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Cardiac Medications
Calhoun Nursing- 4th semester
| Question | Answer |
|---|---|
| Procainamide (Pronestyl) 20-30 mg IV, not to exceed 17 mg/kg, followed by infusion of 1-4 mg/min | Sodium Channel Blocker: Monitor ECG, B/P, Pulse continuously and , Widening QRS complexes, Prolonged QT or PR intervals, or Heart Block |
| Lidocaine (Xylocaine) 1-1.5 mg/kg IV bolus, Then 0.75/kg IV bolus 5-10 min to a loading dose of 3 mg/kgFollowed by 2-4 mg/min infusion | Sodium Channel Blocker: Monitor ECG continuously, B/P and Respiratory status. Watch for confusion, paresthesias, slurred speech, drowsiness, or seizures |
| Quinidine 200-400 mg IV adults given at a rate ≤10 mg/min until arrhythmia is suppressed, QRS complex widens, bradycardia or hypotension occurs. | Sodium Channel Blocker: Monitor B/P, Pulse and ECG continuously and tinnitus, hearing loss, visual disturbances. Watch for Widening QRS complexes, Prolonged QT or PR intervals, or Heart Block. Patient should remain supine to reduce hypotension. |
| Esmolol (Brevibloc) 500 mcg/kg/min for 1 min, then 50 mcg/kg/min for 4 min IV, Titrate up if necessary | Beta Blocker: Monitor Heart rate and B/P, Assess for SOB, wheezing, insomnia, fatique, and seizures. |
| Solalol (Betapace) 80 mg PO bid, may be increaed every 2-3 days, if necessary, to 240-320 mg daily in 2-3 divided doses. | Beta Blocker: Monitor B/P, pulse, orthostatic hypotension, intake and output and daily weight. Assess patient routinely for fluid overload and Hyperglycemia. Contraindicated in Patients with hypokalemia or hypomagnesemia, asthma. |
| Amiodarone (Cordarone) "Drug of choice" 150 mg IV over first 10 min (15mg/min), Use PVC tubing with in-line filter , infuse via central line. | Potassium Channel Blocker: Monitor Heart, B/P, and ECG continously,Teach Patient to wear sunglasses/sunscreen, and report any muscle weakness, tremors, SOB, cough, pleuritic pain, fever, visual disturbances, thyroid problems or hepatotoxicity. |
| Diltiazem (Cardizem) 5-15 mg/hr IV infusion | Calcium Channel Blockers: Monitor Heart rate and B/P. Teach patient to remain supine for at least 1 hr after IV administion,take before meals, Avoid grapefruit juice, report dyspnea, orthopnea, distended neck veins, or swelling of the extemities. |
| Digoxin (Lanoxin)0.5- 1 mg orally or IV initally; 0.125-0.5 mg orally every 6 hrs or IV until a total of 1-1.5 mg is reached. Used to slow the heart rate and Increase cardiac output. | Antiarrythmic, Intropic: Assess Apical pulse for 1 min, Monitor Heart rate, Rhythm,Potassium and Creatinine levels. Teach patient to report anorexia, N/V/D, paresthesias, confusion, visual disturbances which indicate toxicity. |
| Digoxin Therapeutic level: | 0.5-2 ng/mL |
| Digoxin antidote: | Digoxin Immune Fab (Digibind) |
| Atropine 0.5 mg IV push (Can repeat every 3 to 5 mins for a total dosage up to 3 mg (to increase Heart Rate to 60 bpm) | Anticholinergic, Antidysrhythmic: Dries up secretions, Increases cardiac output, increases Heart rate, and Bronchdilator. Monitor Heart rate and rhythm. Assess for chest pain, urinary retention, dry mouth. Avoid use in glucoma patients. |
| Tensilon (Anticholinesterases) antidote: | Atropine |
| Adenoside (Adenocard): 6 mg over 1-3 secs, then flush 20 mL, then elevate the arm ; If patient does not convert to a stable rhythm in 1-2 mins, then give another, 12 mg over 1-3 secs, then flush 20 mL, elevate arm, can repeat 1 more time Totaling 30 mg | Monitor Heart rate and Rhythm.(A short period of asystole is common after adm;(bradycardia or hypotension may occur.) Assess patient for facial flushing, SOB, dyspnea, and chest pain. |
