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136 Cards in this Set
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- Back
Lipid Lowering Drugs (Statins)
HMG-CoA reductase inhibitors Lipitor (Atorvastatin) Mevacor (Lovastin) Zocor (Simvastatin) Pravachol (Pravastatin) |
Lipitor (Atorvastatin)
Mevacor (Lovastin) Zocor (simvastatin) Pravachol (Pravastatin) |
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How do the Statins' work to lower lipid level?
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The HMG-CoA reductase inhibitors (Statins) block an enzyme that converts HMG-CoA to cholesterol precursor-inhibits cholesterol synthesis
Largest and most potent class of lipid lowering |
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Lipid lowering drug
Niacin, nicotinic acid |
Prescribed for someone who can't tolerate the HMG-CoA reductase inhibitors - less expensive
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Side effects of HMG-CoA reductase inhibitors (Statins)
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GI upset
liver enzyme elevation; (must check periodically) myostitis (muscle pain) rhabdomyolysis (rare) |
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Nursing considerations of HMG-CoA reductase inhibitors (Statins)
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Take with evening meal to avoid GI upset (fattiest meal of the day)
report muscle pain Can increase the effect of coumadin, monitor PT more closely Photosensitivity - use sunscreen Avoid grapefruit |
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Side effects of Niacin, nicotinic acid
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Liver toxicity is the major problem
Triggers release of histamine and prostaglandins so itching and flushed skin are common - this improves in time Gastritis Hyperglycemia hyperurecemia |
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Nursing considerations of Niacin, nicotinic acid
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Can use sustained-release form but this is more toxic to liver
Can take ASA 30 min. before aspirin to reduce prostaglandin production Not typically used in diabetics |
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Fibric acid derivatives
Lopid (Gemfibrozil) Atromid-S (Clofibrate) Action |
Action: decrease triglyceride levels and raise HDL levels so they're also used to reduce triglycerides to prevent pancreatitis; less effect on LDL but can be used with caution with statins if LDL and triglycerides are high
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Fibric acid derivatives
Lopid (Gemfibrozil) Atromid-S (Clofibrate) side effects |
Dyspepsia
abdominal pain vomiting diarrhea rash myalgia drowsiness dizziness blurred vision biliary disorders |
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Fibric acid derivatives
Lopid (Gemfibrozil) Atromid-S (Clofibrate) nursing considerations |
If used with HMG-CoA reductase inhibitors can cause sever myositis (monitor for upset stomach)
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Lipid lowering drugs
Bile acid sequestrants Questran (Cholestyramine) Colestipol (Colestid) |
Used to be the first-line prescribed but so awkward to take (granules) and cause GI upset - not so much prescribed anymore
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Lipid lowering drugs
Bile acid sequestrants Questran (Cholestyramine) Colestipol (Colestid) Side effects |
Poor palatability
GI complaints - nausea, vomiting, heartburn, abd pain, belching, bloating, constipation |
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Lipid lowering drugs
Bile acid sequestrants Questran (Cholestyramine) Colestipol (Colestid) Nursing Considerations |
They decrease LDL levels but may actually increase triglycerides
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Medications for Acute Coronary Syndrome: Nitrates (Vasodilators)
May be given SL, IV, PO, or transdermal |
Names of drugs
Nitroglycerine SL; nitrolingual spray, SL, nitroglycerine IV Nitrobid ointment Nito-transderm Long acting: isosorbide dinitrate (Isordil) Isosorbide Mononitrate (Imdur) |
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Medications for Acute Coronary Syndrome: Nitrates (Vasodilators)
Action |
Relax smooth muscle of coronary and peripheral blood vessels causing an increase in their diameter. Preload is reduced by increased venous dilation
Afterload is reduced by decreasing peripheral resistance decreases, workload on heart is reduced (decreasing demand). Myocardial perfusion is improved by increasing blood flow through collateral coronary vessels. (Increasing supply) demand/supply ration improves Indication: Angina, hypertension |
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Medications for Acute Coronary Syndrome: Nitrates (Vasodilators)
Side effects |
Flushing
headache dizziness hypotension tachycardia Contraindicated: severe anemia cerebral hemorrhage head trauma glaucoma hyperthyroidism Can cause vascular collaspe if pt took Viagra within 24 hours (viagra causes vasodilation also) |
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Nitrates: Vasodilators
Nursing Considerations |
Check BP before each dose.
