DRUG Brand name: Acebutolol HCL Generic name: Monitan

ROUTE DOSE

CLASSIFICATION Antiarrhythmic/An tidysrhythmic

HYPERTENSION: The initial dosage of acebutolol in uncomplicated mild-tomoderate 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.

MECHANISM OF ACTION 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.

INDICATION
y y

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

SIDE EFFECTS CNS: fatigue, headache, dizziness, insomnia, depression CV: chest pain, edema, bradycardia, heart failure, hypotension GI: nausea, constipation, diarrhea, dyspepsia, flatulence, vomiting GU: dysuria, impotence, nocturia, urinary frequency Musculoskeletal: arthralgia, myalgia Respiratory: dyspnea, bronchospasm, cough Skin: rash

Hypertention Ventricular arrhythmias

NURSING RESPONSIBILITIES y Use cautiously with patients with cardiac failure, peripheral vascular disease, bronchospastic disease and diabetes. y Check apical pulse before giving drug; if lower than 60 beats/minute, withhold drug and call prescriber. Also monitor blood pressure. y Before surgery, tell anaesthesiologi st that patient is taking drug. y Acebutolol may mask signs and symptoms of yperthyroidism . y Drug loses its selectivity for the beta receptor at higher doses. Watch for peripheral effects.

DRUG Brand name: Adenocor Generic name: Adenosine

ROUTE DOSE 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.

CLASSIFICATION Antiarrhythmics

MECHANISMOF ACTION 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 ( WolffParkinson-White syndrome ).

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

CONTRAINDICATUON 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.

SIDE EFFECTS CNS: dizziness, lightheadedness, numbness, tingling in arms, headache. CV: facial flushing. GI: nausea. Respiratory: chest pressure, dyspnea, shortness of breath.

NURSING RESPONSIBILITIES y Alert: Because new arrhythmias, including heart block and transient asystole, may develop, monitor cardiac rhythm and be prepared to give appropriate therapy. y Use cautiously in patients with asthma, emphysema, or bronchitis because bronchoconst riction may occur. y 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. y Discard unused drug; adenosine lacks preservatives.

DRUG Brand name: cordarone Generic name: Amiodarone HCL

ROUTE DOSE Intravenous infusion 50 mg/mL

CLASSIFICATION Antiarrhythmic

MECHANISM OF ACTION Effects result from blockade of potassium chloride leading to a prolongation of action potential duration.

INDICATION
y

y y

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).

CONTRAINDICATI ON 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.

SIDE EFFECTS 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

NURSING RESPONSIBILITIES y Use with extreme caution in patients receiving other antiarrhythmic s. y Use cautiously in patients with pulmonary, hepatic, or thyroid disease. y Be aware of the high risk of adverse reactions. y Obtain baseline pulmonary, liver, and thyroid functions tests and baseline chest X-ray. y Give loading doses in a hospital setting and with continuous ECG monitoring because of the slow onset pf antiarrhythmic effect and the risk of lifethreatening y arrhythmias.

DRUG Brand name: Tenormin Generic name: atenolol

ROUTE DOSE IV doses may be mixed with D5W , normal saline silution. Give slow IV injection. Injection:5mg/10ml Tablets: 25mg,50 mg, 100mg

CLASSIFICATION Antihypertensive

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

INDICATION
y y y

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

SIDE EFFECTS 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

Hypertension Angina pectoris To reduce CV mortality and risk of reinfraction in patients with acute MI

NURSING RESPONSIBILITIES y Monitor the apical pulse for 1 minute before administration. y Record rate and rhythm of heartbeat. y Monitor heart rate continuously during IV administration. y Place on electrocardiogr aphic telemetry during IV administration y IV dose may be diluted with normal saline or 5% dextrose. y For dialysis client s, give 50 mg following each dialysis session.

DRUG Brand name: bretynol Generic name: Bretylium tosylate

ROUTE DOSE 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 530 minute intervals until total dose of 35 mg/kg/da

CLASSIFICATION Antiarryhthmic

MECHANISMOF ACTION 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.

