Indication:
Angiotensin-converting enzyme inhibitors
(ACE inhibitors)
- Antihypertensive
- to decrease blood pressure
- to prevent myocardial infarction and cerebral vascular accident
Generic names:
ACE inhibitors
benazepril, enalapril, lisinopril, ramipril
Mechanism of action:
ACE inhibitors
- prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor
- blood vessels enlarge and blood pressure decreases
Most common side effects:
ACE inhibitors
- hypotension and dizziness
- hyperkalemia
- dry cough
- taste changes
Nursing considerations:
ACE inhibitors: hypotension and dizziness
- take blood pressure and hold if BP < 100/60
- use caution when getting up due to orthostatic hypotension
Nursing considerations:
ACE inhibitors: hyperkalemia
- check potassium and hold if increased - normal potassium is 3.5 - 5
- use caution with kidney failure clients - clients retain potassium
- avoid salt substitutes - contains potassium
- use caution with potassium-sparing diuretics - spironolactone: retains potassium
Nursing considerations:
ACE inhibitors: dry cough
May need to prescribe different med if cough is intolerable to client.
Nursing considerations:
ACE inhibitors: taste changes
Advise client that the changes to diet may need to occur such as eating smaller meals, or drinking lemon juice between meals.
These changes can make eating foods more tolerable.
Most common adverse reaction:
ACE inhibitors
(Immediate complication)
angioedema (swelling of face and neck)
Nursing considerations:
ACE inhibitors: angioedema
(Immediate complication)
- assess airway
- assess for swelling and difficulty breathing
Hold med and notify HCP.
Indication:
Angiotensin receptor blockers
- Antihypertensive
- to decrease blood pressure
- to reduce risk of stroke and myocardial infarction
Generic names:
Angiotensin receptor blockers
irbesartan, losartan, olmesartan, valsartan
Mechanism of action:
Angiotensin receptor blockers
- blocks angiotensin II, a potent vasoconstrictor
- blood vessels enlarge and blood pressure decreases
Most common side effects:
Angiotensin receptor blockers
hypotension and dizziness
Nursing considerations:
Angiotensin receptor blockers: hypotension and dizziness
- take blood pressure and hold if BP < 100/60
- use caution when getting up due to orthostatic hypotension
Nursing considerations:
Angiotensin receptor blockers: hyperkalemia
- check potassium and hold if increased - normal potassium is 3.5 - 5
- use caution with kidney failure clients - clients retain potassium
- avoid salt substitutes - contains potassium
- use caution with potassium-sparing diuretics - spironolactone: retains potassium
Most common adverse reaction:
Angiotensin receptor blockers
(Immediate complication)
angioedema (swelling of face and neck)
Nursing considerations:
Angiotensin receptor blockers: angioedema
(Immediate complication)
- assess airway
- swelling or difficulty breathing
Hold med and notify HCP.
Indication:
Antiarrhythmic: adenosine
(Immediate complication)
- to treat supraventricular tachycardia (SVT)
- will chemically cardiovert to normal sinus rhythm when given IV push
Indication:
Antiarrhythmic: amiodarone
(Immediate complication)
To treat or prevent life-threatening ventricular fibrillation or ventricular tachycardia.
Indication:
Antiarrhythmic: lidocaine
(Immediate complication)
- to treat or prevent life-threatening ventricular fibrillation or ventricular tachycardia
- given when amiodarone is not available
Indication:
Antiarrhythmic: atropine
(Immediate complication)
- will increase the heart rate when given IV push
- to treat heart blocks and symptomatic bradycardia
Indication:
Anticoagulants
To treat and prevent blood clots for clients with:
- arrhythmias such as atrial fibrillation
- valve replacement
- myocardial infarction
- deep vein thrombosis
- pulmonary embolism
Generic names:
Anticoagulants
- apixaban, dabigatran, rivaroxaban
- enoxaparin
- heparin
- warfarin
Most common adverse reaction:
Anticoagulants
(Immediate complication)
Bleeding
Nursing considerations:
Anticoagulants
- assess for bleeding
- hold if platelets <150,000 or active bleeding
- hold if significant decrease in hemoglobin and hematocrit
- avoid herbs since many cause bleeding
Indication:
Anticoagulant: enoxaparin
- a low molecular weight heparin given subcutaneously
- to prevent blood clots, especially post-op clients
Indication:
Anticoagulant: heparin
-
heparin IV
- to treat an active blood clot
- bridge therapy for PO anticoagulants
- heparin subcutaneous - to prevent blood clots
Nursing considerations:
Anticoagulant: heparin
- If giving IV: hold if aPTT or PTT is > therapeutic
- don’t store with insulin bottles - both are given by units and bottles look the same
Therapeutic aPTT for Intravenous heparin:
45 to 100
- the control value is 30 - 40: (control value can vary)
- therapeutic is 1.5 to 2.5 times the control value
How to calculate: therapeutic is 1.5(30) to 2.5(40) = 45 to 100. Decrease infusion rate if therapeutic level is >100
Antidote to heparin:
protamine sulfate
Indication:
Anticoagulant: warfarin
To prevent blood clots for those with arrhythmias or valve replacement.
