DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATUON SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: Acebutolol HCL Generic name: Monitan

HYPERTENSION: The initial dosage of acebutolol in uncomplicated mild-to-moderate hypertension is 400 mg. This can be given as a single daily dose, but in occasional patients twice daily dosing may be required for adequate 24-hour blood-pressure control. An optimal response is usually achieved with dosages of 400 to 800 mg per day, although some patients have been maintained on as little as 200 mg per day. Patients with more severe hypertension or who have demonstrated inadequate control may respond to a total of 1200 mg daily (administered b.i.d.), or to the addition of a second antihypertensive agent. Beta-1 selectivity diminishes as dosage is increased.

Antiarrhythmic/Antidysrhythmic

Unknown. Possible mechanism include reduced cardiac output, decreased Symphathetic outflow to peripheral vasculature, and inhibition of renin release. Drugs decreases myocardial contractility and heart rate has mild intrinsic symphathomimetic activity.

Hypertention Ventricular

arrhythmias

Contraindicated in patients with persistent severe bradycardia, second- and third- degree heart block, overt cardiac failure, and cardiogenic shock.

CNS: fatigue, headache, dizziness, insomnia, depression

CV: chest pain, edema, bradycardia, heart failure, hypotension

GI: nausea, constipation, diarrhea, dyspepsia, flatulence, vomitingGU: dysuria, impotence, nocturia, urinary frequency

Musculoskeletal: arthralgia, myalgia

Respiratory: dyspnea, bronchospasm, cough

Skin: rash

Use cautiously with patients with cardiac failure, peripheral vascular disease, bronchospastic disease and diabetes.

Check apical pulse before giving drug; if lower than 60 beats/minute, withhold drug and call prescriber. Also monitor blood pressure.

Before surgery, tell anaesthesiologist that patient is taking drug.

Acebutolol may mask signs and symptoms of yperthyroidism.

Drug loses its selectivity for the beta receptor at higher doses. Watch for peripheral effects.

DRUG ROUTE DOSE CLASSIFICATION MECHANISMOF ACTION

INDICATION CONTRAINDICATUON SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: AdenocorGeneric name: Adenosine

Adenosine injection should be given as a rapid bolus by the peripheral IV route. It should be given as close to the patient as possible and followed by a rapid saline flush (this is best achieved by using a three-way tap system) The recommended IV doses for adults are as follows: Initial dose: 6 mg given as a rapid IV bolus (administered over a 1-2 second period). Repeat administration: If the first dose does not result in elimination of the supraventricular tachycardia within 1-2 minutes, 12 mg should be given as a rapid IV bolus. This 12 mg dose may be repeated a second time if required. Central venous administration of adenosine has not been systematically studied; however, in the ICU setting this route of administration is acceptable.

Antiarrhythmics A naturally occurring nucleoside that acts on the AV node to slow conduction and inhibit reentry pathways. Adenosine is also useful in treating PSVT, including those with accessory bypass tracts ( Wolff-Parkinson-White syndrome ).

Conversion of paroxysmal supraventricular tachycardia ( PSVT ) to sinus rhythm.

Contraindicated in patients hypersensitive to drug and in those with second- or third- degree heart block or sinus node disease ( such as sick sinus syndrome or symptomatic bradycardia ) unless and artificial pacemaker is present; adenosine decreases conduction through the AV node and may produce first-, second- or third- degree heart block. Patients who develop high level heart block after a single dose of adenosine shouldn’t receive additional doses.

CNS: dizziness, light-headedness, numbness, tingling in arms, headache.

CV: facial flushing.

GI: nausea.

Respiratory: chest pressure, dyspnea, shortness of breath.

Alert: Because new arrhythmias, including heart block and transient asystole, may develop, monitor cardiac rhythm and be prepared to give appropriate therapy.

Use cautiously in patients with asthma, emphysema, or bronchitis because bronchoconstriction may occur.

Crystals may form if solution is cold. If crystals are visible, gently warm solution to room temperature. Don’t use solutions that aren’t clear.

Discard unused drug; adenosine lacks preservatives.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATION

SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: cordaroneGeneric name: Amiodarone HCL

Intravenous infusion 50 mg/mL

Antiarrhythmic Effects result from blockade of potassium chloride leading to a prolongation of action potential duration.

Life-threatening recurrent ventricular fibrillation or recurrent hemodynamically unstable ventricular tachycardia unresponsive to adequate doses of other antiarrhythmics or when alternative drugs can’t be tolerated.

