Marco, Carmela Dawn M.

BSN IV 3 / A
NCM 106 DRUGS Angiotensin- Converting Enzyme Inhibitors Inhibits the formation of angiotensin
II (vasoconstrictor) and blocks the release of aldosterone wherein it excreted sodium and retained the potassium. It dilates venules and arterioles thus improving renal blood flow (Captopril, Enalapril Maleate, Ramipril)

SIDE EFFECTS/ CONTRAINDICATION To treat heart failure S/E:

Constant, irritated cough Nausea, vomiting, diarrhea, headache, dizziness, fatigue, insomnia, hyperkalemia, hypotension, tachycardia Should not be taken with Potassium- sparing Diuretics

NURSING INTERVENTION
Monitor lab test related to renal function and blood glucose level Explain to the client that dizziness may occur during the first week of therapy Instruct client to report any occurrence of bleeding Instruct to take the medication 20 minutes to 1 hour before a meal Inform that the taste of food will diminished during the first month of the therapy Instruct the client to take the medication with or without food Assess client for possible angioedema

Angiotensin II Receptor Blockers

It prevent the release of aldosterone and block angiotensin II from the AT1 receptors found in many tissues that cause vasodilation and decreased peripheral resistance (Losartan, Valsartan, Telmisartan)

To treat heart failure thus preventing kidney failure S/E:

diarrhea, headache, dizziness, fatigue, insomnia, metallic or salty taste, hyperkalemia, hypotension, tachycardia

Beta- adrenergic Blockers

Blocks beta-1 and beta-2 receptor sites, it blocks the action of catecholamines, epinephrine and norepinephrine thereby decreasing heart rate and blood pressure (Atenolol, Propanolol, Nadolol, Metoprolol)

Effective as antianginal, antidysrhythmic, and antihypertensive S/E: Decrease in heart rate and
blood pressure, bronchospasm, behavioural or psychotic response Clients with 2nd and 3rd degree AV block should not take

Monitor vital signs closely If discontinuing the therapy, it should be tapered for 1 or 2 weeks to prevent rebound effect Instruct client how to take a pulse rate Advise the client to call HCP if dizziness or faintness occurs

Calcium Channel Blockers

it relax coronary artery spasm and relax peripheral arterioles thus decreasing cardiac oxygen demand (Nifedipine, Diltiazem, Verapamil)

Treatment for stable and variant angina pectoris, certain dysrhythmias and hypertension S/E: headache,hypotension, flushing
of the skin, dizziness

Monitor changes in live and kidney Frequently given with nitrates to Instruct client how to take a pulse Advise the client to call HCP if
dizziness or faintness occurs Monitor vital signs Have the client sit or lie down when taking the medication for the first time Offer sips of water before giving nitroglycerin SL Instruct the client to apply the patch once a day usually in the morning and avoid hairy areas Monitor for heart rate it should be 60 bpm and above if not dont give Instruct client to eat foods rich in potassium:fresh and dried fruits, fruit juices, and vegetables Monitor for cardiac toxicity (cardiac dysrhythmias) have Digoxin Immune Fab, if ever itll occur Prevent antacid because it can decrease digoxin absorption rate prevent angina function, serum liver enzymes

Nitrates
It causes generalized vascular and coronary vasodilation thus increasing blood flow through the coronary arteries to the myocardial cells it reduces myocardial ischemia can cause hypotension (Nitroglycerin SL or Patch)

To relieve angina S/E: Headache,

hypotension, dizziness, weakness, faintness, reflex tachycardia

Cardiac Glycosides It inhibits the sodium- potassium

pump, resulting in an increase intracellular sodium causes increases myocardial contractility, decreases heart rate and decreases the conduction of the heart cells (Digitalis)

To treat heart failure and to correct also atrial flutter and atrial fibrillation S/E: Anorexia, nausea, vomiting,
blurred vision, diplopia, photophobia, drowsiness, fatigue, confusion

Marco, Carmela Dawn M. BSN IV 3 / A

DRUGS Thiazide Diuretics It acts on the distal convoluted
renal tubule to promote sodium, chloride, and water excretion (Chlorothiazide, Benzthiazide, Hydrochlorothiazide)

SIDE EFFECTS/ CONTRAINDICATION To treat hypertension and peripheral edema S/E:

Hypokalemia, Hypercalcemia, Hypomagnesemia, Bicarbonte loss Hyperglycemia Hyperuricemia Hyperlipeidemia Contraindicated with renal failure

