Cardiovascular Medications PDF

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 - i...

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 injury. o Extrinsic Pathway 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 thromboplastin time) Pharmacologic Class: Indirect thrombin inhibitor  Monitor platelet count  When administering heparins via SC, inject into ACTIONS AND USES abdomen with a 25-28 G needle at a 90º angle. Do not Heparin is a natural substance found in the liver and in the aspirate once the needle has entered the skin and never lining of blood vessels. Its normal function is to prolong massage the site after injection. coagulation time, thereby preventing excessive clotting within blood vessels. As a result, heparin prevents the  IM administration is contraindicated due to bleeding enlargement of existing clots and the formation of new risk. ones. It has no ability to dissolve existing clots.  Antidote – Protamine Sulfate The binding of heparin to antithrombin III inactivates BLOOD LEVELS several clotting factors and inhibits thrombin activity. The o The normal aPPT is 20 to 40 seconds onset of action for IV heparin is immediate, whereas o To maintain a therapeutic level of anticoagulation subcutaneous heparin may take up to 1 hour to achieve a when the client is receiving a continuous infusion therapeutic effect. therapy, the aPPT should be 1.5 to 2.5 times the normal value INDICATIONS o aPPT therapy should be measured every 4 to 6 hours DVT, pulmonary embolism, unstable angina, evolving MI, during initial continuous infusion therapy and then and prevention of thrombosis in high-risk patients 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 antagonist  If life-threatening bleeding occurs during therapy, the anticoagulant effects of warfarin can be reduced ACTIONS AND USES by intramuscular (IM) or subcutaneous Warfarin inhibits the action of vitamin K. Without administration of its antagonist, vitamin K1. adequate vitamin K, the synthesis of clotting Factors II, VII, IX, and X is diminished. Because these clotting  Antidote – Vitamin K factors are normally circulating in the blood, it takes several days for their plasma levels to fall and for the anticoagulant effect of warfarin to appear. BLOOD LEVELS o The normal INR is 1.3 to 2.0 seconds INDICATIONS o The treatment goal of warfarin sodium is to raise Prevention of stroke, MI, DVT, and pulmonary the INR to an appropriate value—an INR of 2 to 3 embolism in patients undergoing hip or knee surgery seconds is appropriate for most patients. or in those with long-term indwelling central venous o If the INR is above the recommended range, catheters or prosthetic heart valves. The drug may be warfarin should be reduced. given to prevent thromboembolic events in high-risk patients following an MI or an atrial fibrillation episode. 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 drug Active internal bleeding for the treatment of stroke, History of hemorrhage brain attack (stroke) arterial thrombosis, deep vein Uncontrolled hypertension thrombosis, occluded shunts Intracranial problems, including trauma or catheters and pulmonary History of hepatic or renal disease emboli. Recently required, prolonged CPR 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 clots  Monitor vital signs closely and assess pulses Pharmacologic Class: Thrombolytic  Determine aPPT, PT, fibrinogen level, hematocrit, and platelet count  Monitor all excretions for occult blood  Antidote - Aminocaprioc Acid (Amicar)  Monitor for neurological changes (use only in acute life threatening conditions)  Monitor for hypotension and tachycardia  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 notify primary health care provider 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 (Oral)  Monitor vital signs Pharmacologic Class: ADP receptor blocker  Monitor bleeding time  Instruct patient to take medicine with food if ACTIONS AND USES gastrointestinal upset occurs Clopidogrel prolongs bleeding time by inhibiting  Instruct patient the use of the drug—tablets should platelet aggregation, directly inhibiting ADP binding not be crushed and split to its receptor. This binding is irreversible and the  Discontinue drug at least 5 days before surgery 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 to prevent thrombi formation in patients with coronary artery stents, and to prevent postoperative deep venous thromboses. 