The Cardiovascular System

Captopril

other: enalapril, enalaprilat, fosinopril, lisinopril, benazepril, moexipril, perindopril, quinapril, ramilpril, trandolapril

class: ACE inhibitor

adverse effects:

• severe hypotension

• rash

• metallic taste in mouth

• hyperkalemia

• neutropenia

• dry, nonproductive cough

• angioedema - swelling of mouth and throat

interventions:

• low dose and gradually increased

• diuretics temporarily stopped

• monitor BP following first dose

• manage severe hypotension with IV fluid therapy

• monitor & report dry cough , angioedema (tx IV epinephrine)

• monitor potassium levels (do not use salt substitutions)

• monitor WBC’s with differential every 2 weeks for first 3 months

contraindications:

• pregnant & lactating

• hx angioedema, allergy to ACE inhibitors, hypotension

• caution = dec. renal function, bone marrow depression, other meds causing immunosuppression, autoimmune disorders (RA), older adults, hx cardiovascular disease, CVD, heart failure, hyperkalemia, hyponatremia

• less effective in african americans and increased risk of angioedema

• patient taking lithium

Losartan

other: valsartan, irbesartan, candesartan, azilsartan, olmesartan, telmisartan, eprosartan

class: angiotensin II receptor blockers (ARB’s)

action: treat hypertension / prevent CVA or stroke / valsartan & candesartan treat heart failure / candesartan help prevent migraine headaches

adverse effects:

• angioedema

• dizziness

• hypotension

• headache

• insomnia

interventions:

• monitor BP before dose

• manage severe hypotension with IV fluid therapy

• treat severe angioedema with IV epinephrine

• immediately discontinue with angioedema

• monitor for & report CNS affects = headache & insomnia

contraindications:

• pregnant

• allergic to ARB’s

• children under age of 6

• children over age of 6 with low creatinine clearance

• caution = concurrently taking diuretics, hyperkalemia, liver or renal disorders or planning pregnancy

eplerenone

class: aldosterone antagonists

action: production of aldosterone to treat hypertension / treat manifestations of heart failure following MI

adverse effects:

• hyperkalemia d/t potassium-sparing effects

interventions:

• monitor signs of hyperkalemia = palpitations, muscle twitching, weakness, slow irregular heart rate, muscle cramps, hyperactive bowel sounds, diarrhea

• monitor potassium levels, BUN, and creatinine

• client does not use potassium-containing salt substitute, potassium-sparing diuretics, other meds increase potassium levels.

contraindications:

• potassium levels above range

• type 2 diabetics with microalbumineria, increase serum creatinine, decreased creatinine clearance, lactating women

• caution = children, hx liver failure, med increase potassium level

• concurrent administration of ketoconazole, clarithromycin, ritonavir

• NSAID’s = dec. anti hypertensive effects

Aliskiren

class: direct renin inhibitors

action: treat hypertension

adverse effects:

• hyperkalemia

• cough

• angioedema

• diarrhea

• dyspepsia

• abdominal pain

interventions:

• monitor hyperkalemia signs

• monitor potassium, BUN, creatinine

• assure clients not taking potassium-sparing diuretics or other meds raising potassium levels

• monitor for and report persistent cough

• report angioedema, treat with epinephrine

• monitor and report GI manifestations

• foods high in fat avoided

contraindications:

• pregnancy & lactation

• allergy

• have hyperkalemia, hypercalcemia, dehydration under age of 18 years

• caution = older adults, taking meds increase levels, low creatinine clearance, DM, respiratory disorders, hx airway surgery or angioedema

Nifedipine

other: diltiazem, amlodipine, felodipine, isradipine, nicardipine, nisoldipine

class: calcium channel blockers

action: treat mild-moderate hypertension / angina pectoris

adverse effects:

• reflex tachycardia = inc. angina pectoris

• headache

• lightheadedness

• dizziness

• facial flushing

• perception of heat

• peripheral edema

• arrhythmias

• gingival hyperplasia (not common)

interventions:

• given with beta blocker to prevent tachycardia

• monitor heart rate, lightheadedness, dizziness

• inform facial flushing may occur

• monitor for peripheral edema and report (diuretic needed)

