Exam 2 Drugs List PDF

Exam 2 Drugs List Loop Diuretics (Potassium Wasting) (Furosemide) Use: Treat HF, HTN, renal dysfunction, nephrotic syndrome, acute pulmonary and peripheral edema MOA: Inhibition of sodium and water reabsorption from loop of Henle and distal renal tubules; increases excretion of potassium, chloride,...

Exam 2 Drugs List Loop Diuretics (Potassium Wasting) (Furosemide) Use: Treat HF, HTN, renal dysfunction, nephrotic syndrome, acute pulmonary and peripheral edema MOA: Inhibition of sodium and water reabsorption from loop of Henle and distal renal tubules; increases excretion of potassium, chloride, magnesium, ammonium, phosphate, and calcium Responsibilities of Nurse: Weigh the patient at the same time every day. A loss of 2.2 lb is equivalent to a fluid loss of 1 L. Urinary output should be at least 30 mL/hr (otherwise may have a renal disorder) Monitor vital signs & be alert for marked decreases in blood pressure Monitor for hypokalemia signs such as muscle weakness, abdominal distension, leg cramps, and/or cardiac dysrhythmia Monitor serum potassium levels, especially when a patient is taking digoxin. Hypokalemia enhances the action of digitalis, causing digitalis toxicity Administer IV furosemide slowly; hearing loss may occur if it is rapidly injected Side Effects & Adverse Reactions: SE: Nausea, diarrhea, dizziness, tinnitus, abdominal cramps, constipation, rash, headache, weakness, blurred vision, muscle cramps, photosensitivity, paresthesia, **injection site reaction for IV AR: hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypovolemia, orthostatic hypotension, diabetes mellitus, hearing loss, hypercholesterolemia, gout LT: aplastic or hemolytic anemia, leukopenia, thrombocytopenia, agranulocytosis, Stevens-Johnson syndrome Patient Education: · Take in the morning to prevent sleep disturbance and nocturia · Rise slowly to avoid orthostatic hypotension · Potassium replacement with food or supplements to prevent hypokalemia Thiazide Diuretic (Hydrochlorothiazide) Use: increase urine output → treat HTN and edema due to heart failure, nephrotic syndrome, and ascites MOA: action is on the renal distal tubules, promoting sodium, potassium, and water excretion and decreasing preload and cardiac output; also decreases edema; acts on arterioles and cases vasodilation, thus decreasing BP Responsibilities of Nurse: · Weigh the patient at the same time every day · Note urine output to determine fluid loss or retention · Monitor vital signs & serum electrolytes → potassium, glucose, uric acid, and cholesterol levels. In combination with Digoxin regime, if hypokalemia happens → digitalis toxicity will occur · Monitor for hypokalemia signs such as muscle weakness, leg cramps and cardiac dysrhythmias · Drugs and herbs that can cause a reaction: digoxin, corticosteroids, antidiabetics, ginkgo, licorice Observe for signs and symptoms of hyperglycemia Side Effects & Adverse Reactions: SE: Dizziness, headache, blurred vision, anorexia, nausea, vomiting, diarrhea, abdominal cramps, constipation, rash, photosensitivity, paresthesia, weakness, erectile dysfunction AF: Orthostatic hypotension, hyponatremia, hypomagnesemia, hypochloremia, hyperglycemia, hypercalcemia, hyperuricemia, hypercholesterolemia, hypertriglyceridemia, metabolic alkalosis, pulmonary edema, ocular hypertension, gout LT: Hypokalemia, aplastic anemia, leukopenia, hemolytic anemia, thrombocytopenia, agranulocytosis, renal failure, Stevens-Johnson syndrome Patient Education: Rise slowly to avoid orthostatic hypotension If patient is prediabetic: blood glucose needs to be checked periodically due to large doses of hydrochlorothiazide increases blood glucose levels  Photosensitivity drug Eat foods rich in potassium or take supplements Potassium Sparing Diuretic (Spironolactone) Use: edema, HTN, HF, hypokalemia, and hyperaldosteronism MOA: inhibits aldosterone effects on distal renal tubules to promote sodium and water excretion and potassium retention Responsibilities of Nurse: · Weight patient at the same time every day to determine fluid loss or gain · Monitor urinary output, report if less than 30mL/hr · Monitor for hyperkalemia signs → nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, lg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG · Take in the morning to avoid nocturia Side Effects & Adverse Effects: SE: Nausea, vomiting, diarrhea, abdominal cramps, dizziness, drowsiness, headache, confusion, weakness, muscle cramps, gout, paresthesia, dehydration, ataxia, erectile dysfunction AR: Hyperkalemia, hypomagnesemia, hyponatremia, hypocalcemia, hypovolemia, hyperglycemia, hyperuricemia, orthostatic hypotension, bradycardia, metabolic acidosis/alkalosis LT: Agranulocytosis, leukopenia, thrombocytopenia, renal/hepatic failure, Stevens-Johnson syndrome Patient Education: Avoid foods rich in potassium when taking potassium-sparing diuretics Do not discontinue the drug without consulting a health care provider Take with or after a meal to avoid nausea Beta Blockers (Metoprolol) Use: control hypertension, acute myocardial infarction, angina, HF MOA: blocks beta-1 adrenergic receptors in cardiac tissues Responsibilities of Nurse: o Obtain a medication and herbal history from the patient. Report if a drug-drug or drug-herbal interaction is probable. o Assess blood pressure and pulse, along with other vital signs. Report abnormal blood pressure and bradycardia, and compare vital signs with baseline findings. Side Effects & Adverse Reactions: SE: Dizziness, headache, nausea, vomiting, diarrhea, erectile dysfunction, peripheral edema cardioselective beta blockers act more strongly on the beta1 receptor, which decreases heart rate but avoids bronchoconstriction because of their lack of activity at the beta2 receptor AR: Bradycardia, hypotension, palpitations, diabetes mellitus LT: dysrhythmias, agranulocytosis, thrombocytopenia, HF Patient Education: o Encourage patient to comply with drug regimen. *Beta blockers should not be abruptly discontinued. The dose should be tapered over a specified number of days to avoid reflex tachycardia, recurrence of anginal pain, or rebound hypertension. o Patients who have decreased heart rate and blood pressure usually cannot take beta blockers. o Teach patients or family members how to take a radial pulse and BP, and to report abnormal findings to healthcare provider. Calcium Channel Blockers (Amlodipine) Use: treat hypertension and coronary artery disease MOA: Inhibits influx of extracellular calcium across myocardial and vascular smooth muscle cell membranes, resulting in decreased myocardial contractility Responsibilities of Nurse: o Monitor BP. A sudden drop in BP should be reported. o Monitor laboratory tests related to renal function (BUN, creatinine, protein). o Monitor intake and output and daily weight. **Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention). Side Effects & Adverse Effects: SE: Dizziness, drowsiness, anxiety, flushing, fatigue, weakness, syncope, peripheral edema, depression, visual impairment, paresthesia, diaphoresis, arthralgia, myalgia, muscle cramps, nausea, anorexia, abdominal pain, vomiting, diarrhea, constipation, nightmares, insomnia, weight loss/gain, rash, pruritus, erectile dysfunction AR: Orthostatic hypotension, bradycardia, chest pain, tachycardia, palpitations, dyspnea, hyperglycemia LT: Angioedema, dysrhythmia exacerbation, MI, thrombocytopenia Patient Education: o Rise slowly to avoid orthostatic hypotension o Inform patients not to take over-the-counter (OTC) drugs such as cold medications without first contacting a health care provider Angiotensin Converting Enzyme Inhibitors (ACE) (Lisinopril) Use: treats HTN and HF, decreases development of HF post myocardial infarction (MI) MOA: Blocks conversion of angiotensin I to angiotensin II Responsibilities of Nurse: o Monitor BP. A sudden drop in BP should be reported. o Monitor laboratory tests related to renal function (BUN, creatinine, protein) and blood glucose levels. o Report to a health care provider any bruising, petechiae, or bleeding. These may indicate a severe adverse reaction (agranulocytosis) to an angiotensin antagonist such as captopril Side Effects & Adverse Reactions: SE: (Nonproductive dry cough), fatigue, insomnia, headache, dizziness, nausea, vomiting, diarrhea, hyperkalemia, tachycardia, hypotension AR: orthostatic hypotension, angioedema, agranulocytosis, renal impairment Patient Education: o Warn patients not to abruptly discontinue use of captopril without notifying a health care provider. Rebound hypertension could result o *Advise patients not to use salt substitutes that contain potassium. Advise patients to avoid foods high in potassium because hyperkalemia is an adverse effect