Monitor BP closely; Postural hypotension may occur - have client change position slowly, esp after taking SL NTG. Give tylenol for HA Treating angina: instruct client to take up to 3 SL NTG tabs in 5-minute intervals if necessary. If pain is not relieved after 15 minutes, physician should be contacted immediately or client should report to hospital. Tablets are inactivated by light, heat, cold, air, and moisture; store at room temperature, in tight fitting amber glass container. |
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Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate Action |
Action: Narcotic analgesic used to relieve severe pain and anxiety associated with acute MI; peripheral vasodilation reduces venous return, thereby decreasing myocardial workload
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Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate Indications |
Indications:
Acute MI Pulmonary edema Pain |
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Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate Side effects |
Side effects:
Respiratory depression hypotension nausea, vomiting constipation |
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Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate Nursing considerations |
Nursing considerations:
When administering IV monitor closely for hypotension and respiratory depression In acute care setting - give until patient is free from chest pain or to relieve pulmonary congestion |
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Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents |
Beta-Blockers
Metoprolol (Lopressor) Atenolol (Tenormin) Carvidol (Coreg) Propanolol (Inderol) |
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Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents Action |
Action:
Block sympathetic stimulation of beta receptors; 1. Decreases automaticity of SA node 2. Decreases velocity of conduction through AV node 3. Decreases myocardial contractility Decreases myocardial workload & O2 demand by decreasing contractility, HR & BP |
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Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents Indications |
Indications:
Hypertension angina arrhythmias prevention of MI heart failure |
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Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents Side effects |
Side effects:
May cause bradycardia fatigue depression Can cause erectile dysfunction Contraindicated in heart block greater than 1st degree without pacemaker Contraindicated with asthma |
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Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents Nursing considerations |
Nursing considerations
Use with caution in patients with asthma. May mask signs of hypoglycemia, and hyperthyroidism; Warn patient not to discontinue suddenly as it could exacerbate angina or precipitate MI. Use glucagon to reverse effects of overdose. Used to treat dysrhythmias caused by excessive sympathetic stimulation of the heart - SVT's and ventricular dysrhythmias |
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Medication for Acute Coronary Syndrome
Calcium channel blockers (2nd line drugs) |
Calcium channel blockers:
Diltiazem (Cardizem) Verapamil (Calan, Isoptin) Nifedapine (Procardia) |
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Medication for Acute Coronary Syndrome
Calcium channel blockers (2nd line drugs) Action |
Action:
Inhibit calcium influx across slow channels of myocardial and vascular smooth muscle cell; dilates peripheral arteries and arterioles, and coronary arteries; inhibits coronary spasm. Causes vasodilation, increased myocardial oxygen supply & decreased peripheral resistance. Slows AV conduction and prolongs repolarization. Two types of calcium channel blockers: ones that primarily affect heart rate by slowing, and ones that primarily affect BP by lowering. |
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Medication for Acute Coronary Syndrome
Calcium channel blockers (2nd line drugs) Indications |
Indications:
Angina Mild to moderate hypertension tachydysrhythmias such as rapid atrial fibrillation |
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Medication for Acute Coronary Syndrome
Calcium channel blockers (2nd line drugs) Side effects |
Side effects:
bradycardia peripheral edema hypotension |
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Medication for Acute Coronary Syndrome
Calcium channel blockers (2nd line drugs) Nursing considerations |
nursing considerations
Monitor BP at start of therapy and during dosage adjustment. Smaller doses for elderly or frail patients. Diltiazem (Cardizem) may be given as an IV infusion for rapid atrial fibrillation. This is titrated to effect, and require frequent BP and continuous cardiac monitoring. It may also be given PO. Verapamil (Calan, Isoptin) is also given for tachyarrhythmias Nifedapine (Procardia) is primarily a vasodilator. |
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Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors: Captopril (capoten) Lisinopril (Zestril) Elanapril (Vasotec) Quinapril (Accupril) Ramipril (Altace) Decrease Preload Decrease Afterload |
