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HEART HEART
– a hollow muscle with four chambers comprising two upper atria and two lower ventricles, pumps oxygenated
blood to the body’s cells and also collects waste products from the
tissues
TWO-STEP PROCESS known as the cardiac cycle includes:
DIASTOLE (resting period when the veins carry blood back to the heart) and
SYSTOLE (contraction period when the heart pumps blood out to the arteries
for distribution to the body)
DEOXYGENATED blood is carried by the veins to the right side of the heart,
which directs the blood to the lungs where it takes on oxygen
OXYGENATED blood from the lungs circulates to the left side of the heart to be pumped out to every cell in the body
through the arteries
CARDIAC GLYCOSIDESCARDIAC GLYCOSIDES
ACTION: inhibits the sodium-potassium ATpase, resulting in cardiac contraction
INDICATION: CHF, atrial fibrillation and or flutter, and paroxysmal atrial contractions
CARDIAC GLYCOSIDESCARDIAC GLYCOSIDES
UNDESIRABLE EFFECTS: - anorexia, nausea (first sign of adult toxicity), upset stomach (first sign of toxicity in older child)
- Vertigo, headache, depression, muscle
weakness, drowsiness, confusion
CARDIAC GLYCOSIDESCARDIAC GLYCOSIDES
NURSING INTERVENTIONS: Monitor K+, Mg, and Ca – may be associated with digitalis toxicityBefore each dose, assess apical pulse for full minute, record and report changes in rate and rhythm
CARDIAC GLYCOSIDESCARDIAC GLYCOSIDES
NURSING INTERVENTIONS: Withhold drug and contact provider if pulse is <60/minute
Weigh daily, monitor I & O, and signs of CHF
CARDIAC GLYCOSIDESCARDIAC GLYCOSIDES
NURSING INTERVENTIONS: Administer separately from antacids (1-2 hours apart)
CARDIAC GLYCOSIDESCARDIAC GLYCOSIDES
CLIENT EDUCATION: Avoid giving with mealsTeach to take pulse correctly and report if pulse is out of parameterWeigh every other day and recordRestrict alcohol, sodium, smoking
NITROGLYCERINNITROGLYCERIN
NITROGLYCERIN INTRAVENOUS: Nitro-Bid IV, Tridil
SUBLINGUAL: NitrostatTOPICAL: Nitro-Bid, Nitrol, NitrostatTRANSDERMAL: Deponit, Minitran, Nitro-Dur, Nitrodisc, Transderm-Nitro
NITROGLYCERINNITROGLYCERIN
ACTION: Relaxes the vascular smooth system
venous return arterial BP
left ventricular workloadMyocardial oxygen consumption
INDICATION: Angina Pectoris
NITROGLYCERINNITROGLYCERIN
UNDESIRABLE EFFECTS: - Headache (most common)
- hypotension, postural hypotension, dizziness, weakness, reflex tachycardia- SUBLINGUAL- burning, tingling sensation in the mouth
NITROGLYCERINNITROGLYCERIN
NURSING INTERVENTIONS Record characteristics and precipitating factors of anginal painMonitor BP and apical pulse before administrationhave client sit or lie down if taking drugs for the first time
NITROGLYCERINNITROGLYCERIN
NURSING INTERVENTIONS Client must have continuous ECG monitoring if given intravenouslyDefibrillator must not be discharged through paddle electrode overlying Nitro-Bid ointment or the transderm nitropatch (may cause burns in client)
NITROGLYCERINNITROGLYCERIN
CLIENT EDUCATION Avoid alcoholTeach client to recognize symptoms of hypotensionAdvise to make the position changes slowly and to avoid prolonged standing
NITROGLYCERINNITROGLYCERIN
CLIENT EDUCATION Protect drug from light, moisture, and heatinstruct to apply Transderm-Nitro patch once a day, usually in the morningRotation of sites is necessary
ANTIARRHYTHMIC: LIDOCAINEANTIARRHYTHMIC: LIDOCAINE
ACTION:Decreases cardiac excitability, cardiac conduction is delayed in the atrium or ventricle
INDICATIONS:Ventricular dysrhythmias such as PVCs, Ventricular Tachycardia, and Ventricular Fibrilation
ANTIARRHYTHMIC: LIDOCAINEANTIARRHYTHMIC: LIDOCAINE