of ACE inhibitors. o Inform patients not to take over-the-counter (OTC) drugs such as cold medications without first contacting a health care provider. o Warn pregnant patients and those contemplating becoming pregnant not to take angiotensin-converting enzyme (ACE) inhibitors or (ARBs); they reduce placental blood flow and can cause harm to the fetus. o Teach patients to rise slowly to avoid orthostatic hypotension Angiotensin II Receptor Blocker (ARB) (Valsartan) Use: treat HTN and HF, and decreases development of HF post myocardial infarction (MI) MOA: Potent vasodilator that inhibits binding of angiotensin II (prevents release of aldosterone) Responsibilities of Nurse: o Monitor BP. A sudden drop in BP should be reported. o Monitor laboratory tests related to renal function (BUN, creatinine, protein) and liver enzymes (ALT, AST, ALP) o Assess that urine output is at least 30 mL per hour (600 mL per 24 hr) Side Effects & Adverse Reaction: SE: Dizziness, drowsiness, palpitations, blurred vision, headache, edema, nausea, diarrhea, abdominal and back pain, arthralgia, fatigue, muscle cramps, pharyngitis, cough, erectile dysfunction **ARBs do not cause the constant, irritated cough that ACE inhibitors can, but work similarly to ACE inhibitors. AR: Orthostatic hypotension, chest pain, hyperkalemia, rhabdomyolysis, elevated hepatic enzymes LT: Renal dysfunction, neutropenia Patient Education: o Regularly monitor and record BP o Avoid high-potassium diet and salt substitutes (which contain potassium) o Do not abruptly stop taking the medication, which could cause rebound HTN o Warn pregnant patients and those contemplating becoming pregnant not to take angiotensin-converting enzyme (ACE) inhibitors or (ARBs); they reduce placental blood flow and can cause harm to the fetus. Direct Acting Vasodilators (Hydralazine) Use: moderate to severe hypertension MOA: relax smooth muscles of blood vessels, especially arteries causing vasodilation Responsibilities of Nurse: o Monitor patient’s BP and HR o Use with caution with older adults that may be more sensitive to hypotensive effects o Monitor patient closely for lupus-like syndrome (sore throat, fever, muscle and joint ache) and report to provider Side Effects & Adverse Reactions: SE: Hypotension, reflex tachycardia, palpitations, edema, nasal congestion, headache, dizziness, lupus-like symptoms, and neurologic symptoms (tingling, numbness) AR: increased intracranial pressure (ICP), neutropenia, leukopenia, agranulocytosis Patient Education: o Rise slowly to avoid orthostatic hypotension o Take with meals to increase absorption o Tell patient to report all adverse effects such as (fatigue, muscle aches, joint pain) Cardiac Glycosides (Digoxin) Use: Heart Failure, Atrial Fibrillation and Atrial Flutter, Paroxysmal Atrial Tachycardia MOA: Inhibits sodium-potassium ATPase, promoting influx of calcium, which leads to increased force of cardiac contraction, cardiac output, and tissue perfusion; decreases ventricular rate Responsibility of Nurse: o Report if a drug-drug or drug-herb interaction is probable. o *If a patient is taking digoxin and a potassium-wasting diuretic or cortisone drug, hypokalemia can result, causing digitalis toxicity. A low serum potassium level enhances the action of digoxin. Serum potassium level (normal range is 3.5 to 5.0 mEq/L). Patients taking a thiazide and/or cortisone with digoxin should take a potassium supplement. o Digitalis toxicity can occur from hypokalemia (< 3.5 mEq/L), hypomagnesemia (10.2 mg/dL). o Assess for signs and symptoms of *digitalis toxicity. Common symptoms include anorexia, nausea, vomiting, diarrhea, *bradycardia, cardiac dysrhythmias, and *visual disturbances. Report symptoms immediately to the health care provider. o Monitor serum digoxin level (normal therapeutic drug range is 0.8 to 2 ng/mL). A serum digoxin level greater than 2 ng/mL is indicative of digitalis toxicity. o Ascertain apical pulse rate before administering digoxin. Take apical pulse for one full minute. Do not administer if pulse rate is below 60 beats/min. o Determine signs of peripheral and pulmonary edema, which indicate HF is present. Side Effects & Adverse Reactions: SE: Anorexia, *nausea, vomiting, diarrhea, abdominal pain, headache, *blurred or yellow vision, dizziness, weakness, confusion, visual impairment, anxiety AR: Bradycardia, hallucinations, bowel