NCM 112 Cardiovascular Medications.pptx

Cardiovascular Medications Prepared by: Angela Kate L. Garcia, RN Hemostasis - “hem-” means blood and “- stasis” means to stop - is the stopping of blood flow. It is an essential mechanism that protects the body from both external and internal injury - is achieved once a blood...

Cardiovascular Medications Prepared by: Angela Kate L. Garcia, RN Hemostasis - “hem-” means blood and “- stasis” means to stop - is the stopping of blood flow. It is an essential mechanism that protects the body from both external and internal injury - is achieved once a blood clot is formed and the body is protected from excessive hemorrhage - involves a number of clotting factors that are activated in a series of sequential steps Basic steps in hemostasis: o Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. o Coagulation Cascade is a series of steps in response to bleeding caused by tissue injury, where each step activates the next and ultimately produces a blood clot. o Intrinsic Pathway is activated in response to o Extrinsic Pathway injury. is activated when blood leaks out of a vessel and enters tissue spaces. o Fibrinogen, also known as clotting factor I, forms fibrin that binds together platelets and some plasma proteins in a hemostatic plug. o Prothrombin, also known as clotting factor II, activates thrombin. Anticoagulants - are drugs used to prolong bleeding time and thereby prevent blood thrombi from forming or growing larger. - impart a negative charge to the surface of the platelets, which inhibits the clumping action or aggregation of these cells. - The process of clot removal is called fibrinolysis.  Heparin Sodium - acts by enhancing actions of antithrombin III. Antithrombin III is a protein in plasma that inactivates thrombin, and several other procoagulant enzymes, and inhibits coagulation. - Within minutes after IV administration, the loss of activated clotting factors prevents the formation of fibrin clots. - Heparin molecules have been shortened and modified to create a newer class of drugs called low- molecular-weight heparins (LMWHs). - Heparin is also called unfractionated heparin to distinguish it from the LMWHs.  Enoxaparin Sodium - low-molecular-weight heparin (LMWH) - The mechanism of action and use are similar to that of heparin, except their inhibition is more specific to active Factor X and has a longer half-life than heparin. - Duration of action is two to four times longer than that of heparin. - LMWH produces a more stable response than heparin—fewer follow-up laboratory tests are needed. - preferred drugs for a number of clotting disorders, including the prevention of DVT following surgery—less likely to cause thrombocytopenia Name: Heparin Sodium NURSING INTERVENTION Therapeutic Class: Anticoagulant (Parenteral)  Monitor aPPT (activated partial Pharmacologic Class: Indirect thrombin thromboplastin time) inhibitor  Monitor platelet count  When administering heparins via SC, inject ACTIONS AND USES into abdomen with a 25-28 G needle at a 90º Heparin is a natural substance found in the liver angle. Do not aspirate once the needle has and in the lining of blood vessels. Its normal entered the skin and never massage the site function is to prolong coagulation time, thereby after injection. preventing excessive clotting within blood vessels. As a result, heparin prevents the  IM administration is contraindicated due enlargement of existing clots and the formation to bleeding risk. of new ones. It has no ability to dissolve BLOOD LEVELS  Antidote – Protamine Sulfate existing clots. o The normal aPPT is 20 to 40 seconds o To maintain a therapeutic level of The binding of heparin to antithrombin III anticoagulation when the client is receiving inactivates several clotting factors and inhibits a continuous infusion therapy, the aPPT thrombin activity. The onset of action for IV should be 1.5 to 2.5 times the normal value heparin is immediate, whereas subcutaneous o aPPT therapy should be measured every 4 heparin may take up to 1 hour to achieve a to 6 hours during initial continuous infusion therapeutic effect. therapy and then daily  Warfarin Sodium - acts by inhibiting