• withhold med for systolic < 90 mmhg

• regular dental checks up

contraindications:

• children

• hypersensitivity

• systolic BP < 90 mmhg

• second or third degree AV block

• sick sinus syndrome

• concurrent use grapefruit, rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, or St John’’s worts

• caution = severe renal / hepatic impairment, hx heart failure, severe ventricular arrhythmias, geriatric clients

Doxazosin

other: prazosin, terazosin

class: alpha 1 blockers

action: treat hypertension as well as symptomatic benign prostatic hypertrophy (BPH)

adverse effects:

• orthostatic hypotension

• reflex tachycardia

• headache

• dizziness

interventions:

• monitor & report frequent headaches

• report significant drop in systolic blood pressure that is greater than 20 mmhg

• monitor for orthostatic hypotension and increase in pulse two to six hours after first dose

contraindications:

• hypersensitivity

• children

• hx hypotension or syncope

• caution = hepatic disease, geriatric clients

Atenolol & Metoprolol

class: beta blockers

other:

• cardioselective beta blockers = esmolol, acebutolol, betaxolol, bistro lol, nebivolol

• nonselective beta blockers = propanolol, carvedilol, labetalol, nadolol, pindolol, sotalol, timolol

action: reduction of heart rate, decreased contractile force, lesser impulse conduction / tx for hypertension. angina pectoris, dysrhythmias, MI, heart failure

adverse effects:

• bradycardia

• heart failure

• SOB

• edema

• coughing

• sudden withdrawal can cause rebound excitation

• anginal pain

• MI

interventions:

• monitor heart rate if less than 50 bpm hold

• monitor signs of heart failure (SOB, peripheral edema of extremities, night cough)

• do not stop abruptly, taper over 1-2 weeks

contraindications:

• sinus bradycardia

• greater than first degree blocks

• moderate to severe heart failure

• cardiogenic shock

• do not use atenolol with PVD or Raynaud’s disease

• do not use metoprolol children less than 6 years

• caution = heart failure controlled by digitalis and diuretics, asthma, COPD, or other chronic respiratory disorders, renal or liver disorder, myasthenia gravies, hyperthyroidism, DM, major depression, pheochromocytoma

Clonidine

other: methyldopa, guanfacine

class: centrally acting alpha 2 agonists

action: treat hypertension / severe pain relief (epidural injection) / management of ADHD

adverse effects:

• drowsiness

• dizziness

• xerostomia (dry mouth)

• rebound hypertensive crisis if abrupt discontinuation

interventions:

• CNS effects

• tell dryness will decrease overtime

• taper slowly over several days

contraindications:

• anticoagulant therapy

• caution = severe cardiac disease

• CVD

• renal disorder

Carvedilol / Labetolol

class: Alpha / Beta blockers

action: treat hypertension, heart failure with digoxin, ACE inhibitors, and diuretics / prolong clients chance of survival following MI

adverse effects:

• dizziness

• hypotension

• bradycardia

• postural hypotension

• exacerbation of asthma

interventions:

• monitor BP & report hypotension

• monitor HR & report below 60 BPM

contraindications:

• severe, unstable heart failure, asthma or another type of bronchospastic disorder, heart block or severe bradycardia, cardiogenic shock

• pregnancy lactation

• caution = under 18 yrs, DM, renal or hepatic disorders, PVD

Hydralazine

class: direct-acting vasodilators

action: moderate-severe hypertension / treats hypertensive crisis and on short-term basis, use it with digitalis and other vasodilators to treat heart failure

adverse effects:

• reflex tachycardia

• dizziness

• weakness

• fatigue

• headache

• fluid retention

• edema

• SLE-like syndrome = facial rash, joint pain, fever, nephritis, pericarditis

interventions:

• monitor for severe tachycardia

• monitor for hypotension

• monitor and report SLE

• monitor for edema & crackles in lungs

• do not stop abruptly

contraindications:

• allergy

• caution = cerebrovascular or cardiovascular disease, severe renal and hepatic impairment