UNDESIRABLE EFFECTS:Bradycardia, Tachycardia, Hypotension, Confusion, Drowsiness (1st sign of Toxicity), dizziness, nausea, vomiting, seizure (severe toxicity), cardiac arrest
ANTIARRHYTHMIC: LIDOCAINEANTIARRHYTHMIC: LIDOCAINE
NURSING INTERVENTIONS:Monitor ECG, BP, Pulse, and Rhythm continuouslyMonitor serum lidocaine levels throughout therapyMonitor intake and outputAdminister lidocaine IV
ANTIARRHYTHMIC: LIDOCAINEANTIARRHYTHMIC: LIDOCAINE
NURSING INTERVENTIONS:In case of circulatory depression, have dopamine available
HYPERTENSIONHYPERTENSION – when a person’s blood pressure is above normal limits
for a sustained period
HYPOTENSIONHYPOTENSION – if a blood pressure becomes too low, the vital centers in
the brain as well the rest of the tissues of the body may not receive enough
oxygenated blood to continue functioning
RENIN AND SODIUM RETENTION
- Cells in the kidneys respond to low blood pressure by releasing an enzyme
called RENIN
RENIN – an enzyme from the kidneys that activates angiotensin
Through a complex series of events, RENIN causes the kidneys to reabsorb
sodium
Sodium reabsorption, in turn, is always accompanied by water retention, which
helps to restore blood volume and blood pressure
ANGIOTENSIN AND BLOOD VESSEL CONSTRICTION
- Renin also activates the blood protein angiotensinogen to angiotensin
ANGIOTENSIN is a powerful VASOCONSTRICTOR: it narrows the diameters of blood vessels, thereby
raising the blood pressure
CONCEPT: ANTIHYPERTENSIVE CONCEPT: ANTIHYPERTENSIVE AGENTSAGENTS
Monitor blood pressure and pulse closely
Rise slowly to reduce orthostatic hypotension
Eating must be considered (diet)
CONCEPT: ANTIHYPERTENSIVE CONCEPT: ANTIHYPERTENSIVE AGENTSAGENTS
Stay on medications. Client has a high tendency to stop a medication
when they are feeling better
ACE INHIBITORSACE INHIBITORSBenazepril (Lotension)Captopril (Capoten)Enalapril (Vasotec)Fosinopril (Monopril)Perindopril (Aceon)Quinapril (Accupril)Ramipril (Altace)
““PRIL SISTERS”PRIL SISTERS”
ACE INHIBITORSACE INHIBITORS
ACTION:Suppresses renin-angiotensin-aldosterone system: blocks conversion of angiotensin I to angiotensin II (a potent vasoconstrictor)
ACE INHIBITORSACE INHIBITORS
INDICATIONS:•Hypertension
•adjunctive therapy for CHF•Reduces development of severe heart
failure following MI in clients with left ventricular function
•Prevents kidney failure in Type II diabetes
ACE INHIBITORSACE INHIBITORS
UNDESIRABLE EFFECTS:•Gastric irritation
•Headache, dizziness•Tachycardia
•Cough•Pruritus•Infection
•hyperkalemia
ACE INHIBITORSACE INHIBITORS
NURSING INTERVENTIONS:Obtain baseline and monitor serum/urine protein, BUN, creatinine, glucose, CBC, potassium and serum levels
Provide mouthcare: alteration in taste may occur
ACE INHIBITORSACE INHIBITORS
CLIENT EDUCATION:Report any signs of infection, bruising, or bleeding
Captopril, Moexipril, Quinapril will have reduced absorption if given with food
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
Candesartan (Atacand)Eprosartan (Teveten)Irbesartan (Avapro)Losartan (Cozaar)
Telmisartan (Micardis) Valsartan (Diovan)
““SARTAN SISTERS”SARTAN SISTERS”
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
ACTION:Blocks the binding of angiotensin II to the AT 1 receptor found in many tissues (ex. adrenal, vascular smooth muscle)This blocks the vasoconstriction effect of the renin-angiotensin system as well as the release of aldosterone resulting in decrease BP
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
INDICATION:Hypertension. Used alone or with other antihypertensives
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
UNDESIRABLE EFFECTS•Occasional cough, upper respiratory infection•Dizziness •Diarrhea•Overdosage: decreased blood pressure
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
