Cardiovascular Pharmacology Study Guide Flashcards
Heparin Drug Class uniqueness and actions
Drug Therapy for Thromboembolic Disorders
Drug class: Anticoagulant
Example: Heparin
Actions/Uses/Therapeutic outcomes:
-Used to treat DVT, PE, peripheral arterial embolism, MI and PCIs.
-Therapeutic range: 1.5 – 2.5
-Used to treat thromboembolism
-Promote neutralization of activated clotting factors
-Does not dissolve clots
-Antidote: Protamine sulfate
Med combination therapy beneficial for angina pectoris treatment
-Combination therapy is beneficial for many patients.
-Beta blockers, calcium channel blockers, long acting nitrates and ranolazine can reduce the frequency of angina episodes
Nitroglycerin SL tablets -dosing regimen, N/I, refill, storage, patient education
Drug therapy for Angina Pectoris
Drug class: Nitrates
Example: Nitroglycerin
Nitroglycerin Sublingual administration:
-Onset: 1-2 minutes
-Duration: 30 minutes
-Instruct pt to lie down or sit at the first sign of angina attack
-Place tablet under the tongue, allow to dissolve and not to swallow immediately
-Call 911 if chest pain not relieved 5 minutes after admin
-One or two tablets may be taken a few minutes before engaging in activities that may trigger angina attack
-Chart pt’s ability to place med under tongue correctly
Patient education:
-Taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be taken with food.
-Make sure pt knows how to read the expiration date and have prescription filled (must be refilled every 6 months and old tablets must be safely discarded)
Medication Storage:
-Store Nitroglycerin in its original dark-colored glass container with a tight lid
Nitroglycerin spray -dosing regimen, N/I, refill, storage, patient education
Drug therapy for Angina Pectoris
Drug class: Nitrates
Nitroglycerin Translingual Spray admin:
-Onset: 2 minutes
-Duration: 30-60 minutes
-One or two sprays onto under tongue for acute attack; repeat if needed in 3-5 minutes;
-Patient should be in a sitting position upon admin
-Canister should be held vertically with the valve head uppermost and the spray orifice as close to the mouth as possible.
-Do not shake container
-Pt’s mouth should be closed immediately after each dose
-Spray is highly flammable; take precautions
Heparin, Enoxaparin therapy - admin regimen, N/I, patient education, do’s & don’ts
Drug Therapy for Thromboembolic Disorders
Drug class: Anticoagulant
Example: Heparin
Actions/Uses/Therapeutic outcomes:
-Used to treat DVT, PE, peripheral arterial embolism, MI and PCIs.
-Therapeutic range: 1.5 – 2.5
-Used to treat thromboembolism
-Promote neutralization of activated clotting factors
-Does not dissolve clots
-Antidote: Protamine sulfate
Administration regimen:
-2 nurses must confirm dosage calculations
-Blood samples for labs are drawn 4 to 6 hours after IV infusion
-Effects of Heparin only lasts for 4 hours, so continuous infusion is needed
Dos and Don’ts and patient education:
-Subcutaneous injection: tissue over abdomen
-Do not inject within 2 inches of umbilicus
-Site should NOT be massaged before or after injection
-Sites should be rotated
-90 degree angle for injection
-Do not aspirate and do not inject into a hematoma or infected site
-After injection, apply gentle pressure for 1- 2 minutes to control local bleeding
-Ice packs may be used
-Intramuscular is not recommended
Example: Enoxaparin
Actions:
-Prevents completion of the coagulation cascade
-Used to prevent DVT after hip or knee surgery or abdominal surgery
Admin regimen and Do’s and Don’ts
-Subcutaneous: do NOT expel air bubble from prefilled syringe before admin (to prevent loss of drug)
-Inject anterolateral or posterolateral into abdominal wall every 12 to 24 hours
-Entire length of needle should be introduced into a skinfold held between the thumb and forefinger
-Inject drug slowly and leave for 10 seconds after
-Do not rub injection site
-Rotate site every 12 hours
-Periodic cbc and stool occult blood tests are recommended
-DO NOT inject Intramuscularly
-Dosage adjustment required in patients with creatinine lower than 30 mL/min
-Men less than 125 lb and women less than 99 lb must be observed carefully for s/s of bleeding
Nursing Interventions, - pre assessment, patient education in treatment with ACE inhibitor DRUG THERAPY FOR HIGH BP
Use: Reduces blood pressure, preserves cardiac output, and increases renal blood flow.
