Cardiovascular Pharmacology Flashcards
Atenolol (Black Box Alert)
Trade Name: Tenormin
Classification: B-Blocker; antiHTN, anti antianginal, antiarrhythmic
Common Side/Adverse Effects: HoTN, constipation, dizziness
Black Box Alert: Do not abruptly discontinue, may vause acute tachycardia, HTN, or ischemia
Nursing Interventions: Monitor BP, pulse, and resp. Monitor bowel activity/consistency. Assess for HF
Teaching Points: Don’t abruptly discontinue taking. Change positions slowly. Avoid tasks that require alertness.
Aspirin (high alert)
Trade Names: Bayer, Ascriptin, Bufferin, Durlaza, Ecotrin
Classification: Nonsterioidal salicylate; anti-inflammatory, antipiuretic, anticoagulant
Common Use: mild/mod pain, fever, platelet aggregation
Common side/adverse effects: GI discomfort, nausea, vomiting, tinnitus
Nursing Interventions: Monitor urinary pH for toxicity. Assess for ecchymosis (bruising). Evaluate for therapeutic response.
Teaching Points: Don’t chew/crush/dissolve/divide enteric-coated tabs. Avoid alcohol. Report tinnitus or GI pain/bleeding.
Captopril (Black Box Alert)
Trade Name: Capoten
Classification: ACE-Inhibitor; antiHTN, vasodilator
Common Use: HTN, HF, DM neuropathy
Common Side/Adverse Effects: Rash, taste disturbances, HoTN, dry cough, angioedema
Black Box Warning: May cause injury/death to developing fetus
Nursing Interventions: Assess skin for rash, assist w/ ambulation, discontinue if angioedema occurs
Teaching Points: Change positions slowly, take same time each day, no double dosing if one is missed
Digoxin
Trade Names: Digitek, Digox, Lanoxin
Classification: Cardiac gycoside; antiarrhthmic, cardiotonic
Common Use: mild/moderate HF, increase C/O, decrease HR
Common Side/Adverse Effects: dizziness, headache, visual disturbances
Nursing Interventions: Monitor pulse and EKG for bradycardia and dysrhythmias. Monitor toxicity signs (GI disturbances, neuro abnormalities).
Teaching Points: Take pulse, contact HCP if pulse is <60 or >100. Don’t double does if missed one. Inform dentist or other physician of taking digoxin.
Digibind
Generic Name: Digoxin immune fab
Classification: antidote; antibody fragments
Common Use: Antidote for digoxin toxicity
Possible Side/Adverse Effects: fever, hyper/hypo -kalemia, SOB, swelling
Nursing Interventions
Diltiazem
Trade Names: Cardizem, “ CD, “ LA, Cartia XT, Taztia XT, Tiazac
Classification: Ca+ Channel Blocker; antianginal, antiHTN, antiarrhythmic
Common Use: HTN, angina
Common Side/Adverse Effects: peripheral edema, arrhythmias, HF
Nursing Interventions: Assist w/ ambulation, assess for peripheral edema, monitor pulse rate for bradycardia
Teaching points: Change positions slowly. Avoid tasks that require alertness. How to monitor pulse and contact HCP if pulse rate is <50.
Verapamil
Trade Names: Calan, “ SR, “ Isoptin SR, Verelan, “ PM
Classification: Ca+ Channel Blaocker; antiHTN, antianginal, antiarrhythmic
Common Use: HTN, angina, dysrhythmia
Common Side/Adverse Effects: constipation, dizziness, lightheadedness
Nursing Interventions: Monitor BP and EKG. Assess pulse quality/rate/rhythm. Assess for peripheral edema.
Teaching points: Change positions slowly. Report persistent angina. Don’t abruptly discontinue med.
Enalapril
BLACK BOX ALERT
Trade Names: Epaned, Vasotec
Classification: ACE-inhibitor; AntiHTN, vasodilator
Common Use: HTN, CHF, LV dysfunction
Common Side/Adverse Effects: Dry cough, angioedema, ortho/hypo, headache
Black Box Warning: Fetal injury
Nursing Interventions: Assist w/ ambulation. Monitor CBC, BUN, K+, creatinine, and BP. Monitor bowl activity/consistency.