Action: Prevent conversion of Angiotensin I to Angiotensin II. (Angiotensin II is a potent vasoconstrictor, so the effect of ace inhibitors is vasodilation; this reduces afterload with a reflex increase in HR). They also decrease adrenocortical secretion of aldosterone, reduce sodium and water retention and extracellular fluid volume. They preserve renal function in diabetic patients. Decrease vascular and ventricular remodeling
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Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors: Captopril (capoten) Lisinopril (Zestril) Elanapril (Vasotec) Quinapril (Accupril) Ramipril (Altace) Decrease Preload Decrease Afterload |
Indications:
hypertension heart failure post myocardial infarction (MI) |
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Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors: Captopril (capoten) Lisinopril (Zestril) Elanapril (Vasotec) Quinapril (Accupril) Ramipril (Altace) Decrease Preload Decrease Afterload |
Side effects:
hyperkalemia dizziness hypotension Cough -- should switch to ARB; Angioedema - should stop using immediately |
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Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors: Captopril (capoten) Lisinopril (Zestril) Elanapril (Vasotec) Quinapril (Accupril) Ramipril (Altace) Decrease Preload Decrease Afterload |
Nursing implications
Start slowly, 24 hours after MI with gradual dose increase Monitor BP, electrolytes, BUN, and creatinine Teach patients about orthostatic hypotension Contraindicated with pregnancy |
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Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs) Losartin (Cozaar) Ibesartan (Avapro) |
Action:
Block angiotensin II receptor sites in many tissues, leading to vasodilation and decreased aldosterone secretion. They also help preserve renal function in diabetic patients. |
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Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs) Losartin (Cozaar) Ibesartan (Avapro) |
Indications:
Hypertension and patients who develop a cough on ACE Inhibitors |
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Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs) Losartin (Cozaar) Ibesartan (Avapro) |
Side effects:
Hyperkalemia dizziness muscle cramps angioedema |
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Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs) Losartin (Cozaar) Ibesartan (Avapro) |
Nursing considerations
Usually given once a day, but some patients need BID treatments Contraindicated with pregnancy |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors Aggrastat (Tirofiban) Integrilin (Eptifibatide) IV Med |
Action:
Blocks GpIIb/IIIa receptor, a surface receptor involved in the final common pathway of platelet aggregation--prevents platelet aggregation |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors Aggrastat (Tirofiban) Integrilin (Eptifibatide) IV Med |
Indications:
acute coronary syndrome Non-Q wave MI Unstable angina Coronary stenting |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors Aggrastat (Tirofiban) Integrilin (Eptifibatide) IV Med |
Side effects:
Bleeding |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors Aggrastat (Tirofiban) Integrilin (Eptifibatide) IV Med |
Nursing considerations:
Monitor for bleeding, know how to calculate rate--given as an infusion; know indications and contraindications calculate dose guaiac stools soft toothbrushes |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Aspirin (ASA) Clopidogrel (Plavix) |
Action:
decreases platelet aggregation (ASA has other actions) ASA decreases mortality by 71% in the acute phase of MI |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Aspirin (ASA) Clopidogrel (Plavix) |
Indications:
Prophylaxis MI, angina (+ purposes) post stent |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Aspirin (ASA) Clopidogrel (Plavix) |
Side effects:
GI, allergy bleeding |
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Medications for Acute Coronary Syndrome
Antiplatelet agents Aspirin (ASA) Clopidogrel (Plavix) |
Nursing considerations:
Do not crush enteric product, give with food or milk Chew ASA 4 (81 mg tablets) |
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Medications for Acute Coronary Syndrome
Fibrolytic Agents Alteplase (t-Pa, rtPA) Reteplase Streptokinase |
Action:
Lyse clots by converting plasminogen to active plasminogen -- plasminogen, the enzyme responsible for degradation of fibrin clots |
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Medications for Acute Coronary Syndrome
Fibrolytic Agents Alteplase (t-Pa, rtPA) Reteplase Streptokinase |
Indications:
Lyse intracoronary clot to restore blood flow, salvage ischemic myocardium, limit infarct size, and save LV function |
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Medications for Acute Coronary Syndrome
Fibrolytic Agents Alteplase (t-Pa, rtPA) Reteplase Streptokinase |
Side effects:
Hemorrhagic stroke or bleeding from other sites Allergic reaction |
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Medications for Acute Coronary Syndrome
Fibrolytic Agents Alteplase (t-Pa, rtPA) Reteplase Streptokinase |
