| HMG CoA reductase inhibitor; Hyperlipidemia | Atorvastatin: Class and Indication |
| Inhibits HMG CoA reductase, causing decreased production of cholesterol | Atorvastatin: Mechanism of Action |
| Myopathy - myalgia, rhabdomyolysis; ocular and liver toxicity, headache | Atorvastatin: Side Effects |
| Pregnancy, liver problems | Atorvastatin: C/C |
| Take with evening meal (enzymes more active at night); may not see improvement for 6-12 months | Atorvastatin: Nursing Implications |
| Thiazide diuretic; Hypertension and edema in HF | Hydrochlorothiazide: Class and Indication |
| Block Na+ reabsorption, accelerating urine formation and removal of Na+ and H2O | Hydrochlorothiazide: Mechanism of Action |
| Dehydration, electrolyte imbalances | Hydrochlorothiazide: Side Effects |
| Should not be used if creatinine clearance is low | Hydrochlorothiazide: C/C |
| Monitor electrolytes, fluids | Hydrochlorothiazide: Nursing Implications |
| Non-selective beta-1 adrenergic antagonist; Hypertension | Propranolol: Class and Indication |
| Reduce HR; Reduce PVR; Reduce secretion of renin | Propranolol: Mechanism of Action |
| Bradycardia, hypotension, rebound hypertension, bronchospasm, bronchoconstriction, depression, impotence | Propranolol: Side Effects |
| COPD/asthma, diabetes, reduced renal output, SABA/LABA, abrupt withdrawal not advised | Propranolol and Metoprolol: C/C |
| Monitor pulse rates; warn patient to not change position abruptly; warn to not abruptly stop medication | Propranolol and Metoprolol: Nursing Implications |
| Selective beta-1 adrenergic antagonist; Hypertension | Metoprolol: Class and Indication |
| Competes with endogenous catecholamines at adrenergic cardiac receptors; High doses may affect beta-2 receptors | Metoprolol: Mechanism of Action |
| Bradycardia, hypotension, rebound hypertension, depression, impotence | Metoprolol: Side Effects |
| Angiotensin Converting Enzyme (ACE) inhibitor; Hypertension | Lisinopril: Class and Indication |
| Blocks conversion of angiotensin I to angiotensin II; Blocks breakdown of bradykinin; Increases prostaglandin production | Lisinopril: Mechanism of Action |
| Non-productive cough, angioedema, hypotension, hyperkalemia, renal failure | Lisinopril: Side Effects |
| Renal disease, pregnancy | Lisinopril: C/C |
| Monitor BP and labs carefully; Take 1 hour before meals; Take 2 hours apart from antacids | Lisinopril: Nursing Implications |
| Angiotensin II Receptor Blocker (ARB); Hypertension | Losartan: Class and Indication |
| Blocks angiotensin II from binding on receptors in blood vessels and renal cortex | Losartan: Mechanism of Action |
| Headache, dizziness, weakness, syncope | Losartan: Side Effects |
| Renal disease, pregnancy, use cautiously if patients experienced angioedema using ACE inhibitors | Losartan: C/C |
| Monitor BP and labs | Losartan: Nursing Implications |
| Calcium channel blockers; Hypertension | Verapamil, Nifedipine, Diltiazem: Class and Indication |
| Bind to different subunits of L-type calcium channels; bind to open-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cells | Verapamil and Diltiazem: Mechanism of Action |
| Orthostatic hypotension, peripheral edema, bradycardia, reflex tachycardia, constipation, cardiac suppression | Verapamil, Nifedipine, Diltiazem: Side Effects |
| Heart block or sick sinus syndrome; beta blockers; cautiously in older adults; caution with kidney and liver disorders and heart failure | Verapamil, Nifedipine, Diltiazem: C/C |
| Monitor heart rate, EKG, BP, edema, and weight; don't eat grapefruit | Verapamil, Nifedipine, Diltiazem: Nursing Implications |
