Medications 1

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Nitroglycerin

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Classification: nitrate vasodilator; BP reducer and antianginal Both left ventricular preload and afterload are reduced and myocardial oxygen consumption or demand is decreased.
SE: Transient Headache
nursing considerations:go to ed if pain not relieved with 3 tablets in 15 minutes. half-life 1-4 minutes.

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coumadin

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anticoagulant;Indirectly interferes with blood clotting by depressing hepatic synthesis of vitamin K-dependent coagulation factors: II, VII, IX, and X.
side effects: Major or minor hemorrhage from any tissue or organ; hypersensitivity (dermatitis, urticaria, pruritus, fever). GI: Anorexia, nausea, vomiting, abdominal cramps, diarrhea, steatorrhea, stomatitis. Other: Increased serum transaminase levels, hepatitis, jaundice, burning sensation of feet, transient hair loss. Overdosage: Internal or external bleeding, paralytic ileus; skin necrosis of toes (purple toes syndrome), tip of nose, buttocks, thighs, calves, female breast, abdomen, and other fat-rich areas.
Determine PT/INP prior to initiation of therapy and then daily until maintenance dosage is established.
Obtain a CAREFUL medication history prior to start of therapy and whenever altered responses to therapy require interpretation; extremely IMPORTANT since many drugs interfere with the activity of anticoagulant drugs (see INTERACTIONS).
Adjust dose to maintain PT at 1½–2½ times the control (12–15 s), or 15%–35% of normal prothrombin activity, or an INR of 2–4 depending on diagnosis.
Lab tests: For maintenance dosage, PT/INR determinations at 1–4-wk intervals depending on patient's response; periodic urinalyses, stool guaiac, and liver function tests. Blood samples should be drawn at 12–18 h after last dose (optimum).
Monitor closely older adult, psychotic, or alcoholic patients because they present serious noncompliance problems.
Note: Patients at greatest risk of hemorrhage include those whose PT/INR are difficult to regulate, who have an aortic valve prosthesis, who are receiving long-term anticoagulant therapy, and older adult and debilitated patients. therapeutic pt @ 1.5-2.5 times the control, INR @ 2.0-3.0 onset: 12-24hrs peak 1.5 hrs to 3 days;duration 3-5 days, antidote; vitamin K avoid foods high in vitamin K: many green leafy vegetables do not interchange brands, potencies may not be equivalent

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Lovenox

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Anticoagulant;Low molecular weight heparin with antithrombotic properties. Does not affect PT. Does effect thrombin time (TT) and activated thromboplastin time (aPTT) up to 1.8 times the control value.
side effects:Allergic reactions (rash, urticaria), fever, angioedema arthralgia, pain and inflammation at injection site, peripheral edema, arthralgia, fever. Digestive: Abnormal liver function tests. Hematologic: Hemorrhage, thrombocytopenia, ecchymoses, anemia. Respiratory: Dyspnea. Skin: Rash, pruritus.
nursing considerations:Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood.
Monitor platelet count closely. Withhold drug and notify physician if platelet count less than 100,000/mm3.
Monitor closely patients with renal insufficiency and older adults who are at higher risk for thrombocytopenia.
Monitor for and report immediately any sign or symptom of unexplained bleeding

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Epogen

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Anticoagulant;Glycoprotein that stimulates RBC production. Hypoxia and anemia generally increase the production of erythropoietin. Side Effects:CNS: Seizures, headache. CV: Hypertension. GI: Nausea, diarrhea. Hematologic: Iron deficiency, thrombocytosis, clotting of AV fistula. Other: Sweating, bone pain, arthralgias. Uses:Elevates the hematocrit of patients with anemia secondary to chronic kidney failure (CRF); patients may or may not be on dialysis; other anemias related to malignancies and AIDS. Autologous blood donations for anticipated transfusions. Reduce need for blood in anemic surgical patients.
Nursing considerations:Control BP adequately prior to initiation of therapy and closely monitor and control during therapy. Hypertension is an adverse effect that must be controlled.Lab tests: Baseline transferren and serum ferritem. Monitor aPTT & INR closely. Patients may require additional heparin during dialysis to prevent clotting of the vascular access or artificial kidney. Determine Hct twice weekly until it is stabilized in the target range (30%–33%) and the maintenance dose of epoetin alfa has been determined; then monitor at regular intervals. Perform CBC with differential and platelet count regularly. Monitor BUN, creatinine, phosphorus, and potassium regularly.