Teaching points: Change positions slowly. skipping or discontinuing drug may result in rebound HTN. Report swelling in face/lips/tongue (angioedema).
Furosemide
BLACK BOX ALERT
Trade Names: Lasix
Classification: Loop diuretic; diuretic
Common Use: Edema fr HF, HTN
Common Side/Adverse Effects: Dehydration. Hypo -Ca+, -K+, -Na+, Mg, -volemia, -Cl. Nausea. Abd cramps.
Black Box Warning: Large amounts can lead to huge increase of diuresis and electrolyte depletion.
Nursing Interventions: Monitor BP/vitals/I&O/weight/electrolytes. Watch for hypokalemia. Monitor signs of hearing loss.
Teaching points: Take in the morning to avoid nocturia. Report any hearing loss. Eat food high in K+.
Hydrochlorothiazide
Trade Names: Microzide
Classification: Sulfonamide derivative; thiazide diuretic, antiHTN
Common Use: HTN, edema, diabetes insipidus
Common Side/Adverse Effects: S/s of ortho/HoTN. Dehydration. Hypo -kalemia, -natremia, -chloremia.
Nursing Interventions: Monitor weight and vitals. Monitor I&O and K+ levels. Monitor s/s of hearing loss.
Teaching points: Take in the morning or early in the day to avoid nocturia. Report any signs of gout. Change positions slowly.
Lidocaine
Trade Names: Lidoderm, Xylocaine
Classification: Amide anesthetic; Class 1B Anti-dysrhythmic, anesthetic.
Common Use: Ventricular dysrhythmias
Common Side/Adverse Effects: HoTN, edema, skin irritation
Nursing Interventions: Monitor EKG nd VS during and after administration for dysrhythmias. Drowsiness indicates high serum lvls of lidocaine. Monitor LOC.
Teaching points: Report dizziness, numbness, double-vision, nausea, difficulty breathing
Lisinopril
BLACK BOX ALERT
Trade Names: Zestril, Prinivil, Qbrelis
Classification: ACE-inhibitor; antiHTN
Common Use: HTN, HF, MI
Common Side/Adverse Effects: Headache, dizziness, HoTN, dry cough, angioedema
Black Box Warning: May cause fetal injury/mortality.
Nursing Interventions: Assess for edema. Auscultate lungs for rales. Assist w/ ambulation.
Teaching points: Change positions slowly. Report persistent cough, vomiting, swelling in face/lips/tongue (angioedema), diff. breathing. Limit alcohol intake.
Morphine
BLACK BOX ALERT
Trade Names: Duramorph, Embeda, Infumorph, Kadian
Classification: Opioid agonist; opioid analgesic
Common Use: Severe pain, decreases anxiety
Common Side/Adverse Effects: Confusion, sedation, HoTN, constipation, resp depression
Black Box Warning: Addiction, abuse, misuse
Nursing Interventions: Take vitals before and after administration. Watch for decreased resp and BP. Monitor bowel activity/consistency.
Teaching points: Change positions slowly, call for assistance when ambulating. Avoid tasks that require alertness. Avoid alcohol and other CNS depressants. Report constipation, urinary retention, and ineffective pain treatment.
Metoprolol
BLACK BOX ALERT
Trade Names: Lopressor, Toprol XL
Classification: Beta blocker; antianginal, antiHTN
Common Use: HTN, angina, HF, MI treatment
Common Side/Adverse Effects: Fatigue, weakness, bradycardia, pulmonary edema
Black Box Warning: Abrupt w/drawal may result in life-threatening arrhythmias, HTN, myocardial ischemia.
Nursing Interventions: Monitor vitals for HoTN, SOB. Assess for s/s of HF. Monitor I&O.