Cardiac arrest, pulseless ventricular tachycardia, or ventricular fibrillation

Supraventricular arrhythmias

Ventricular and supraventricular arrhythmias

Acute management of atrial fibrillation

Long-term management of recurrent atrial fibrillation

Heart failure (impaired left ventricular ejection fraction, impaired exercise tolerance, and ventricular arrhythmias).

Contraindicated in patients hypersensitive to drug. Also contraindicated in those with cardiogenic shock, second- or third- degree AV block, severe SA node disease resulting in bradycardia unless an artificial pacemaker is present, and in those for whom bradycardia has caused syncope.

CNS: peripheral neuropathy, ataxia, paresthesia, tremor, insomnia, sleep disturbances, headache, malaise, fatigue

CV: bradycardia, hypotension, arrhythmias, heart failure, heart failure, heart block, sinus arrest, edema

EENT: asymptomatic corneal microdeposits, optic neuropathy or neuritis resulting in visual impairment, abnormal smell, visual disturbances

GI: abnormal taste, anorexia, nausea, vomiting, constipation, abdominal pain

Hematologic: coagulation abnormalities

Hepatic: hepatic dysfunction, hepatic failure

Metabolic: hypothyroidism, hyperthyroidism

Respiratory: adult respiratory distress syndrome, SEVERE PULMONARY TOXICITY

Skin: photosensitivity, solar dermatitis, blue-gray skin

Use with extreme caution in patients receiving other antiarrhythmics.

Use cautiously in patients with pulmonary, hepatic, or thyroid disease.

Be aware of the high risk of adverse reactions.

Obtain baseline pulmonary, liver, and thyroid functions tests and baseline chest X-ray.

Give loading doses in a hospital setting and with continuous ECG monitoring because of the slow onset pf antiarrhythmic effect and the risk of life-threatening

arrhythmias.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: TenorminGeneric name: atenolol

IV doses may be mixed with D5W , normal saline silution.

Give slow IV injection.

Injection:5mg/10mlTablets: 25mg,50 mg, 100mg

Antihypertensive A beta blocker that selectively blocks beta-adrenergic receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; depresses renin secretion.

Hypertension Angina pectoris To reduce CV

mortality and risk of reinfraction in patients with acute MI

Contraindicated in patients with sinus bradycardia, greater than first-degree heart block, overt cardiac failure, or cardiogenic shock.

CNS: fatigue, lethargy, vertigo, drowsiness, dizziness, fever

CV: bradycardia, hypotension, heart failure, intermittent claudication

GI: nausea, diarrhea

Muscuskeletal: leg pain

Respiratory: dyspnea, bronchospasm

Skin: rash

Monitor the apical pulse for 1 minute before administration.

Record rate and rhythm of heartbeat.

Monitor heart rate continuously during IV administration.

Place on electrocardiographic telemetry during IV administration

IV dose may be diluted with normal saline or 5% dextrose.

For dialysis client s, give 50 mg following each dialysis session.

DRUG ROUTE DOSE CLASSIFICATION MECHANISMOF ACTION

INDICATION CONTRAINDICATUON SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: bretynolGeneric name: Bretylium tosylate

IV bolus, followed by an IV infusion

Adult dosage:VF/ PULSELESS VT refractory to defibrillation/lidocaine: 5 mg/kg rapid IVP initial bolus followed by a flush with 20 ml NS; if needed may repeat at 10 mg/kg rapid IVP; thereafter repeat at 5-30 minute intervals until total dose of 35 mg/kg/da

Antiarryhthmic Unknown. Considered a class III antiarrythmic that initially exerts transient adrenergic stimulation through release of norepinephrine. Subsequent depletion of norepinephrinecauses adrenergic blocking actions to predominate, prolonging repolarization and increasing duration of action potential and an effective refractory period.

Ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) unresponsive to other antiarrhythmics.

Contraindicated in digitalized patients, unless arrhythmia is life-threatening and not caused by cardiac glycosides, and in those unresponsive to other antiarrhythmics.

CNS: vertigo, dizziness, light-headedness, syncope

CV: SEVERE HYPOTENSION, bradycardia, angina pain, transient arrhythmias, transient hypertension, increased PVC’s

GI: severe nausea, vomiting

Dosage adjustments may be necessary in patients with renal insufficiency.

Drug isn’t considered a first-line choice in the treatment of VT or VF.

Use with extreme caution in patients with fixed cardiac output ( aortic stenosis and pulmonary hypertension) to avoid severe and sudden drop in blood pressure.

Keep patient supine until tolerance to hypotension develops.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: TiazacGeneric name: Diltiazem HCL

OralCapsules, extended-release60 mg

Antianginals A calcium channel blocker that inhibits calcium ion influx across cardiac and smooth-muscle cells, decreasing myocardial contractility and oxygen demand. Also dilates coronary arteries arterioles.