| Vasopressin | Antidiuretic Hormone: |
| Furosemide(Lasix)20-40 mg, may repeat in 1-2 hr and increase by 20 mg every 1-2 hr until response is obtained, maintenance dose may be given q 6-12 hrs | Diuretic: Use in edema due to heart failure, hepatic impairment or renal disease and Hypertension. Monitor B/P, pulse and fluid status. Monitor wt daily, I&O's, lung sounds, s/s of dehydration, tinnitus, hearing loss. Digoxin toxicity risk |
| Potassium Chloride (K-Dur) | Electrolyte/Supplement: Used to treat/prevent potassium depletion, Arrhythmias due to digoxin toxicity and during Diuretic therapy. Monitor pulse, B/P ECG and renal function, potassium, bicarb, PH, magnesium, and chloride serum levels. |
| Epinephrine (Adrenalin) drip 2 to 10 mcg/min | Monitor for return of rhythm and pulse, Watch for tachycardia, dysrhythmias, hypertension, and coarse V-Fib. |
| Dopamine (Intropin) drip 2 to 10 mcg/min | Assess for increased B/P and Monitor for tachycardia, dysrhythmias, hypertension, urine output < 30 mL/hr or numbness in extremities and IV site for infiltration. |
| Enalapril (Vasotec) | ACE inhibitor: Antihypertensive (Decreases B/P) Monitor B/P and pulse. Observe for acute renal failure (Reversible), Routine Renal function test, Instruct patient to remain in bed 3 hrs after 1st dose. S/E: Proteinuria, Neutropenia, Skin rash, and Cough |
| Verapamil (Calan), Nifedipine (Procardia), Diltiazem (Cardizem): | Calcium Channel Blocker: Antianginal, Antiarrhythmic, Antihypertensive, Vascular H/A Monitor B/P, Potassium, (HF and elderly Patients risk of adverse reactions)Dizziness, Hypotension,Fatigue, H/A, syncope,Hypokalemia. Take 1 hr before or 2 hrs after meals |
| propranolol (Inderal) | Beta Blocker: Antianginal, Antiarrhythmic, Antihypertensive, Vascular H/A. Monitor Apical Heart rate, B/P. HF,bronchitis, asthma, COPD, renal or hepatic insufficiency patients are at risk for S/E: Fatigue,Hallucinations,Impotence, Wheezing, and HF. |
| Nitroglycerin (NTG)2-4 mg Sublingually every 5 mins; upto 3 tabs over 15 mins; vasodilator,decreases preload & afterload,(Hold if systolic <100) replace NTG q 3-5 months,Contraindicated in Pt's taking sexual dysfunction drugs (sildenafil,Viagra ect) | Antianginal-nitrates: Monitor V/S, Relief or prevention of anginal attacks. Increased cardiac output. Reduction of blood pressure. Monitor V/S, relief, have pt lie down. S/E: H/A, Flushing, Dizziness,Weakness,othostatic changes, Hypotension, Nausea |
| Streptokinase (Streptase) Thrombolytic: Deep vein thrombosis, Arterial thrombosis, Coronary Thrombosis, Dissolving clos in arteriovenous cannula | Assess for bleeding, allergic reactions, dysrhythmias, Thrombin time after therapy. Assess pedal pulses for circulation, Roll & tilt vial gently to mix, S/E:Anaphylactic responce:dyspnea-bronchospasm,periorbital swelling,hemorrhagic infarction at MI site. |
| Sodium Channel Blockers Class 1 | Decrease the speed of electrical conduction in the heart muscle. |
| Beta-Blockers or Beta-Adrenergic Class 2 | Decreases contractility,B/P,heart rate and reduces O2 demand during an MI. S/E: Bradycardia,Fatigue, Insomnia,Bizarre dreams,Sexual dysfunction, Hypertriglyceridemia,Decreased HDL,Depression |
| Potassium Channel Blockers Class 3 | Slows nerve impulses in the heart. |