Nursing considerations:
Important to recognize S/S of MI ASAP to initiate treatment Selection criteria: <65 - 70 yrs; <6 hrs since onset Contraindications: CVA, recent surgery or trauma, HTN, coagulopathy |
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Medications for Acute Coronary Syndrome
Anticoagulation Agents 1. Heparin 2. Low-molecular wt heparin: Lovenox (enoxaparin) (LMWH is now used for ACS) |
Action:
Heparin prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III (keep clots stable) Lovenox: Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin |
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Medications for Acute Coronary Syndrome
Anticoagulation Agents 1. Heparin 2. Low-molecular wt heparin: Lovenox (enoxaparin) (LMWH is now used for ACS) |
Indications:
Unstable angina MI DVT, PE Lovenox: Improved bioavailability, longer 1/2 life, and less bleeding than heparin |
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Medications for Acute Coronary Syndrome
Anticoagulation Agents 1. Heparin 2. Low-molecular wt heparin: Lovenox (enoxaparin) (LMWH is now used for ACS) |
Side effects:
Bleeding hematoma hypochromic anemia Thrombocytopenia cardiac toxicity infection at site hematoma Guaiac all stools |
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Medications for Acute Coronary Syndrome
Anticoagulation Agents 1. Heparin 2. Low-molecular wt heparin: Lovenox (enoxaparin) (LMWH is now used for ACS) |
Nursing considerations:
Monitor PTT for IV heparin -- be able to calculate units per hour for heparin Reverse with protamine sulfate Lovenox - give SC, don't aspirate or rub |
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Medications used to control heart rate and rhythm
Sodium Channel Blocker IV Lidocaine Used for ventricular dysrhythmias only |
Action:
Blocks sodium channels; slows conduction Reduced automaticity in ventricles Accelerates repolarization decreases action potentials Raises fibrillation threshold Fine narrow window of being therapeutic or toxic to the Central Nervous System |
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Medications used to control heart rate and rhythm
Sodium Channel Blocker IV Lidocaine Used for ventricular dysrhythmias only |
Indications:
V-tach; V-fibrillation not responding to defibrillation Significant ventricular ectopy in ischemic setting |
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Medications used to control heart rate and rhythm
Sodium Channel Blocker IV Lidocaine Used for ventricular dysrhythmias only |
Side effects:
Signs of toxicity: drowsiness disorientation decreased hearing ability paresthesia muscle twitching Respiratory arrest |
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Medications used to control heart rate and rhythm
Sodium Channel Blocker IV Lidocaine Used for ventricular dysrhythmias only |
Nursing implications:
Given IV as a bolus followed by an infusion Reduce dose in elderly Rapidly metabolized so easy to control levels GIVEN IV ONLY Beware of CNS toxic effects esp in elderly, monitor levels |
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Medications used to control heart rate and rhythm
Potassium Channel Blocker Amiodorone First line for serious ventricular dysrhythmias--ACLS protocols Bolus, IV drip initially 18 hrs. change to PO dose |
Action:
Suppresses ventricular and atrial ectopy. Delays repolarization reduces automaticity in SA node; reduced conduction velocity in AV node Reduces contractility Affects sodium, potassium, and calcium channels as well as alpha and beta adrenergic blocking properties |
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Medications used to control heart rate and rhythm
Potassium Channel Blocker Amiodorone First line for serious ventricular dysrhythmias--ACLS protocols Bolus, IV drip initially 18 hrs. change to PO dose |
indications:
V-tach, V-fib as well as SVT, A-fib, A-flutter |
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Medications used to control heart rate and rhythm
Potassium Channel Blocker Amiodorone First line for serious ventricular dysrhythmias--ACLS protocols Bolus, IV drip initially 18 hrs. change to PO dose |
Side effects:
Widening QRS, Prolonged PR and QT interval Dilates coronary arteries and peripheral blood vessels Hypotension, and may have negative inotropic effects and long half-life (14-50 days) Serious side effects: 1. Pulmonary (Pulmonary fibrosis) 2. Optic neuropathy (corneal micro-deposits 3. Increased dysrhythmias Hyper or Hypo thyroidism skin pigmentation |
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Medications used to control heart rate and rhythm
Potassium Channel Blocker Amiodorone First line for serious ventricular dysrhythmias--ACLS protocols Bolus, IV drip initially 18 hrs. change to PO dose |
Nursing implications:
given IV as bolus followed by an infusion Also given PO as maintenance dose May be given orally Monitor QT interval Long-term use: Lund and eye toxicity Need to mix in D5W NOT STABLE IN NORMAL SALINE Glass bottle, not plastic |
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Medications used to control heart rate and rhythm
Procainamide (pronestyl) Sodium Channel Blocker Given IV only |
action:
blocks sodium channels leading to decreased conduction speed in atria, ventricles & Purkinje system Delays repolarization Widens QRS, prolongs QT Suppresses ventricular and atrial ectopy, increases ventricular threshold, prolongs QT interval |
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Medications used to control heart rate and rhythm
Procainamide (pronestyl) Sodium Channel Blocker Given IV only |
Indications:
Control ventricular dysrhythmias May also be useful for SVT with or without aberrancy |
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Medications used to control heart rate and rhythm
Procainamide (pronestyl) Sodium Channel Blocker Given IV only |
Side effects:
May cause decrease WBC, platelets, lupus like syndrome negative inotropic Widens QT (if >50% stop administering) |
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Medications used to control heart rate and rhythm
Procainamide (pronestyl) Sodium Channel Blocker Given IV only |
Nursing considerations:
Given IV as slow bolus followed by an infusion Monitor QT interval May terminate VT or VT |
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Medications used to control heart rate and rhythm
Digoxin Should be on a cardiac monitor |
Action:
Increases force of myocardial contraction; prolongs refractory period of the AV node; decreases conduction through the SA and AV node therefore: Increases cardiac output (positive inotropic effect) and slows heart rate (negative chronotropic effect) |
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Medications used to control heart rate and rhythm
Digoxin Should be on a cardiac monitor |
Indications:
Heart failure Tachy-dysrhythmias |
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Medications used to control heart rate and rhythm
Digoxin Should be on a cardiac monitor |
Side effects:
Increased PR interval, bradycardia Digitalis toxicity: CV: BRADYCARDIA, tachycardia, ectopic beats, pulse deficit GI: Anorexia, NAUSEA & VOMITING; abdominal pain, diarrhea Neuro: HEADACHE, DOUBLE, BLURRED, OR COLORED VISION; RESTLESSNESS, CONFUSION, drowsiness, muscle weakness |
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Medications used to control heart rate and rhythm
Digoxin Should be on a cardiac monitor |
Nursing implications:
Factors predisposing to dig toxicity: hypokalemia, severe liver and kidney disease -- detoxified in liver, secreted in kidney Myocardial disease, elderly MONITOR AP FOR 1 FULL MINUTE PRIOR TO ADMINISTERINE; WITHHOLD DOSE AND NOTIFY PHYSICIAN IF HR <60 MONITOR CONTINUOUSLY DURING IV ADMINISTRATION |
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Medications used to control heart rate and rhythm
Magnesium |
Action:
Natural calcium channel blocker |
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Medications used to control heart rate and rhythm
Magnesium |
Indications:
Torsades de pointes Mg deficiency Dig toxicity |
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Medications used to control heart rate and rhythm
Magnesium |
Side effects:
Flushing, sweating, bradycardia, hypotension, depressed reflexes |
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Medications used to control heart rate and rhythm
Magnesium |
Nursing considerations:
given as a bolus for VF, VT, or torsades de pointes only |
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Medications used to control heart rate and rhythm
Adenosine Supraventricular tachycardia |
Action:
Slows conduction through the AV node, interrupts AV-nodal reentry pathways Vasodilator |
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Medications used to control heart rate and rhythm
Adenosine Supraventricular tachycardia |
Indications:
Converts SVT to SR Cardiac imaging |
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Medications used to control heart rate and rhythm
Adenosine Supraventricular tachycardia |
Side effects:
Sinus bradycardia, ventricular ectopy, chest pain Flushing |
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Medications used to control heart rate and rhythm
Adenosine Supraventricular tachycardia |
Nursing implications:
Given as rapid bolus - 1-3 seconds followed by flush; short half-life given as slow infusion for myoview procedure |
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Medications used to control heart rate and rhythm
Atropine |
Action:
Blocks effects of acetylcholine on vagus nerve |
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Medications used to control heart rate and rhythm
Atropine |
Indications:
Symptomatic bradycardia, asystole, heart block |
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Medications used to control heart rate and rhythm
Atropine |
Side effects:
tachycardia, chest pain |
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Medications used to control heart rate and rhythm
Atropine |
Nursing considerations:
Given IVP |
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Medications used to control heart rate and rhythm
Ca Channel Blockers: Diltiazem - IV or PO Verapamil - IV or PO |
Action:
Suppresses SA node and AV node - reducing heart rate Decreases force of contraction |
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Medications used to control heart rate and rhythm
