Action: it is used for treating heart pain, high BP, and abnormal heart rhythms. It decreases the force of contraction of the heart and its rate of contraction.
Side Effects: bradycardia, AV block, arrhythmias, hypotension, syncope, cardiac failure, hepatic injury
Doses: adult oral: 120-540 mg/day, immediate release tablets are administered up to 4 times a day, extended releases are administered once daily and should not be chewed or crushed
Tablets (immediate release): 30, 60, 90, and 120 mg.
Tablets (extended release): 120, 180, 240, 300, 360, 420 mg.
Capsules (extended release): 120, 180, 240, 300, 360, 420 mg.
Injection: 5 mg/ml. Powder for injection: 100 mg.
Injectable Solution: 5, 10, 50, 125 mg/ml.
Nursing considerations: Administration of diltiazem with digoxin can increase digoxin blood levels. Therefore, blood levels of digoxin usually are monitored to avoid toxicity from digoxin. Similarly, concurrent administration of diltiazem with an anti-seizure medication, carbamazepine can increase blood levels of the seizure medication, and occasionally lead to toxicity.
Obtain baseline ECG, HR, and BP before beginning therapy.
Teach client to avoid grapefruit juice.
Action: reduce fluid volume in the vessels, potassium wasting (3.5-5; normal K+) the diuretic effect of furosemide can cause depletion of sodium, chloride, body water and other minerals. Furosemide is a powerful diuretic that is used to treat excessive accumulation of fluid and/or swelling (edema) of the body caused by heart failure, cirrhosis, chronic kidney failure, and the nephrotic syndrome.
Side Effects: hypokalemia, electrolyte imbalance, metabolic alkalosis, dehydration, ototoxicity
Doses: The usual starting oral dose for treatment of edema in adults is 20-80 mg as a single dose. The same dose or an increased dose may be administered 6-8 hours later. Doses may be increased 20-40 mg every 6-8 hours until the desired effect occurs. The effective dose may be administered once or twice daily. Some patients may require 600 mg daily.
Nursing Considerations: furosemide competes with aspirin for elimination in the urine by the kidneys. Monitor serum electrolyte levels, asses hydration status, change positions slowly (hypo orthostatic)
Angiotensin-converting enzyme (ACE) inhibitors (prils & tans)
Action: potent natural vasoconstrictor - treats high blood pressure, ACE is an enzyme in the body that causes the formation of angiotensin II. Angiotensin II causes contraction of the muscles surrounding arteries and constriction of arteries in the body, thereby elevating blood pressure. ACE inhibitors such as benazepril lower blood pressure by inhibiting the formation of angiotensin II, thus relaxing the arteries. Relaxing the arteries not only lowers blood pressure, but also improves the pumping efficiency of a failing heart and thereby benefits patients with heart failure.
Side Effects: hypotension, renal impairment/failure, anemia, pancreatitis, dry hacking cough
Doses: The usual starting dose of benazepril is 10 mg daily. If patients are taking a diuretic (water pill) the starting dose is 5 mg daily. Doses may be increased to 20-40 mg once daily or divided and administered twice daily.
Nursing Considerations: first dose may cause severe hypotension, monitor BP, first dose is to be administered at bedtime, monitor blood levels of potassium, NSAIDS may reduce the effects of ACE inhibitors
Vasodilators (cause dilation of blood vessels)
Action: treat high blood pressure, lowering high BP, Helps prevent strokes, heart attacks and kidney problems, It works by relaxing blood vessels so blood can flow through the body more easily.
Side Effects: MI, neutropenia, blood dyscrasia, peripheral neuritis
Doses: Start with 10 mg four times daily for the first 2-4 days, increase to 25 mg four times daily for the balance of the first week. For the second and subsequent weeks, increase dosage to 50 mg four times daily. For maintenance, adjust dosage to the lowest effective levels.
Nursing Considerations: they may produce reflex tachycardia, may produce angina in clients with coronary artery disease, monitor for sodium and water retention
Action: Atenolol is a beta-adrenergic blocking agent that blocks the effects of adrenergic chemicals, for example, adrenaline or epinephrine, released by nerves of the sympathetic nervous system. One of the important function of beta-adrenergic nerves is to stimulate the heart muscle to beat more rapidly. By blocking the stimulation by these nerves, atenolol reduces the heart rate and is useful in treating abnormally rapid heart rhythms. Atenolol also reduces the force of contraction of heart muscle and lowers blood pressure. By reducing the heart rate, the force of muscle contraction, and the blood pressure against which the heart must pump, atenolol reduces the work of heart muscle and the need of the muscle for oxygen.
Side Effects: CHF, severe bradycardia, heart block, broncospasm, MI/angia exacerbation if abrupt d/c
Doses: The dose for treating high blood pressure or angina is 25-100 mg once daily.
Acute myocardial infarction (heart attack) is treated with two 5 mg injections administered 10 minutes apart followed by treatment with 100 mg oral atenolol for 6-9 days. If atenolol injections are not appropriate, patients may be treated with 100 mg daily of oral atenolol for 7 days.
Nursing Considerations: monitor vitals, hold medication if HR is less than 60 bpm or if BP systolic is less than 90, monitor for orthostatic hypotension