To manage of Prinzmetal’s or variant angina or chronic stable angina pectoris.

Hypertension Atrial fibrillation

or flutter; paroxysmal supraventricular tachycardia

Contraindicated in patients hypersensitive to drug and in those with sick sinus syndrome or second- or third- degree AV block in the absence of an artificial pacemaker, ventricular tachycardia, systolic blood pressure below 90 mm HG, acute MI, or pulmonary congestion (documented by X-ray). I.V. preparations are contraindicated in patients who have atrial fibrillation or flutter with an accessory bypass tract, as in Wolff-Parkinson-White syndrome or short PR interval syndrome.

CNS: headache, dizziness, asthenia, somnolence

CV: edema, arrhythmias, flushing, bradycardia, hypotension, conduction abnormalities, heart failure, AV block, abnormal ECG

GI: nausea, constipation, abnormal discomfort

Hepatic: acute hepatic injury

Skin: rash

Use cautiously in elderly patients and in those with heart failure or impaired hepatic or renal functions.

Monitor blood pressure and heart rate when starting therapy and during dosage adjustments.

Maximum antihypertensive effects may not be seen for 14 days.

If systolic blood pressure is below 90 mm HG or heart rate is below 60 beats/minute, withhold dose and notify prescriber.

Alert: Don’t confuse Cardizem SR with Cardene SR.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: norpaceGeneric name: disopyramide

The usual adult dose of disopyramide is 400 to 800 mg per day by mouth given in divided doses of 100 to 150 mg every 6 hours. The dose for sustained release preparations is 300 mg every 12 hours. Higher maintenance doses of 1200 mg/day have been used for refractory arrhythmias. Careful electrocardiographic and blood pressure monitoring are necessary in this setting to avoid drug overdose.

Loading dose — For rapid control of an arrhythmia, the regimen can be amended by beginning with an oral loading dose of 300 mg of disopyramide followed by the usual maintenance regimen of 400 to 800 mg/day.Intravenous dose — Investigational reports have suggested that disopyramide can be given intravenously, as an initial bolus of 1 to 2 mg/kg over 5 to 10 minutes followed by an infusion of 1 mg/kg per hour.

Antiarryhthmics A class IA antiarrhythmic that depresses phase O and prolongs the action potential. All class I drugs have membrane-stabilizing effects.

Ventricular tachycardia and ventricular arrhythmias believed to be life-threatening.

Contraindicated in patients hypersensitive to drug and in those with sick sinus syndrome, cardiogenic shock, congenital QT interval prolongation, or second- or third- degree heart block in the absence of an artificial pacemaker.

CNS: dizziness, agitation, depression, fatigue, headache, nervousness, acute psychosis, syncope

CV: hypotension, heart failure, heart block, edema, arrhythmias, shortness of breath, chest pain

EENT: blurred vision, dry eyes or nose

GI: dry mouth, nausea, vomiting, anorexia, bloating, gas, weight gain, abdominal pain, constipation, diarrhea

GU: urinary hesitancy, urinary retention, urinary frequency, urinary urgency, impotence

Hepatic: cholestatic jaundice

Muscuskeletal: muscle weakness, aches, pain

Skin: rash, pruritus, dermatosis

Use with extreme caution and avoid, if possible, in patients with heart failure. Use cautiously in patients with underlying conduction abnormalities, urinary tract diseases (especially prostatic hyperplasia), hepaticor renal impairment, myasthenia gravis, or acute angle-closure glaucoma.

Correct electrolyte abnormalities before starting therapy.

Patients with atrial fibrillation or flutter should be digitalized before starting disopyramide because of the risk of enhancing AV conduction.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: inderalGeneric name: Propranolol HCL

Capsules (extended-release) : 60mg, 80mg,120mg,169mgInjection: 1 mg/mlOral:4 mg/ml concentratesTablets:10mg, 20mg, 40mg

Antianginals A nonselective beta blocker that reduces cardiac oxygen demand by blocking catecholamine-induced increases in heart rate, blood pressure, and force of myocardial contraction. Depresses renin secretion and prevents vasodilation of cerebral arteries

Angina pectoris Mortality reduction

after MI Supraventricular,

ventricular and atrial arrhythmias; tachyarrhythmias caused by excessive catecholamine action during anesthesia, hyperthyroidism, or pheochromocytoma

Hypertension Prevention of

frequent, severe, uncontrollable, or disabling migraine or vascular headache.

Contraindicated in patients with bronchial asthma, sinus bradycardia and heart block greater than first-degree, cardiogenic shock, and heart failure (unless failure is secondary to a tachyarrhythmia that can be treated with propranolol).