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

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

SIDE EFFECTS CNS: vertigo, dizziness, lightheadedness, syncope CV: SEVERE HYPOTENSION, bradycardia, angina pain, transient arrhythmias, transient hypertension, increased PVC s GI: severe nausea, vomiting

NURSING RESPONSIBILITIES y Dosage adjustment s may be necessary in patients with renal insufficienc y. y Drug isn t considered a first-line choice in the treatment of VT or VF. y Use with extreme caution in patients with fixed cardiac output ( aortic stenosis and pulmonary hypertensio n) to avoid severe and sudden drop in blood pressure. y Keep patient supine until tolerance to hypotensio n develops.

DRUG Brand name: Tiazac Generic name: Diltiazem HCL

ROUTE DOSE Oral Capsules, extended-release 60 mg

CLASSIFICATION Antianginals

MECHANISM OF ACTION 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.
y

INDICATION To manage of Prinzmetal s or variant angina or chronic stable angina pectoris. Hypertension Atrial fibrillation or flutter; paroxysmal supraventricular tachycardia

CONTRAINDICATION 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.

SIDE EFFECTS 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

NURSING RESPONSIBILITIES
y

y y

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 antihypertensi ve 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 Brand name: norpace Generic name: disopyramide

ROUTE DOSE 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.

CLASSIFICATION Antiarryhthmics

MECHANISM OF ACTION A class IA antiarrhythmic that depresses phase O and prolongs the action potential. All class I drugs have membranestabilizing effects.

INDICATION
y

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

SIDE EFFECTS 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

NURSING RESPONSIBILITIES
y

Ventricular tachycardia and ventricular arrhythmia s believed to be lifethreatenin g.

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 Brand name: inderal Generic name: Propranolol HCL

ROUTE DOSE Capsules (extendedrelease) : 60mg, 80mg,120mg,169mg Injection: 1 mg/ml Oral:4 mg/ml concentrates Tablets:10mg, 20mg, 40mg

CLASSIFICATION Antianginals

MECHANISM OF ACTION A nonselective beta blocker that reduces cardiac oxygen demand by blocking catecholamineinduced increases in heart rate, blood pressure, and force of myocardial contraction. Depresses renin secretion and prevents vasodilation of cerebral arteries

INDICATION
y y y

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

SIDE EFFECTS 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

y y

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.

NURSING RESPONSIBILITIES y Use cautiously in patients with hepatic or renal impairment, nonallergic bronchospas tic diseases, or hepatic disease and in those taking other antihyperten sives. y Always check patient s apical pulse before giving drug. y Give drug consistently with meals. y Drug masks commom signs and symptoms of shock and hypoglycemi a

DRUG Brand name: Intropin Generic name: Dopamine HCL

ROUTE DOSE 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 1030 min. interval.

CLASSIFICATION Adrenergic

MECHANISMOF ACTION 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.

INDICATION 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

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

SIDE EFFECTS CNS: headache CV: increase heart rate, hypertension, PVC s angina, phlebitis, nonspecific chest pain, palpitations, hypotension GI: nausea, vomiting Respiratory: shortness of breath, asthma attacks Other: hyprsensitivity reactions, anaphylaxis

NURSING RESPONSIBILITIES y Use cautiously in patients with history of hypertensio n. Drug may cause exaggerate d pressor response. Also, use cautiously in patients with history of sulfite sensitivity. y Before starting therapy dobutamin e, correct hypovolemi a with plasma volume expanders. y Give a cardiac glycoside before dobutamin e. Because drug increases AV node conduction, patients with atrial fibrillation may develop a rapid ventricular rate.

DRUG Brand name: Nitrostat Generic name: nitroglycerin

ROUTE DOSE Adult: 2.5-2.6 mg sustaninedrelease by capsule or tablet. Adult: 1 sublingual tab dissolved under the tonge. Adult: initially infused at 5mcg.