Drug class: Angiotensin-Converting Enzyme Inhibitors aka ACE Inhibitors
Examples: Lisonipril, Enalapril, Ramipril
Premedication assessment:
-Obtain baseline BP in supine and standing position (hold med if systolic bp is less than 100 mm Hg or if the heart rate is less than 50 bpm
-Obtain history of bowel elimination patterns
-Initiate lab studies to serve as baseline
-Ask if pt is pregnant
-Ask if pt has persistent cough
Nursing Intervention/Patient Education:
-Teach pt to rise slowly from a supine to sitting and then standing position
-Initial dose may cause hypotension with dizziness, tachycardia and fainting (commonly with pts taking diuretics)
-Discontinue diuretics 1 week before starting ACE inhibitor
-Lie down immediately if symptoms develop
Adverse affects:
-Nausea, Diarrhea, Fatigue, headache, Orthostatic hypotension (dizziness, weakness, faintness), chronic cough, birth defects for those who are prego, difficulty breathing, swollen lips, swollen eyes, swollen face, swollen tongue.
***ACE Inhibitors are not as effective in lowering bp in African Americans unless used with a diuretic
Coumadin therapy- N/I, dietary management, patient education, adverse effects
Drug Therapy for Thromboembolic
Drug class: Vitamin K Inhibitor
Example: Warfarin (Coumadin)
Uses:
-Prevents and treat venous thrombosis and embolism
-Prevention and treatment of thromboembolism associated with atrial fibrillation
-Reduces risk of death, recurrent MI, and thromboembolic events, such as stroke and MI.
-Prevents and treats of thromboemboli associated with cardiac valve replacement.
Nursing intervention
-Obtain baseline vital signs
-Be aware of most recent PT or INR results to determine range of therapy for Warfarin.
-Inspect skin and mucous membranes for petechial, ecchymosis or hematoma
-Ensure pt is not pregnant
Patient education and Dietary management
-Not to eat foods high in Vitamin K (leafy vegetables)
Adverse effect:
-Bleeding (petechiae, ecchymoses or hematomas and bleeding gums
Therapeutic Outcome with- ACEI, Heparin, Nitrates, Vasodilator, Beta adrenergic blockers
ACEI for angina pectoris
-Reduction in frequency of recurrent myocardial infarction
Nitrates for angina pectoris
-Relief of angina pain during attack
-Reduced frequency and severity of angina attacks
-Increased tolerance of activities
Beta Adrenergic blockers for angina pectoris
-Reduced frequency and severity of angina attacks
-Increased tolerance of activities
-Reduced use of nitroglycerin for acute angina attack
Heparin for Thromboembolic
-Prevents DVT
-Used to treat thromboembolism and promote neutralization of activated clotting factors
Comparison of the Beta-adrenergic blocking agents to other Anti-HTN agents
Clinical advantages of beta blockers in treating HTN including:
-minimal postural or exercise hypotension
-minimal effect on sexual function
-BP reduction in supine position
-little to no effect in the central nervous system
***Beta blockers are not as effective in African American patients and should be avoided in patients with asthma, Type 1 diabetes, heart failure caused by systolic dysfunction, and peripheral vascular disease.
Patient care plan and nursing interventions with an angiotensin-converting inhibitor (ACE
Drug Therapy for HTN and Angina Pectoris
Drug class: Angiotensin-Converting Enzyme Inhibitors aka ACE Inhibitors
Premedication assessment:
-Obtain baseline BP in supine and standing position (hold med if systolic bp is less than 100 mm Hg or if the heart rate is less than 50 bpm
-Obtain history of bowel elimination patterns
-Initiate lab studies to serve as baseline
-Ask it pt is pregnant
-Ask if pt has persistent cough
Nursing Intervention/Patient Education:
-Teach pt to rise slowly from a supine to sitting and then standing position
-Initial dose may cause hypotension with dizziness, tachycardia and fainting (commonly with pts taking diuretics)
-Discontinue diuretics 1 week before starting ACE inhibitors
-Lie down immediately if symptoms develop
Instructions following Calcium Channel Blockers in management of Heart Failure
-Verapamil and diltiazem must be avoided in patients with heart failure.
-Caution the patient that hypotension and syncope may occur during the first week of therapy.
-These adverse effects decline once the dosage is stabilized.
-Take blood pressure readings every shift in the hospitalized patient and stress the need for the patient to monitor blood pressure after discharge.
-Prevent hypotensive episodes by instructing the patient to rise slowly from a supine or sitting position and perform exercises to prevent blood pooling when standing or sitting in one position for a prolonged period.