Ca Channel Blockers: Diltiazem - IV or PO Verapamil - IV or PO |
Indications:
PSVT AF for rate control |
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Medications used to control heart rate and rhythm
Ca Channel Blockers: Diltiazem - IV or PO Verapamil - IV or PO |
Side effects:
HYPOTENSION Heart block, CHF Use with caution after administering Beta-blockers Avoid use with AV blocks |
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Medications used to control heart rate and rhythm
Ca Channel Blockers: Diltiazem - IV or PO Verapamil - IV or PO |
Nursing considerations:
Diltiazem may be given as a bolus followed by an infusion; Verapamil is less frequently used and can be given as a bolus; Both Diltiazem and Verapamil can be given PO |
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Medications used to control heart rate and rhythm
Beta-blockers Lopressor - IV or PO Sotolol - Given PO, has beta-blocking properties Inderol |
Action:
Slows HR and conduction through AV node Decreaes automaticity |
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Medications used to control heart rate and rhythm
Beta-blockers Lopressor - IV or PO Sotolol - Given PO, has beta-blocking properties Inderol |
Indications:
Ventricular and supraventricular dysrhythmias |
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Medications used for Heart Failure
Diuretics: Loop - Furosemide (Lasix) |
Action:
Loop diuretics inhibit sodium and chloride reabsorption in the ascending loop of Henle, increasing renal excretion of sodium, chloride, and water. They increase excretion of potassium |
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Medications used for Heart Failure
Diuretics: Loop - Furosemide (Lasix) |
Indications:
Hypertension Peripheral and pulmonary edema, Heart failure |
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Medications used for Heart Failure
Diuretics: Loop - Furosemide (Lasix) |
Side effects:
Hypokalemia rapid parenteral administration may cause hearing loss and tinnitus |
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Medications used for Heart Failure
Diuretics: Loop - Furosemide (Lasix) |
Nursing considerations:
administer in morning if possible May be given IV (slowly) or PO. Monitor serum potassium - may need potassium replacement; monitor creatinine |
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Medications used for Heart Failure
Diuretics: Thiazide and thiazide-like |
Action:
Interferes with sodium transport across tubules of nephron's cortical diluting segment, thereby increasing renal excretion of sodium, chloride, water, potassium, and calcium; Antihypertensive effect and a direct effect on arteriolar dilation |
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Medications used for Heart Failure
Diuretics: Thiazide and thiazide-like |
Indications:
Peripheral edema, mild to moderate left-sided heart failure, hypertension |
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Medications used for Heart Failure
Diuretics: Thiazide and thiazide-like |
Side effects:
Hypokalemia, increased uric acid levels |
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Medications used for Heart Failure
Diuretics: Thiazide and thiazide-like |
Nursing considerations: Administer in am if possible.
Monitor serum potassium levels; monitor creatinine, BUN, and uric acid |
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Medications used for Heart Failure
Aldosterone antagonist: Spiroaldactone Aldactone |
Action:
Interferes with RAAS activation Increases urine NA & H20 excretion, sparing potassium Decreases vascular and ventricular remodeling |
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Medications used for Heart Failure
Nestritide (Natrecor) Human B-type natriuretic peptide |
action:
Relaxes vascular smooth muscle Inhibits sodium and water retention; suppresses renin secretion; reduces aldosterone secretion, decreases PCWP |
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Medications used for Heart Failure
Nestritide (Natrecor) Human B-type natriuretic peptide |
Indications:
Acutely decompensated heart failure who have dyspnea at rest or with minimal activity |
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Medications used for Heart Failure
Nestritide (Natrecor) Human B-type natriuretic peptide |
Side effects:
HYPOTENSION Cardiac dysrhythmias; angina; back pain, HA; anxiety; nausea |
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Medications used for Heart Failure
Nestritide (Natrecor) Human B-type natriuretic peptide |
Nursing considerations:
Given as a weight-based infusion; continuous cardiac monitoring with frequent BP; I&O; report CP, SOB |
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Inotropic Medications
Dopamine Chemical precursor of norepinephrine Naturally occurring catacholamine Alpha 1, Beta 1, and dopaminergic receptor stimulation |
Actions are dose related:
1-5 mcg/kg/min "renal dose" dopaminergic stimulation renal and mesenteric vasodilation increased renal perfusion increased urine output |
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Inotropic Medications
Dopamine Chemical precursor of norepinephrine Naturally occurring catacholamine Alpha 1, Beta 1, and dopaminergic receptor stimulation |