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 advanced Dopamine heart failure—the increase in myocardial contractility  used as a short-term rescue measure for improves cardiac, peripheral, and kidney function by clients with severe, acute heart failure increasing cardiac output, decreasing preload, improving  increases myocardial contractility, blood flow to the periphery and kidneys, decreasing edema, thereby improving cardiac performance and increasing fluid retention. 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  used for short-term management of HF; may be given before heart transplant ADVERSE EFFECTS AND TOXICITY NURSING INTERVENTION Hepatotoxicity manifested by elevated  Positive inotropic and cardiotonic medications liver enzyme levels are used for IV administration Hypersensitivity manifested by wheezing,  Stop the infusion if BP drops or dysrhythmias shortness of breath, and pruritus, occur urticaria, clammy 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.  The increase in myocardial Cardiac Glycosides contractility increases cardiac,  Digoxin peripheral, and kidney function by increasing cardiac output, decreasing inhibit the sodium-potassium pump, thus preload, improving blood flow to the increasing intracellular calcium, which periphery and kidneys, decrease causes the heart muscle fibers to contract edema, and increasing fluid excretion. more efficiently As a result, fluid in the lungs and produce a positive inotropic action, which extremities is decreased. increases the force of myocardial contractions used second-line for heart failure (medications affecting the renin- produce a negative chronotropic action, angiotensin-aldosterone system are which slows the heart rate. used more often) and cardiogenic produce a negative dromotropic action shock, atrial tachycardia, atrial that slows conduction velocity through fibrillation, and atrial flutter; they are the AV node used less frequently for rate control in atrial dysrhythmias  Early signs of digoxin toxicity present as NURSING INTERVENTION gastrointestinal manifestations  Monitor for toxicity (anorexia, n/v, diarrhea), then, heart  Monitor serum digoxin level, electrolyte rate abnormalities and visual levels, and renal function test results disturbances appear  The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/dL (0.63 to 2.56 nmol/L). SIDE/ ADVERSE EFFECTS AND TOXICITY  An increased risk of toxicity exists in clients Anorexia, N/V, Diarrhea with hypercalcemia, hypokalemia, Headache hypomagnesemia, or hypothyroidism. Visual disturbances: diplopia, blurred  Monitor the potassium level vision, yellow-green halos, photophobia  Instruct the patient to avoid over-the-counter Drowsiness medications. Bradycardia  Monitor the patient taking a potassium-losing Fatigue, weakness diuretic or corticosteroids closely for hypokalemia  Monitor the apical pulse for 1 full minute; if the apical pulse rate is lower than 60 beats  Antidote: Digoxin immune Fab is used in per minute, the medication should be extreme toxicity. withheld and the PHCP notified. Antihypertensives CLASSIFICATIONS OF DIURETICS Loop diuretics  Diuretics Osmotic diuretics Potassium-retaining diuretics A. Thiazide Diuretics Thiazide diuretics - increase sodium and water excretion by inhibiting sodium reabsorption in the NURSING INTERVENTION distal tubule of the kidney  Instruct the patient to take the medication in the morning to avoid nocturia and sleep - used for hypertension and peripheral interruption. edema  Instruct the patient to take medication with - not effective for immediate diuresis food to avoid gastrointestinal upset.  Instruct the patient to change positions slowly - used in patients with normal renal to prevent orthostatic hypotension. function  Instruct the patient to use sunscreen when in - should be used with caution in the client direct sunlight because of increased taking lithium and digoxin, corticosteroids, photosensitivity. or hypoglycemic medications  Instruct the patient with diabetes mellitus to have the blood glucose level checked periodically. Antihypertensives SIDE/ ADVERSE EFFECTS Hypokalemia, hyponatremia,  Diuretics hypocalcemia, hypomagnesemia Thrombocytopenia B. Loop Diuretics Hyperuricemia - increase sodium and chloride Orthostatic hypotension reabsorption from the loop of Henle Rash and the distal tubule Ototoxicity and deafness Thiamine deficiency - cause depletion of water and electrolytes, increased uric acid levels Dehydration and the excretion of calcium. - causes rapid diuresis, thus decreasing NURSING INTERVENTION vascular fluid volume, cardiac output, and BP  Monitor electrolytes, calcium, magnesium, BUN, creatinine, and