-If faintness occurs, instruct the patient to sit or lie down.
Dietary instructions for patients on Coumadin therapy
Dietary instructions for patients on
Coumadin/warfarin therapy
- LIMIT foods high in Vitamin K.
Rationale: Coumadin/warfarin is a Vitamin K inhibitor (drug class) for thromboembolic disease.
To ensure that warfarin is effectively thinning your blood, it’s important to eat about the same amount of vitamin K every day. Vitamin K normally helps your blood clot so wounds don’t bleed too much. Warfarin works against vitamin K, making your blood clot more slowly.
Digoxin toxicity-explain, causes, prevention, management and nursing intervention
Causes:
-Older adults commonly experience digoxin toxicity as a result of digoxin’s long half-life.
-In children, digoxin toxicity is often first detected by the development of atrial dysrhythmias.
-Hypokalemia potentiates the effects of digoxin and can lead to toxicity.
Prevention:
-Early symptoms of toxicity are anorexia and mild nausea, but they are often overlooked or are not associated with drug toxicity.
-Any change in pulse rhythm and rate or central nervous system signs (e.g., mental status, orientation, hallucinations, behavioral changes) should be investigated and reported.
Management:
-Blood should be drawn before the daily dose of medication is given or at least 6 hours after administration.
-It is important to be consistent with regard to the time of drawing blood and administering the dose.
-Always check the potassium level of the patient before administration and replace the potassium if low before giving the dose of digoxin.
Nursing Interventions:
-Always have the mathematical computations checked by another professional nurse.
-Use the correct type of syringe to facilitate the accuracy of the dosage measurement.
-Always question any order that is unusual before administration.
-Read the medication label carefully for proper drug and strength.
Treatment of digoxin toxicity
-The basic treatment of digoxin-induced dysrhythmias consists of stopping the digoxin and any potassium-depleting diuretics, checking the potassium level (i.e., administering potassium as indicated), and administering antidysrhythmic drugs (e.g., phenytoin).
Antidote for severe digoxin intoxication
-Digoxin immune fab (ovine) (Digibind).
LMWHs, Enoxaparin -uses, admin and Nursing Care
Drug Therapy for Thromboembolic Disorders
Brand name: LOVENOX
Drug class: Anticoagulant
Example: Enoxaparin (example of a Low Molecular Weight Heparin)
Notes:
- LMWHs have less potential for hemorrhage and longer duration of action than other anticoagulants
-Enoxaparin prevents completion of the coagulation cascade
- No antiplatelet activity and does not affect the PTT or aPTT
Uses:
-Enoxaparin is used to prevent DVT (deep vein thrombosis=blood clot) after hip replacement surgery, knee replacement surgery, or abdominal surgery
-Approved for use in combination with Warfarin (blood thinner) to treat acute DVT (deep vein thrombosis=blood clot), with or without PE (pulmonary embolism, when blood clot travels to lungs)
-Also used to treat ST segment elevation MI (myocardial infarction=heart attack)
Actions:
-Prevents completion of the coagulation cascade
-Used to prevent DVT after hip or knee surgery or abdominal surgery
Admin regimen and Do’s and Don’t’s
-Should not be used in patients with allergy to pork by-products, Enoxaparin is manufactured from heparin derived from pigs
-Do not inject intramuscularly! ( medication safety alert in book)
-Subcutaneous: do NOT expel air bubble from prefilled syringe before admin (to prevent loss of drug)
-Inject anterolateral or posterolateral into abdominal wall every 12 to 24 hours
-Entire length of needle should be introduced into a skinfold held between the thumb and forefinger
-Inject drug slowly and leave for 10 seconds after
-Do not rub injection site
-Rotate site every 12 hours
-Periodic cbc and stool occult blood tests are recommended
-DO NOT inject Intramuscularly
-Dosage adjustment required in patients with creatinine lower than 30 mL/min
-Men less than 125 lb and women less than 99 lb must be observed carefully for s/s of bleeding
Dosage range:
-Prophylaxis: 30 mg twice daily or 40 mg once daily depending on medical/surgical condition
-Therapeutic: 1mg/kg ever 12 hours or 1.5/kg every 24 hours administered at the same daily.