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Calan

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Calcium channel blocker;Inhibits calcium ion influx through slow channels into cells of myocardial and arterial smooth muscle. Dilates coronary arteries and arterioles and inhibits coronary artery spasm. Decreases and slows SA and AV node conduction without affecting normal arterial action potential or intraventricular conduction. Associated vasodilation of arterioles decreases total peripheral vascular resistance and reduces arterial BP at rest. May slightly decrease heart rate. Side effects: Edema, nausea constipation, headache, drowsiness. Nursing consideration: management of chronic stable angina, sysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrilation, PO: take before meals, except sustained release to be taken with food. increased hypotensive effects with grapefruit juice. radial pulse before takin. limit caffeine.

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Atenolol

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Beta-adrenergic antagonist; In therapeutic doses, atenolol selectively blocks beta1-adrenergic receptors located chiefly in cardiac muscle. With large doses, preferential effect is lost and inhibition of beta2-adrenergic receptors may lead to increased airway resistance, especially in patients with asthma or COPD. Mechanisms for antihypertensive action include central effect leading to decreased sympathetic outflow to periphery, reduction in renin activity with consequent suppression of the renin-angiotensin-aldosterone system, and competitive inhibition of catecholamine binding at beta-adrenergic receptor sites.Side effects:Dizziness, vertigo, light-headedness, syncope, fatigue or weakness, lethargy, drowsiness, insomnia, mental changes, depression. CV: Bradycardia, hypotension, CHF, cold extremities, leg pains, dysrhythmias. GI: Nausea, vomiting, diarrhea. Respiratory: Pulmonary edema, dyspnea, bronchospasm. Other: May mask symptoms of hypoglycemia; decreased sexual ability.nursing considerations: do not stop abruptly. take before meals at bedtime. check pulse if less than 50 beats per minute, hold the med and contact clinician. teach radial pulse

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Digoxin

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cariac glycoside;Widely used cardiac glycoside of Digitalis lanata. Acts by increasing the force and velocity of myocardial systolic contraction (positive inotropic effect). It also decreases conduction velocity through the atrioventricular node. Action is more prompt and less prolonged than that of digitalis and digitoxin. increases contractility of the heart.Side effects:Headache, hypotension. Nursing consideration: check pulse, if less than 60 beats per minute. hold the med and contact MD. contact md if loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression. sodium-restricted and potassium rich (bananas, oj) diet to keep potassium level normal.

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Procardia

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calcium-channel blocker;Calcium channel blocking agent that selectively blocks calcium ion influx across cell membranes of cardiac muscle and vascular smooth muscle without changing serum calcium concentrations. Class IV antiarrhythmic.
SIde effects: orthostatic hypotension Nursing consideration: take on empty stomach;onset 20 minutes, peak 1/2 hour-6hrs, duration 6-8hrs.

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Aspirin

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Salicylate;Reduces inflammation, pain, and fever. Also inhibits platelet aggregation, reducing ability of blood to clot.

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Diazepam

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Valium;anxiolitic;Side effects: drowsiness, fatigue, ataxia, hypotension, paradoxic anxiety especially in the elderly, orthostatic hypotension, blurred vision Nursing consideration: treatment of anxiety, acute alcohol withdrawl, seizures, preoperative and skeletal muscle relaxant, IVP doses should not exceed 5 mg/minute, resuscitation eqipment available;onset immediate, duration 15minutes-1hour. longterm use withdrawl symptoms: n/v/sweating abdominal muscle cramps, tremors and possibly convulsions may be habit-forming if used over 4 months.

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Insulin--regular

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antidiabetic;side effects: hypoglycemia, lipodystrophy; Only insulin than can be given IV
Sub q onset 1/2-1 hr, peak 10-30 minutes duration: 1/2-1hr
IV: onset:10-30min. peak:10-30, duration:.5-1hr