CLASSIFICATION Antianginals

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

INDICATION
y

CONTRAINDICATION Contraindicated in patients with early MI, severe anemia, increased intracranial pressure, angleclosure 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.

SIDE EFFECTS 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

NURSING RESPONSIBILITIES
y

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)

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 Brand name: Altace Generic name: ramipril

ROUTE DOSE Capsule: 1.25mg, 2.5mg, 10mg Adult: initially, 2.5 P.O

CLASSIFICATION Antihypertensive

MECHANISM OF ACTION 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.

INDICATION
y y y

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

SIDE EFFECTS 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, 11astroenteritis

Hypertension Heart failure To reduce risk of MI, stroke and death from CV causes

NURSING RESPONSIBILITIES y Use cautiously in patients with renal impairment. y Monitor blood pressure regularly for drug effectiveness. y Closely assess renal function in patients during few weeks of therapy. Regular assessment of renal function is advisable. y Although ACE inhibitors reduce blood pressure in all races studied, this response is less in black patients who receive the drug as monotherapy .

DRUG Brand name: Metoprol Generic name: Metoprolol Tartrate

ROUTE DOSE Injection: 1mg/ml in 5 ml ampoules Tablets: 50mg, 100mg Adults: initially, 50 mg P.O b.i.d or 100 mg P.O once daily.

CLASSIFICATION Antihypertensive

MECHANISM OF ACTION 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.

INDICATION
y y

CONTRAINDICATION 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.

SIDE EFFECTS CNS: fatigue, dizziness, depression CV: bradycardia, hypotension, heart failure, AV block GI: nausea, diarrhea Respiratory: dyspnea Skin: rash

y y

Hypertension Early intervention in acute MI metoprolol tartrate Angina pectoris Stable symptomatic heart failure

NURSING RESPONSIBILITIES y Use cautiously in patients with heart failure, diabetes, or respiratory or hepatic disease y Always check patient s apical pulse rate before giving drug. If it s lower than 60 beats/minut e, withhold and call prescriber immediately. y Monitor glucose level y Monitor blood pressure frequently. y Store drug at room temperature and protect from light.

DRUG Brand name: Corgard Generic name: Nadolol

ROUTE DOSE Tablets: 20mg,40mg,80mg, 120mg Adults: 40mg P.o once daily

CLASSIFICATION Antianginals

MECHANISMOF ACTION A beta blockers that reduces cardiac oxygen demand by blocking catecholamineinduced increases in heart rate, blood pressure, and force by myocardial contraction. Depresses rennin secretion.

INDICATION
y y

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

SIDE EFFECTS CNS: fatigue, dizziness, fever CV: bradycardia, hypotension, heart failure,and conduction disturbances GI: nausea, vomiting, diarrhea, abdominal pain, constipation RESPIRATORY: Increased airway clearance

Angina pectoris Hypertension

NURSING RESPONSIBILITIES y Check apical pulse before giving medication. y If slower than 60bpm, withhold the drug and call prescriber. y Monitor blood pressure frequently. y Drugs masks signs and symptoms of shock and hyperthyroid ism

DRUG Verapamil HCl Brand name: Generic name:

ROUTE DOSE

CLASSIFICATION Antianginals

MECHANISMOF ACTION 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.

INDICATION
y y

CONTRAINDICATUON 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.

SIDE EFFECTS CNS: dizziness, headache, asthenia CV: Transient hypotension, heart failure GI: constipation SKIN: rash

y y

Vasospastic angina Prophylaxis for paroxysmal supraventricular tachycardia Supraventricular arrhythmias hypertension

NURSING RESPONSIBILITIES y use cautiously in elderly pt. and in pt. with increased intracranial pressure or hepatic or renal failure y monitor liver function during prolonged treatment y monitor theblood pressure y notufy the prescriber if the signs and symptoms of heart failure occur.

Drugs Study for Cardiovascular Disorder

Submitted by: Diana M. Resultay A301/Group 3B Submitted to: Ms. Jogi Reyes RN, MAN