-Dosage adjustment for patients older than 75 years of age
Adverse effects Common:
-Hematoma (bruising) and bleeding at injection site * can be avoided by using proper technique
Serious Adverse effects:
-Bleeding- check for abnormal bleeding, blood in urine, stool, or vomit, also check dressings for excessive bloody drainage
-Thrombocytopenia ( low platelet count) Can be caused by use of Enoxaparin* monitor platelet counts
-Rare but serious, Thrombotic thrombocytopenic pupura is possible 3 months after the start of treatment* signs are neurologic abnormalities, fever, followed by renal impairment (kidney failure)
Drug Interactions:
-No drug interactions exist, BUT should be used with caution in patients in patients receiving antiplatelet or warfarin therapy
Patient education for Coumadin therapy in preventing venous thrombosis
Brand name: Coumadin, Jantoven
Generic name: Warfarin
Drug Class: Vitamin K inhibitor
Actions:
-Potent anticoagulant that acts by inhibiting the activity of Vitamin K, ( Vitamin K promotes clotting, it counteracts that)
-Inhbits the activation of clotting factors II, VII, IX, and X, as well as proteins C S in the blood
-Blockade of the activation of these factors prevents clot formation.
* This drug inhibits Vitamin K ability to activate the clotting factors mentioned above, therefore preventing clot formation
Patient Education
-Monitor closely for evidence of hemorrhage when therapy is initiated
-Diet should consist of foods rich in Vit K, including green leafy vegetables
-PT and INR blood tests should be performed regularly to ensure dosage administered is therapeutic and toxic
-Compliance with lab testing very important to determine correct maintenance dose
-Not intended for patients 6-12 weeks pregnant, and at term pregnancy. exclusion is for pregnant patient with prosthetic heart valve (risk vs. benefit weighed)
-If one dose is missed, patient should take the next dose
-If two doses missed, patient should contact health provider
Dosing:
-initial: 2-5 mg/day adjusting dose every few days until INR is in target range
*loading dose not recommended as it does not anticoagulate any faster than maintenance dose
-maintenance: 2-10 mg daily as determined by INR blood test
Antidote: Vitamin K
Adverse effects:
-Bleeding, excessive. ( petechiae, ecchymoses, hematomas) bleeding gums, blood in urine or stool, for patient of child bearing age monitor menstrual bleeding
-S&S of internal bleeding: decreased BP, increased pulse rate, cold and clammy skin, feelings of faintness, disoriented sensorium.
Drug interactions that enhance therapeutic effect but can cause toxicity: can increase risk of internal bleeding, hemorrhaging, toxicity
-many, but good to know day to day OTC drugs like Nsaids and Tylenol, aspirin, and omeprazole that can increase risks of internal bleeding
Nursing instructions regarding administration of trans lingual nitroglycerin spray
Drug therapy for Angina Pectoris
Brand names: Nitrolingual and Nitromist
Availability: spray, translingual metered dose container, 0.4 mg
Drug class: Nitrates
Nitroglycerin Translingual Spray admin:
-Onset: 2 minutes
-Duration: 30-60 minutes
-One or two sprays onto under tongue for acute attack; repeat if needed in 3-5 minutes;
-Patient should be in a sitting position upon admin
-Canister should be held vertically with the valve head uppermost and the spray orifice as close to the mouth as possible.
-Spray onto or under tongue (translingual= on the tongue)
-Do not shake container
-Pt’s mouth should be closed immediately after each dose
-Spray is highly flammable; take precautions
-May be used prophylactically 5-10 minutes before exercise
*Semi unrelated but may be relevant in Nitrates category**Med safety alert: AHA recommends that if chest pain is not relieved by one SUBLINGUAL nitroglycerin dose within 5 minutes, patient should seek emergency attention
Nursing instructions with usage of Digoxin in treatment of heart failure-adverse effects, pre nursing admin asses
Drug therapy for Heart Failure
Drug class: Digitalis Glycosides
Example: Digoxin (generic name)
Brand name: Lanoxin
Actions: increase the force of contraction and slow the heart rate
Uses: treatment of mild to severe systolic HF that does not respond to diuretics, beta blockers or ACE Inhibitors
Therapeutic outcome: improved cardiac output resulting from improved tissue perfusion and improved tolerance to activity as demonstrated by the ability to perform ADLs without supplemental oxygen therapy or fatigue.