Nursing considerations:
Anticoagulant: warfarin
- assess for bleeding - hold if actively bleeding
- check PT and INR - hold if PT or INR is > therapeutic level
- don’t increase or decrease amount of green leafy vegetables consumed - they contain vitamin K, which is the antidote
Therapeutic INR for warfarin:
- 2-3 for clients with atrial fibrillation
- 3-4 for clients with a prosthetic valve
Therapeutic PT for warfarin:
16.5 to 25
- the control value is 11 - 12.5: (control value can vary)
- therapeutic is 1.5 to 2 times the control value
How to calculate: therapeutic is 1.5(11) to 2(12.5) = 16.5 to 25. Hold if the therapeutic level is >25.
Antidote to warfarin:
phytonadione (vitamin K)
Indication:
Antiplatelets
To prevent blood clots.
Generic names:
Antiplatelets
- aspirin (or called acetylsalicylic acid)
- clopidogrel, prasugrel
Most common adverse reaction:
Antiplatelets
(Immediate complication)
Bleeding
Nursing considerations:
Antiplatelets
Assess for bleeding
- hold if platelets <150,000 or active bleeding
- hold if significant decrease in hemoglobin and hematocrit
- avoid herbs since many cause bleeding
Indication:
Antiplatelet: aspirin
Can also be given as an analgesic to prevent pain and inflammation.
Most common side effects and nursing considerations:
Antiplatelet: aspirin
- assess for ringing in ears - ototoxic
- don’t give to children < 18 years old - can cause Reye’s syndrome
Indication:
Beta blockers
- Antihypertensive
- to decrease blood pressure and heart rate
- to prevent myocardial infarction
Generic names:
Beta blockers
atenolol, carvedilol, metoprolol, nebivolol, propranolol
Mechanism of action:
Beta blockers
- blocks beta receptors
- decreases cardiac output and cardiac oxygen consumption
- heart beats more slowly and with less force
Most common side effects:
Beta blockers
- bradycardia and hypotension
- erectile dysfunction
Nursing considerations:
Beta blockers: bradycardia and hypotension
Check heart rate and blood pressure.
hold if HR <60 or BP <100/60
Nursing considerations:
Beta blockers: erectile dysfunction
Teach client that taking medications that lower blood pressure and erectile dysfunction drugs together can cause severe hypotension.
Nursing considerations:
Beta blockers: asthma/COPD and diabetics
- use caution with asthma or COPD - can cause bronchoconstriction
- use caution with diabetics - can mask signs of hypoglycemia
Indication:
Calcium channel blockers
- Antihypertensive
- to decrease blood pressure and heart rate
- to treat angina
Generic names:
Calcium channel blockers
- amlodipine, nifedipine
- diltiazem and verapamil
Mechanism of action:
Calcium channel blockers
- prevents movement of calcium in cardiac cells
- this dilates the arteries of the heart, which decreases blood pressure and myocardial oxygen demand
Most common side effects:
Calcium channel blockers
- hypotension and dizziness
- bradycardia
- edema
Nursing considerations:
Calcium channel blockers: hypotension and dizziness
- check BP - hold if BP <100/60
- falls precautions
Nursing considerations:
Calcium channel blockers: bradycardia
Check heart rate and hold if < 60.
Nursing considerations:
Calcium channel blockers: edema
Assess for peripheral and pulmonary edema.
hold med and notify HCP
Nursing considerations:
Calcium channel blockers: food-med interaction
Drinking grapefruit juice and taking medication together will decrease blood pressure.
Indication:
digoxin
To decrease heart rate with heart failure or atrial fibrillation.