the hepatic synthesis of coagulation Factors II, VII, IX, and X. - the anticoagulant activity of warfarin can take several days to reach its maximum effect. - Warfarin prolongs clotting time (PT) and the international normalized ratio (INR). - It is used for long-term anticoagulation and is used mainly to prevent thromboembolic conditions. Name: Warfarin Sodium NURSING INTERVENTION Therapeutic Class: Anticoagulant (Oral)  Monitor PT and INR Pharmacologic Class: Vitamin K  If life-threatening bleeding occurs during antagonist therapy, the anticoagulant effects of warfarin can be reduced by intramuscular ACTIONS AND USES (IM) or subcutaneous administration of its Warfarin inhibits the action of vitamin K. antagonist, vitamin K1. Without adequate vitamin K, the synthesis of clotting Factors II, VII, IX, and X is  Antidote – Vitamin K diminished. Because these clotting factors are normally circulating in the blood, it BLOOD LEVELS takes several days for their plasma levels o The normal INR is 1.3 to 2.0 seconds to fall and for the anticoagulant effect of o The treatment goal of warfarin sodium is warfarin to appear. to raise the INR to an appropriate value— an INR of 2 to 3 seconds is appropriate for INDICATIONS most patients. Prevention of stroke, MI, DVT, and o If the INR is above the recommended pulmonary embolism in patients range, warfarin should be reduced. undergoing hip or knee surgery or in those with long-term indwelling central venous catheters or prosthetic heart valves. The drug may be given to prevent Thrombolytics - promote the process of fibrinolysis, or clot destruction, by converting plasminogen to plasmin, an enzyme that digests fibrin and breaks it down into small soluble fragments - used early in the course of MI—within 4 to 6 hours of the onset of the infarct - The therapeutic effect of thrombolytics is greater when they are administered no later than 4 hours after clot formation occurs. INDICATIONS CONTRAINDICATIONS Alteplase is a preferred Active internal bleeding drug for the treatment of History of hemorrhage brain attack (stroke) stroke, arterial Uncontrolled hypertension thrombosis, deep vein Intracranial problems, including trauma thrombosis, occluded History of hepatic or renal disease shunts or catheters and Recently required, prolonged CPR pulmonary emboli. Intracranial or intraspinal surgery within the previous 2 months History of thoracic, pelvic, or abdominal surgery in the previous 10 days Name: Alteplase (Activase) NURSING INTERVENTION Therapeutic Class: Drug for dissolving  Monitor vital signs closely and assess clots pulses Pharmacologic Class: Thrombolytic  Determine aPPT, PT, fibrinogen level, hematocrit, and platelet count  Antidote - Aminocaprioc Acid  Monitor all excretions for occult blood (Amicar)  Monitor for neurological changes (use only in acute life threatening  Monitor for hypotension and tachycardia conditions)  Must give drug within 12 hours of onset of symptoms of MI and within 3 hours of thrombotic stroke for maximum effectiveness  Avoid parenteral injections during alteplase infusion to decrease risk of bleeding  Apply direct pressure over a puncture site for 20-30 minutes  Handle the patient as little as possible when moving  Instruct to use electric razor for shaving and to brush teeth gently  Withhold drug if bleeding develops and Antiplatelet Drugs produce an anticoagulant effect by interfering with platelet aggregation used to prevent clot formation in arteries Platelets are a key component of hemostasis: too few platelets or diminished platelet function can profoundly increase bleeding time. may be used with anticoagulants Name: Clopidogrel (Plavix) NURSING INTERVENTION Therapeutic Class: Antiplatelet drug  Monitor vital signs (Oral)  Monitor bleeding time Pharmacologic Class: ADP receptor  Instruct patient to take medicine with food blocker if gastrointestinal upset occurs  Instruct patient the use of the drug— ACTIONS AND USES tablets should not be crushed and split Clopidogrel prolongs bleeding time by  Discontinue drug at least 5 days before inhibiting platelet aggregation, directly surgery inhibiting ADP binding to its receptor. This binding is irreversible