uric - used for hypertension, pulmonary acid levels. edema, edema associated with heart  Administer IV furosemide slowly over failure, hypercalcemia, and renal disease 1 to 2 minutes, because hearing loss can occur if injected rapidly. Antihypertensives SIDE/ ADVERSE EFFECTS Hypokalemia, hyponatremia, hypocalcemia,  Diuretics hypomagnesemia Thrombocytopenia Hyperuricemia C. Potassium-retaining (Sparing) Diuretics Orthostatic hypotension - act on the distal tubule to promote sodium and Ototoxicity and deafness water excretion and potassium retention. Thiamine deficiency - used for edema and hypertension, to increase Dehydration 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 severe Adrenergic Blockers hypotension. - decrease sympathetic vasoconstriction  Monitor for fluid retention and edema. by reducing the effects of  Instruct the client to change positions norepinephrine at peripheral nerve slowly to prevent orthostatic hypotension. endings, resulting in vasodilation and  Instruct patient in how to monitor the BP. decreased BP  Instruct patient to monitor for edema.  Instruct patient to decrease salt intake. - used to maintain renal blood flow  Instruct patient to avoid over-the-counter medications SIDE/ ADVERSE EFFECTS Orthostatic hypotension Reflex tachycardia Sodium and water retention Edema Weight gain Gastrointestinal disturbances Drowsiness Nasal congestion Centrally Acting Sympatholytic SIDE/ ADVERSE EFFECTS (Adrenergic Blockers) Sodium and water retention 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, and - ACE inhibitors prevents peripheral protein, albumin, BUN, creatinine, vasoconstriction by blocking and potassium levels. conversion of angiotensin I to  Monitor for hypoglycemic reactions angiotensin II in the client with diabetes mellitus.  If captopril is prescribed, instruct - ARBs prevent peripheral the client to take the medication 20 vasoconstriction and secretion of to 60 minutes before a meal and aldosterone and block the binding monitor for bruising, petechiae, or of AII to type 1 AII receptors bleeding.  Instruct the patient not to - Both are used to treat discontinue medications, because hypertension and heart failure; rebound hypertension can occur. ACE inhibitors are administered for  Inform patient that the taste of food their cardioprotective effect after may be diminished during the first myocardial infarction. month of therapy.  NURSING INTERVENTION Antianginal Medications  Sublingual medications  Offer sips of water before giving, because  Nitrates dryness may inhibit medication absorption. - produce vasodilation, decrease preload and  Instruct the patient to place under the tongue afterload, and reduce myocardial oxygen and leave until fully dissolved. consumption.  Instruct the patient not to swallow the medication. - Contraindicated in the client with significant  Instruct the at-home patient to take 1 tablet hypotension, increased intracranial pressure, for pain and to immediately contact or severe anemia and in those taking emergency medical services if pain is not medication to treat erectile dysfunction relieved; in the hospitalized client, 1 tablet is administered every 5 minutes for a total of 3 - Should be used with caution with severe doses (the BP is checked before each renal or hepatic disease administration).  Inform the patient that a stinging or burning - Avoid abrupt withdrawal of long-acting sensation may indicate that the tablet is fresh. preparations to prevent the rebound effect  Instruct the patient to store medication in a of severe pain from myocardial ischemia. dark, tightly closed bottle.  Instruct the patient to take acetaminophen for a headache.  Translingual medications (spray)  Topical ointments SIDE/ ADVERSE  Instruct the patient to direct the spray  Instruct the patient to remove the EFFECTS against the oral mucosa ointment on the skin from the Headache  Instruct the patient to avoid inhaling the previous dose. Orthostatic spray.  Instruct the patient to squeeze a hypotension ribbon of ointment of the prescribed Dizziness,  Sustained-released medication length onto the applicator or dose- weakness  Instruct the patient to swallow and not measuring paper. Faintness to chew or crush the medication.  Instruct the patient to spread the Flushing or pallor ointment over a 2.5- by 3.5-inch (6.5 Dry mouth  Transdermal patch by 9 cm) area and cover with plastic Reflex  Instruct the patient to apply the patch wrap, using the chest, back, tachycardia to a hairless area, using a new patch abdomen, upper arm, or anterior and different site each day. thigh (avoid hairy areas).  