor
- Blurred vision
- Rash, pruritus
- Photosensitivity
- Increased liver function tests
LOVASTATIN: Purpose
Reduction of cholesterol levels
GEMFIBROZIL: Nursing Considerations
- Administer 30 minutes before a.m. and p.m. meals
- Monitor blood glucose, renal/hepatic studies in long-term therapy
- Avoid alcohol, high-fat diet, smoking, sedentary lifestyle
- Rx
GEMFIBROZIL: Side Effects
- Fatigue, vertigo
- Headache
- Dyspepsia
- Nausea, vomiting, diarrhea
- Abdominal pain
- Leukopenia
- Rash, urticaria
- Taste perversion
- Myopathy
- Angioedema
GEMFIBROZIL: Purpose
Reduction of cholesterol levels
FLUVASTATIN: Nursing Considerations
- Contact provider immediately if unexplained muscle pain, tenderness, or weakness; in rare cases, can cause breakdown of skeletal muscle tissue, leading to kidney failure
- Take without regard to meals
- Peak response 3–4 weeks
- Rx; Preg Cat C
FLUVASTATIN: Side Effects
- Confusion
- Urinary pain
- Headache, dizziness
- Hepatotoxicity
- Photosensitivity
- Abdominal pain, constipation
- Nausea, diarrhea
- Arthralgia
- Thrombocytopenia
CLOPIDOGREL: Nursing Considerations
- Monitor blood studies in long-term therapy
- Report signs of unusual bruising, bleeding; it may take longer to stop bleeding
- Discontinue 5 days before elective surgery
- Take without regard to food
- Rx
CLOPIDOGREL: Side Effects
- GI bleeding
- Nausea, vomiting, diarrhea, GI discomfort
- Depression
- Bleeding, including life-threatening bleeding
- Rash
- Headache, dizziness
- Edema
- Chest pain
- Glomerulonephritis
- Hepatic failure
- URI, bronchospasms
- Arthralgia
CLOPIDOGREL: Purpose
Risk reduction for stroke, MI, peripheral arterial disease in high-risk patients, acute coronary syndrome, TIA, and angina