| Bind reversibly to closed-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cells | Nifedipine: Mechanism of Action |
| Direct vasodilator; severe hypertension | Hydralazine: Class and Indication |
| Causes peripheral vasodilation in arterioles; Increases heart rate and cardiac output | Hydralazine: Mechanism of Action |
| Headache, reflex tachycardia, edema and flushing, N/V/ diarrhea | Hydralazine and Sodium Nitroprusside: Side Effects |
| Any condition where drop in BP would be harmful. Caution in older adults; caution in liver and kidney patients; fluid and electrolyte imbalances | Hydralazine: C/C |
| Monitor BP and serum electrolytes | Hydralazine: Nursing Implications |
| Direct vasodilator; Hypertensive emergency | Sodium nitroprusside: Class and Indication |
| Direct relaxation of arteries and veins | Sodium nitroprusside: Mechanism of Action |
| Requires dilution; can cause irreversible ischemic injury and death; risk of cyanide accumulation | Sodium nitroprusside: C/C |
| Monitor BP and serum electrolytes, should not be given with another medication | Sodium nitroprusside: Nursing Implications |
| Cardiac glycoside; Heart failure | Digoxin: Class and Indication |
| Increase contractile force of myocardium, decrease HR by inhibiting Na/K pump; Increased ICF Na causes exchange for Ca | Digoxin: Mechanism of Action |
| Headache, dizziness, nausea, vomiting, bradycarda, arrhythmias | Digoxin: Side Effects |
| Visual disturbances, cardiac disturbances | Digoxin: Toxicity |
| Ventricular dysrhythmia; heart block or sick sinus syndrome; aortic stenosis; acute MI; electrolyte imbalance; renal failure | Digoxin: C/C |
| Check pulse before administering; Same time daily; Monitor drug and K+ levels | Digoxin: Nursing Implications |
| Antidote for Digoxin; Digoxin toxicity | Digibind: Class and Indication |
| Antidysrhythmic; Narrow QRS tachycardia | Adenosine: Class and Indication |
| Slows conduction through AV node | Adenosine: Mechanism of Action |
| Sinus arrest, flushing, sinus bradycardia, hypotension, dyspnea, dysrhythmias | Adenosine: Side Effects |
| Atrial fibrillation, atrial flutter, heart block | Adenosine: C/C |
| Flush IV port immediately after bolus | Adenosine: Nursing Implications |
| Potassium channel blocker; Pulseless ventricle fibrillation, ventricle tachycardia, atrial fibrillation | Amiodarone: Class and Indication |
| Blocks K+ channels decreasing heart rate, contractility, and conduction | Amiodarone: Mechanism of Action |
| Pulmonary toxicity, new arrhythmia | Amiodarone: Side Effects |
| Interacts with grapefruit, cardiac drugs | Amiodarone: C/C |
| Half life is 25-110 days - toxicity can occur even after discontinuing; Emergency use primarily, but also in atrial fibrillation patients long-term | Amiodarone: Nursing Implications |
| COX inhibitor; Angina | Aspirin: Class and Indication |
| Slows platelet aggregation by blocking thromboxane, reducing risk of further occlusion | Aspirin: Mechanism of Action |
| GI side effects, tinnitus, hearing loss, bleeding risk | Aspirin: Side Effects |
| Anticholinergic; Bradycardia (1st line) | Atropine: Class and Indication |
| Blocks parasympathetic activation by acetylcholine; causes fight-or-flight symptoms | Atropine: Mechanism of Action |
| Drying of mucosa; constipation; urinary retention; ventricular fibrillation | Atropine: Side Effects |
| COPD/asthma, cardiovascular disease | Atropine: C/C |
| Catecholamine; Bradycardia (2nd line), hypotensive shock, heart failure | Dopamine: Class and Indication |