Actions are dose related:
5-10 mcg/kg/min +Inotropic effect Beta 1 stimulation Increased myocardial contractility Increased cardiac output May increase heart rate No increase in Oxygen demand Decreases afterload |
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Inotropic Medications
Dopamine Chemical precursor of norepinephrine Naturally occurring catacholamine Alpha 1, Beta 1, and dopaminergic receptor stimulation |
Actions are dose related:
10 mcg/kg/min Alpha stimulation and beta vasoconstriction increased blood pressure may damage kidney and mesentery |
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Inotropic Medications
Dopamine Chemical precursor of norepinephrine Naturally occurring catacholamine Alpha 1, Beta 1, and dopaminergic receptor stimulation |
Indications:
Cardiogenic shock Trauma Endotoxic sepsis Post-op renal failure CHF Dopamine and nitropresside are frequently used together - nipride counteracts the adrenergic constrictive effects of dopamine |
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Inotropic Medications
Dopamine Chemical precursor of norepinephrine Naturally occurring catacholamine Alpha 1, Beta 1, and dopaminergic receptor stimulation |
Nursing considerations:
Vesicant - should be given in a central line Can cause necrosis Regitine to counteract |
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Inotropic Medications
Dopamine Chemical precursor of norepinephrine Naturally occurring catacholamine Alpha 1, Beta 1, and dopaminergic receptor stimulation |
Side effects:
tachyarrythmias ectopy hyper or hypotension Don't use in hypovolemic state Monitor HR, BP, PCWP, CO, Urine output Discontinue slowly - wean |
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Dobutamine (dobutrex) (increases contractility of heart)
Dobutamine is a synthetic catecholamine. It is a direct acting inotropic agent with predominant beta 1 stimulator activity, and mild beta 2. |
It's predominant effects are to increase cardiac output by improving increasing myocardial contractility, minimal increase in heart rate and BP, and decreased peripheral vascular resistance.
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Dobutamine (dobutrex) (increases contractility of heart)
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It is used for short-term inotropic support in cardiac decompensation resulting from depressed contractility (organic heart disease or post-op cardiac surgery), for left ventricular failure, and cardiogenic shock. May be used to treat chronic CHF on a short-term basis in hospital (Dobutamine holiday) or at home.
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Dobutamine (dobutrex) (increases contractility of heart)
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Effective dose range is from 2.5-20 mcg/kg/min
Usual dosage range on D5W is 2.5-5 mcg/kg/min Standard concentration is 500 mg in 250 mL D5W |
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Dobutamine (dobutrex) (increases contractility of heart)
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Side effects:
ventricular irritability tachycardia may increase myocardial ischemia in patient having MI May cause precipitous hypotension |
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Dobutamine (dobutrex) (increases contractility of heart)
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contraindicated:
hypovolemia IHSS (ideopathic hypertrophic subaortic stenosis) Hypersensitivity to sulfites Shock without adequate fluid replacement |
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Dobutamine (dobutrex) (increases contractility of heart)
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Nursing considerations:
Monitor heart rate/rhythm continuously Monitor BP when titrating up or down Usually start at 0.5 to 1 mcs/kg/min and titrate up at 2-10 minute intervals (monitoring bP and MP) until desired rate or effect is reached Be prepared to show me your calculations for mcs/kg/min Strict I&O, daily weights, monitor electrolytes |
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Milirone (expensive)
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Works the same as Dobutamine (dobutrex)
Vasodilation Monitor BP |
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Epinephrine
Naturally occurring catecholamine Produced by the adrenal gland secondary to stress |
Effects:
Increased systemic vascular resistance, increased BP, HR, and myocardial contractility |
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Epinephrine
Naturally occurring catecholamine Produced by the adrenal gland secondary to stress |
Indications:
First line agent in cardiac arrest Asystole Profound bradycardia anaphylactic shock Post-op esp. after cardiac surgery to improve cardiac output |
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Epinephrine
Naturally occurring catecholamine Produced by the adrenal gland secondary to stress |
Side effects:
Hyperglycemia tachycardia V-fib Cerebral hemorrhage with rapid increase in BP Prolonged use may elevate lactic acid and increase metabolic acidosis |
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Epinephrine
Naturally occurring catecholamine Produced by the adrenal gland secondary to stress |