necrosis, palpitations LT: Dysrhythmias, thrombocytopenia Patient Education: · Show patient how to check pulse rate before taking digoxin. · Instruct patients to report side effects: pulse rate less than 60 beats/min, nausea and vomiting, headache, diarrhea, and visual disturbances, including diplopia. · Advise patients to eat foods high in potassium, such as fresh and dried fruits, fruit juices, and vegetables, including potatoes. Alpha Adrenergic Blocker (Prazosin) Use: HTN, benign prostatic hypertrophy MOA: dilates peripheral blood vessels by blocking alpha-adrenergic receptors Responsibilities of Nurse: o Monitor vital signs and report any changes o **Check daily weights and monitor for fluid retention in extremities o Rise slowly to avoid orthostatic hypotension o Check urinary output. Report if it is decreased (less than 600 mL/day) because the drug is contraindicated if renal disease is present. Side Effects & Adverse Reactions: SE: orthostatic hypotension (dizziness, faintness, lightheadedness, and increased heart rate, which may occur with first dose), nausea, headache, drowsiness, nasal congestion caused by vasodilation, edema, and weight gain AR: dyspnea, palpitations Patient Education: o Rise slowly due to orthostatic hypotension o Do not abruptly stop taking medication o Regularly monitor and record BP and daily weights, since prazosin may lead to edema. o Inform patients not to take over-the-counter (OTC) cold, cough, or allergy medications without first contacting the health care provider. Nitrates (Nitroglycerine) Use: control angina, Acute Myocardial Infarction (AMI), hypertensive emergency, pulmonary edema, and heart failure MOA: decreases myocardial demand for oxygen; decreases preload by dilating veins, indirectly decreasing afterload Responsibility of Nurse: · Position the patient sitting or lying down when administering a nitrate for the first time. After administration, check vital signs while the patient is lying down and then sitting up. Have the patient rise slowly to a standing position. · Offer sips of water before giving sublingual (SL) nitrates; dryness may inhibit drug absorption. Nitroglycerin is not swallowed because it undergoes first-pass metabolism by the liver, which decreases its effectiveness. · SL nitrates onset: 1-3 minutes. If systolic blood pressure is withing parameters, administer a 2nd dose in 5 minutes if chest pain still present. If chest pain still presents after 2nd dose and SBP is within parameters can give a 3rd dose in 5 minutes. *No more than 3 tablets Side Effects & Adverse Reactions: SE: hypotension, tachycardia, headache, blurred vision, dizziness, syncope, weakness, diaphoresis, flushing, nausea, vomiting, dry mouth, paresthesia, peripheral edema, rash, pharyngitis, tolerance. AR: Orthostatic hypotension, chest pain, dyspnea, tachycardia, bradycardia, palpitations, methemoglobinemia. Life-threatening: MI, pulmonary edema LT: MI, pulmonary edema Patient Education: o Administer SL nitroglycerin tablet if chest pain occurs. If pain has not subsided or has worsened in 5 minutes, call 911. o *Advise patients to seek medical attention if nitroglycerin does not relieve pain after three tablets. o Advise patients not to ingest alcohol while taking nitroglycerin to avoid hypotension, weakness, and faintness. o Advise patients to notify a health care provider if chest pain is not completely alleviated. Tolerance to nitroglycerin can occur. Inform patients not to discontinue beta blockers and calcium blockers without a health care provider’s approval. Withdrawal symptoms (reflex tachycardia and pain) may be severe. o Show how to take SL nitroglycerin, stinging or biting sensation is normal due to tablet being “fresh”. o Medication is light-sensitive o Is okay to take Tylenol for a headache while on nitroglycerin which commonly occurs within the first time taking o Advise patients taking beta blockers and calcium blockers to notify a health care provider if dizziness or faintness occurs because it may indicate hypotension. o Nitroglycerin should not be taken with PDE-5 inhibitors, such as Viagra or Cialis, because it can cause severe hypotension Anticoagulant oral (Warfarin) Use: prevent thrombosis associated with PE, MI, unstable angina, prosthetic heart valves, DVT, and PCI; to treat atrial fibrillation MOA: Inhibits hepatic synthesis of vitamin K