| Calcium Channel Blockers Class 4 | Decreases muscle cell contraction, thereby allowing blood vessels to expand & carry more blood & oxygen to the tissues. S/E: H/A, Hypotension,Dizziness,Edema,Nausea, Constipation,Tachycardia,HF,Hypokalemia,Dysrhythmia,Syncope,Dry cough |
| Bile Sequestrants: Cholestyramine (Questran), Colesevelam (Welchol), Colestipol (Colestid) Treats type llA hyper-lipidemia & (hypercholesterolemia when dietary measures fail) | Monitor PT, Visual changes and rickets, adm. other meds 1hr before or 6hrs after giving bile seq. Teach Pt to mix powder w/ liquid or applesause S/E:Abdminal pain,N/V,distention,belching,constipation,causes reduced absorption of A,D,E,K vits & other meds. |
| Statins: Atorvastatin (Lipitor),Simvastatin (Zocor), Fluvastatin (Lescol), Pravastatin (Pravachol), Lovastatin (Mevacor)Lowers LDL's and Triglycerides | Obtain & Monitor liver enzymes (q 6 months),& CPK. Teach Pt to avoid grapefruit juice and report any muscle tenderness. S/E:Abdminal pain,N/V,distention,belching,constipation,causes reduced absorption of A,D,E,K vits & other meds and renal faiure. |
| Fibric Acid: Gemfibrate (Lopid), Fenofibrate (Tricor, Clofibrate (Claripex) Used with diet changes to lower elevated cholesterol "LDL's" and triglycerides | Obtain baseline labs: liver function,CBC,& electrolytes & monitor labs q 3-6 months. S/E:Abdominal/epigastic pain, N/V/D,Gas, Heartburn,Dyspepsia,Gallstones,Myopathy,(Tricor:also Weakness,Fatique,H/A give with meals) |
| Water soluble Vitamins: Niacin (Niaspan), Nicotine Acid (Nicobid) Large doses decrease lipoproteins & triglycerides and increase HDL's. Premedicate patient with Benedril or ASA | Teach Patient to take w/ milk/food,& change positions slowly, S/E:Flushing,Pruritus,H/A,Orthostatic hypotension,ER form:Hepatotoxicity,Pt to report dk urine,light stool,anorexia, jaundice,severe stomach pains),Hyperglycemia,Hyperuricemia,Upper GI distress |
| Anticoagulant: Heparin (Hep-Lock) SQ or IV | Monitor PTT, APTT, Hgb, HCT, Platelets, stools for occult blood. Avoid IM injection. Antidote: Protamine sulfate S/E: Hemorrhage, Agranulocytosis, Leukopenia, Hepatitis |
| Anticoagulant: Warfarin (Coumadin) Prevents the formation of prothrombin from Vitamin K | Monitor PT & INR, Give Orally. Avoid sudden changes in food high in Vitamin K. Antidote: Vitamin K |
| Antiplatelets: Clopidogrel (Plavix), Asprin (ASA), Ticlopidine (Ticlid), Dipyridamole (Persantine) Short term use after cardiac interventions, Prevention of clots | Monitor for signs of bleeding, also monitor CBC q 2 wks for 3 months & if signs of infection occur |
| Anticoagulant,Antithrombotics: Low-Molecular-weight Heparin: enoxaparin(Lovanox) Give SQ, Prevention of thrombolytic formation "PREVENTS CLOTS" (Deep vein Thrombosis) | Monitor for signs of bleeding and CBC. Use soft toothbrush, avoid cuts |
| Morphine: Use for Severe pain, Pulmonary edema, MI's, Chronic Cancer pain | Opioid analgesic: Routes: PO,IM,IV |
| Antidote for Narcotic-induced respiratory depression: | Naloxone (Narcan) 0.1 mg-0.4 mg IV every 2 to 3 minutes as needed, until 1 mg is achieved |
| Digoxin/Digitalis Toxicity S/S: | the first signs of toxicity usually include abdominal pain, anorexia, Confusion, N/V/D, visual disturbances (yellow or green blurred vision), bradycardia, and other arrhythmias. Monitor for Hypokalemia, which can increase the chances of toxicity. |
Created by:
maliakaye5
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