Func. class.: Antihypertensive, antianginal
Chem. class.: β₁-Adrenergic blocker

Therapeutic outcome: Decreased B/P, heart rate, AV conduction

• Monitor B/P during beginning treatment, periodically thereafter; pulse q4hr
• PO route-give with food to prevent GI upset
• Teach patient not to discontinue product abruptly; taper over 2 wk; may cause precipitate angina if stopped abruptly
•  Teach patient not to use OTC products containing α-adrenergic stimulants (such as nasal decongestants, cold preparations); to avoid alcohol, smoking and to limit sodium intake as prescribed
•  Teach patient to report symptoms of CHF
• Advise to report Raynaud's symptoms

Func. class.: Antihypertensive

Chem. class.: β-Blocker; β₁-, β₂-blocker (high doses)

Therapeutic outcome: Decreased B/P, heart rate, prevention of angina pectoris, MI

Black Box Warning: Abrupt discontinuation

• Monitor B/P during beginning treatment, periodically thereafter; pulse q4hr
• Given before meals, at bedtime
• Teach patient not to use OTC products containing α-adrenergic stimulants (such as nasal decongestants, OTC cold preparations); to limit alcohol, smoking; to limit sodium intake as prescribed
• Teach patient to report symptoms of CHF
• Advise to change position slowly
•  Advise patient that product may mask symptoms of hypoglycemia in diabetic patients
•  Advise patient to use contraception while taking this product

Func. class.: Antianginal, calcium channel blocker, antihypertensive

Chem. class.: Dihydropyridine

Therapeutic outcome: Decreased angina pectoris, dysrhythmias, B/P

Black Box Warning: Hypersensitivity to dihydropyridine

Food Interaction:Grapefruit juice: increased hypotension

• Assess fluid volume status, CHF
• Assess for angina
• Monitor B/P and pulse; if B/P drops, call prescriber
• Monitor ALT, AST, bilirubin daily; if these are elevated, hepatotoxicity is suspected
• Monitor if platelet count is <150,000/mm³; product is usually discontinued and another product started
• Monitor cardiac status: B/P, pulse, respiration, ECG
• Give once a day, without regard to meals
• Advise to avoid large amounts of grapefruit juice or alcohol

Func. class.: Antihypertensive, angiotensin converting enzyme (ACE) inhibitor

Chem. class.: Enalaprilat lysine analog

Therapeutic outcome: Decreased B/P in hypertension, decreased preload, afterload in CHF

• Assess blood studies: platelets, WBC with differential, baseline, periodically q3mo; if neutrophils <1000/mm³, discontinue treatment
• Monitor B/P
•  Monitor renal, liver function tests
• Check potassium levels throughout treatment
• Check for edema in feet, legs daily
• Caution patient not to discontinue product abruptly
• Teach patient to notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, coughing, shortness of breath
• Caution patient to report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P
• Emphasize the need to rise slowly to sitting or standing position to minimize orthostatic hypotension
• Instruct patient to avoid increasing potassium in the diet

Func. class.: Inotropic antidysrhythmic, cardiac glycoside

Chem. class.: Digitalis preparation

Therapeutic outcome: Decreased edema, pulse, respiration, crackles

• Assess and document apical pulse for 1 min before giving product; if pulse <60 in adult or <90 in an infant or is significantly different, take again in 1 hr; if <60 in adult, call prescriber; note rate, rhythm, character
• Monitor electrolytes: potassium, sodium, chloride, magnesium, calcium; renal function studies: BUN, creatinine; other blood studies: ALT, AST, bilirubin, Hct, Hgb, product levels (therapeutic level 0.5-2 ng/ml) before initiating treatment and periodically thereafter
• Monitor I&O ratio, daily weights; monitor turgor, lung sounds, edema
• Monitor cardiac status: apical pulse, character, rate, rhythm; resolution of atrial dysrhythmias by ECG; if tachydysrhythmia develops, hold product; delay cardioversion while product levels are determined
• Do not give at same time as antacids or other products that decrease absorption
• Instruct patient to notify prescriber of any loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow-green vision, rash, depression; teach toxic symptoms of this product and when to notify prescriber
• Advise patient to maintain a sodium-restricted diet as ordered; to take potassium supplements as ordered to prevent toxicity
• Instruct patient to report shortness of breath, difficulty breathing, weight gain, edema, persistent cough
• Teach patient purpose of product is to regulate the heart's functioning
• Teach patient as outpatient to check and record pulse for 1 min before taking dose; if there is a change of >15 bpm from usual pulse, prescriber should be notified
• Teach patient to take medication at the same time each day, take missed doses within 12 hr; do not double doses; notify prescriber if doses are missed for 2 days or more; how to monitor heart rate
• Serum digoxin level 0.5-2 ng/ml
• Treatment of overdose: Discontinue product, administer potassium, monitor ECG, administer an adrenergic blocking agent, digoxin immune FAB