-Goal of treatment for heart failure is to give adequate doses of digoxin so that the most optimal cardiac effects can be achieved:
-Increased cardiac output
-Slowed pulse rate
-Decreased vasoconstriction
-These reduce signs and symptoms of:
-Dyspnea
-Orthopnea
-Edema
Dosing:
-Loading doses (digitalization) are no longer thought to be necessary
-Maintenance dose given once daily
-Patients must continue to take Digoxin preparations for the remainder of their lives
Availability:
PO: 0.0625-, 0.125-, 0.187.5-, and 0.25- mg tablets, for peds: 0.05 mg/ml oral elxir
IV: 0.1 mg/ml in 1 ml ampules; 0.25 mg/ml in 2-ml ampules
Premedication assessment:
-Take pt’s apical pulse for 1 minute (withhold drug is pulse is <60 or >100 bpm
-Obtain baseline vital signs, lung sounds, weight, lab values
-Monitor for digoxin toxicity, hypokalemia, hypomagnesemia or sudden increase in normal or low pulse rate.
-Have mathematical computations checked by another nurse
-Give Digoxin after meals to minimize gastric irritation
-Getting baseline electrocardiogram before therapy is recommended
-Serum levels checked prior to starting therapy, and throughout therapy
-Antidote ( to be used in Digoxin toxicity): Digiband
Adverse effect:
-Cardiac rhythm
-Loss of appetite, nausea, vomiting, extreme fatigue, weakness of the arms and legs
-Psychiatric disturbances
-Visual disturbances
-Electrolyte imbalance
Management Combination therapy for Angina pectoris
-Combination therapy is beneficial for many
patients.
SEVEN DRUG GROUPS:
1) Beta blockers,
2)ACE inhibitors
3) Nitrates (ex: nitroglycerin)
4)calcium channel blockers
5)Statins
6)platelet-active agents (ex: Aspirin)
7) Myocardial (MI) sodium channel blocker: (ex: ranolazine) can reduce the frequency of angina episodes.
MOST effective drugs treating angina/ischemia are:
(B)Beta-Blockers
(C) Calcium channel blockers
(N) Nitrates.
Digoxin- admin, pre-nursing assessment, antidote, drug interaction (enhancers/reducers)
Drug therapy for Heart Failure
Drug class: Digitalis Glycosides
Example: Digoxin
Actions: increase the force of contraction and slow the heart rate
Uses: treatment of mild to severe systolic HF that does not respond to diuretics, beta blockers or ACE Inhibitors
Premedication assessment:
-Take pt’s apical pulse for 1 minute (withhold drug is pulse is <60 or >100 bpm
-Obtain baseline vital signs, lung sounds, weight, lab values
-Monitor for digoxin toxicity, hypokalemia, hypomagnesemia or sudden increase in normal or low pulse rate.
-Have mathematical computations checked by another nurse
-Give Digoxin after meals to minimize gastric irritation
-Getting baseline electrocardiogram before therapy is recommended
Adverse effect:
-Cardiac rhythm
- loss of appetite, nausea, vomiting, extreme fatigue, weakness of the arms and legs
-Psychiatric disturbances
-Visual disturbances
-Electrolyte imbalance
Drug enhancers
-Quinidine, diltiazem, verapamil, ranolazine, macrolide antibiotics, propafenone, beta blockers, thiazide and loop diuretics and calcium chloride
Drug reducers
-St. John’s wort, aminoglycoside antibiotics, cholestyramine, colestipol, rifampin and antacids
Patient education and storage instructions regarding nitroglycerin tablets
Patient education:
-Taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be taken with food.