Teaching points: Take BP and pulse before taking med. Change positions slowly. Avoid tasks that require alertness.
Methyldopa
Trade Names: Aldomet
Classification: Centrally acting antiadrenergics; antiHTN
Common Use: HTN
Common Side/Adverse Effects: Headache, muscle weakness, swelling in ankles or feet
Nursing Interventions: Monitor BP
Teaching points: Change positions slowly. Abrupt w/drawal can result in rebound HTN. Do not take with iron supplements – iron blocks absorption.
Metolazone
Trade Names: Zaroxolyn
Classification: Thiazide diuretic; diuretic, antiHTN
Common use: HTN, edema fr HF
Common Side/Adverse Effects: Dizziness, hypokalemia, headache, HoTN
Nursing Interventions: Fall-prevention. Monitor for electrolyte depletion – s/s of hypokalemia and hyponatremia. Monitor I&O and weight.
Teaching points: Change positions slowly. Eat foods high in K+. Caution when exercising – sweating can exaggerate diuretic side effects and cause even more fluid/electrolyte loss.
Nitroglycerine
Trade Names: Nitrostat, Rectiv, Nitro-Bid, Nitro-Dur
Classification: Nitrate; Antianginal, antiHTN, coronary vasodilator
Common Use: acute anginal pain
Common Side/Adverse Effects: orthohypo, headache, reflex tachycardia
Nursing Interventions: Check BP before and after administrating. Rotate transdermal patches, on for 12-14hr off for 10-12hr. Assess location, quality, and duration of anginal pain.
Teaching points: Take at first sign of angina, can take another dose if not relieved after 5min. If not relieved after 3 doses w/in 15 min, immediately call HCP or go to ER. Keep containers away from heat. Change positions slowly.
Potassium Chloride
Trade Names: Klor-Con, Klor-Con M10, Klor-Con M15, Klor-Con M20, K-Tab
Classification: Electrolyte; potassium replenisher
Common Use: Prevents/corrects K+ deficiency
Common Side/Adverse Effects: GI discomfort (nausea, vomiting, diarrhea), hyperkalemia, dysrhythmias
Nursing Interventions: Monitor K+ levels. IV potassium must ALWAYS be diluted before administrating. Be alert to s/s of hyperkalemia.
Teaching points: Report any paresthesia, weakness, tarry/bloody stools.
Procainamide
Trade Names: Pronestyl
Classification: Membrane stabilizer; antiarrythmic (IA)
Common Use: dysrhythmias
Common Side/Adverse Effects: Diarrhea, dizziness, nausea, vomiting, seizures
Nursing Interventions: Take BP and apical pulse before administration. Monitor BP. HoTN = toxicity.
Teaching points: Do not cut/crush/chew long-acting tablets.
Spironolactone
BLACK BOX ALERT
Trade Names: Aldactone, Carospir
Classification: diuretics, K+ sparing diuretic
Common Use: HTN, edema
Common Side/Adverse Effects: Hyperkalemia, dehydration, hyponatremia, nausea, vomiting
Black Box Warning: Shown to produce tumors in chronic toxicity studies.
Nursing Interventions: Monitor serum electrolyte values. Monitor I&O and weight. Monitor for s/s of hyponatemia or hyperkalemia.
Teaching points: Limit potassium-rich foods. Report any leg cramps, weakness, fatigue or nausea. Report irregular or slow pulse.
Triamterene
Trade Names: Dyrenium
Classification: Potassium-sparing diuretic
Common Use: Edema, HTN
Common Side/Adverse Effects: Nausea, diarrhea, dry mouth, dizziness
Nursing Interventions: Monitor serum electrolyte values. Monitor I&O and weight. Monitor for s/s of hyponatemia or hyperkalemia.
Teaching points: Limit potassium-rich foods. Don’t use salt alternatives. Report irregular heartbeats, weakness, or loss of movement immediately.
Magnesium (sulfate?)