Furosemide

class: loop diuretics

action: treat pulmonary edema in heart failure, edema caused by renal, hepatic or cardiac failure and hypertension

adverse effects:

• electrolyte imbalances = hyponatremia, hypochoremia, severe fluid loss/dehydration, hypokalemia

• hypotension

• otoxicity

• hyperglycemia

• increased uric acid levels / hyperdrive is

interventions:

• monitor electrolytes levels

• watch for signs of electrolyte imbalance = confusion, muscle twitching, weakness, irregular pulse, nausea

• monitor BP frequently

• monitor for hearing loss

• monitor blood glucose levels

• increase dosage of insulin

• monitor uric acid levels

• monitor for dysrhythmias

• take potassium supplement if taking digoxin

• monitor hypokalemia signs = thready irregular pulse, orthostatic hypotension, anxiety, confusion, skeletal muscle weakness, hypoactive bowel sounds, nausea/vomiting, dilute polyuria

contraindications:

• allergy

• hepatic coma

• anuria

• electrolyte imbalance

• caution = renal or hepatic disorders or diabetes

• older adults

Hydrochlorothiazide

other: chlorothiazide, methylcothiazide, indapamide, chlorthalidone, metolazone

class: thiazide diuretics

action: treatment for heart failure, hypertension, cirrhosis of the liver and renal failure

adverse effects:

• fluid & electrolye imbalances (hypokalemia)

• dehydration

• hypochloremia (low chloride)

• hyponatremia (low sodium)

• hyperglycemia

• uric acid levels monitor / hyperuricemia

interventions:

• monitor electrolytes

• monitor for dysrhythmias from hypokalemia

• potassium supplement needed when taking digoxin

• monitor blood glucose

• insulin dosage may be increased

• monitor uric acid levels

contraindications:

• allergy

• decrease urine output (anuria)

• electrolyte imbalance

• caution = older adults, pregnancy/lactation, renal or hepatic impairment

Spironolactone

class: potassium-sparing diuretics

other: triamterene, amiloride

action: do not cause hypokalemia / treat hypertension, edema caused by heart failure, cirrhosis of the liver, nephrotic syndrome, hypokalemia

adverse effects:

• hyperkalemia

• women = menstrual irregularities, abnormal hair growth, deepening of the voice

• men = gynecomastia, impotence

interventions:

• monitor potassium levels

• monitor for cardiac dysrhythmias

• may be combined with thiazide or loop diuretics

• look for gender-related endocrine effects

contraindications:

• pregnancy

• renal failure

• severe renal insufficiency

• increase in renal impairment

• anuria

• hyperkalemia

• caution = hepatic dysfunction, diabetes, older adults

Digoxin

class: cardiac glycosides

action: treated some cardiac dysrhythmias, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia

adverse effects:

• cardiac dysrhythmias = toxicity

• early = nausea, anorexia, vomiting

• fatigue

• visual changes = blurred vision, halos, yellow tinge

• harmful to woman more

interventions:

• recognize vomiting leads to hypokalemia, increasing risk of dig toxicity

• monitor GI manifestations

• take apical pull for full minutes before administration

• monitor dig and potassium levels frequently

• monitor cardiac rhythm as

• immune fab = antidote

contraindications:

• uncontrolled ventricular dysrhythmias

• AV block

• severe heart disease

• digoxin toxicity

• caution = hypokalemia, hypercalcemia, taking diuretics, infants, children, older adults

• no longer drug of choice for heart failure

Dobutamine

other: dopamine

class: sympathomimetics

action: increase cardiac output in severe heart failure but are used on a short-term basis only via IV

adverse effects:

• tachycardia

• cardiac dysrhythmias

• anginal pain

interventions:

• monitor cardiac rhythm & vital signs

• treat cardiac dysrhythmias as needed

• prepare to decrease/discontinue for tachydysrhythmias or onset of anginal pain

contraindications:

• allergy

• idopathic hypertrophic aortic stenosis

• caution = heart disease, hypertension, preexisting tachycardia, hypovolemia, pregnant, lactating, taking MAOI’s / tricyclic antidepressants, receiving general anesthetics