Nursing implications:
Increased heart rate may precipitate ventricular ectopy especially with ischemic hearts Monitor cardiac output and hemodynamic profile every 4 hours and 30 min after any dose change Monitor blood sugar levels frequently - may require insulin drip while on epi |
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Norepinephrine (Levophed)
Naturally occurring catecholamine; similar to epinephrine Alpha and beta 1 stimulation |
Indications:
hypotension due to trauma, sepsis, vasodilation medications, MI; shock |
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Norepinephrine (Levophed)
Naturally occurring catecholamine; similar to epinephrine Alpha and beta 1 stimulation |
Side effects:
Extravasation leads to necrosis and tissue sloughing Increases myocardial oxygen demand (use with caution with ischemic heart disease) |
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Norepinephrine (Levophed)
Naturally occurring catecholamine; similar to epinephrine Alpha and beta 1 stimulation |
Nursing implications:
Monitor CO and hemodynamic profile every 4 hours and 30 minutes after every dose change Monitor peripheral pulses when dose is >2 mcg/kg/min Give via pump Atrial monitoring of BP is best |
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Neosynephrine
Stimulates alpha receptors Pronounced vasoconstriction; Increases SVR (afterload); increases blood pressure |
Indications:
hypotension due to shock states; vasodilating medications; and sepsis |
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Neosynephrine
Stimulates alpha receptors Pronounced vasoconstriction; Increases SVR (afterload); increases blood pressure |
Side effects:
hypertension HA reflex bradycardia due to vagus nerve stimulation blurred vision and dry eyes restlessness |
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Neosynephrine
Stimulates alpha receptors Pronounced vasoconstriction; Increases SVR (afterload); increases blood pressure |
Nursing implications:
Monitor BP, hemodynamic profile, and HR Produces vasoconstriction in skin, mucous membranes and pupils Monitor peripheral circulation frequently Monitor infusion sites for extravasation |
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Vasodilators:
Nitroprusside (Nipride) Potent vasodilator in both veins and arteries Veins dilate -- venous pooling; reduces systemic vascular resistance of arteries Reducing preload and afterload Reduces BP Increases Cardiac Output |
Indications:
Heart failure Hypertension |
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Vasodilators:
Nitroprusside (Nipride) Potent vasodilator in both veins and arteries Veins dilate -- venous pooling; reduces systemic vascular resistance of arteries Reducing preload and afterload Reduces BP Increases Cardiac Output |
Nursing considerations:
Light sensitive - cover with aluminum foil or paper bag replace every 24 hours no other medication can be added (no mixing) Discontinue slowly |
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Vasodilators:
Nitroprusside (Nipride) Potent vasodilator in both veins and arteries Veins dilate -- venous pooling; reduces systemic vascular resistance of arteries Reducing preload and afterload Reduces BP Increases Cardiac Output |
Side effects:
hypotension prolonged use can lead to cyanide poisoning (blurred vision, tinitus, delirium |
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Nitroglycerine
Nitrate, vasodilator, anti-anginal |
Mechanism of action/effects:
Relaxes vascular smooth muscle more effective on venous system Decreases preload Decreases ventricular volume Increases perfusion Peripheral vasodilation (mild arterial dilation) Decreases afterload Decreases ventricular workload Decreases myocardial oxygen demand Dilate coronary arteries, improving oxygen supply to heart |
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Nitroglycerine
Nitrate, vasodilator, anti-anginal |
Indications:
Angina MI CHF Hypertension |
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Nitroglycerine
Nitrate, vasodilator, anti-anginal |
Side effects:
hypotension bradycardia or reflex tachycardia Headache |
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Nitroglycerine
Nitrate, vasodilator, anti-anginal |
Nursing considerations:
glass bottle only Special administration set--readily absorbed into plastic No other medication added to nitro Monitor CP, BP, PCWP, heart rate and rhythm, CO and urinary output |
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Anticoagulation agent:
Coumadin |
Action:
Depresses hepatic synthesis of vitamin K dependent coagulation factors ONSET is 12-25 hours, peak 1 1/2 - 3 days; duration 3-5 days metabolized in liver |
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Anticoagulation agent:
Coumadin |
Indications:
Valve replacement; PE, DVT, MI atrial dysrhythmias |
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Anticoagulation agent:
Coumadin |
Side effects:
Bleeding agranulocytosis |
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Anticoagulation agent:
Coumadin |
Nursing considerations:
Monitor PT/INR for Coumadin (given coumadin in the evening after labs are back and dose can be calculated) - reverse with Vitamin K and/or fresh frozen plasma |