Pharm Class
Side Effect (SE)
GTN
Metoprolol
Captopril
100
GTN
Nitrate
100
1 S/E of GTN
Dizziness/orthostatic hypotension/reflex tachycardia
100
How do you administer the drug? Rationale?
Administer under patient’s tongue, Instruct patient not to chew or swallow. To achieve rapid relieve of angina
100
2 Contraindications for Metoprolol
1. Hypersensitivity to drug or BB 2. Sinus Bradycardia 3. Heart Block 4. Uncompensated Heart failure 5. Asthma, chronic lung disease 6. Cardiogenic shock
100
MOA
Inhibits the conversion of angiotensin I to angiotensin II. This leads to a decrease in vascular peripheral resistance (vasodilation) and lowered blood pressure. Because of vasodilation, it also reduces preload and afterload.
200
Metoprolol
Beta blocker
200
2 SE of Aspirin
GI bleeding/ ototoxicity/ thrombocytopenia
200
For acute angina, give at pain onset. True/False? Rationale?
True. To achieve rapid relieve of angina.
200
MOA
Selectively blocks the beta1-adrenergic receptors of sympathetic nervous system in the heart and kidneys. This action results in • decreased myocardial excitability / contractility • reduced cardiac output • reduced myocardial oxygen consumption • slowing of heart rate • decreased renin release from kidney; and decreased peripheral resistance
200
Two contraindications for patients on Captopril
1. Hypersensitivity to other ACE inhibitors 2. Angioedema 3. Pregnancy 4. Renal artery stenosis
300
Aspirin
Non Steriodal Anti-inflammatory drug (NSAID)
300
3 SE of Captopril
1. Dizziness, drowsiness, headache, fatigue 2. Orthostatic hypotension, arrhythmias, angina pectoris 3. Nausea, vomiting, constipation, dyspepsia, abdominal pain 4. Oliguria 5. Agranulocytosis 6. Hepatitis 7. Hyperkalemia 8. Persistent cough, upper respiratory tract infection 9. Angioedema, rash, photosensitivity
300
For angina prophylaxis give before activities that may cause anginal pain.
To achieve rapid relieve of angina.
300
What two vital signs should the nurse monitor when patient is on metoprolol? Rationale?
Assess blood pressure and pulse before giving drug. Notify doctor if vital signs are not within the specified range. To prevent the occurrence of severe hypotension and bradycardia that can lead to decreased cardiac output.
300
3 Nursing considerations for patients on captopril.
1. Assess patient for contraindications of renal artery stenosis and pregnancy. Do not administer to patient with renal artery stenosis or who is pregnant. 2. Assess blood pressure and WBC before giving the first dose. Monitor blood pressure closely for sudden blood pressure drop within 3 hours of initial dose until blood pressure has stabilized. Blood pressure can drop rapidly leading to cardiovascular collapse, especially when given to patient on concurrent diuretic therapy. 3. Monitor vital signs, fluid intake and output, and daily weight. To monitor patient’s response to drug therapy, and to detect for adverse effects like oliguria, upper respiratory tract infection and worsening of renal function. 4. Monitor for signs and symptoms of hyperkalemia such as muscle twitching and paresthesias. To allow early detection of hyperkalemia. Doctor needs to review prescription. 5. Monitor serum electrolytes (especially potassium and sodium) to detect the adverse effects hyperkalemia and hyponatremia. 6. Assess serum BUN and creatinine levels to monitor for worsening of renal function especially if patient has renal insufficiency. Drug can cause oliguria and renal toxicity. 7. Supervise patient during ambulation as drug can cause dizziness due to orthostatic hypotension or blood pressure drop. To prevent fall and injury. 8. Monitor for swelling of face, eye area, tongue, lips, hands or feet because angioedema is a life-threatening adverse effect of drug. Initiate resuscitation measures as ordered. Discontinue drug immediately and do not use in future.
400
Simvastatin
HMG CoA Reductase inhibitor
400
3 SE of Simvastatin
Muscle pain/ increase liver enzymes/ steven johnson
400
What should the patient do during acute chest pain? Rationale?
If the first dose does not relieve angina within 5 minutes, administer a second dose. or If pain is not relieved within 5 minutes after the second dose, give the third dose. or If pain is not relieved within 5 minutes after the third dose, inform doctor immediately. Rationale: To detect possibility of myocardial infarction and impending ischemia.
400
What are two adverse effects to report?
Report adverse effects of: (a) decreased cardiac output i.e., fatigue, dyspnea with exertion, hypotension and decreased level of consciousness. (b) bronchoconstriction
400
4 Health education for patient on Captopril
1. Educate patient that drug can cause persistent, dry cough. Dry cough is an adverse effect of drug. Inform doctor if dry cough is intolerable. Doctor may review prescription and consider drugs from other classes. 2. Instruct patient to move slowly when rising because drug can cause dizziness due to orthostatic hypotension or blood pressure drop. 3. Teach patient how to monitor his/her blood pressure and keep a record. To evaluate patient’s response to drug. Bood pressure should drop but not below normal range. 4. Advise patient to immediately report swelling of face, eye, tongue, lips, hands or feet, and rashes. Angioedema is a life-threatening adverse effect of drug. 5. Advise patient to avoid potassium supplement or restrict taking potassium rich foods while taking this drug. Drug increases serum potassium level. 6. Advise patient to report signs and symptoms of hyperkalemia such as muscle twitching and paresthesia. To allow early detection and treatment of hyperkalemia.
500
Captopril
Angiotensin Converting Enzyme (ACE) Inhibitor
500
4 SE of Metoprolol
Bronchoconstriction/ arrhythmia/ hypoglycemia/ Dizziness/ Orthostatic hypotension
500
Rationale for supervising patient in ambulation
To prevent the risk of fall due to dizziness caused by orthostatic hypotension.
500
Identify one blood test to monitor when patient is on metoprolol. Rationale?
Monitor blood glucose levels in diabetic patient. Report altered blood glucose levels. Drug can cause the adverse effect of hypoglycaemia or hyperglycemia.
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