NURSING INTERVENTIONS•Monitor renal function tests•Monitor BP and apical HR prior to each dose and on a regular basis•If hypotension occurs, place client in the supine position with feet slightly elevated •Maintain hydration
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
NURSING INTERVENTIONS•Assist with ambulation when dizziness occurs•Assess for signs of upper respiratory infection, cough, and diarrhea
ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)BLOCKERS (ARBS)
CLIENT EDUCATION•Report any signs of an infection•Caution about exercising during hot weather due to potential dehydration and hypotension
ALPHA ADRENERGIC ALPHA ADRENERGIC BLOCKERSBLOCKERS
Doxazosin (Cardura)Prazosin (MInipress)Terazosin (Hytrin)
““SIN”SIN”
ALPHA ADRENERGIC ALPHA ADRENERGIC BLOCKERSBLOCKERS
ACTION:Blocks alpha1 adrenergic receptors resulting in vasodilation of arteries and veins, peripheral vascular resistance: relaxes smooth muscle bladder/prostate
ALPHA ADRENERGIC ALPHA ADRENERGIC BLOCKERSBLOCKERS
INDICATIONS:Hypertension
UNDESIRABLE EFFECTS:Dizziness, drowsiness, weakness, depression, palpitations, tachycardia, orthostatic hypotension
ALPHA ADRENERGIC ALPHA ADRENERGIC BLOCKERSBLOCKERS
NURSING INTERVENTIONS•Monitor BP frequently and protect from falling/injury•Assess BP and HR immediately before each dose•Assist with ambulating if client is dizzy
ALPHA ADRENERGIC ALPHA ADRENERGIC BLOCKERSBLOCKERS
CLIENT EDUCATION:•Safety precautions•Repot if edema is present in the morning•Sugarless gum, sips of tepid water, etc may relieve dry mouth
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
CARDIOSELECTIVE (BETA1 RECEPTORS):
Acebutolol (Sectral)Atenolol (Tenormin)Betaxolol (Kerlone)
Metoprolol (Lopressor)
““LOL TEAM”LOL TEAM”
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
NONSELECTIVE (BETA1 and BETA 2 RECEPTORS):
Carteolol (Cartrol)Carvedilol (Coreg)
Labetalol (Normodyne)Nadolol (Corgard)
““LOL TEAM”LOL TEAM”
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
ACTION:•Binds to Beta1 (cardiac) and/or Beta 2 (lungs) adrenergic receptor sites that prevents the release of catecholamine
B1 BLOCKERS AFFECT 1
Beta1 Blockers affect the Beta1 receptors in the heart. They the
excitability, cardiac workload, oxygen consumption, renin release and lower
blood pressure
B2 BLOCKERS AFFECT 2
Beta2 Blockers stimulate the beta receptors in the lung, relax bronchial smooth muscle, vital capacity, and airway resistance. Higher doses
may cause undesirable cardiac effects
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
INDICATIONS:•Hypertension, angina, MI, Migraine, headaches, situational anxiety, thyrotoxic storm/crisis, upper GI bleeding, familial essential tremors, and assist in treatment of dysrrhythmias
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
UNDESIRABLE EFFECTS:•Bradycardia•Lipidemia, decrease libido•Bronchospasm•CHF•Peripheral vascular constriction•Emotional exhaustion•Reduces recognition of hypoglycemia
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
NURSING INTERVENTIONS:•Monitor blood sugar closely in clients with diabetes•Monitor triglyceride and cholesterol level•Monitor BP and pulse prior to administration•If pulse is below 60 withhold the medication and notify the physician
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
NURSING INTERVENTIONS:•Monitor any change in the cardiac rhythm or any signs of CHF
BETA ADRENERGIC BETA ADRENERGIC BLOCKERSBLOCKERS
CLIENT EDUCATION:•Instruct client regarding self assessment of pulse, character, and rhythm, signs and symptoms of CHF•Avoid heat, excessive exercise, hot showers, baths, and hot tubs
CALCIUM CHANNEL CALCIUM CHANNEL BLOCKERSBLOCKERS
Amlodipine (Norvasc)Bepridil (Vascor)