and the platelet will be affected for the remainder of its life span. INDICATIONS Prevention of thromboembolic events in patients with a recent history of MI, stroke, or peripheral artery disease. It is also approved for thrombi prophylaxis in patients with unstable angina, including those who are receiving vascular bypass procedures or PCI. It may be given off-label Positive Inotropic and Cardiotonic Medications A change in contractility of the heart is called inotropic effect. Drugs that increase contractility are called positive inotropic agents. Examples of positive inotropic drugs: epinephrine, norepinephrine, thyroid hormones, and dopamine Drugs that decrease contractility are called negative inotropic agents. Examples include quinidine and beta-adrenergic antagonists such as propranolol.  These are used for short-term management of Dopamine advanced heart failure—the increase in  used as a short-term rescue myocardial contractility improves cardiac, measure for clients with severe, peripheral, and kidney function by increasing acute heart failure cardiac output, decreasing preload, improving  increases myocardial blood flow to the periphery and kidneys, contractility, thereby improving decreasing edema, and increasing fluid retention. cardiac performance As a result, fluid retention in the lungs and extremities is decreased. Dobutamine  used for short-term management of HF  Increases myocardial contractility, thus improving cardiac performance Inamrinone Lactate (Inocor)  used for short-term management of HF in those who have not responded adequately to cardiac glycosides, diuretics, and vasodilators Milrinone Lactate ADVERSE EFFECTS AND TOXICITY NURSING INTERVENTION Hepatotoxicity manifested by  Positive inotropic and cardiotonic elevated liver enzyme levels medications are used for IV Hypersensitivity manifested by administration wheezing, shortness of breath,  Stop the infusion if BP drops or and pruritus, urticaria, clammy dysrhythmias occur skin, and flushing  Inamrinone should not be mixed with glucose-containing solutions  Monitor apical pulse and BP  Monitor for hypersensitivity  Assess lung sounds for wheezing and crackles  Monitor for edema  Monitor for relief of HF as noted by reduction in edema, lessening of dyspnea, orthopnea, and fatigue  Monitor electrolyte and liver enzyme levels, platelet count, and renal function studies. Cardiac Glycosides The increase in myocardial contractility increases cardiac,  Digoxin peripheral, and kidney function by increasing cardiac output, inhibit the sodium-potassium decreasing preload, improving pump, thus increasing blood flow to the periphery and intracellular calcium, which causes the heart muscle fibers to kidneys, decrease edema, and contract more efficiently increasing fluid excretion. As a result, fluid in the lungs and produce a positive inotropic extremities is decreased. action, which increases the force of myocardial contractions used second-line for heart produce a negative chronotropic failure (medications affecting action, which slows the heart rate. the renin-angiotensin- produce a negative dromotropic aldosterone system are used action that slows conduction more often) and cardiogenic velocity through the AV node shock, atrial tachycardia, atrial fibrillation, and atrial flutter; they are used less frequently for rate control in atrial  Early signs of digoxin NURSING INTERVENTION toxicity present as  Monitor for toxicity gastrointestinal manifestations  Monitor serum digoxin level, (anorexia, n/v, diarrhea), then, electrolyte levels, and renal function heart rate abnormalities and test results visual disturbances appear  The optimal therapeutic range for SIDE/ ADVERSE EFFECTS AND digoxin is 0.5 to 2.0 ng/dL (0.63 to TOXICITY 2.56 nmol/L). Anorexia, N/V, Diarrhea  An increased risk of toxicity exists in Headache clients with hypercalcemia, Visual disturbances: diplopia, hypokalemia, hypomagnesemia, or blurred vision, yellow-green hypothyroidism. halos, photophobia  Monitor the potassium level Drowsiness  Instruct the patient to avoid over- Bradycardia the-counter medications. Fatigue, weakness  Monitor the patient taking a potassium-losing diuretic or  Antidote: Digoxin immune Fab is corticosteroids closely for used in hypokalemia extreme toxicity.  