Drug Study on Beta Blocker Nursing Pharmacology PDF

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COLLEGE OF NURSINGNCM 106 – PHARMACOLOGYDRUG STUDYBSN-IIGENERIC NAME : Digoxin BRAND NAME : Digitek CLASSIFICATION : cardiac glycosideACTION INDICATION CONTRAINDICATION ADVERSEREACTIONNURSINGCONSIDERATION This drug inhibits sodium potassium- activated adenosine triphosphatase, promoting movement of...

Description

COLLEGE OF NURSING NCM 106 – PHARMACOLOGY DRUG STUDY BSN-II GENERIC NAME BRAND NAME CLASSIFICATION ACTION

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Digoxin Digitek cardiac glycoside INDICATION

CONTRAINDICATION

ADVERSE REACTION  This drug inhibits  It is indicated to heart Digoxin is contraindicated to The adverse reactions of Digoxin are; sodium failure, paroxysmal the following: potassiumsupraventricular  CNS: Agitation, fatigue,  CNS: Fever activated tachycardia, atrial dizziness, hallucinations.  CV: arrhythmias, adenosine fibrillation and flutter. chest pain,  CV: arrhythmias, heart triphosphatase, block hypotension. promoting  GI: Anorexia, nausea,  GI: Abdominal pain, movement of diarrhea, vomiting. anorexia, nausea, calcium from vomiting. extracellular to  Hematologic: intracellular thrombocytopenia. cytoplasm and  Hepatic: strengthening hepatotoxicity. myocardial  Metabolic: contraction. It hypokalemia also acts on CNS  Skin: burning at to enhance vagal injection site. tone.  Other: hypersensitivity reactions.

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NURSING CONSIDERATION Drug is prescribed primarily for patients who haven’t responded to cardiac glycosides, diuretics, and vasolidator. Dosage depends on clinical response, including assessment of pulmonary wedge pressure and cardiac output, as well as lessening of dyspnea, orthopnea, and fatigue. In patients with atrial fibrillation and flutter, drug may be added to cardiac glycoside therapy because it slightly enhances AV conduction and increases ventricular response rate. Correct hypokalemia before or during therapy. Monitor platelet count.

 Monitor patients with hypersensitivity reactions, such as pericarditis, ascites, myositis, vasculitis, and pleuritis.  Monitor intake and output and daily weight.  Patients with end-stage cardiac disease may receive home treatment while awaiting heart transplantation. GENERIC NAME BRAND NAME CLASSIFICATION ACTION

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Amlodipine Norvasc Calcium channel blocker INDICATION

 Amlodipine  This drugs is indicated to; inhibits calcium  Chronic stable angina, ion influx across vasospastic angina. cardiac and  Hypertension. smooth muscle cells, dilates coronary arteries and arterioles, and decreases blood pressure and myocardial oxygen deman.

CONTRAINDICATION  It is contraindicated in patients hypersensitive to drug.

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ADVERSE REACTION CNS: headache, fatigue, dizziness, light-headedness, paresthesia. CV: edema, flushing, palpitations. GI: nausea, abdominal pain. GU: sexual difficulties. Musculoskeletal: muscle pain. Respiratory: dyspnea. Skin: rash, pruritus.

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NURSING CONSIDERATION Monitor patient carefully. Monitor blood pressure frequently during initiation of therapy. Because drug induced vasodilation has a gradual onset, acute hypotension is rare. Notify prescriber signs of heart failure occur, such as swelling of hands and feel or shortness of breath. Abrupt withdrawal of drug may increase frequency and duration of chest pain. Don’t confuse amlodipine with amiloride.

GENERIC NAME BRAND NAME CLASSIFICATION ACTION  To reduce 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.

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Propanolol Inderal beta blocker INDICATION

CONTRAINDICATION

 Angina pectoris  It is contraindicated I patients with bronchial  To decrease risk of death asthma, sinus after MI. bradycardia and heart  Supraventricular, block greater than firstventricular and atrial degree, cardiogenic arrhythmias; shock, and overt and tachyarryhthmias caused decompensated heart by excessive failure (unless failure is catecholamine action secondary to a during anesthesia, tachyarrhythmia that can hyperthyroidism, or be treated with pheochromocytoma. propranolol.  Hypertension  To prevent frequent, severe, uncontrollable, or disabling migraine or vascular headache.  Essential tremor.  Hypertrophic subaortic stenosis.  Adjunct therapy in pheochromocytoma.

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ADVERSE REACTION CNS: fatigue, lethargy, fever, vivid dreams, hallucinations, mental depression, dizziness, insomnia. CV: hypotension, bradycardia, heart failure, intensification of AV block, intermittent claudication. GI: abdominal cramping, constipation, diarrhea, nausea, vomiting. Hematologic: agranulocytosis. Respiratory: bronchospasm. Skin: rashes.

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NURSING CONSIDERATION Always check patient’s apical pulse before giving drug. If extremes in pulse rates occur, withhold drug and notify the prescriber. Give drug consistently with meals. Food may increase absorption of propranolol. Drug masks common signs and symptoms of shock and hypoglycemia. Don’t stop drug before surgery for pheochromocytoma. Tell the anesthesiologist that the patient is taking propranolol. Compliance may be improved by giving drug twice daily or as extendedrelease capsules. Check with prescriber. Don’t confuse propranolol with Pravachol. Don’t confuse Inderal with Inderide, Isordil, Adderall, or Imuran.

GENERIC NAME BRAND NAME CLASSIFICATION

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ACTION  Unknown. Thought to stimulate alpha2 receptors and inhibit the central vasomotor centers, decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature, and lowering peripheral vascular resistance, blood pressure, and heart rate.