| Low dose - activates receptors in kidneys producing renal artery dilation; Moderate dose - activates beta-1 receptors increasing heart rate and contractility; High dose - activates alpha receptors producing vasoconstriction | Dopamine: Mechanism of Action |
| Changes in blood pressure, dysrhythmias and palpitations, angina, tissue necrosis | Dopamine: Side Effects |
| Tachydysrhythmias, ventricular fibrillation | Dopamine: C/C |
| Monitor IV site for extravasation, own IV line required | Dopamine: Nursing Implications |
| Catecholamine; Cardiac arrest, bradycardia | Epinephrine: Class and Indication |
| Adrenergic agonist | Epinephrine: Mechanism of Action |
| Tachycardia | Epinephrine: Side Effects |
| Tachydysrhythmias, beta blockers | Epinephrine: C/C |
| Class 1b Na+ channel blocker, local anesthetic; ventricular arrhythmias | Lidocaine: Class and Indication |
| Blocks Na+ channels of heart's conduction system, slowing conduction | Lidocaine: Mechanism of Action |
| Many, new arrhythmias | Lidocaine: Side Effects |
| IV drip must be started soon after bolus or serum level will drop below therapeutic range | Lidocaine: Nursing Implications |
| Opioid; Angina | Morphine: Class and Indication |
| Reduces some sympathetic response, venodilator | Morphine: Mechanism of Action |
| Respiratory depression | Morphine: Side Effects |
| Nitrate; Angina | Nitroglycerin: Class and Indication |
| Relaxes smooth muscles in vascular system | Nitroglycerin: Mechanism of Action |
| Headache is most common; hypotension; facial flushing; tachycardia | Nitroglycerin: Side Effects |
| Do not take with Viagra or other PDE5 inhibitors - may cause life threatening hypotension; Alcohol | Nitroglycerin: C/C |
| Monitor vitals; Advise patient to remain supine or seated when taking medication; Emphasize changing position slowly; Offer sips of water before giving sublingually | Nitroglycerin: Nursing Implications |
| Atorvastatin: Class and Indication | HMG CoA reductase inhibitor; Hyperlipidemia |
| Atorvastatin: Mechanism of Action | Inhibits HMG CoA reductase, causing decreased production of cholesterol |
| Atorvastatin: Side Effects | Myopathy - myalgia, rhabdomyolysis; ocular and liver toxicity, headache |
| Atorvastatin: C/C | Pregnancy, liver problems |
| Atorvastatin: Nursing Implications | Take with evening meal (enzymes more active at night); may not see improvement for 6-12 months |
| Hydrochlorothiazide: Class and Indication | Thiazide diuretic; Hypertension and edema in HF |
| Hydrochlorothiazide: Mechanism of Action | Block Na+ reabsorption, accelerating urine formation and removal of Na+ and H2O |
| Hydrochlorothiazide: Side Effects | Dehydration, electrolyte imbalances |
| Hydrochlorothiazide: C/C | Should not be used if creatinine clearance is low |
| Hydrochlorothiazide: Nursing Implications | Monitor electrolytes, fluids |
| Propranolol: Class and Indication | Non-selective beta-1 adrenergic antagonist; Hypertension |
| Propranolol: Mechanism of Action | Reduce HR; Reduce PVR; Reduce secretion of renin |
| Propranolol: Side Effects | Bradycardia, hypotension, rebound hypertension, bronchospasm, bronchoconstriction, depression, impotence |
| Propranolol and Metoprolol: C/C | COPD/asthma, diabetes, reduced renal output, SABA/LABA, abrupt withdrawal not advised |
| Propranolol and Metoprolol: Nursing Implications | Monitor pulse rates; warn patient to not change position abruptly; warn to not abruptly stop medication |
| Metoprolol: Class and Indication | Selective beta-1 adrenergic antagonist; Hypertension |
| Metoprolol: Mechanism of Action | Competes with endogenous catecholamines at adrenergic cardiac receptors; High doses may affect beta-2 receptors |