clotting factors (II [prothrombin], VII, IX, and X) and anticoagulant proteins Responsibilities of Nurse: o Obtain a history of abnormal clotting or health problems that affect clotting, such as severe alcoholism or severe liver or renal disease. Warfarin is contraindicated for patients with blood dyscrasias, peptic ulcer, cerebrovascular accident (CVA), hemophilia, or severe hypertension. Use with caution in patients with acute traumatic injury. o Report if drug-drug or drug-herb interaction or other interaction with complementary and alternative therapy is probable. Warfarin is highly protein bound and can displace other highly protein-bound drugs, or warfarin could be displaced, which may result in bleeding. o Flowchart that lists prothrombin time (PT) or international normalized ratio (INR) and warfarin dosages. A baseline PT or INR should be obtained before warfarin is administered. o Monitor vital signs. An increased pulse rate followed by a decreased systolic pressure can indicate a fluid volume deficit resulting from external or internal bleeding o Monitor PT or INR for warfarin before administering anticoagulant. PT should be 1.25 to 2.5 times the control level, or INR should be 2 to 3, except for patients with prosthetic heart valves, in whom INR may be up to 3.5. Monitor platelet count because anticoagulants can decrease it. o Examine the patient’s mouth, nose (epistaxis), urine (hematuria), and skin (petechiae, purpura) for bleeding. Watch older adults closely for bleeding; their skin is thin, and capillary beds are fragile. o Check stools periodically for occult blood. o **The anticoagulant antagonist phytonadione (vitamin K1) is used for warfarin overdose or uncontrollable bleeding. Usually 5–10 mg of vitamin K1 is given via slow intravenous infusion at once, and if it fails to control bleeding, *fresh frozen plasma may be needed for transfusion. Side Effects & Adverse Reactions: SE: Headache, alopecia, fever, weakness, priapism, petechiae, ecchymosis AR: Purple-toe syndrome (abnormal circulation to toes), bone fracture, hypotension, chest pain, hematuria, ocular hemorrhage, intracranial/vaginal/GI bleeding LT: Hemorrhage Patient Education: o Patients need to let their dentist know about their anticoagulant medication due to bleeding o Patients to use a soft toothbrush to prevent gums from bleeding o Warn patients to shave with an electric razor. Bleeding from shaving cuts may be difficult to control o Advise patients to have laboratory tests such as PT or INR performed as ordered by a health care provider. The warfarin dose is regulated according to INR derived from PT o Patients may carry a medical identification card or wear a MedicAlert bracelet that lists the patient’s name, telephone number, and the drug taken o Smoking increases drug metabolism, so warfarin dose may need to be increased. If a patient insists on smoking, notify the health care provider o Check with a health care provider before taking over-the-counter (OTC) drugs. Aspirin should not be taken with warfarin because it intensifies warfarin’s action, and bleeding is apt to occur. Suggest that patients use acetaminophen o Many herbal products interact with anticoagulants and may increase bleeding. Closely monitor INR or PT o Control external hemorrhage from accidents or injuries by applying firm, direct pressure for at least 5 to 10 minutes with a clean, dry, absorbent material Anticoagulant Subcutaneous, Low Molecular Weight (Enoxaparin) Use: (Subcut, or IV) prophylaxis of AMI, thrombosis, and unstable angina and for prophylaxis and treatment of PE and DVT MOA: inactivates the Xa factor, but it is less able to inactivate thrombin Responsibilities of Nurse: o Monitor vital signs. An increased pulse rate followed by a decreased systolic pressure can indicate a fluid volume deficit resulting from external or internal bleeding o Frequent laboratory monitoring of aPTT is not required, because LMWH does not have the standard effect of heparin. o Examine the patient’s mouth, nose (epistaxis), urine (hematuria), and skin (petechiae, purpura) for bleeding. Watch older adults closely for bleeding; their skin is thin, and capillary beds are fragile o Check stools periodically for occult blood o The half-life of LMWHs is two to four times longer than that of heparin. Bleeding because of LMWH use is less likely to occur than when heparin is given