Milrinone

other: amrinone/inamrinone

class: phosphodiesterase inhibitor

action: used for both short-term and long term management of heart failure

adverse effects:

• ventricular dysrhythmias

• hypokalemia

• hypotension

• anginal chest pain

interventions:

• correct fluid deficits & hypokalemia before infusion

• monitor potassium levels and correct

• monitor vital signs & cardiac rhythm

• monitor for occurrence of chest pain

contraindications:

• allergy

• aortic or pulmonary valve disorders

• caution = renal impairment, hx of arrhythmias, electrolyte imbalances, abnormal digoxin levels

Sacubitril/valsartan

class: angiotensin receptor/neprilysin inhibitor (ARNi)

action: used to treat hypertension, heart failure, dec risk of hospitalizations and cardiovascular death

adverse effects:

• hyperkalemia

• kidney failure

• hypotension

• cough

• dizziness

• angioedema (allergic reaction causing swelling of throat & face)

• oliguria

• decreased Hgb & Hct'

• increase creatinine & BUN

interventions:

• monitor BP, renal function, & potassium prior to dose

• monitor urine output

• monitor manifestations heart failure = weight gain, edema, crackle lung sounds, JVD, SOB

contraindications:

• pregnant, lactating

• hypersensitivity

• hx angioedema

• taking aliskiren, ACE inhibitors, or ARB’s

• caution = kidney / liver impairments

Empagliflozin

other: canagliflozin, dapagliflozin, ertugliflozin

class: sodium-glucose cotransporter-2. inhibitors (SGLT2i)

action: improve blood glucose for clients who have diabetes and improve cardiovascular mortality by decreasing the risk for cardiovascular death & hospitalization for clients who have CVD and type 2 DM, and heart failure

adverse effects:

• DKA

• hypoglycemia

• dehydration

• hypotension

• bone fractures

• kidney injury

• UTI’s

• genital yeast infections

• increased urination

• upper respiratory tract infection

• elevated cholesterol levels

• nausea

• constipation

• joint pain

interventions:

• monitor glucose, LDL, kidney function prior & during

• monitor manifestations of dehydration = low blood pressure, low hematocrit, electrolyte imbalances

• assess for DKA = nausea, vomiting, poor appetite, abdominal pain, fatigue, confusion, SOB

• UTI manifest = elevated WBC in urine, cloudy urine, pain with urinating

contraindications:

• type 1 DM

• severe kidney disease

• kidney failure

• dialysis

• caution = DKA risk, reduced caloric intake, fasting due to illness, surgery, alcohol use, hypotension, receiving diuretics, moderate kidney impairment, anyti-hyperglycemias

Ivabradine

class: hyperpolarization-activated cyclic nucleotide-gated channel (HCN) blocker

action: reduce risk of hospitalizations due to worsening heart failure symptoms / stable symptomatic heart failure with EF 35% of less, rest heart rate 70/min

adverse effects:

• bradycardia

• hypotension

• hypertension

• atrial fibrillation

• tornadoes de pointes

• lethal ventricular rhythms

• visual impairment

interventions:

• monitor BP, HR, cardiac rhythm

• monitor for bradycardia, atrial fibrillation, heart rhythm blocks, QT interval prolongation, torsades de pointes

contraindications:

• sudden or worsening heart failure

• severe liver impairment

• BP less than 90/50 mmHg

• pacemaker that maintains their heart rate

• heart block

• symptomatic bradycardia

• taking potent CYP3A4

• pregnant

• caution = bradycardia, first or second-degree heart blocks

Epinephrine

other: norepinephrine, phenylephrine

class: adrenergic agonist

adverse effects:

• chest pain

• MI

• hypertensive crisis

• cardiac arrhythmias

• tissue necrosis

• increase heart rate

• tremors

• nervousness

• insomnia

• seizures

• cerebral hemorrhage

• norepinephrine = bradycardia, vascular resistance, pulmonary hypertension

interventions:

• monitor cardiac rhythm, level of consciousness, vital signs, hemodynamics

• monitor for arrhythmias

• monitor renal function

• monitor blood glucose

• assess peripheral extremities for coldness or mottling due to decrease in peripheral blood flow

contraindications:

• none for epinephrine

• hypersensitive to sympathomimetics

• caution = cerebrovascular disorders, hx hypertension, taking MAOI’s

Vasopressin

class: Antidiuretic hormone

action: vasopressor / used to treat clients who have vasodilators shock or hemorrhagic shock that is unresponsive to IV fluids and other vasopressors / treat DI, post-op abdominal distention and acute esophageal variceal bleeding, hypotension like shock

adverse effects:

• increased blood pressure

• arrhythmias

• heart block

• decreased cardiac output

• chest pain

• MI

• severe peripheral vascular constriction

• water intoxication

• bradycardia

• heart failure

• hyponatremia

• seizures

• increased bilirubin

• hemorrhagic shock

• decrease platelets

• kidney insufficiency

• n/v

• diarrhea

• sweating

• abdominal cramps

interventions:

• monitor for water toxicity = drowsiness, headache, confusion, weight gain, anuria

• monitor clients heart rhythm, kidney function, sodium level, creatinine level

• assess for MI, chest pain, seizures

contraindications:

• hypersensitivity

• caution = vascular, kidney, cardiovascular disorders

Atorvastatin

other: simvastatin, lovastatin, rosuvastatin, pravastatin, fluvastatin, pitavastatin

class: HMG-CoA reductase inhibitors

action: reducing LDL, and triglycerides, increase HDL / recommended as first line therapy for hyperlipidemia

adverse effects:

• cataract development

• rash

• memory loss

• headache

• GI disturbances

• myopathy (muscle pain)

• rhabdomyolysis

• hepatotoxicity

interventions:

• monitor for muscle pain

• measure creatine kinase

• monitor liver function tests

contraindications:

• pregnancy and lactation

• active liver disease or elevated liver enzymes

• children less than 8 years old

• cautions = hx liver disorders, alcoholism, renal disorders

Ezetimibe

class: cholesterol absorption inhibitors

action: reducing total cholesterol, LDL, triglycerides and HDL

adverse effects:

• myopathy

• myoglobinuria

• rhabdomyalysis

• angioedema

• pancreatitis

• cholecystitis

• thrombocytopenia

• upper respiratory tract infections

• diarrhea

• arthralgia

• pain in extremities

• fatigue

• sinusitis

• influenza

• nasopharyngitis

• headaches

• back pain

• elevated liver enzymes

interventions:

• liver enzyme baselines regularly

• assess rhabdomyolysis = muscle pain, elevated CK levels

• assess liver injury = fatigue, poor appetite, abdominal pain, dark urine, jaundice

contraindications:

• pregnancy / lactating

• severe liver disease

• persistent elevated liver enzymes

• concurrently taking meds that inhibit CYP3A4

• caution = taking statins, fenofibrate, or allergy, mild liver impairment, renal impairments

Colesevelam

class: Bile-acid sequestrants

other: cholestyramine, colestipol

action: helps decrease total and LDL levels

adverse effects:

• bleeding due to binding with fat soluble vitamin K in intestine

• pancreatitis

• bowel obstruction

• bradycardia

• MI

• hypertriglyceridemia

• hypoglycemia

• hypertension

• dysphagia

• elevated liver enzymes

• nausea / vomiting

• constipation

• dyspepsia

• headache

• fatigue

• flu-like

• rhinitis

• sore throat

• muscle pain

interventions:

• need baseline lab tests such as lipid panel

• monitor INR prior

• monitor blood glucose levels

• monitor levels of digoxin

• assess for GI manifestations & pancreatitis or gallbladder disease

contraindications:

• bowel obstruction / biliary obstruction

• very high triglyceride level

• triglyceride induced pancreatitis

• caution = fat-soluble vitamin deficiencies such as vitamin A, D, E, K, taking warfarin

Gemfibrozil

other: fenofibrate, fenofibric acid

class: fibrates

action: reduce high levels of plasma triglycerides / increase HDL

adverse effects:

• GI manifestations

• nausea

• abdominal pain

• diarrhea

• gallstones

• liver toxicity

• myopathy

interventions:

• monitor for gi manifestations

• measure CK

• monitor for muscle pain

• monitor LFT’s

contraindications:

• gallbladder disease

• liver dysfunction

• severe renal impairment

• pregnant, lactating, pediatric age

Alirocumab

other: evolocumab

class: PCSK9 Monoclonal antibody inhibitors

action: clients who have known CHD, high risk for cardiovascular disease, stroke, unstable angina / also with cholesterol lowering diets and other antilipidemic medications for client who have primary hyperlipidemia

adverse effects:

• vasculities

• angioedema

• musculoskeletal pain

• injection site reactions

• flu-like manifestations

interventions:

• baseline lab tests lipid panel

• assess hypersensitivity

contraindications:

• hypersensitivity

• latex allergy

Inclisiran

class: short-interfering RNA (siRNA)

action: helps decrease LDL levels

adverse effects:

• injection site reaction

• muscoskeletal pain

• UTI

• diarrhea

• bronchitis

• pain in extremities

• SOB

interventions:

• lipid panels

• assess adverse effects

contraindications:

• pregnancy

Bempedoic acid

class: adenosine triphosphate-citrate lease inhibitors

action: helps decrease LDL levels

adverse effects:

• hyperuricemia

• increase plasma uric acid & creatinine

• tendon rupture

• myopathy

• muscle spasms

• diarrhea

• extremity pain

• upper respiratory infection

• back pain

• anemia

• elevated liver enzymes

interventions:

• lipid panels

• LFT’s

• kidney function tests

• CBC’s

• liver enzymes

• creatinine kinase levels

contraindications:

• pregnant

Nitroglycerins

other: isosorbide dinitrate, isosorbide mononitrate

class: nitrates

action: treat and prevent angina pectoris

adverse effects:

• headache

• hypotension

• tachycardia

• reflex tachycardia

interventions:

• monitor length and severity of headache

• avoid touching ointment

• monitor BP & pulse

• transdermal effects = 30-60 mins

• give beta blocker / calcium channel blockers to suppress tachycardia

contraindications:

• allergy

• increased ICP

• severe anemia

• pericardial tamponade

• constrictive pericarditis

• uncorrected hypovolemia

• pregnant / lactating

• caution = head trauma, glaucoma, cardiomyopathy, severe liver disease, dry mouth causing conditions, older adults

Ranolazine

class: antianginal

action: treats chronic stable angina

adverse effects:

• allergy

• constipation

• nausea

• headache

• blurred vision

• numbness / tingling

• syncope

• dizziness

• bradycardia

• prolonged QT interval

• palpitations

• hypotension

• orthostatic hypotension

• ringing in ear

• SOB

• peripheral edema

• tremors

• renal failure

• pulmonary fibrosis

• blood in urine

• low WBC / platelets

interventions:

• monitor electrolytes

• heart rhythm

• monitor kidney function tests, creatinine BUN, urine output

• monitor blood glucose for metformin

contraindications:

• meds inhibiting or increase activity of liver enzymes

• caution = diltiazem, fluconazole, erythromycin, verapamil, metformin, renal impairment, renal failure

• congenital QT syndrome

• heart failure

• cardiomyopathy

• bradycardia

• atrio-ventricular heart rhythm blocks

• MI

• stroke

• hypomagnesemia

• hypokalemia

• hypocalcemia

• liver cirrhosis

Propanolol

class: Class II Beta Blockers

other: acebutolol, esmolol, sotalol, bisoprolol, nadolol, pindolol

action: treat heart failure

adverse effects:

• bradycardia

• rebound excitation

• angina pain / MI

• peripheral arterial insufficiency = pallor / increase sensitivity to cold of fingers or toes

• CNS effects = confusion, fatigue, drowsiness

interventions:

• monitor HR

• monitor signs of heart failure

• taper off 1-2 weeks

contraindications:

• sinus bradycardia

• second to third degree heart block

• pulmonary edema

• mitral or aortic valve disease

• cardiogenic shock

• PVD

• asthma

• COPD

• caution = hyperthyroidism, thyrotoxicosis, renal or liver disorders, myasthenia gravies, cerebrovascular disorders, stroke or DM, hypoglycemia