Trade Names: Epsom salt, magnesium sulfate injection
Classification: Minerals electrolyte; antacid, anticonvulsant, electrolyte, laxative
Common Use: Dysrhythmias (VF, VT, or torsades de point) from hypomagnesemia
Common Side/Adverse Effects: decreased HR and RR, cardiac arrest, respiratory paralysis
Nursing Interventions: Monitor EKG. RR should be >=16/min and patellar reflex must be present before each parental dose to prevent resp arrest. Seizure precautions.
Teaching points: Report signs of hypermagnesmia: dizziness, palpitations, fatigue, weakness, altered mental status
Heparin
Trade Names: Hep-lock
Classification: Antithrombotics; anticoagulants
Common Use: Prevent DVT, pulmonary emboli, and emboli fr Afib. STEMI, NSTEMI, unstable angina.
Common Side/Adverse Effects: Bruising or bleeding easily, burning or itching on feet, major hemorrhage
Nursing Interventions: Bleeding precautions. Monitor PPT and aPTT (should be 1.5-2.5 times normal). Monitor/assess urine and stool for occult blood or hematuria. IV 30 min w/in admission.
Teaching points: Use electric razor and a soft toothbrush to prevent bleeding. Blow nose gently. Inform dentist and other physicians of heparin therapy.
Warfarin
BLACK BOX ALERT
Trade Names: Coumadin, Jantoven
Classification: Coumarins; Anticoagulants
Common Use: Prophylaxis of venous thrombosis, pulmonary embolism, and Afib w/ embolization. Reduce risk of embolism after MI.
Common Side/Adverse Effects: Cramps, nausea, major bleeding
Black Box Warning: May cause major or fatal bleeding. Risk factors: history of GI bleeding, HTN, cerebrovascular disease, heart disease, malignancy, trauma, INR >4.
Nursing Interventions: Monitor INR closely. Assess for signs of bleeding or hemorrhage (hematuria, bruises, bleeding gums, black tarry stools, fall in BP). Vitamin K is an antidote.
Teaching points: Use electric razor and a soft toothbrush to prevent bleeding. Advise all HCP they are taking warfarin. Report symptoms of unusual bleeding or bruising. Frequent lab tests are needed to monitor coagulation factors.
Clopidogrel
BLACK BOX WARNING
Trade Names: Plavix
Classification: Platelet aggregation inhibitors; Anti-platelet
Common Use: Decrease vascular clotting, MI, stroke, PAD
Common Side/Adverse Effects: Abd pain, diarrhea, bleeding, skin disorders
Black Box Warning: Diminished effectiveness in CYP2C19 metabolizers increases risk for cardiovascular events.
Nursing Interventions: Monitor platelet count for thrombocytopenia. Administer w/ food to reduce GI upset. Assess for s/s of hepatic insufficiency.
Teaching points: Report any unusual bleeding. Medication may be held 5 days prior to surgery. Inform all HCP of taking medication.
Propranolol
BLACK BOX ALERT
Trade Names: Inderal LA, Hemangeol, InnoPran XL
Classification: Beta-blocker; AntiHTN, antianginal, antiarrhythmic, antimigraine
Common Use: HTN, angina, Afib
Common Side/Adverse Effects: Drowsiness, fatigue, weakness, bradycardia, HoTN
Black Box Warning: Severe angina exacerbation, MI, ventricular dysrhythmias may occur in angina pts after abrupt discontinuation
Nursing Interventions: Monitor EKG for dysrhythmias. Assess pulse for bradycardia. Assess signs of HF.
Teaching points: Don’t abruptly discontinue medication. Change positions slowly. Report if pulse is <50 bpm. Avoid tasks that require alertness.
Hydralazine
Trade Names: none
Classification: Vasodilator; AntiHTN
Common Use: HTN
Common Side/Adverse Effects: tachycardia, drug-induced lupus, headache, angina, edema
Nursing Interventions: Monitor BP and pulse. Assess for
peripheral edema in hands and feet.