o LMWH overdose is rare; if bleeding occurs, protamine sulfate is the anticoagulant antagonist used. The dosage is 1 mg of protamine sulfate for every 100 units of unfractionated heparin or LMWH given to be neutralized Side Effects & Adverse Reactions: SE: may cause bleeding, hematoma, fever, anemia, peripheral edema, and elevated liver enzymes Patient Education: o Patients should be instructed not to take antiplatelet drugs such as aspirin while taking LMWHs o The patient or family member is taught how to administer the subcutaneous injection, which is usually given in the abdomen. Injection sites should be alternated with every dose Anticoagulant Subcutaneous or IV (Heparin) Use: prevent thromboembolism associated with PE, MI, unstable angina, prosthetic heart valves and PCI; and to treat DVT, DIC, and acute coronary syndrome MOA: Inactivates thrombin, which prevents conversion of fibrinogen to fibrin Responsibilities of Nurse: o Monitor vital signs. An increased pulse rate followed by a decreased systolic pressure can indicate a fluid volume deficit resulting from external or internal bleeding o Monitor activated partial thromboplastin time (aPTT) for heparin before administering anticoagulant. Normal aPTT is 20 – 35s, (30 – 85 while on heparin). Monitor platelet count because anticoagulants can decrease it (heparin-induced thrombocytopenia [HIT]). o Examine the patient’s mouth, nose (epistaxis), urine (hematuria), and skin (petechiae, purpura) for bleeding. Watch older adults closely for bleeding; their skin is thin, and capillary beds are fragile. o Check stools periodically for occult blood. o Keep anticoagulant antagonists available, protamine sulfate for heparin, when the drug dose is increased or indications of frank bleeding are evident. Fresh frozen plasma may be needed for transfusion. Side Effects & Adverse Reactions: SE: Itching, chills, headache, epistaxis, erythema, hematoma, hematemesis, hematuria, alopecia, elevated hepatic enzymes, nausea, vomiting, injection-site reaction, priapism AR: Bleeding, intracranial bleeding, ocular hemorrhage, anemia, bone fractures, osteoporosis, hyperkalemia, vitamin D deficiency, GI bleeding, hyperlipidemia, stroke LT: Anaphylaxis, HIT, thrombocytopenia Patient Education: o Patients need to let their dentist know about their anticoagulant medication due to bleeding o Patients to use a soft toothbrush to prevent gums from bleeding o Warn patients to shave with an electric razor. Bleeding from shaving cuts may be difficult to control. o Tell patients to check with a health care provider before taking over-the-counter (OTC) drugs. Inform patients that many herbal products interact with anticoagulants and may increase bleeding. o Control external hemorrhage from accidents or injuries by applying firm, direct pressure for at least 5 to 10 minutes with a clean, dry, absorbent material. Thrombolytic (Alteplase) Use: promote fibrinolysis (dissolves clots) and decrease permanent tissue damage associated with thrombosis in patients with acute myocardial infarction (MI), PE, ischemic stroke, occluded IV catheter (MI – thrombolytics within 12 hours from symptom onset; Ischemic stroke – thrombolytics within 3 – 4.5 hours from symptom onset) MOA: Alteplase promotes conversion of plasminogen to plasmin, an enzyme that digests the fibrin matrix of clots. Alteplase also initiates fibrinolysis Responsibilities of Nurse: o The antidote antithrombotic drug aminocaproic acid is used to stop bleeding by inhibiting plasminogen activation, which inhibits thrombolysis o Monitor vital signs. *Increased pulse rate followed by decreased blood pressure usually indicates blood loss and impending shock. Record vital signs, and report changes o **Observe for signs of allergic reaction to thrombolytics, such as itching, hives, flushing, fever, dyspnea, bronchospasm, hypotension, and/or cardiovascular collapse. o Observe for signs and symptoms of active bleeding from the mouth or rectum. Hemorrhage is a serious complication of thrombolytic treatment. Aminocaproic acid can be given as an intervention to stop bleeding. o Examine the patient for active bleeding for 24 hours after thrombolytic therapy has been discontinued: this should be done every 15 minutes for the first hour, then every 30 minutes until the eighth hour, and then hourly. o Avoid administering aspirin or NSAIDs for pain or