• older adults, having surgery

• allergy stinging insects

• dx pheochromocytoma

• adrenal gland tumor

Amiodarone

other: bretylium, dofetilide, ibutilide, dronedarone, sotalol

class: Class III Potassium channel blockers

action: manage life-threatening ventricular tachycardia or fibrillation / treat atrial dysrhythmias such as a-fib

adverse effects:

• GI manifestations

• ARDS

• pulmonary toxicity with pneumonitis

• dizziness

• fatigue

• malaise

• ataxia

• cough

• blurred vision

• paresthesia

• corneal microdeposits

• bradycardia

• hypotension

• frequent sun = blue-gray discoloration of skin

interventions:

• monitor GI manifestations

• chest x-ray

• PFT’s

• changes in vision & light sensitivity

• monitor BP & pulse

• weight changes & edema

• blue-gray color

contraindications:

• pregnancy / lactation

• allergy

• cardiogenic shock

• bradycardia

• heart block

• sinus node dysfunction

• severe hepatic disease

• caution = hepatic disease, thyroid dysfunction, heart failure, electrolyte imbalance, hypovolemia, pulmonary disease, COPD, heart surgery

Verapamil

other: diltiazem

class: Class IV calcium channel blockers

action: coverts supra ventricular tachycardia to a regular sinus rhythm and slows the rate of atrial fibrillation and flutter

adverse effects:

• hypotension

• bradycardia

• heart failure = peripheral edema of feet and legs, SOB

• lightheadedness

• dizziness

interventions:

• monitor cardiac rhythm and vital signs

• keep supine 1 hr after

• monitor BP carefully

• edema

• monitor intake & output

• monitor crackles in lungs

contraindications:

• hypersensitivity

• serious heart blocks

• sick sinus syndrome

• cardiogenic shock

• systolic less than 90 mmHg

• caution = severe hepatic dysfunction, hx heart failure, serious ventricular arrhythmias

• older adults

Adenosine

class: antidysrhythmic

action: treats paroxysmal supraventricular tachycardia (PSVT)

adverse effects:

• facial flushing

• dizziness

• nausea

• sweating

• nervousness

• headache

• tingling in arms

• PAC

• PVC

• bradycardia

• first or second degree AV block

• ST segment depression

• asystole

• hypotension

• SOB

• chest pain

interventions:

• monitor cardiac and pulmonary systems

• assess HR, RR, BP, lung sounds & ECG

• give rapidly followed by 20 mL IV bolus NS

contraindications:

• hypersensitivity

• second / third degree AV block

• sinus node disease

• bronchoconstrictive disease

• caution = serious cardiovascular or cerebrocascular problems such as MI, hypotension, hypertension, stroke, first-degree AV block, bundle branch block, valvular disease, pericarditis, bronchitis

Magnesium sulfate

class: antidysrhythmic

action: anticonvulsant and antiarrhythmic, specifically torsades de pointes

adverse effects:

• hypotension

• depression of reflexes

• muscle & respirator paralysis

• circulatory collapse

• depression of cardiac function

• CNS depression

• hypocalcemia

• tetany

interventions:

• monitor ECG’s and BP

• monitor mag levels every 6-8 hrs

• monitor creatinine or BUN

• calcium gluconate = antidote

contraindications:

• myocardial damage

• heart block rhythms

• hypermagnesemia

• caution = renal impairment and older

Atropine

class: antidysrhythmic

action: treats symptomatic bradycardia with manifestations like altered mental status, hypotension, chest pain, or heart failure

adverse effects:

• cholinergic effects

• tachycardia

• paradoxical bradycardia

• hypotension

• hypertension

• atrial or ventricular fibrillation

• spasms of larynx

• dry mouth, blurred vision, urinary retention, decrease gastric motility

• constipation

• headache

• drowsiness

• sedation

• respiratory depression

• dizziness

• disorientation

• hallucinations

interventions:

• monitor HR

• monitor for anticholinergic effects

contraindications:

• hypersensitivity

• myasthenia gravies

• tachycardia

• heart transplant

• caution = COPD, CAD< MI, heart failure, tachycardia, hypertension