Monitor the apical pulse for 1 full minute; if the apical pulse rate is lower than 60 beats per minute, the Antihypertensives CLASSIFICATIONS OF DIURETICS  Diuretics Loop diuretics Osmotic diuretics A. Thiazide Diuretics Potassium-retaining - increase sodium and water excretion diuretics by inhibiting sodium reabsorption in NURSING INTERVENTION Thiazide diuretics the distal tubule of the kidney  Instruct the patient to take the - used for hypertension and peripheral medication in the morning to avoid edema nocturia and sleep interruption. - not effective for immediate diuresis  Instruct the patient to take medication with food to avoid gastrointestinal - used in patients with normal renal upset. function  Instruct the patient to change - should be used with caution in the positions slowly to prevent orthostatic client taking lithium and digoxin, hypotension. corticosteroids, or hypoglycemic  Instruct the patient to use sunscreen medications when in direct sunlight because of increased photosensitivity.  Instruct the patient with diabetes mellitus to have the blood glucose Antihypertensives SIDE/ ADVERSE EFFECTS Hypokalemia, hyponatremia,  Diuretics hypocalcemia, hypomagnesemia B. Loop Diuretics Thrombocytopenia - increase sodium and chloride Hyperuricemia reabsorption from the loop of Orthostatic hypotension Henle and the distal tubule Rash Ototoxicity and deafness - cause depletion of water and Thiamine deficiency electrolytes, increased uric acid Dehydration levels and the excretion of calcium. - causes rapid diuresis, thus NURSING INTERVENTION  Monitor electrolytes, calcium, decreasing vascular fluid volume, cardiac output, and BP magnesium, BUN, creatinine, and uric acid levels. - used for hypertension, pulmonary  Administer IV furosemide edema, edema associated with slowly over 1 to 2 minutes, heart failure, hypercalcemia, and renal disease because hearing loss can occur if injected rapidly. Antihypertensives SIDE/ ADVERSE EFFECTS Hypokalemia, hyponatremia,  Diuretics hypocalcemia, hypomagnesemia Thrombocytopenia C. Potassium-retaining (Sparing) Hyperuricemia Diuretics Orthostatic hypotension - act on the distal tubule to promote sodium Ototoxicity and deafness and water excretion and potassium retention. Thiamine deficiency Dehydration - used for edema and hypertension, to increase urine output, and to treat fluid retention and overload - contraindicated in severe kidney or hepatic disease and in severe hyperkalemia and should be used with caution in the client with diabetes mellitus, taking antihypertensives or lithium, or taking angiotensin-converting enzyme inhibitors or potassium supplements, because hyperkalemia can result.  The primary concern with administering potassium- retaining (sparing) diuretics is hyperkalemia. Peripherally Acting α- NURSING INTERVENTION  Give a low first dose to avoid Adrenergic Blockers severe hypotension. - decrease sympathetic  Monitor for fluid retention and vasoconstriction by reducing the edema. effects of norepinephrine at  Instruct the client to change peripheral nerve endings, resulting positions slowly to prevent in vasodilation and decreased BP orthostatic hypotension. - used to maintain renal blood flow  Instruct patient in how to monitor the BP.  Instruct patient to monitor for SIDE/ ADVERSE EFFECTS edema. Orthostatic hypotension  Instruct patient to decrease salt Reflex tachycardia intake. Sodium and water retention  Instruct patient to avoid over-the- Edema counter medications Weight gain Gastrointestinal disturbances Drowsiness Nasal congestion Centrally Acting Sympatholytic SIDE/ ADVERSE EFFECTS Sodium and water retention (Adrenergic Blockers) Edema - stimulate α-receptors in the central nervous Drowsiness, dizziness system to inhibit vasoconstriction, thus reducing peripheral resistance. Dry mouth Hypotension - used to treat hypertension Bradycardia Impotence - contraindicated in impaired liver function Depression NURSING INTERVENTION  Monitor vital signs.  Instruct the patient not to discontinue medication, because abrupt withdrawal can cause severe rebound hypertension.  