-Make sure pt knows how to read the expiration date and have prescription filled (must be refilled every 6 months and old tablets must be safely discarded)
Med Storage:
-Store Nitroglycerin in its original dark-colored glass container with a tight lid
Nursing care plan for Heparin therapy, antidote, lab work
Drug Therapy for Thromboembolic Disorders
Drug class: Anticoagulant
Example: Heparin
Actions/Uses/Therapeutic outcomes: -Used to treat DVT, PE, peripheral arterial embolism, MI and PCIs. -Therapeutic range: 1.5 – 2.5 -Used to treat thromboembolism -Promote neutralization of activated clotting factors -Does not dissolve clots -Antidote: Protamine sulfate
Admin regimen:
-2 nurses must confirm dosage calculations
-Blood samples for labs are drawn 4 to 6 hours after IV infusion
-Effects of Heparin only lasts for 4 hours, so continuous infusion is needed
Do’s and Don’ts and patient education:
-Subcutaneous injection: tissue over abdomen
-Do not inject within 2 inches of umbilicus
-Site should NOT be massaged before or after injection
-Sites should be rotated
-90 degree angle for injection
-Do not aspirate and do not inject into a hematoma or infected site
-After injection, apply gentle pressure for 1-2 minutes to control local bleeding
-Ice packs may be used
-Intramuscular is not recommended
Antidote: Protamine Sulfate
Dietary implications/Pre nursing assessment during coumadin therapy
Drug Therapy for Thromboembolic
Drug class: Vitamin K Inhibitor
Example: Warfarin (Coumadin)
Pre Nursing assessment
-Obtain baseline vital signs
-Inspect skin and mucous membranes for petechial, ecchymosis or hematoma
-Ensure pt is not pregnant
Patient education and Dietary management
-Include info on foods high in Vitamin K (leafy vegetables)
Adverse effect:
-Bleeding (petechiae, ecchymoses or hematomas and bleeding gums
Augmentin is ordered at 35 mg/kg/day in 3 divided doses. Client weight = 35 kg
What is the single dosage for this client? ___ mg per single dose (enter numerical digits only
35 x 35 = 1225
Single dose = 408.33 or 408
Effects of Vasodilators
Drug Therapy for HTN
Drug class: Direct Vasodilators
Example: Hydralazine
Actions:
-causes direct arteriolar smooth muscle relaxation
-increases heart rate, cardiac output and renin release with sodium and water retention
Beta-adrenergic blocking agent advantages other antihypertensive medications
Clinical advantages of beta blockers in treating HTN including:
-minimal postural or exercise hypotension
-minimal effect on sexual function
-BP reduction in supine position
-little to no effect in the central nervous system
Pharmacotherapy Management after- Cardiac valve replacement, MI, TIA, Transplant
-Anticoagulants, Heparin
Dietary Instructions for patients on Coumadin Therapy
-Include info on foods high in Vitamin K (leafy vegetables)
Instructions for patients on digoxin (Lanoxin) in the management of heart failure
Drug therapy for Heart Failure
Drug class: Digitalis Glycosides
Example: Digoxin
Actions: increase the force of contraction and slow the heart rate
Uses: treatment of mild to severe systolic HF that -does not respond to diuretics, beta blockers or ACE Inhibitors
Premedication assessment:
–Take pt’s apical pulse for 1 minute (withhold drug is pulse is <60 or >100 bpm
-Obtain baseline vital signs, lung sounds, weight, lab values
-Monitor for digoxin toxicity, hypokalemia, hypomagnesemia or sudden increase in normal or low pulse rate.
-Have mathematical computations checked by another nurse
-Give Digoxin after meals to minimize gastric irritation
-Getting baseline electrocardiogram before therapy is recommended
Dosage and administration
-Give digoxin after meals to minimize gastric irritation. NOTE: It is recommended that a baseline electrocardiogram be obtained before the initiation of therapy.
-Assuming that the patient has not ingested digoxin during the preceding 2 weeks, the following dosages apply: Adult: PO: Maintenance: 0.125 to 0.25 mg daily.
-Some patients may require 0.375 to 0.5 mg daily. IV: -Maintenance: Same as for PO administration.
-Adult therapeutic blood levels are 0.5 to 2.0 ng/mL.
Adverse effect:
-Cardiac rhythm
-loss of appetite, nausea, vomiting, extreme fatigue, weakness of the arms and legs
-Psychiatric disturbances
-Visual disturbances
-Electrolyte imbalance
Drug enhancers
-Quinidine, diltiazem, verapamil, ranolazine, macrolide antibiotics, propafenone, beta blockers, thiazide and loop diuretics and calcium chloride
Other diseases
-The patient’s other clinical conditions may also induce digoxin toxicity.
-Patients who suffer from hypothyroidism, acute MI, renal disease, severe respiratory disease, or far-advanced heart failure may require lower-than-normal doses of digoxin; monitor closely.
Drug reducers
-St. John’s wort, aminoglycoside antibiotics, cholestyramine, colestipol, rifampin and antacids
N/I during the admin of NTG ointment
Drug therapy for Angina Pectoris
Drug class: Nitrates
Nitroglycerin Topical ointment admin:
-Applied in the morning
-6 hours later the first dose is removed and a second dose is applied
-Second dose is removed after 6 hours, giving a nitrate-free period of 10 to 12 hours until the next morning
Nursing Interventions:
-Apply clean gloves
-Position the dose-measuring applicator paper with the printed side down
-Squeeze the proper amount (usually 1 – 2 inches). Do NOT apply to irritated skin.
-Cover the area with clear plastic wrap and then tape it (may discolor clothing)
-Close tube and store in a cool place
-Reduce frequency over the course of 4 to 6 weeks when terminating