Diltiazem (Cardizem)Felodipine (Plendil)
Nicardipine (Cardene)NIfedipine (Procardia)
Verapamil (Isoptin, Calan)
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
ACTION:•Blocks calcium access to the cells causing a in contractility, arteriolar constriction, PVR, and BP
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
INDICATION:•Hypertension, vasospastic angina, classic chronic stable angina, atrial fibrillation or flutter, migraine headaches
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
UNDESIRABLE EFFECTS:•Hypotension, headache, dizziness, atrioventricular block worsens CHF, peripheral edema, constipation
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
NURSING INTERVENTIONS:•Monitor hepatic and renal function studies•Monitor ECG and avoid giving when heart blocks are present• have emergency equipment available with IV administration
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
NURSING INTERVENTIONS:•Protect drug from light and moisture
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
CLIENT EDUCATION:•Instruct to increase dietary fiber, fluid intake, and exercise•Avoid overexertion when anginal pain is relieved•Encourage to take with meals or milk•Recommend client not to chew or crush sustained-release
CENTRAL ALPHACENTRAL ALPHA22
AGONISTSAGONISTSClonidine (Catapres)
Guanabenz (Wytensin)Guanfacine (Tenex)
Methyldopa (Aldomet)
CENTRAL ALPHACENTRAL ALPHA22 AGONISTS AGONISTS
ACTION:•Decrease the release of adrenergic hormones from the brain, resulting in a in the peripheral vascular resistance and blood pressure
INDICATIONS:•Hypertension
CENTRAL ALPHACENTRAL ALPHA22 AGONISTS AGONISTS
UNDESIRABLE EFFECTS:•Transient drowsiness, headache, weakness during initial therapy•Dry mouth, constipation•Hypotension, bradycardia,•Occasional edema or weight gain
CENTRAL ALPHACENTRAL ALPHA22 AGONISTS AGONISTS
NURSING INTERVENTIONS:•Recommend the last dose of the day be taken at bedtime•Give medication with snack•Thorough effect of oral administration may take 2-3 days•Weigh daily, notify provider if weight gain >4 lbs per week
CENTRAL ALPHACENTRAL ALPHA22 AGONISTS AGONISTS
NURSING INTERVENTIONS:•Drowsiness disappears during continued therapy•Sugarless gums, sips of tepid water may relieve dry mouth•Give diuretic if needed
CENTRAL ALPHACENTRAL ALPHA22 AGONISTS AGONISTS
NURSING INTERVENTIONS:•If need to discontinue, taper dose gradually over more than one week•Urine may darken in color
VASODILATORSVASODILATORS
ACTION:•Direct relaxation of vascular smooth muscle, producing vasodilation of arterioles which decreases afterload
INDICATION:•Hypertension
VASODILATORSVASODILATORS
UNDESIRABLE EFFECTS:•Headache, dizziness, anorexia, nausea, vomiting, diarrhea•Palpitations, tachycardia, hypotension•Occasional postural hypotension•Edema/weight gain (drugs can cause sodium and water retention)
VASODILATORSVASODILATORS
UNDESIRABLE EFFECTS:•Lupus-like reaction (fever, facial rash, muscle and joint ache, splenomegaly)
VASODILATORSVASODILATORS
CLIENT EDUCATION:•Instruct how to take heart rate•Report a 5lb weight gain•Monitor and report muscle and joint aches, fever•Monitor bowel activity•Take with meals
VASODILATORSVASODILATORS
CLIENT EDUCATION:•For NAUSEA: eat unsalted crackers or dry toast•Report peripheral edema of hands and feet•Lie down if dizzy
CONCEPT: DIURETICSCONCEPT: DIURETICS
DIET: Instruct client to eat a low sodium diet and a diet rich in
potassium. Clients taking potassium-sparing diuretics should not eat a diet
rich in potassium
CONCEPT: DIURETICSCONCEPT: DIURETICS
INTAKE AND OUTPUT, DAILY WEIGHT: These are outcomes that can
assist in evaluating the effects of the drugs. There should be an increase in
the urine output.