Monitor liver function tests. Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs) NURSING INTERVENTION  Monitor white blood cells, - ACE inhibitors prevents and protein, albumin, BUN, peripheral vasoconstriction creatinine, and potassium by blocking conversion of levels. angiotensin I to angiotensin  Monitor for hypoglycemic II reactions in the client with diabetes mellitus. - ARBs prevent peripheral  If captopril is prescribed, vasoconstriction and instruct the client to take the secretion of aldosterone and medication 20 to 60 minutes block the binding of AII to before a meal and monitor type 1 AII receptors for bruising, petechiae, or bleeding. - Both are used to treat  Instruct the patient not to hypertension and heart discontinue medications, failure; ACE inhibitors are because rebound administered for their hypertension can occur.   NURSING INTERVENTION Antianginal  Sublingual medications  Offer sips of water before giving, Medications  Nitrates because dryness may inhibit - produce vasodilation, decrease preload medication absorption. and afterload, and reduce myocardial  Instruct the patient to place under oxygen consumption. the tongue and leave until fully dissolved. - Contraindicated in the client with  Instruct the patient not to swallow significant hypotension, increased the medication. intracranial pressure, or severe anemia  Instruct the at-home patient to take and in those taking medication to treat erectile dysfunction 1 tablet for pain and to immediately contact emergency medical services - Should be used with caution with severe if pain is not relieved; in the renal or hepatic disease hospitalized client, 1 tablet is administered every 5 minutes for a - Avoid abrupt withdrawal of long-acting total of 3 doses (the BP is checked preparations to prevent the rebound before each administration). effect of severe pain from myocardial  Inform the patient that a stinging or ischemia. burning sensation may indicate that the tablet is fresh.  Instruct the patient to store medication in a dark, tightly closed  Translingual medications  Topical ointments SIDE/ (spray)  Instruct the patient to remove ADVERSE  Instruct the patient to direct the the ointment on the skin from EFFECTS spray against the oral mucosa the previous dose. Headache  Instruct the patient to avoid  Instruct the patient to squeeze Orthostatic inhaling the spray. a ribbon of ointment of the hypotension  Sustained-released prescribed length onto the Dizziness, medication applicator or dose-measuring weakness  Instruct the patient to swallow paper. Faintness and not to chew or crush the  Instruct the patient to spread Flushing or medication. the ointment over a 2.5- by pallor 3.5-inch (6.5 by 9 cm) area Dry mouth  Transdermal patch and cover with plastic wrap, Reflex  Instruct the patient to apply the using the chest, back, tachycardia patch to a hairless area, using a abdomen, upper arm, or new patch and different site anterior thigh (avoid hairy each day.  As prescribed, instruct the  areas). Instruct the patient using nitroglycerin tablets to  Wear gloves when applying. patient to remove the patch check the expiration date on the medication bottle, after 12 to 14 hours, allowing because expiration may occur within 6 months of 10 to 12 “patch- free” hours obtaining the medication. The tablets will not each day to prevent tolerance. relieve chest pain if they have expired.  Wear gloves when applying. β-Adrenergic Blockers NURSING INTERVENTION  Withhold the medication if the pulse or BP is not within the prescribed - inhibit response to β- parameters. adrenergic stimulation, thus. signs of heart failure or  Monitor for decreasing cardiac output worsening heart failure.  Assess for respiratory distress and - block the release of for signs of wheezing and dyspnea.  Instruct the patient to report catecholamines, dizziness, lightheadedness, or nasal epinephrine, and congestion. norepinephrine, thus  Instruct the patient not to stop the decreasing the heart rate medication, because rebound and BP; they also decrease hypertension, rebound tachycardia, the workload of the heart or an anginal attack can occur. and decrease oxygen  Advise the patient taking insulin that demands the β-adrenergic blocker can mask early signs of hypoglycemia, such as - used for angina, tachycardia and nervousness.  