CNS: fatigue, lethargy, fever, vivid dreams, hallucinations, mental depression, light-headedness, insomnia

CV: bradycardia, hypotension, heart failure, intermittent claudication, intensification of AV block

GI: abdominal cramping, constipation, diarrhea, nausea, vomiting

Hematologic: agranulocytosis

Respiratory: bronchospasm

Use cautiously in patients with hepatic or renal impairment, nonallergic bronchospastic diseases, or hepatic disease and in those taking other antihypertensives.

Always check patient’s apical pulse before giving drug.

Give drug consistently with meals.

Drug masks commom signs and symptoms of shock and hypoglycemia

DRUG ROUTE DOSE CLASSIFICATION MECHANISMOF ACTION

INDICATION CONTRAINDICATUON SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: Intropin Generic name: Dopamine HCL

Adult: initially 1-5 mcg/kg/minute by IV infusion, titrates dosage to desired hemodynamic or renal response. Infusion may be increased by 1-4 mcg/kg/minute at 10-30 min. interval.

Adrenergic Directly stimulatres bete1 receptors of heart to increase myocardial contractility and troke volume. At therapeutic dosages, drugs decreases peripheral vascular resistance afterload, reduces ventricular filling pressure preload, and may facilitate AV node conduction. Net result is increased cardiac output.

Increased cardiac output in short term treatment of cardiac decompensation caused by depressed contractility, suchn as during refractory heart failure; adjunctive therapy in cardiac therapy

Contraindicated in patients hypersensitive to drug or its components and in those with idiopathic hypertrophic subaortic stenosis.

CNS: headache

CV: increase heart rate, hypertension, PVC’s angina, phlebitis, nonspecific chest pain, palpitations, hypotensionGI: nausea, vomiting

Respiratory: shortness of breath, asthma attacks

Other: hyprsensitivity reactions, anaphylaxis

Use cautiously in patients with history of hypertension. Drug may cause exaggerated pressor response. Also, use cautiously in patients with history of sulfite sensitivity.

Before starting therapy dobutamine, correct hypovolemia with plasma volume expanders.

Give a cardiac glycoside before dobutamine. Because drug increases AV node conduction, patients with atrial fibrillation may develop a rapid ventricular rate.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF ACTION

INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Brand name: NitrostatGeneric name: nitroglycerin

Adult: 2.5-2.6 mg sustanined-release by capsule or tablet.

Adult: 1 sublingual tab dissolved under the tonge.

Adult: initially infused at 5mcg.

Antianginals A nitrate that reduces cardiac oxygen demand by decreasing left ventricular end-diastolic pressure (preload) and, to a lesser extent, systemic vascular resistance (afterload). Also increases blood flow through the collateral coronary vessels.

Prophylaxis against chronic angina attacks.

Acute angina pectoris, prophylaxis to prevent or minimize anginal attacks before stressful events.

Hypertension from surgery, heart failure after MI, agina pectoris in acute situations, to produce controlled hypotension during surgery (by I.V. infusion)

Contraindicated in patients with early MI, severe anemia, increased intracranial pressure, angle-closure glaucoma, orthostatic hypotension, allergy to adhesives (transdermal) , or hypersensitivity to nitrates. I.V. nitroglycerin is contraindicated in patients hypersensitive to I.V. form, cardiac tamponade, restrictive cardiomyopathy, or constrictive pericarditis.

CNS: headache, dizziness, weakness

CV: orthostatic hypotension, tachycardia, flushing, palpitations, fainting

EENT: sublingual burning

GI: nausea, vomiting

Skin: cutaneous vasodilation, contct dermatitis, rash

Other: hypersensitivity reactions

Use cautiously in patients with hypotension or volume depletion.

Closely monitor vital signs during infusion, particularly blood pressure, especially in a patient with an MI. Excessive hypotension may worsen the MI.

To apply ointment, measure the prescribed amount on the application paper; then place the paper on any nonhairy area. Don’t rub in. Cover with plastic film to aid absorption and to protect the clothing. Remove all excess ointment from previous site before applying the next dose. Avoid getting ointment on fingers.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING

ACTION RESPONSIBILITIESBrand name: Altace Generic name: ramipril

Capsule: 1.25mg, 2.5mg, 10mg

Adult: initially, 2.5 P.O

Antihypertensive Unknown. Thought to be involved with inhibiting conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Reduced formation of angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion.

Hypertension Heart failure To reduce risk of

MI, stroke and death from CV causes

Contraindicated in patients hypersensitive to ACE inhibitors and in those with a history of angioedema related to treatment with an ACE inhibitor.