| Metoprolol: Side Effects | Bradycardia, hypotension, rebound hypertension, depression, impotence |
| Lisinopril: Class and Indication | Angiotensin Converting Enzyme (ACE) inhibitor; Hypertension |
| Lisinopril: Mechanism of Action | Blocks conversion of angiotensin I to angiotensin II; Blocks breakdown of bradykinin; Increases prostaglandin production |
| Lisinopril: Side Effects | Non-productive cough, angioedema, hypotension, hyperkalemia, renal failure |
| Lisinopril: C/C | Renal disease, pregnancy |
| Lisinopril: Nursing Implications | Monitor BP and labs carefully; Take 1 hour before meals; Take 2 hours apart from antacids |
| Losartan: Class and Indication | Angiotensin II Receptor Blocker (ARB); Hypertension |
| Losartan: Mechanism of Action | Blocks angiotensin II from binding on receptors in blood vessels and renal cortex |
| Losartan: Side Effects | Headache, dizziness, weakness, syncope |
| Losartan: C/C | Renal disease, pregnancy, use cautiously if patients experienced angioedema using ACE inhibitors |
| Losartan: Nursing Implications | Monitor BP and labs |
| Verapamil, Nifedipine, Diltiazem: Class and Indication | Calcium channel blockers; Hypertension |
| Verapamil and Diltiazem: Mechanism of Action | Bind to different subunits of L-type calcium channels; bind to open-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cells |
| Verapamil, Nifedipine, Diltiazem: Side Effects | Orthostatic hypertension, peripheral edema, bradycardia, reflex tachycardia, constipation, cardiac suppression |
| Verapamil, Nifedipine, Diltiazem: C/C | Heart block or sick sinus syndrome; beta blockers; cautiously in older adults; caution with kidney and liver disorders and heart failure |
| Verapamil, Nifedipine, Diltiazem: Nursing Implications | Monitor heart rate, EKG, BP, edema, and weight; don't eat grapefruit |
| Nifedipine: Mechanism of Action | Bind reversibly to closed-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cells |
| Hydralazine: Class and Indication | Direct vasodilator; severe hypertension |
| Hydralazine: Mechanism of Action | Causes peripheral vasodilation in arterioles; Increases heart rate and cardiac output |
| Hydralazine and Sodium Nitroprusside: Side Effects | Headache, reflex tachycardia, edema and flushing, N/V/ diarrhea |
| Hydralazine: C/C | Any condition where drop in BP would be harmful. Caution in older adults; caution in liver and kidney patients; fluid and electrolyte imbalances |
| Hydralazine: Nursing Implications | Monitor BP and serum electrolytes |
| Sodium nitroprusside: Class and Indication | Direct vasodilator; Hypertensive emergency |
| Sodium nitroprusside: Mechanism of Action | Direct relaxation of arteries and veins |
| Sodium nitroprusside: C/C | Requires dilution; can cause irreversible ischemic injury and death; risk of cyanide accumulation |
| Sodium nitroprusside: Nursing Implications | Monitor BP and serum electrolytes, should not be given with another medication |
| Digoxin: Class and Indication | Cardiac glycoside; Heart failure |
| Digoxin: Mechanism of Action | Increase contractile force of myocardium, decrease HR by inhibiting Na/K pump; Increased ICF Na causes exchange for Ca |
| Digoxin: Side Effects | Headache, dizziness, nausea, vomiting, bradycarda, arrhythmias |
| Digoxin: Toxicity | Visual disturbances, cardiac disturbances |
| Digoxin: C/C | Ventricular dysrhythmia; heart block or sick sinus syndrome; aortic stenosis; acute MI; electrolyte imbalance; renal failure |
| Digoxin: Nursing Implications | Check pulse before administering; Same time daily; Monitor drug and K+ levels |
| Digibind: Class and Indication | Antidote for Digoxin; Digoxin toxicity |