Instruct the patient to change dysrhythmias, hypertension, positions slowly to prevent migraine headaches, orthostatic hypotension. prevention of myocardial  Calcium Channel BlockersNURSING INTERVENTION  Monitor for signs of heart failure  Monitor liver enzyme levels - decrease cardiac contractility  Monitor kidney function tests (negative inotropic effect by. patient not to  Instruct the relaxing smooth muscle) and discontinue the medication the workload of the heart, thus  Instruct the patient to notify the decreasing the need for oxygen PHCP if dizziness or fainting occurs  Instruct the patient not to crush or - promote vasodilation of the chew sustained- release tablets coronary and peripheral vessels. SIDE AND ADVERSE EFFECTS - used for angina, dysrhythmias, Bradycardia, hypotension or hypertension Reflex tachycardia (as a result of - should be used with caution in hypotension) Headache, dizziness, the client with heart failure, lightheadedness bradycardia, or atrioventricular Fatigue block Peripheral edema Constipation Flushing of the skin Peripheral NURSING INTERVENTION  Monitor vital signs, especially the BP Vasodilators - decrease peripheral resistance and the heart rate.  Monitor for signs of inadequate by exerting a direct action on. blood flow to the extremities, such the arteries or on the arteries as pallor, feeling cold, and pain and the vein  Instruct the patient that it may take - increase blood flow to the up to 3 months for a desired therapeutic response extremities and are used in  Advise the patient not to smoke, peripheral vascular disorders of because smoking increases venous and arterial vessels vasospasm. - are most effective for disorders  Instruct the patient to avoid aspirin or aspirin-like compounds unless resulting from vasospasm approved by the PHCP. (Raynaud’s disease)  Instruct the patient to take the - may decrease some symptoms medication with meals if of cerebral vascular gastrointestinal disturbances occur.  Instruct the patient to avoid alcohol, insufficiency because it may cause a hypotensive reaction.  Direct-Acting NURSING INTERVENTION Sodium Nitroprusside Arteriolar  Monitor cyanide and thiocyanate levels. -Vasodilators.  Protect from light because the promote an increase in blood flow medication decomposes to the brain and kidneys  When administering, solution must - relax the smooth muscles of the be covered by a dark bag provided by the manufacturer and is stable for blood vessels, mainly the arteries, 24 hours causing vasodilation; with  Discard if the medication is red, vasodilation, BP drops and sodium green, or blue SIDE AND ADVERSE EFFECTS and water are retained, resulting in Reflex tachycardia caused by peripheral edema (diuretics may vasodilation and the drop in BP be given to decrease the edema) Edema - used in the client with moderate to Dizziness, headaches, palpitations Nasal congestion severe hypertension and for acute Gastrointestinal bleeding hypertensive emergencies Neurological symptoms, confusion With sodium nitroprusside, cyanide toxicity and thiocyanate toxicity can occur. Antidysrhythmic NURSING INTERVENTION  Monitor HR, RR, and BP Medications  Monitor electrocardiogram  Provide continuous cardiac monitoring  Maintain.therapeutic serum - suppress dysrhythmias by medication levels inhibiting abnormal pathways of  Do not administer antidysrhythmics electrical conduction through the with food, because food may affect heart absorption  Mexiletine may be administered with food or antacids to reduce - Class I antidysrhythmic are Sodium gastrointestinal distress Channel Blockers  Always administer IV antidysrhythmics - Class II are Beta Blockers via an infusion pump  Monitor for signs of fluid retention - Class III are Potassium Channel such as weight gain, peripheral Blockers (medications that delay edema, or shortness of breath repolarization)  Advise patient to limit fluid and salt intake to minimize fluid retention. - Class IV are Calcium Channel  Instruct patient taking amiodarone to Blockers