DRUG DOSAGE MODE OF ACTION INDICATION AND SIDE EFFECTS SPECIAL PRECAUTION NURSING CONSIDERATION

ROUTE CONTRAINDICATION
THERAPEUTIC AND
FREQUENCY
PHARMACOLOGIC
CLASSIFICATION
GN: nitroglycerin SL tablet Nitroglycerin is INDICATION: - Dizziness - Excessive use may lead to the - Instruct the patient not to chew the sublingual tablet
BN: Nitrostat Sublingual denitrated by - Use to treat angina - headache development of tolerance. Only the
0.3–0.6-mg tablet mALDH in smooth - weakness smallest dose required for effective - Older adults may be more sensitive to the side effects
q3–5min as muscle and other - fast heart rate relief of the acute angina attack of this medication,
Anti-angina needed (max: 3 cells. This results in CONTRAINDICATION - nausea should be used. especially dizziness and lightheadedness, which could
Nitrates doses in 15 min) the release of - Hypersensitivity to - vomiting increase the risk of falls. So nurses should instruct the
nitrite ion, which is drug - Severe hypotension, particularly with patient To minimize it, patient should change to
translingual spray then converted - Should not be taken Overdose S/SX upright posture, may occur with small upright position slowly, move up and down stairs
sublingual to nitric oxide. by patient who is - Vasodilation doses of nitroglycerin particularly in carefully, and lie down at the first sign of dizziness.
1–2 sprays (0.4– Nitric oxide that is taking Viagra - Hypotension patients with constrictive pericarditis,
0.8 mg) released stimulates (excessive - Visual disturbance aortic or mitral stenosis, patients who - Doctors may order Initial dosages of nitrates be less
guanylyl cyclase in hypotension) - Flushing of the skin may be volume-depleted, or are than in younger patients, so nurses should read the
Transdermal smooth muscle, - Contraindicated to - cold, clammy skin already hypotensive. order carefully
topical producing patient with history - dark urine
0.6 mg/h, 0.8 an increase in of increased - difficulty breathing - Inform patient that This medicine may - Administer IV nitroglycerin with extreme caution to
mg/h cGMP which causes intracranial cause headaches. These headaches patients with hypotension or hypovolemia since the IV
Apply once q24h vasodilation. pressure, TX for overdose: are a sign that the medicine is working drug may precipitate a severe hypotensive state
or leave on for severe anemia, gastric lavage and followed - Be aware that moisture on sublingual tissue is required
10–12 h, then right-sided by administration of for dissolution of sublingual tablet. However, because
remove and have myocardial activated charcoal chest pain typically leads to dry mouth, a patient may
a 10–12 h nitrate infarction be unresponsive to sublingual nitroglycerin.
free interval - Be aware that local burning or tingling from the
sublingual form has no clinical significance.
Injection - Be alert for overdose symptoms: Hypotension,
Intravenous tachycardia
0.5 mg/mL, 5
mg/mL
Start with 5
mcg/min and
titrate q3–5min
until desired
response

Ointment
Topical
2% ointment
Apply 1.5–5 cm
(½–2 in) of
ointment q4–6h
GN: verapamil HCl Tablet Bind to and block INDICATION - Dizziness - Elderly patients may need lower - For elderly patient: Give I.V. doses over at least 3
BN: Isoptin oral the L-type calcium - Use to treat angina - Headache doses. minutes to minimize risk of adverse effects.
40–80 mg t.i.d. channel. The L- and hypertension - Hypotension - While you are taking this medicine be - Reduce verapamil dosage in patients with renal or
antianginal, type channels are - Constipation careful to limit the amount of alcohol hepatic impairment, those with severely compromised
antihypertensive, the predominant CONTRAINDICATION - Pulmonary edema that you drink. Alcohol increases cardiac function, and those receiving beta blockers.
antiarrhythmic Sustained calcium channels - Hypersensitivity to dizziness and drowsiness and also - If patient is receiving verapamil I.V., monitor ECG and
release tablet in the myocardium drug Overdose S/SX lowers blood pressure . blood pressure continuously.
Ca channel blocker oral and the vascular - Contraindicated to - Heart block - Monitor BP before and after giving the medication’
90–240 mg smooth muscles. patient with severe - Asystole - Low blood pressure (hypotension) - Lab tests: Baseline and periodic liver and kidney
Dosage form: By blocking these left ventricular - hypotension may occur while taking this medicine. functions.
1–2 times/d up
Capsules channels, CBBs dysfunction, Check with your doctor right away if - Monitor ECG continuously during IV administration.
to 480 mg/d you have the following symptoms:
Tablet cause peripheral cardiogenic shock TX for overdose: - Monitor I&O ratio during IV and early oral maintenance
injection arterial vasodilator - I.V. verapamil is administering I.V. blurred vision; confusion; severe therapy. Renal impairment prolongs duration of action,
and myocardial contraindicated in isoproterenol, dizziness, faintness, or increasing potential for toxicity and incidence of
depression which patients receiving norepinephrine, lightheadedness when getting up adverse effects. Advise patient to report gradual weight
leads to a drop in I.V. beta blockers epinephrine, atropine, or from a lying or sitting position gain and evidence of edema.
blood pressure and in those with calcium gluconate in usual suddenly; sweating; or unusual
ventricular doses. tiredness or weakness .
tachycardia.
- Do not take together with grapefruit
- In elderly patients
juice because it may increase the
and patients with
amount of medication absorbed into
impaired renal or
the bloodstream
hepatic function or
increased
intracranial
pressure.