discomfort when the patient is receiving a thrombolytic. Acetaminophen can be substituted. o Monitor the electrocardiogram (ECG) for presence of reperfusion dysrhythmias as the blood clot is dissolving; antidysrhythmic therapy may be indicated. o Avoid venipuncture/arterial sticks. o Advise patients to report any side effects such as lightheadedness, dizziness, palpitations, nausea, pruritus, or urticaria. Side Effects & Adverse Reactions: SE: Epistaxis, infection, ecchymosis, nausea, vomiting, rash AR: Anaphylactoid (anaphylaxis) reactions, laryngeal edema, angioedema**; cholesterol microembolization, bleeding, hypo/hypertension, GI bleeding, MI, cerebral edema, rhabdomyolysis, bradycardia, tachycardia, heart failure, intracranial hemorrhage, seizures LT: Stroke; dysrhythmias; pulmonary edema, renal failure Patient Education: o Explain thrombolytic treatment to patients and family. Be supportive. Antiplatelet (Aspirin or Clopidogrel) Use: prevention and treatment of stroke; MI, TIA, prosthetic heart valves, and thromboembolism prophylaxis MOA: inhibits cyclooxygenase (COX), an enzyme needed by platelets to synthesize thromboxane A2 (TxA2) Responsibilities of Nurse: o Monitor lab values (may decrease platelet and WBC counts, or increase BUN, creatinine, sodium, or potassium) o Aspirin has prolonged antiplatelet activity and it should be discontinued at least 7 days before surgery Side Effects & Adverse Reactions: SE: may cause abdominal pain, nausea, dyspepsia, gastritis AR: GI bleeding, intracranial bleeding, and epistaxis Patient Education: o Educate patient to stop taking 1 week (7 days) before surgery to avoid excessive bleeding during surgery o Avoid taking herbal therapy without verifying with provider to avoid drug interactions o Children with chickenpox or flulike symptoms should not take aspirin due to the risk of Reye syndrome Antihyperlipidemic (Atorvastatin) Use: decrease cholesterol levels and serum lipids, especially LDL and triglycerides; for treatment of atherosclerosis, hypercholesterolemia, hyperlipoproteinemia, and hypertriglyceridemia MOA: Inhibits HMG-CoA reductase, the enzyme necessary for hepatic production of cholesterol Responsibilities of Nurse: o Monitor the patient’s blood lipid levels—cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL)—every 6 to 8 weeks for the first 6 months after statin therapy, then every 3 to 6 months o For a lipid-level profile, the patient should fast for 12 to 14 hours. The desired values are less than 200 mg/dL for cholesterol; less than 150 mg/dL for triglycerides, although this can vary; less than 100 mg/dL for LDL; and more than 60 mg/dL for HDL. Cholesterol levels higher than 240 mg/dL, LDL levels higher than 160 mg/dL, and HDL levels below 35 mg/dL can lead to severe cardiovascular events or cerebrovascular accident (CVA) o Monitor laboratory tests for liver function (ALT, alkaline phosphatase [ALP], and gamma-glutamyl transferase [GGT]). Antihyperlipidemic drugs can cause liver disorders. o Observe for signs and symptoms of gastrointestinal (GI) upset. Taking the drug with sufficient water or with meals may alleviate some of the discomfort. Side Effects & Adverse Reactions: SE: GI disturbance- dyspepsia, nausea, diarrhea, flatulence; dizziness, headache, insomnia, memory impairment, flushing, nightmares, blurred vision, weakness, myalgia (muscle cramps), abdominal pain, peripheral neuropathy AR: Rhabdomyolysis (rare), tendon rupture hyperglycemia, diabetes mellitus LT: Hepatic/renal failure, stroke, leukopenia, hemolytic anemia, thrombocytopenia Patient Education: o Emphasize the need to comply with the drug regimen to lower blood lipids o Inform patients that it may take several weeks before blood lipid levels decline o Explain that laboratory tests for blood lipids—cholesterol, triglycerides, LDL, and HDL—are usually ordered every 3 to 6 months o Advise patients to have serum liver enzymes monitored as indicated by their health care provider. Lovastatin, pravastatin, and simvastatin are contraindicated in acute hepatic disease and pregnancy o Instruct patients to have an annual eye examination and to report changes in visual acuity o Abruptly stopping the statin drug could cause a threefold rebound effect that may cause death from acute myocardial infarction (AMI) Peripheral Vasodilator (Cilostazol) Use: prevention of thrombosis and MI, CVA, transient