As prescribed, instruct the patient to  Wear gloves when applying. remove the patch after 12 to 14 hours, allowing 10 to 12 “patch- free” hours each day to prevent tolerance.  Instruct the patient using nitroglycerin tablets to check the  Wear gloves when applying. expiration date on the medication bottle, because expiration may occur within 6 months of obtaining the medication. The tablets will not relieve chest pain if they have expired. β-Adrenergic Blockers NURSING INTERVENTION  Withhold the medication if the pulse or BP is not within the prescribed parameters. - inhibit response to β-adrenergic  Monitor for signs of heart failure or stimulation, thus decreasing cardiac. worsening heart failure. output  Assess for respiratory distress and for signs of wheezing and dyspnea. - block the release of  Instruct the patient to report dizziness, catecholamines, epinephrine, and lightheadedness, or nasal congestion.  Instruct the patient not to stop the norepinephrine, thus decreasing medication, because rebound hypertension, the heart rate and BP; they also rebound tachycardia, or an anginal attack can decrease the workload of the heart occur. and decrease oxygen demands  Advise the patient taking insulin that the β- adrenergic blocker can mask early signs of - used for angina, dysrhythmias, hypoglycemia, such as tachycardia and hypertension, migraine headaches, nervousness. prevention of myocardial infarction,  Instruct the patient to change positions and glaucoma slowly to prevent orthostatic hypotension.  Instruct the patient to avoid over-the-counter medications, especially cold medications and nasal decongestants. Calcium Channel Blockers NURSING INTERVENTION  Monitor for signs of heart failure  Monitor liver enzyme levels - decrease cardiac contractility (negative  Monitor kidney function tests inotropic effect by relaxing smooth  Instruct the. patient not to discontinue the muscle) and the workload of the heart, medication thus decreasing the need for oxygen  Instruct the patient to notify the PHCP if dizziness or fainting occurs - promote vasodilation of the coronary  Instruct the patient not to crush or chew and peripheral vessels. sustained- release tablets - used for angina, dysrhythmias, or hypertension SIDE AND ADVERSE EFFECTS - should be used with caution in the Bradycardia, hypotension client with heart failure, bradycardia, or Reflex tachycardia (as a result of hypotension) atrioventricular block Headache, dizziness, lightheadedness Fatigue Peripheral edema Constipation Flushing of the skin Changes in liver and kidney function Peripheral Vasodilators NURSING INTERVENTION  Monitor vital signs, especially the BP and the heart rate. - decrease peripheral resistance by  Monitor for. signs of inadequate blood flow to exerting a direct action on the arteries the extremities, such as pallor, feeling cold, or on the arteries and the vein and pain - increase blood flow to the extremities  Instruct the patient that it may take up to 3 months for a desired therapeutic response and are used in peripheral vascular  Advise the patient not to smoke, because disorders of venous and arterial vessels smoking increases vasospasm. - are most effective for disorders  Instruct the patient to avoid aspirin or aspirin- resulting from vasospasm (Raynaud’s like compounds unless approved by the PHCP. disease)  Instruct the patient to take the medication with meals if gastrointestinal disturbances - may decrease some symptoms of occur. cerebral vascular insufficiency  Instruct the patient to avoid alcohol, because it may cause a hypotensive reaction. Direct-Acting Arteriolar NURSING INTERVENTION Sodium Nitroprusside Vasodilators  Monitor cyanide and thiocyanate levels.  Protect from light because the medication decomposes. - promote an increase in blood flow to the  When administering, solution must be brain and kidneys covered by a dark bag provided by the manufacturer and is stable for 24 hours - relax the smooth muscles of the blood  Discard if the medication is red, green, or vessels, mainly the arteries, causing blue vasodilation; with vasodilation, BP drops and sodium and water are retained, resulting in peripheral edema (diuretics SIDE AND ADVERSE EFFECTS Reflex tachycardia caused by vasodilation and may be given to decrease the edema) the drop in BP - used in the client with moderate to severe Edema hypertension and for acute hypertensive Dizziness, headaches, palpitations emergencies Nasal congestion Gastrointestinal bleeding 