CNS: headache, dizziness, fatigue, asthenia, malaise, light-headedness, anxiety, amnesia, depression, insomnia, nervousness, neuralgia, neuropathy, paresthesia, somnolence, tremor, vertigo, syncope

CV: heart failure, hypotension, postural hypotension, angina pectoris, chest pain,palpitations, MI, edema

EENT: epistaxis, tinnitus

GI: nausea, vomiting, abdominal pain, anorexia, constipation, diarrhea, dyspepsia, dry mouth, astroenteritis

Use cautiously in patients with renal impairment.

Monitor blood pressure regularly for drug effectiveness.

Closely assess renal function in patients during few weeks of therapy. Regular assessment of renal function is advisable.

Although ACE inhibitors reduce blood pressure in all races studied, this response is less in black patients who receive the drug as monotherapy.

DRUG ROUTE DOSE CLASSIFICATION MECHANISM OF INDICATION CONTRAINDICATION SIDE EFFECTS NURSING

ACTION RESPONSIBILITIESBrand name: MetoprolGeneric name: Metoprolol Tartrate

Injection: 1mg/ml in 5 ml ampoulesTablets: 50mg, 100mg

Adults: initially, 50 mg P.O b.i.d or 100 mg P.O once daily.

Antihypertensive Unknown. A selective beta blocker that selectively blocks beta I- adrenalgic receptors; decrease cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses rennin secretion.

Hypertension Early intervention

in acute MI – metoprolol tartrate

Angina pectoris Stable

symptomatic heart failure

Contraindicated in patients hypersensitive to drug or other beta blocker. Also contraindicated in patients with sinus bradycardia, greater than first degree heart block, cardiogenic shock, or overt cardiac failure when used to treat hypertension or angina.

CNS: fatigue, dizziness, depression

CV: bradycardia, hypotension, heart failure, AV block

GI: nausea, diarrhea

Respiratory: dyspnea

Skin: rash

Use cautiously in patients with heart failure, diabetes, or respiratory or hepatic disease

Always check patient’s apical pulse rate before giving drug. If it’s lower than 60 beats/minute, withhold and call prescriber immediately.

Monitor glucose level

Monitor blood pressure frequently.

Store drug at room temperature and protect from light.

DRUG ROUTE DOSE CLASSIFICATION MECHANISMOF INDICATION CONTRAINDICATUON SIDE EFFECTS NURSING

ACTION RESPONSIBILITIESBrand name: CorgardGeneric name: Nadolol

Tablets: 20mg,40mg,80mg, 120mg

Adults: 40mg P.o once daily

Antianginals A beta blockers that reduces cardiac oxygen demand by blocking catecholamine-induced increases in heart rate, blood pressure, and force by myocardial contraction. Depresses rennin secretion.

Angina pectoris Hypertension

Contraindicated in patients with bronchial asthma, sinus bradycardia and greater than first degree heart block, cardiogenic shock, and overt heart failure.

CNS: fatigue, dizziness, fever

CV: bradycardia, hypotension, heart failure,and conduction disturbances

GI: nausea, vomiting, diarrhea, abdominal pain, constipation

RESPIRATORY: Increased airway clearance

Check apical pulse before giving medication.

If slower than 60bpm, withhold the drug and call prescriber.

Monitor blood pressure frequently.

Drugs masks signs and symptoms of shock and hyperthyroidism

DRUG ROUTE DOSE CLASSIFICATION MECHANISMOF INDICATION CONTRAINDICATUON SIDE EFFECTS NURSING

ACTION RESPONSIBILITIESVerapamil HClBrand name: Generic name:

Antianginals Not clearly defined. A calcium channel blocker that inhibits calcium ions influx across cardiac and smooth-muscle cells, thus decreasing myocardial contractility and oxygen demand; it also dilates coronary arteries and arterioles.

Vasospastic angina Prophylaxis for

paroxysmal supraventricular tachycardia

Supraventricular arrhythmias

hypertension

Contraindicated in patients with hypersensitive to drugs and in those with severe left ventricular dysfunction, cardiogenic shock, second-third degree AV block or sick sinus syndrome.

CNS: dizziness, headache, asthenia

CV: Transient hypotension, heart failure

GI: constipation

SKIN: rash

use cautiously in elderly pt. and in pt. with increased intracranial pressure or hepatic or renal failure

monitor liver function during prolonged treatment

monitor thebloodpressure

notufy the prescriber if the signs and symptoms of heart failure occur.

Drugs Study

for

Cardiovascular DisorderSubmitted by: Diana M. Resultay

A301/Group 3B

Submitted to: Ms. Jogi Reyes RN, MAN