ischemic attack (TIA), and for intermittent claudication (pain when walking) MOA: inhibits platelet aggregation and causes vasodilation, especially in femoral vasculature Responsibilities of Nurse: Monitor vital signs, especially blood pressure and heart rate. Tachycardia and orthostatic hypotension can be problematic with peripheral vasodilators Side Effects & Adverse Reactions: SE: Dizziness, headache, tachycardia, palpitations, orthostatic hypotension, nausea, vomiting, diarrhea, and abnormal stools AR: Tachycardia, palpitations, angina, HF, MI, hypo/hypertension, peptic ulcer, gout, diabetes mellitus, elevated hepatic enzymes LT: Thrombocytopenia, leukopenia, aplastic anemia, agranulocytosis, dysrhythmias, Stevens- Johnson syndrome Patient Education: o Recommended to take on an empty stomach, but may be taken with food if GI discomfort occurs o Patients to report side effects of cilostazol, such as flushing, headaches, and dizziness o Desired therapeutic response may take 1.5 to 3 months o *Do not smoke due to vasospasm o Instruct patients to use aspirin or aspirin-like compounds only with the health care provider’s approval. Salicylates help prevent platelet aggregation o *Advise patients not to ingest alcohol with a vasodilator because it may cause a hypotensive reaction Hyperkalemia Treatments (Calcium Gluconate, Sodium Polystyrene Sulfonate) Use: o Oral and IV – Treatment and prevention of hypocalcemia o Oral – Adjunct in the prevention of postmenopausal osteoporosis o IV – Emergency treatment of hyperkalemia (calcium stabilizes cardiac cell resting membranes) and hypermagnesemia (calcium directly opposes effects of magnesium) and adjunct in cardiac arrest or calcium channel blocking agent toxicity MOA: Transmits nerve impulses, contracts skeletal and cardiac muscles, maintains cellular permeability, and promotes strong bones and teeth Responsibilities of Nurse: o Assess the patient for signs and symptoms of calcium imbalance. Signs and symptoms of hypocalcemia are tetany, muscle cramps, bleeding tendencies, and cardiac contractions. Signs and symptoms of hypercalcemia are flabby muscles, pain over bony areas, and kidney stones of calcium composition. o Check serum calcium levels; a normal total calcium level is 8.6 to 10.2 mg/dL. Report abnormal test results. o Assess albumin levels; a normal albumin level is 3.4 to 5.4g/dL. Low levels of albumin decrease total calcium levels. o If the patient is receiving digoxin, calcium enhances the effect of digoxin. *An elevated serum calcium level can cause digitalis toxicity, signs and symptoms of which include nausea, vomiting, anorexia, bradycardia. cardiac dysrhythmias, and visual disturbances. Thiazide diuretics can increase serum calcium levels. Drugs that decrease the effect of calcium are calcium channel blockers, tetracycline, and sodium chloride. o Administer IVFs slowly with 10% calcium gluconate or chloride Assess the IV site for infiltration. Calcium can cause tissue necrosis and sloughing if it infiltrates into subcutaneous tissue. Side Effects & Adverse Reactions: SE: Nausea, vomiting, constipation, pain, drowsiness, headache, muscle weakness AR: Hypercalcemia, ECG changes, metabolic alkalosis, heart block, rebound hyperacidity LT: Renal failure, cardiac dysrhythmias, cardiac arrest Patient Education: o Instruct patients to avoid overuse of antacids and chronic use of laxatives. Overuse of certain antacids may cause alkalosis, decreasing calcium ionization. Chronic use of laxatives decreases calcium absorption from the gastrointestinal (GI) tract. Suggest high-fiber foods for improving bowel elimination. o Advise patients to take oral calcium supplements with meals or after meals to increase absorption. Remind the patient that foods rich in protein and vitamin D enhance calcium absorption. o Instruct patients to report symptoms of hypercalcemia, including muscle weakness and pain over bony areas. Remind patients to report any chest pain or urinary problems because calcium can cause ECG changes and renal stones. o Instruct patients to report symptoms of hypocalcemia, including neuromuscular signs such as numbness, tingling sensations in fingers and toes, and muscle cramps. Wheezing may develop from bronchospasm, dysphagia, voice changes, fatigue, and seizures. o Instruct the patient to consume high-calcium foods such as milk and dairy products.