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 medication levels - suppress dysrhythmias by inhibiting  Do not administer antidysrhythmics with food, abnormal pathways of electrical conduction because food may affect absorption through the heart  Mexiletine may be administered with food or antacids to reduce gastrointestinal distress  Always administer IV antidysrhythmics via an - Class I antidysrhythmic are Sodium Channel infusion pump Blockers  Monitor for signs of fluid retention such as - Class II are Beta Blockers weight gain, peripheral edema, or shortness of breath - Class III are Potassium Channel Blockers  Advise patient to limit fluid and salt intake to (medications that delay repolarization) minimize fluid retention.  Instruct patient taking amiodarone to use - Class IV are Calcium Channel Blockers sunscreen and protective clothing to prevent photosensitivity reactions. Adrenergic Agonists A. Dobutamine C. Epinephrine - increases myocardial force and cardiac output. - used for cardiac stimulation in cardiac arrest through stimulation of β-receptors - used for bronchodilation in asthma or allergic - used in patients with heart failure and for reactions patients undergoing cardiopulmonary bypass - produces mydriasis surgery - produces local vasoconstriction when combined with local anesthetics and prolongs anesthetic B. Dopamine action by decreasing blood flow to the site - increases BP and cardiac output 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 caused by low cardiac output - vasoconstricts and increases the BP in 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 - bind with acids in the intestines, which  Cholestyramine comes in a gritty powder that must. be mixed thoroughly in juice or prevents reabsorption of cholesterol water before administration - Should not be used as the only therapy in  Monitor for early signs of peptic ulcer clients with elevated triglyceride levels such as nausea and abdominal discomfort because they may raise triglyceride levels followed by abdominal pain and distention  Instruct patient that the medication must be taken with and followed by sufficient SIDE AND ADVERSE EFFECTS fluids Constipation Gastrointestinal disturbances: Heartburn, nausea, belching, bloating Antilipemic Medications SIDE AND ADVERSE EFFECTS Blurred vision, dizziness Rash, pruritus B. HMG-CoA Reductase Inhibitors (-statin) Elevated liver enzyme levels - block an enzyme called HMG-CoA Muscle cramps. and fatigue reductase that is responsible for Diarrhea or constipation synthesizing cholesterol in the liver Abdominal pain or cramps - Lovastatin is highly protein-bound and should not be administered with NURSING INTERVENTION anticoagulants.  Monitor serum liver enzyme levels  Instruct the patient to have an annual eye - Lovastatin should not be administered with examination, because the medications gemfibrozil. can cause cataract formation. - Administer lovastatin with caution to the  If lovastatin is not effective in lowering client taking immunosuppressive drugs. the lipid level after 3 months, it should be discontinued.  Instruct the patient who is taking an antilipemic medication to report any unexplained muscular pain to the PHCP immediately.  NURSING INTERVENTION Antilipemic Medications  Instruct patient that it will take several weeks before the lipid level declines. C. Other Antilipemic Medications  Instruct the patient to have an annual eye - Gemfibrozil should not be taken with examination. and to report changes in anticoagulants, because they compete for vision. protein sites  Instruct the patient with diabetes mellitus who is taking gemfibrozil to monitor - Do not administer gemfibrozil with HMG- blood glucose levels regularly. CoA reductase inhibitors because it  Nicotinic acid has numerous side and increases the risk for myositis, myalgias, adverse effects, including gastrointestinal and rhabdomyolysis. disturbances, flushing of the skin, elevated liver enzyme levels, - Fish oil supplements have been associated hyperglycemia, and hyperuricemia. with a decreased risk for cardiovascular  Instruct the patient that taking aspirin or heart disease; plant stanol and sterol nonsteroidal anti-inflammatory drugs 30 esters and cholestin have been associated minutes before nicotinic acid may assist with reducing cholesterol levels in reducing the side effect of cutaneous flushing. - Administer lovastatin with caution to the  Instruct the patient to take nicotinic acid client taking immunosuppressive drugs. with meals to reduce gastrointestinal discomfort.