| Adenosine: Class and Indication | Antidysrhythmic; Narrow QRS tachycardia |
| Adenosine: Mechanism of Action | Slows conduction through AV node |
| Adenosine: Side Effects | Sinus arrest, flushing, sinus bradycardia, hypotension, dyspnea, dysrhythmias |
| Adenosine: C/C | Atrial fibrillation, atrial flutter, heart block |
| Adenosine: Nursing Implications | Flush IV port immediately after bolus |
| Amiodarone: Class and Indication | Potassium channel blocker; Pulseless ventricle fibrillation, ventricle tachycardia, atrial fibrillation |
| Amiodarone: Mechanism of Action | Blocks K+ channels decreasing heart rate, contractility, and conduction |
| Amiodarone: Side Effects | Pulmonary toxicity, new arrhythmia |
| Amiodarone: C/C | Interacts with grapefruit, cardiac drugs |
| Amiodarone: Nursing Implications | Half life is 25-110 days - toxicity can occur even after discontinuing; Emergency use primarily, but also in atrial fibrillation patients long-term |
| Aspirin: Class and Indication | COX inhibitor; Angina |
| Aspirin: Mechanism of Action | Slows platelet aggregation by blocking thromboxane, reducing risk of further occlusion |
| Aspirin: Side Effects | GI side effects, tinnitus, hearing loss, bleeding risk |
| Atropine: Class and Indication | Anticholinergic; Bradycardia (1st line) |
| Atropine: Mechanism of Action | Blocks parasympathetic activation by acetylcholine; causes fight-or-flight symptoms |
| Atropine: Side Effects | Drying of mucosa; constipation; urinary retention; ventricular fibrillation |
| Atropine: C/C | COPD/asthma, cardiovascular disease |
| Dopamine: Class and Indication | Catecholamine; Bradycardia (2nd line), hypotensive shock, heart failure |
| Dopamine: Mechanism of Action | Low dose - activates receptors in kidneys producing renal artery dilation; Moderate dose - activates beta-1 receptors increasing heart rate and contractility; High dose - activates alpha receptors producing vasoconstriction |
| Dopamine: Side Effects | Changes in blood pressure, dysrhythmias and palpitations, angina, tissue necrosis |
| Dopamine: C/C | Tachydysrhythmias, ventricular fibrillation |
| Dopamine: Nursing Implications | Monitor IV site for extravasation, own IV line required |
| Epinephrine: Class and Indication | Catecholamine; Cardiac arrest, bradycardia |
| Epinephrine: Mechanism of Action | Adrenergic agonist |
| Epinephrine: Side Effects | Tachycardia |
| Epinephrine: C/C | Tachydysrhythmias, beta blockers |
| Lidocaine: Class and Indication | Class 1b Na+ channel blocker, local anesthetic; ventricular arrhythmias |
| Lidocaine: Mechanism of Action | Blocks Na+ channels of heart's conduction system, slowing conduction |
| Lidocaine: Side Effects | Many, new arrhythmias |
| Lidocaine: Nursing Implications | IV drip must be started soon after bolus or serum level will drop below therapeutic range |
| Morphine: Class and Indication | Opioid; Angina |
| Morphine: Mechanism of Action | Reduces some sympathetic response, venodilator |
| Morphine: Side Effects | Respiratory depression |
| Nitroglycerin: Class and Indication | Nitrate; Angina |
| Nitroglycerin: Mechanism of Action | Relaxes smooth muscles in vascular system |
| Nitroglycerin: Side Effects | Headache is most common; hypotension; facial flushing; tachycardia |
| Nitroglycerin: C/C | Do not take with Viagra or other PDE5 inhibitors - may cause life threatening hypotension; Alcohol |
| Nitroglycerin: Nursing Implications | Monitor vitals; Advise patient to remain supine or seated when taking medication; Emphasize changing position slowly; Offer sips of water before giving sublingually |
