HCTZ

(hydrochlorothiazide)

Thiazide diuretic. Management of mild to moderate hypertension. Therapeutic Effects: Lowering of blood pressure in hypertensive patients and diuresis with mobilization of edema.  Assess patient, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Notify health care professional if these signs of electrolyte imbalance occur. Patients taking digoxin are at risk of digoxin toxicity because of the potassium-depleting effect of the diuretic.

Metoprolol XL

(Toprol-XL)

Beta Blocker.  Decreased blood pressure and heart rate. Decreased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure.  Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of CHF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention). Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.  Cannot be stopped abruptly.

Enalapril

(Vasotec)

ACE inhibitor.  Alone or with other agents in the management of hypertension. Slowed progression of left ventricular dysfunction into overt heart failure.    Therapeutic Effects: Lowering of blood pressure in hypertensive patients. Improved symptoms in patients with CHF. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional.  ↑ risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or angiotensin II receptor antagonists.

Losartan

(Cozaar)

IAngiotensin II receptor antagonist.  Indications:  Alone or with other agents in the management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension.  Therapeutic Effects: Lowering of blood pressure. Slowed progression of diabetic nephropathy (irbesartan and losartan only). Reduced cardiovascular death and hospitalizations due to CHF in patients with CHF.  Lab Test Considerations: Monitor renal function and electrolyte levels periodically. Serum potassium, BUN, and serum creatinine may be ↑.

Nitroglycerin SL

Nitrate.  Vasodilator.  Acute  and long-term prophylatic management of angina pectoris. Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions. Reduces myocardial oxygen consumption.
Therapeutic Effects: Relief or prevention of anginal attacks. Increased cardiac output. Reduction of blood pressure.  First dose should be taken while in a sitting or reclining position, especially in geriatric patients. Acute Anginal Attacks: Advise patient to sit down and use medication at first sign of attack. Relief usually occurs within 5 min. Dose may be repeated if pain is not relieved in 5-10 min. Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min. 

ASA

(acetylsalicylic acid)

Anti platelet agent, Prophylaxis of transient ischemic attacks and MI. Decreases platelet aggregation.  Administer after meals or with food or an antacid to minimize gastric irritation. Food slows but does not alter the total amount absorbed.
[image]Do not crush or chew enteric-coated tablets Do not take antacids within 1-2 hr of enteric-coated tablets.  If MI is impending, have patient chew ASA to increase speed of absorption.

Atorvastatin

(Lipitor)

Synthetic lipid lowering agent. Lowers total and LDL cholesterol and triglycerides. Slightly increase HDL. Slows of the progression of coronary atherosclerosis with resultant decrease in CHD-related events.  Lab Test Considerations: Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 wk of therapy, and periodically thereafter.
[image]Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo. If AST levels ↑ to 3 times normal, HMG-C If patient develops muscle tenderness during therapy, monitor CK levels. If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued. .
oA reductase inhibitor therapy should be reduced or discontinued.  

t-PA

Tissue Plasminogen

Activator

Thrombolytic.  Acute myocardial infarction (MI).  Therapeutic Effects: Lysis of thrombi in coronary arteries, with preservation of ventricular function or improvement of ventricular function (and ↓ risk of CHF or death). Lysis of pulmonary emboli or deep vein thrombosis. Lysis of thrombi causing ischemic stroke, reducing risk of neurologic sequelae.  Begin therapy as soon as possible after the onset of symptoms. Assess patient carefully for bleeding every 15 min during the 1st hr of therapy, every 15-30 min during the next 8 hr, and at least every 4 hr for the duration of therapy. Frank bleeding may occur from sites of invasive procedures or from body orifices. Internal bleeding may also occur (decreased neurologic status; abdominal pain with coffee-grounds emesis or black, tarry stools; hematuria; joint pain). If uncontrolled bleeding occurs, stop medication and notify physician immediately.

Furosemide

(Lasix)

Potassium wasting diuretic. Edema due to heart failure, hepatic impairment or renal disease.  Therapeutic Effects: Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions). Decreased blood pressure.  Assess fluid status. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify physician or other health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.

Morphine

Narcotic analgesic.  Pain associated with MI.  Therapeutic Effects: Decrease in severity of pain. High Alert: Assess level of consciousness, blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Assess geriatric patients frequently; older adults are more sensitive to the effects of opioid analgesics and may experience side effects and respiratory complications more frequently.

Digoxin

(Lanoxin)

Cardiac glycoside. Treatment of CHF.  Therapeutic Effects: Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect). Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if pulse rate is <60 bpm in an adult,  Observe for signs and symptoms of toxicity. In adults, the first signs of toxicity usually include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias.  Hypokalemia, hypomagnesemia, or hypercalcemia may make the patient more susceptible to digitalis toxicity

Warfarin

(Coumadin)

Anticoagulant.  Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization. Therapeutic Effects: Prevention of thromboembolic events. Assess patient for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools, urine, or nasogastric aspirate). PT, INR and other clotting factors should be monitored frequently during therapy. Therapeutic PT ranges from 1.3-1.5 times greater than control; however, the INR, a standardized system that provides a common basis for communicating and interpreting PT results, is usually referenced. Normal INR (not on anticoagulants)is 0.8 to 1.2. An INR of 2.5 to 3.5 is recommended for patients at very high risk of embolization (for example, patients with mitral valve replacement and ventricular hypertrophy). Lower levels are acceptable when risk is lower. If overdose occurs or anticoagulation needs to be immediately reversed, the antidote is vitamin K (phytonadione, AquaMEPHYTON

Clopidogrel

(Plavix)

Thienopyridine class inhibitor of platelet receptors. Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors.
Therapeutic Effects: Decreased occurrence of atherosclerotic events in patients at risk. Lab Test Considerations: Monitor bleeding time during therapy. Prolonged bleeding time, which is time- and dose-dependent, is expected.  Advise patient to notify health care professional promptly if fever, chills, sore throat, or unusual bleeding or bruising occurs.
[image]Advise patient to notify health care professional of medication regimen prior to treatment or surgery. 

Heparin

Anticoagulant. Therapeutic Effects: Prevention of thrombus formation. Prevention of extension of existing thrombi (full dose).  Lab Test Considerations: Monitor activated partial thromboplastin time (aPTT) and hematocrit prior to and periodically throughout therapy. Toxicity and Overdose: Protamine sulfate is the antidote. Due to short half-life, overdose can often be treated by withdrawing the drug. Subcut: Administer deep into subcut tissue. Alternate injection sites between the left and right abdominal wall above the iliac crest. Inject entire length of needle at a 45° or 90° angle into a skin fold held between thumb and forefinger; hold skin fold throughout injection. Do not aspirate or massage. Rotate sites frequently.