Hard candy, sips of water, sugarless gum; may be effective if patient has dry
mouth
CONCEPT: DIURETICSCONCEPT: DIURETICS
UNDESIRABLE EFFECTS: Fluid and electrolyte imbalance. Monitor the fluid and electrolytes while a client is taking
diuretics and report changes to provider.
CONCEPT: DIURETICSCONCEPT: DIURETICS
REVIEW HR & BP : due to potential hypovolemia, monitor the HR and BP. If client is taking digoxin, evaluate for signs of hypokalemia due to risk of
digoxin toxicity
CONCEPT: DIURETICSCONCEPT: DIURETICS
TAKE WITH OR AFTER MEALS AND IN A.M.: instruct client to take with
or after meals if GI distress occurs. Nausea and vomiting may be a result of electrolyte disturbance. Administering the diuretics early in the day will help
avoid nocturia
LOOP DIURETICSLOOP DIURETICS
Bumetadine (Bumex)Ethacrynic Acid (Edecrin)
Furosemide (Lasix)Toresemide (Demadex)
LOOP DIURETICSLOOP DIURETICS
ACTION:•Inhibits sodium, chloride and water reabsorption in the proximal portion of the ascending loop of Henle
LOOP DIURETICSLOOP DIURETICS
INDICATION:•Edema associated with congestive heart failure, cirrhosis with ascites or renal dysfunction.•Furosemide for hypertension or in combination with other antihypertensive medications
LOOP DIURETICSLOOP DIURETICS
UNDESIRABLE EFFECTS:•Hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hyperglycemia, and hyperurecemiaRemember that everything is decreased except the glucose and uric acid
LOOP DIURETICSLOOP DIURETICS
UNDESIRABLE EFFECTS:•Hypotension, blurred vision, headaches, dizziness, lightheadedness, anorexia, nausea, diarrhea, dehydration, muscle cramp. ototoxicity
LOOP DIURETICSLOOP DIURETICS
NURSING INTERVENTIONS:•Monitor serum glucose, and electrolytes
CLIENT EDUCATION:•Report changes in hearing, irritability, vomiting, anorexia, nausea, diarrhea, twitching, or tetany
THIAZIDESTHIAZIDES
Chlorothiazide (Diuril)Chlorthalidone (Hygroton)
Hydrocholorthiazide (Esidrix)Metolazone (Zaroxolyn)
THIAZIDESTHIAZIDES
ACTION:•Increase urine output by inhibiting reabsorption of sodium, chloride, and water in the distal portion of the ascending loop of Henle
THIAZIDESTHIAZIDES
INDICATIONS:•Edema associated with Congestive Heart Failure, •cirrhosis with ascites, and some types of renal impairment•Hypertension
THIAZIDESTHIAZIDES
UNDESIRABLE EFFECTS:•Hypokalemia, hyponatremia , hyperuricemia, hypercalcemia, hyperglycemia•Orthostatic hypotension, anorexia, nausea, or vomiting, dehydration, photosensitivity
THIAZIDESTHIAZIDES
NURSING NTERVENTIONS:•Check for allergies to sulfonamides•Monitor serum glucose and potassium levels
THIAZIDESTHIAZIDES
CLIENT EDUCATION:•Instruct to discontinue thiazides prior to parathyroid function tests due to the altered calcium levels
POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS
Amiloride (Midamor)Spironolactone (Aldactone)Triamterene (Dynerium)
POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS
ACTION:•Promotes excretion of sodium and water, but retains potassium in the distal renal tubule
POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS
INDICATION:•Used with loop or thiazide diuretics in treating CHF and hypertension•Diuretic induced hypokalemia•Steroid induced edema•hyperaldosteronism
POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS
UNDESIRABLE EFFECTS:•Nausea, diarrhea, dizziness, headache, dry mouth, rash, photosensitivty•Increased potassium levels result in peaked T waves on ECG
POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS
NURSING INTERVENTIONS:•Monitor potassium and digitalis levels
POTASSIUM SPARING POTASSIUM SPARING DIURETICSDIURETICS
CLIENT EDUCATION:Inform client that maximum hypotensive effect may not be seen for 2 weeksCounsel client to avoid citrus juices, colas, milk low in sodium, some salt substitutes, or other potassium supplements
OSMOTIC DIURETICSOSMOTIC DIURETICS
ACTION:•Increases osmotic pressure of glomerular filtrate, thus preventing reabsorption of water. •Increases excretion of sodium and chloride
OSMOTIC DIURETICSOSMOTIC DIURETICS
INDICATION:•Oliguria, edema, increased intraocular pressure•Treat certain drug toxicities
OSMOTIC DIURETICSOSMOTIC DIURETICS
UNDESIRABLE EFECTS:•Dry mouth, thirst, nausea, vomiting•Blurred vision, headache, dizziness•Cellular dehydration•Fluid and electrolyte imbalance•Pulmonary edema
OSMOTIC DIURETICSOSMOTIC DIURETICS
NURSING INTERVENTIONS:•Monitor renal function tests, serum and urine potassium and sodium levels, CVP and vital signs•Watch for rapid increase in BP and symptoms of sympathetic over activity (HR, tremor,
ANTICOAGULANTANTICOAGULANTWARFARIN (Coumadin)
ACTION:Interferes with the hepatic synthesis of Vitamin K-clotting factors (II, VII, IX, & X)
INDICATIONS:Prevents or slows extension of blood clot
ANTICOAGULANTANTICOAGULANT
UNDESIRABLE EFFECTS:Anorexia, nausea, diarrhea, rash, bleeding, hematuria, thrombocytopenia, hemorrhage
WARFARIN (Coumadin)
ANTICOAGULANTANTICOAGULANT
NURSING INTERVENTIONSCheck platelet count, PTObserve for bleedingReview bleeding protocolAvoid ASA, may use acetaminophen
WARFARIN (Coumadin)
ANTICOAGULANTANTICOAGULANTHEPARIN SODIUM
ACTION:Combines with antithrombin III to retard thrombin activity.
INDICATIONS:Thrombosis. Reduces risk of myocardial infarction. CVA clots associated with atrial fibrillation, pulmonary embolism
ANTICOAGULANTANTICOAGULANTHEPARIN SODIUM
UNDESIRABLE EFFECTS:Hemorrhagic tendencies: hematuria, bleeding gums, frank hemorrhage
ANTICOAGULANTANTICOAGULANTHEPARIN SODIUM
NURSING INTERVENTIONS:Monitor PTTMonitor for signs of unusual bleeding (petechiae, hematuria, GI bleeding, gum bleeding)Initiate bleeding protocols
ANTIPLATELETANTIPLATELETASPIRIN
ACTION:Platelet aggregation inihibitor; inhibits platelet synthesis or thromboxane, a vasoconstrictor and inducer of platelet aggregation.
ANTIPLATELETANTIPLATELETASPIRIN
INDICATIONS:TIAs, CVAs with a history of TIA, reduces risk of death from MI in clients with history of infarction or unstable angina. UNDESIRABLE:GI discomfort, bleeding, dizziness, tinnitus
ANTIPLATELETANTIPLATELETASPIRIN
NURSING INTERVENTIONS:Monitor liver and renal function tests, CBC, clotting times, vital signs-instruct to take with food & a full glass of water
THROMBOLYTIC AGENTSTHROMBOLYTIC AGENTSStreptokinase (Streptase)Urokinase (Abbokinase)
Alteplase (activase)
THROMBOLYTIC AGENTSTHROMBOLYTIC AGENTSACTION:Binds with plasminogen causing conversion to plasmin which dissolves blodd loss
INDICATIONS:Dissolves blood clots due to coronary artery thrombi, deep vein thrombosis, pulmonary embolism
THROMBOLYTIC AGENTSTHROMBOLYTIC AGENTSUNDESIRABLE EFFECTS:Headache, nausea, rash, fever, bleeding, hemorrhage, allergic reactions, hypotension
THROMBOLYTIC AGENTSTHROMBOLYTIC AGENTSNURSING INTERVENTIONS:Monitor CBC esp Hgb, Hct, coagulation testsEvaluate bleeding at a sutured wound, arterial siteInitiate bleeding protocols