Teaching points: Change positions slowly. Weigh twice a week and assess feet and ankles for fluid retention. Report muscle/joint aches, fever, lupus-like reaction.
Nifedipine
Trade Names: Adalat CC, Afeditab CR, Procardia, Procardia XL
Classification: Calcium channel blocker; Antianginal, antiHTN
Common Use: Prinzmetal’s variant angina, chronic stable angina, HTN
Common Side/Adverse Effects: Peripheral edema, headache, dizziness, flushed skin
Nursing Interventions: Assess for peripheral edema. Monitor BP for HoTN. Assist w/ ambulation if dizziness occurs.
Teaching points: Change positions slowly. Report palpitations, SOB, nausea and increased angina. Avoid grapefruit juice.
Amlodipine
Trade Names: Norvasc, Katerzia
Classification: Calcium channel blocker; antiHTN
Common Use: HTN, CAD
Common Side/Adverse Effects: Peripheral edema, headache, flushing
Nursing Interventions: Assess BP (w/hold if systolic is <90mm Hg). Assess for peripheral edema. Assess skin for flushing.
Teaching points: Don’t abruptly disc. taking med. Avoid tasks that require alertness. Avoid eating grapefruit products.
Bumetanide
BLACK BOX ALERT
Trade Names:
Classification: Loop diuretic; diuretic
Common Use: Edema associated with HF, renal or hepatic disease
Common Side/Adverse Effects: Muscle cramps, HoTN, hypokalemia, hyponatremia
Black Box Warning: Excess dosage can lead to increased diuresis w/ fluid and electrolyte loss.
Nursing Interventions: Monitor vitals, electrolytes, I&O, weight. Watch for s/s of hypokalemia (muscle weakness, tremor, cramps, cold/clammy skin). Digoxin toxicity
Teaching points: Report hearing abnormalities (tinnitus fullness in ears). Eat foods high in K+. Change positions slowly.
Clonidine
BLACK BOX ALERT
Trade Names: Catapres, Catapres-TTS, Duraclon, Kapvay
Classification: adrenergics; antiHTN
Common Use: HTN, ADHD, severe pain
Common Side/Adverse Effects: Dry mouth, dizziness, sedation, HoTN
Black Box Warning: Not to be used for perioperative, obstetric, or postpartum pain.
Nursing Interventions: Monitor BP, pulse, mental status. Slowly reduce med dosage over 2-4 days if it is to be discontinued.
Teaching points: Sugarless gum, sips of water may relieve dry mouth. Change positions slowly. Skipping or discontinuing doses may result in severe rebound HTN.
Lostartan
BLACK BOX ALERT
Trade Names: Cozaar
Classification: Angiotensin II receptor antagonists; antiHTN
Common Use: HTN
Common Side/Adverse Effects: Upper respiratory tract infection, dizziness, HoTN
Black Box Warning: May cause fetal unjury/mortality. Discont. asap once pregnancy is detected.
Nursing Interventions: Maintain hydration, Assess for signs of upper rep infection or cough. Monitor BP, pulse.
Teaching points: Avoid tasks that require alertness. Female pts of childbearing age take measures to avoid pregnancy. Report any signs of infection or CP.
Aliskiren
BLACK BOX ALERT
Trade Names: Tekturna
Classification: Renin inhibitor; antiHTN
Common Use: HTN
Common Side/Adverse Effects: Angioedema, periorbital edema, general edema
Black Box Warning: May cause fetal injury/mortality. Discont asap once pregnancy detected.
Nursing Interventions: Assess for edema. Monitor I&O, weigh daily. Monitor BP, K+, renal function
Teaching points: Report signs of angioedema. Pregnant pts should avoid exposure to med on second and third trimester.
Enoxaparin
BLACK BOX ALERT
Trade Names: Lovenox
Classification: antithrombotics, low molecular weight heparins; anticoagulant
Common Use: Prevention of DVT, pulmonary embolism, ischemia complications fr unstable angina, MI, STEMI
Common Side/Adverse Effects: Immune-mediated thrombocytopenia, bleeding episodes
Nursing Interventions: Antidote is protamine sulfate. Monitor CBC esp platelet count. Monitor for bleeding.