Most common adverse reactions:
digoxin
- bradycardia
- nausea/vomiting
- vision changes
Nursing considerations:
digoxin: bradycardia
Check heart rate - hold if:
- <60 for adult
- <70 for child
- <90 in an infant
Nursing considerations:
digoxin: toxicity
- monitor for symptoms of toxicity: nausea/vomiting, vision changes, and bradycardia
- check potassium level: can get toxicity if potassium is low
therapeutic level of digoxin:
1 - 2
2 or greater is considered toxicity.
Antidote to digoxin:
digoxin immune fab
Indication:
Nitrates
- Antianginal
- Vasodilator
- to treat chest pain and decrease blood pressure
Generic names:
Nitrates
- isosorbide dinitrate, isosorbide mononitrate
- nitroglycerin
Mechanism of action:
Nitrates
Relaxes vascular smooth muscle causing vasodilation and decreased blood pressure.
Most common side effects:
Nitrates
- headache
- hypotension
Nursing considerations:
Nitrates: headache and hypotension
- headache - lower the head of the bed to decrease pain
-
hypotension
- don’t give if BP <100/60
- don’t give if taking erectile dysfunction drugs - can cause severe hypotension
Nursing considerations:
nitroglycerin sublingual
- give 1 sublingual tablet every 5 minutes for chest pain
- give up to 3 doses
- call ambulance or notify HCP if not relieved by 2 doses
Indication:
Thrombolytics
- “clot busters”
- to break up blood clots
Generic names:
Thrombolytics
alteplase, streptokinase, tenecteplase
Most common side effects and nursing considerations:
Thrombolytics
Assess for active bleeding or recent stroke.
hold med if actively bleeding
Indication:
Vasopressor: dopamine
(Immediate complication)
To treat shock.
Nursing considerations:
Vasopressor: dopamine
- assess blood pressure and heart rate while giving - give fluids before giving med to increase blood pressure
- may cause arrhythmias - keep client on continuous ECG monitoring
Indication:
Vasopressor: epinephrine
(Immediate complication)
To treat anaphylaxis, shock, severe asthma attack, treat life-threatening arrhythmias.
asystole, ventricular tachycardia, ventricular fibrillation
Nursing considerations:
Vasopressor: epinephrine IM shot
Teach client to self-administer in outer thigh as an IM shot for those at risk of anaphylaxis.
Nursing considerations:
Diuretics
- Assess kidney function due to diuresis - BUN, creatinine, urine output
- Assess lung sounds - fluid can back up into lungs and there should be decreased crackles and clear lung sounds after giving
- Assess for edema - edema should decrease after giving
Indication:
Loop diuretics
To treat edema and hypertension.
Generic names:
Loop diuretics
- also called “potassium-wasting diuretics” because potassium and urine is excreted
- furosemide, bumetanide, torsemide
Indication:
Thiazide diuretics
To treat edema and hypertension.
Generic names:
Thiazide diuretics
- also called “potassium-wasting diuretics” because potassium and urine is excreted
- hydrochlorothiazide, chlorthalidone
Most common side effects:
Loop diuretics and Thiazide diuretics
hypokalemia
Nursing considerations:
Loop diuretics and Thiazide diuretics: hypokalemia
- Check potassium level - can cause decreases in potassium
- Assess for muscle cramps or dysrhythmias - can be caused by low potassium
-
Give potassium supplements if potassium is low
- can be given PO (by mouth) if not severe
- given IVPB if severe hypokalemia
Indication:
Potassium-sparing diuretic
To treat hypertension and edema by diuresis.
Generic names:
Potassium-sparing diuretic
Spironolactone
What are signs/symptoms of bleeding?
- bright red blood from anywhere
- hematuria
- melena/tarry stools
- bruising
- bleeding gums
- large drops in hemoglobin and hematocrit
- low platelet count of <50,000
- epistaxis
- hematemesis
- petechiae/purpura
These symptoms could indicate the the client has taken too much anticoagulant or antiplatelet medication.
What are interventions for bleeding precautions?
- no straining (give stool softeners)
- no nail clippers or straight-edge razors
- no meds that increase the risk of bleeding
- apply pressure for at least 5 minutes to any bleeding site
- limit invasive procedures
- prevent falls
- assess for signs of bleeding
- avoid herbs that start with the letter “G”
- floss and brush teeth gently
Which medications increase the risk of bleeding?
- Antiplatelets
- Anticoagulants
- NSAIDs
- Thrombolytics
- Chemotherapy
- Herbs that start with the letter “G” (garlic, ginger)
