Medication Administration

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Beta Blockers

B1 = Heart & B2 = Lungs
(You have 1 heart and 2 lungs)

Antihypertensive Medications

ACE inhibitors, Beta Blockers, Calcium Channel Blockers, Diuretics (ABCD)

Beta Blockers

block norepinephrine and epinephrine (adrenaline) from binding to beta receptors; reduce heart rate; reduce blood pressure by dilating blood vessels; and may constrict air passages by stimulating the muscles that surround the air passages to contract.

Beta Blockers

could be selective or non selective, It could work for either a Beta 1 or Beta 2 or Both a Beta 1 & Beta 2.

Beta 1 sites

in the heart are responsible for increasing HR, Contractility (the force of heart beat), and AV conduction

Non-Selective Beta Blockers

They will block both beta 1 and beta 2 receptors. They can slow not only cardiac output, but also the renal and other systems.

Selective Beta Blockers

They block beta 1 receptors and are very useful in hypertension and certain cardiac diseases. They relax the heart and slow its pumping, thus lowering blood pressure and heart rate. This allows the mechanism of the heart to improve over time.

Beta 2 sites

are found in bronchial and vascular smooth muscles which cause relaxation and dilation

Metoprolol (Lopressor)

Hold med if HR is < 50 BPM via APICAL pulse only.

Beta Blockers

end in "OLOL" (Generic only), i.e. Metoprolol (Lopressor) Generic (Trade)

Metoprolol (Lopressor)

Known as a Lazy drug b/c side effects /adverse reactions are fatique, weakness, impotence, hypotension, depression, bradycardia, ↓ myocardial contraction

Metoprolol (Lopressor)

Selective Beta 1 Site, does not effect Beta 2 receptors, Blocks stimulation of Beta 1 receptors

Diuretics

↓ intravascular volume by ↑ urine production

What is the formula for mean arterial pressure?

Systolic + 2(Diastolic) / 3

Dieretics

end in "IDE" (Generic only), i.e. Furosemide (Lasix) Generic (Trade)

Furosemide (Lasix)

Loop diuretic, it inhibits the reabsorption of Na and Ch from the loop of Henle and distal renal tubule. It increases renal excretion of H2o, Na, Cl, Mg, K+, Ca. A diuresis, decreases BP, and mobilization of excessive fluid.

Administering Furosemide (Lasix) to quickly

Can cause damage to the 8th cranial nerve, resulting in loss of hearing. ("Ototoxic")

Ototoxic

Permanent hearing problem

Adverse Reaction to Furosemide (Lasix)

Dehydration, Hypochloremia, Hypokalemia, Hypomagnesemia, Hyponatremia, Hypovolemia, Metabolic acidosis

Furosemide (Lasix) and potassium levels and digoxin toxicity

Hypokalemia precipitates digoxin toxicity. Be careful when giving diuretics, which can cause hypokalemia and increase risk of dig. toxicity.

Furosemide (Lasix) Implementation

Assess fluid status prior to therapy, Monitor BP and pulse prior to administration, Monitor electrolytes, renal and hepatic function, and glucose levels.

1 K of weight loss

equals 1 L of fluid loss

Hydrochlorothiazide (HCTZ)

inhibit Na and H2O retention at distal tubules, less potent diuretic. Milder than Lasiz but will affect BP stronger than Lasix.

Hydrochlorothiazide (HCTZ)

Slower acting diuretic

Adverse Reaction to Hydrochlorothiazide (HCTZ)

Hypokalemia, Hyperuricemia, May cause increase serum cholesterol, LDL, and triglycerides

Calcium Channel Blockers

blocks calcium entry into cells of vascular smooth muscle and myocardium, dilates coronary arteries, inhibits coronary artery spasms thus decreases angina, decreases AV conduction, systemic vasodilation resulting in decreased BP

Adverse Reaction to Diltiazem (Cardizem)

Arrhythmias, CHF, Stevens-Johnson Syndrome, Peripheral Edema

Stevens-Johnson Syndrome

Burn from inside out

Diltiazem (Cardizem) Implementation

Assess for S/S of digoxin Toxicity, Do NOT crush time released medication, Change Position slowly, Monitor BP, pulse, I&O's, daily weights, ECG, and K+ levels.

Cardiac Glycosides

Slows AV node conduction, decreases conduction thrus SA & AV node, strengthens force of contraction, increases CO. Strengthens heart muscle & slows heart better pump.

Digoxin (Lanoxin) Loading Dose

Large Dose administered to get to therepeautic range

Digoxin (Lanoxin)

Hold Med if HR < 60 BPM via APICAL pulse for 1 full minute.

Digoxin (Lanoxin) Therapeutic Level

0.5 - 2 ng/mL

Digoxin (Lanoxin) Implementation

Loading dose administered over 12 - 24 hours, Monitor apical pulse for 1 full minute before administration, Monitor K, Mg, Ca, Monitor renal & hepatic function

Digoxin (Lanoxin) K levels

If K is low it can potentiate Digoxin medication

Anticoagulants

Blood thinner, prevents clot formation and extenstion, does not dissolve existing clots, prevention of DVT, PE, Embolism 2° A-Fib, Stroke and MI.

Anticoagulants are contradicated in clients with

coagulation disorders, ulcer disease, malignancy, recent surgery, trauma, or active bleeding.

Heparin

Prevents the conversion of thrombin to prothrombim

Reason why Lose Dose Heparin is given

To prevent DVT in patients on prolonge bed rest.

Heparin

Needs to be verified by another RN or LPN

Heparin usual dose

5000 u SQ q8 - 12 h

Adverse Reaction in Heparin

Bleeding, Anemia, Thrombocytopenia (low platelet count)

Heparin antidote

Protamine Sulfate

Heparin Half Life

2 - 6 hours

Warfarin (Coumadin)

interferes with hepatic synthesis of Vitamin K dependent clotting factor

Warfarin Half Life

0.5 - 3 days

Adverse Reaction in Warfarin

Bleeding

Warfarin antidote

Vitamin K, aquamephyton, whole blood

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