Teaching points: Don’t take OTC meds esp aspirin w/o consulting HCP. Report unusual bleeding or bruising.
Alteplase
High Alert
Trade Names: Activase, Cathflo Activase, tissue plasminogen activator, t-PA
Classification: plasminogen activators; thrombolytics
Common Use: Acute ischemic stroke, pulmonary embolism, acute MI, occluded catheters
Common Side/Adverse Effects: Decreased BP, bleeding
Nursing Interventions: Continuous cardiac monitoring for dysrhythmias. Check BP, pulse, resp every 15 min until stable.
Teaching points: Avoid activities that may increase risk of bleeding or injury.
Atorvastatin
Trade Names: Lipitor
Classification: Hydroxymethylglutaryl CoA reductase inhibitor; lipid-lowering agents
Common Use: High cholesterol, reduce risk of angina, stroke, MI
Common Side/Adverse Effects: Headache, myalgia, cataracts, rash, photosensitivity
Nursing Interventions: Monitor for headache. Assess for rash. Monitor cholesterol and triglyceride.
Teaching points: Follow special diet, Do not crush/chew/dissolve/cut tablets. Report dark urine, muscle fatigue, bone pain.
Niacin
Trade Names: Niaspan, vitamin B3
Classification: Antihyperlipidemic, water-soluble vitamin
Common Use: Dyslipidemia, recurrent MI, CADm hypertriglyceridemia
Common Side/Adverse Effects: Face and neck flushing, GI upset, pruritus
Nursing Interventions: Ceck for headache, dizziness, blurred vision. Monitor bowel activity, stool consistency. Evaluate degree of GI upset.
Teaching points: Report dizziness. Report nausea, vomiting, loss of appetite, yellowing skin, dark urine.
Amiodarone
BLACK BOX ALERT
Trade Names: Nexterone, Pacerone
Classification: Cardiac agent; Antiarrhythmics
Common Use: VF, unstable VT
Common Side/Adverse Effects: visual impairment, cardiotoxicity, pulmonary toxicity, photosensitivity
Black Box Warning: Pts should be hospitalized when med is initiated. Alternative therapies should be tried first before using amiodarone.
Nursing Interventions: Only indicated for pts w. life-threatening dysrhythmias. Monitor signs of pulmonary toxicity (worsening cough). Assess pulse for quality rhythm, bradycardia.
Teaching points: Report SOB or cough. Protect against photosensitivity reaction on skin exposed to sunlight.
Adenosine
Trade Names: Adenocard
Classification: Cardiac agent; antidysrhythmic
Common Use: Dysrhythmias, PSVT (paroxysmal supraventricular tachycardia). Restarts for 6 sec.
Common Side/Adverse Effects: facial flushing, dyspnea, transient short-lasting heart block,
Nursing Interventions: Monitor BP, apical pulse, RR. Auscultate breath sounds for clarity. Monitor I&O.
Teaching points: Report continued cp, lightheadedness, difficulty breathing, head/neck pain. May induce feelings of impending doom, but resolves quickly.
Fish Oil
Trade Names:
Classification: supplement
Common Use: HTN, hyperlipidemia, hypertriglyceridemia
Common Side/Adverse Effects: can increase chance of bleeding, heartburn, loose stools, nosebleeds
Nursing Interventions: May have additive effect w/ antiHTN meds
Teaching points:
Sildenafil
Trade Names: Viagra, Revatio
Classification: erectile dysfunction agents, vasodilators
Common Use: Pulmonary arterial HTN (PAH), erectile dysfunction
Common Side/Adverse Effects: headache, heartburn, muscle aches, sensitivity to light, flushing
Nursing Interventions: Monitor cardiovascular status. Monitor diet (high fat meals can slow absorption)
Teaching points: Never take drug with nitrates. Report painful urination, dizziness, rash, loss of vision.