Clonidine Catapres centrally acting alpha agonist INDICATION

CONTRAINDICATION

 Essential and renal  Contraindicated in hypertension patients hypersensitive drug.  Severe cancer pain that is unresponsive to epidural or spinal opiate analgesia or other more conventional methods of analgesia.  Migraine phrophylaxis.  Dysmenorrhea  Vasomotor symptoms of menopause  Opiate dependence.  Smoking cessation.  Attention deficit hyperactivity disorder.

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ADVERSE REACTION CNS: drowsiness, dizziness, sedation, weakness, fatigue, malaise, agitation, depression. CV: bradycardia, severe rebound hypertension, orthostatic hypotension. GI: constipation, dry mouth, nausea, vomiting, anorexia. GU: urine retention, impotence. Metabolic: weight gain. Skin: dermatitis, rash. Other: loss of libido.

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GENERIC NAME BRAND NAME

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Losartan Cozaar

NURSING CONSIDERATION Drug may be given to lower blood pressure rapidly in some hypertensive emergencies. Monitor blood pressure and pulse rate frequently. Elderly patients may be more sensitive to younger ones to drugs hypotensive effects. Observe patient for tolerance to drug’s therapeutic effects, which may require increased dosage. Noticeable antihypertensive effects of transdermal clonidine may take 2 to 3 days. Remove transdermal patch before defibrillation to prevent arcing. Stop drug gradually by reducing dosage over 2 to 4 days to avoid rapid rise in blood pressure, agitation, headache, and tremor. Don’t stop drug before surgery.

CLASSIFICATION ACTION

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angiotensin II receptor antagonist INDICATION

 Inhibits  Hypertension vasoconstrictive  Nephropathy in type 2 and aldosteronediabetic patients. secreting action  To reduce risk of stroke of angiotensin II in patients with by blocking hypertension and left angiotensin II ventricular hypertrophy. receptor on the surface of vascular smooth muscle and other tissue cells.

CONTRAINDICATION 

Patient with history of angioedema, volumeand/or Na-depletion, heart failure, unstented unilateral/bilateral renal artery stenosis, aortic or mitral stenosis, cirrhosis. Black race. Renal impairment and mild to moderate hepatic impairment. Children and elderly. Lactation.

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ADVERSE REACTION Patients with hypertension or left ventricular hypertrophy. CNS: dizziness, asthenia, fatigue, headache, insomnia. CV: edema, chest pain EENT: nasal congestion, sinusitis, pharyngitis, sinus disorder. GI: abdominal pain, nausea, diarrhea, dyspepsia. Respiratory: cough, upper respiratory infection. Other: angioedema.

NURSING CONSIDERATION 

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Obtain B/P, apical pulse immediately before each dose, in addition to regular monitoring (be alert to fluctuations). Question for possibility of pregnancy. Assess medication history (esp. diuretics). Maintain hydration (offer fluids frequently). Assess for evidence of upper respiratory infection, cough. Monitor B/P, pulse. Assist with ambulationif dizziness occurs. Monitor daily pattern of bowel activity, stool consistency.

GENERIC NAME BRAND NAME CLASSIFICATION

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Metoprolol Toprol beta blocker

ACTION

INDICATION

CONTRAINDICATION

 Unknown. A selective beta blocker that selectively blocks beta1 receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses renin secretion.

 Hypertension  Early intervention in acute MI.  Angina pectoris  Stable symptomatic heart failure resulting from ischemia, hypertension, or cardiomyopathy.

 Contraindicated in patients hypersensitive to drug or other beta blockers.  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.

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ADVERSE REACTION CNS: fatigue, dizziness, depression CV: hypotension, bradycardia, heart failure, AV block, edema. GI: nausea, diarrhea. Respiratory: dyspnea Skin: rash

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NURSING CONSIDERATION Always check patient’s apical pulse rate before giving drug. If it’s slower than 60 beats/ minute, withhold drug and call prescriber immediately. In diabetic patients, monitor glucose level closely because drug masks common signs and symptoms of hypoglycemia. Monitor blood pressure frequently; drug masks common signs and symptoms of shock. Beta blocker may mask tachycardia caused by hyperthyroidism. In patients with suspected thyrotoxicosis, taper off beta blocker to avoid thyroid storm. When stopping therapy, taper dose over 1 to 2 weeks. Beta selectivity is lost at higher doses. Watch for peripheral side effects. Don’t confuse metoprolol with metaproterenol or metolazone.

 Don’t confuse Toprol-XL with Topamax, Tegretol, or Tegretol-XR.

GENERIC NAME BRAND NAME CLASSIFICATION ACTION

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Nifedipine Adalat calcium channel blocker INDICATION

 Thought to inhibit  Vasospastic angina calcium ion influx  Hypertension across cardiac and  Raynaud's syndrome smooth muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arterioles.

CONTRAINDICATION  Cardiogenic shock, acute unstable angina, use w/in 1 mth of MI. Treatment of angina attack in chronic stable angina or acute reduction of BP in adults. Concomitant use w/ strong CYP3A4 inducers.

ADVERSE REACTION  CNS:

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Dizziness, headache, weakness, somnolence, syncope, nervousness. CV: flushing, peripheral edema, heart failure, MI, hypotension, palpitations. EENT: nasal congestion. GI: nausea, diarrhea, constipation, abdominal discomfort. Musculoskeletal: muscle cramps. Respiratory: dyspnea, pulmonary edema, cough. Skin: rash, pruritus.

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NURSING CONSIDERATION Don’t give immediaterelease capsules within 1 week of acute MI or in acute coronary syndrome. Don’t use capsules S.L to rapidly reduce severe high blood pressure because the result may be fatal. Monitor blood pressure regularly, especially in patients who take beta blockers or antihypertensives. Watch for symptoms of heart failure. Don’t confuse nifedipine with nimodipine or nicardipine....