NURSING INTERVENTION Instruct client to slowly change

position because dizziness may occur Suggest to use sun block when in direct sunlight Advise to take drugs with food Potassium supplement may be administer Dont give in patient with creatinine clearance < 30ml/min In giving the drug, UO must increase in 5 to 20 minutes if not refer Monitor UO it should be 25ml/ hour or 600ml/ day Monitor vital signs, be alert for decrease in blood pressure Give the medication in the morning to prevent sleep disturbance Advise to eat before taking the drug Monitor UO it must increase if decrease report to the physician Administer in the morning to prevent nocturia Instruct to take the medication with or after a meal to avoid nausea Instruct to avoid exposure in direct sunlight Do not take potassium supplement if serum potassium level is in normal range Inform client and family how to administer cold medications by spray or drops in the nostrils and the head must be in the upright position Encourage the client to report side effects to the healthcare provider Monitor vital signs especially respiratory rate Records urine output Check bowel sounds for decreased peristalsis Check for pupil if it is pinpoint it a sign of overdose Have Naloxone (Narcan) available as antidote for respiratory depression Encourage client to ingest foods rich in fiber, drink adequate amounts of fluids Raise bedside rails Provide mouth care Avoid hot environment and excess physical exertion

Loop Diuretics
It acts on the thick ascending loop of Henle to inhibit chloride transport of sodium into the circulation (Furosemide, Torsemide, Bumetanide)

To treat fluid retention caused by HF, renal dysfunction, cirrhosis S/E: Fluid and Electrolyte Imbalance Metabolic Alkalosis Orthostatic hypotension Thrombocytopenia Skin Disturbances Transient Deafness Should not be in combination
with other loop diuretics

Potassium Sparing Diuretics It acts primarily in the collecting

duct renal tubules and late distal tubule to promote sodium and water excretion thus potassium retained (Spironolactone, Triamterene, Amiloride HCl)

To increase UO and to treat fluid retention caused by HF, hepatic cirrhosis S/E: Nausea, vomiting, diarrhea
rash, dizziness, headache, weakness, dry mouth photosensitivity Contraindicated with severe kidney or hepatic disease

Adrenergic Agonist
It acts on one or more adrenergic sites thus it promotes CNS and cardiac stimulation and bronchodilation (Epinephrine[A1,B1,B2], Dopamine [A1,B1], Dobutamine[B1])

To treat allergic reaction, anaphylaxis, bronchospasm and cardiac arrest S/E: Anorexia, nausea, vomiting,
nervousness, agitation, pallor, dizziness tremors, syncope,

Opioid Analgesic It depress the CNS thus depress of

pain impulses by binding with the opiate receptor in the CNS (Morphine Sulfate)

To relieve severe pain from MI S/E: Anorexia, nausea, vomiting,

constipation, drowsiness, dizziness, urinary retention, bradycardia, pruritus

Anticholinergic
It inhibits acethylcholine by occupying the receptors and blocks the action of vagus nerve thus it increases heart rate (Atropine Sulfate)

For preoperative medication to reduce salivation, increases heart rate and dilate the pupils S/E: Dry mouth, nausea, headache,
constipation, rash, photophobia, urinary retention

Marco, Carmela Dawn M. BSN IV 3 / A

DRUGS Antidysrhythmic It
decreases automaticity and increases the threshold of the ventricles (Lidocaine)

SIDE EFFECTS/ CONTRAINDICATION To treat ventricular dysrhythmias such as PVCs, VTach, VFib S/E: Drowsiness, nausea, confusion,
dyspnea, vomiting, hypotension lethargy,

NURSING INTERVENTION
Continuous cardiac monitoring Assess for lidocaine toxicity (confusion, drowsiness, hearing impairment, muscle twitching, seizure) Careful monitoring of arterial blood gas analysis Catecholamines should not be infused in the same site

Sodium Carbonate
It increases the plasma bicarbonate, buffers excess hydrogen ion concentration, and raises blood pH that neutralize acidosis

To treat metabolic acidosis that may accompany with cardiac arrest S/E:
Tetany Edema Gastric distention, flatulence Pain at injection site

Magnesium Sulfate Act at the myoneural junction to

prevent release of acetylcholine and to decrease the motor and plate potential

To treat refractory VTach and VFib, Cardiac Arrest S/E: Hypotension, mild bradycardia,
flush, sweating

Calcium Chloride
It is essential element in the body that help to maintain cardiac function and blood coagulation

It combats the effect of hyperkalemia as measured by ECG S/E: Hypotension, bradycardia,

tingling,

Monitor I&O make sure that the UO is 100ml or more in 4 hours before each dose Take appropriate seizure precaution Keep IV Calcium Gluconate at bedside Take meals before taking the medication Monitor for hypercalcemia (anorexia, vomiting, constipation)

Sloughing
formation

and

abscess Give 1 to 2 glass of water to reduce reactions and improve the therapy response Warm vasopressin in your hands and mixed until it is distributed evenly in the solution Monitor urine specific gravity and I&O to aid for the evaluation of effectiveness Monitor vial sign especially respiration and blood pressure Raise bedside rails because confusion may occur Do not mix medication with other medication

Vasopresin It increase permeability of renal

tubular epithelium to adenosine monophosphate and water, the epithelium promotes reabsorption of water an concentrated urine

To treat VFib that is refractory with defibrillator S/E:

Vasoconstriction, decreased CO Diaphoresis and urticarial Abdominal cramps

Sedatives It depress the central nervous

system including the motor and sensory activities (Benzodiazepine, Triazolam)

Used for sedation S/E:

Lethargy Drowsiness Hangover Dizziness