use sunscreen and protective clothing to prevent photosensitivity reactions. Adrenergic Agonists A. Dobutamine C. Epinephrine - increases myocardial force and cardiac. - used for cardiac stimulation in cardiac output through stimulation of β- arrest receptors - used for bronchodilation in asthma or - used in patients with heart failure and allergic reactions for patients undergoing - produces mydriasis cardiopulmonary bypass surgery - produces local vasoconstriction when combined with local anesthetics and B. Dopamine prolongs anesthetic action by - increases BP and cardiac output decreasing blood flow to the site through positive inotropic action and increases renal blood flow through its action on α- and β-receptors D. Norepinephrine - stimulates the heart in cardiac arrest - used to treat mild kidney failure - vasoconstricts and increases the BP in caused by low cardiac output hypotension and shock  Administer the medication through a large vein.  Antilipemic Medications - reduce serum levels of cholesterol, triglycerides, or low-density. lipoprotein - When cholesterol, triglyceride, and low-density lipoprotein levels are elevated, the patient is at increased risk for coronary artery disease - In many cases, diet alone will not lower blood lipid levels; therefore, antilipemic medications will be prescribed. Antilipemic Medications A. Bile Sequestrants NURSING INTERVENTION  Cholestyramine comes in a gritty - bind with acids in the intestines, powder.that must be mixed which prevents reabsorption of thoroughly in juice or water cholesterol before administration - Should not be used as the only  Monitor for early signs of peptic therapy in clients with elevated ulcer such as nausea and abdominal discomfort followed by triglyceride levels because they abdominal pain and distention may raise triglyceride levels  Instruct patient that the SIDE AND ADVERSE EFFECTS Constipation medication must be taken with Gastrointestinal disturbances: and followed by sufficient fluids Heartburn, nausea, belching, bloating Antilipemic SIDE AND ADVERSE EFFECTS Blurred vision, dizziness Medications B. HMG-CoA Reductase Rash, pruritus Elevated liver enzyme levels Inhibitors (-statin). Muscle cramps and fatigue - block an enzyme called HMG-CoA Diarrhea or constipation reductase that is responsible for Abdominal pain or cramps synthesizing cholesterol in the liver NURSING INTERVENTION - Lovastatin is highly protein-bound  Monitor serum liver enzyme and should not be administered levels with anticoagulants.  Instruct the patient to have an annual eye examination, because - Lovastatin should not be the medications can cause administered with gemfibrozil. cataract formation.  If lovastatin is not effective in - Administer lovastatin with caution lowering the lipid level after 3 to the client taking months, it should be immunosuppressive drugs. discontinued.  Instruct the patient who is taking an antilipemic medication to report any unexplained muscular  NURSING INTERVENTION Antilipemic  Instruct patient that it will take several weeks before the lipid Medications C. Other Antilipemic Medications level declines. - Gemfibrozil should not be taken  Instruct the patient to have an. with anticoagulants, because they annual eye examination and to compete for protein sites report changes in vision.  Instruct the patient with diabetes - Do not administer gemfibrozil with mellitus who is taking gemfibrozil HMG-CoA reductase inhibitors to monitor blood glucose levels because it increases the risk for regularly. myositis, myalgias, and  Nicotinic acid has numerous side rhabdomyolysis. and adverse effects, including gastrointestinal disturbances, - Fish oil supplements have been flushing of the skin, elevated liver associated with a decreased risk enzyme levels, hyperglycemia, for cardiovascular heart disease; and hyperuricemia. plant stanol and sterol esters and  Instruct the patient that taking cholestin have been associated aspirin or nonsteroidal anti- with reducing cholesterol levels inflammatory drugs 30 minutes before nicotinic acid may assist in - Administer lovastatin with caution reducing the side effect of to the client taking cutaneous flushing.