Free Mosby's 2014 Nursing Drug Reference by Linda Skidmore-Roth

angina.
    CONTRAINDICATIONS:
    Persons with 2nd-/3rd-degree heart block, sick sinus syndrome, hypotension of <90 mm Hg systolic, Wolff-Parkinson-White syndrome, or cardiogenic shock should not use these products; worsening of those conditions may occur.
    Precautions: Congestive heart failure because edema may be increased. Hypotension may worsen because B/P is decreased. Patients with renal/hepatic disease should use these products cautiously because they are metabolized in the liver and excreted by the kidneys.
    Administer:
    • PO before meals and at bedtime
    SIDE EFFECTS:
    The most common side effects are dysrhythmias and edema. Also common are headache, fatigue, drowsiness, and flushing.
    PHARMACOKINETICS:
    Onset, peak, and duration vary widely with route of administration. Products are metabolized by the liver and excreted in the urine primarily as metabolites.
    INTERACTIONS:
    Increased levels of digoxin and theophylline may occur when used with these products. Increased effects of β-blockers and antihypertensives may occur with calcium channel blockers.
    POSSIBLE NURSING DIAGNOSES:
    • Decreased cardiac output
[adverse reactions]
    • Ineffective cardiac tissue perfusion
[uses]
    NURSING CONSIDERATIONS
    Assess:
    • Cardiac system: B/P, pulse, respirations, ECG intervals (PR, QRS, QT)
    Evaluate:
    • Therapeutic response: decreased anginal pain; decreased B/P, dysrhythmias
    Teach patient/family:
    • How to take pulse before taking product; patient should record or graph pulses to identify changes
    • To avoid hazardous activities until stabilized on this product because dizziness commonly occurs
    • The need for compliance in all areas of medical regimen, including diet, exercise, stress reduction, and product therapy
    SELECTED GENERIC NAMES
    amLODIPine
    clevidipine
    diltiazem
    felodipine
    isradipine
    niCARdipine
    NIFEdipine
    verapamil
     
    CARDIAC GLYCOSIDES
    ACTION:
    Cardiac glycosides act by inhibiting sodium and potassium ATPase and then making more calcium available to activate contracted proteins. Cardiac contractility and cardiac output are increased.
    USES:
    Cardiac glycosides are used for congestive heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, and rapid digitalization in these disorders.
    CONTRAINDICATIONS:
    Hypersensitive reactions may occur, and allergies should be identified before these products are given. Also, persons with ventricular tachycardia, ventricular fibrillation, and carotid sinus syndrome should not use these products.
    Precautions: Persons with acute MI and those who have or may develop serum potassium, calcium, or magnesium imbalances should use these products cautiously. Also, geriatric patients and those with AV block, severe respiratory disease, hypothyroidism, or renal/hepatic disease should exercise caution when these products are prescribed.
    Administer:
    • Potassium supplements if ordered for potassium levels <3 mg/dl
    SIDE EFFECTS:
    The most common side effects are cardiac disturbances, headache, hypotension, and GI symptoms. Also common are blurred vision and yellow-green halos.
    PHARMACOKINETICS:
    Onset, peak, and duration vary widely with the route of administration. Digitoxin is inactivated by the liver, and inactive metabolites are excreted in urine. Digoxin is excreted in urine mainly as the parent product and metabolites.
    INTERACTIONS:
    Toxicity may occur when used with diuretics, succinylcholine, quiNIDine, and thioamines. Increased blood levels may occur with propantheline bromide, spironolactone, quiNIDine, verapamil, aminoglycosides (PO), amiodarone, anticholinergics, and quiNINE. Diuretics may increase toxicity.
    POSSIBLE NURSING DIAGNOSES:
    • Decreased cardiac output
[adverse reactions]
    • Ineffective cardiac tissue perfusion
[uses]
    NURSING CONSIDERATIONS
    Assess:
    • Cardiac system: B/P, pulse, respirations, and increased urine output
    • Apical pulse for 1 min before giving product; if pulse <60 bpm, take again in 1 hr;