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What interventions should the health care professional use when caring for a patient who is taking the direct acting vasodilator (hydralazine) drug hydralazine (Apresoline)?
- Advise patient that headache and palpitations may occur following first dose.
- Monitor pulse and report tachycardia.
- A beta blocker may be added to decrease tachycardia; watch for hypotension with additional antihypertensive agent.
- Monitor and report signs of a systemic lupus erythematosus-like reaction (facial rash, joint pain, fatigue) to provider (hydralazine will be discontinued).
- Monitor for edema, crackles in lungs.
- Hydralazine may be combined with a diuretic to minimize edema.
- Taper hydralazine slowly when discontinued.
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What interventions should the health care professional use when caring for a patient who is taking the cardiac glycoside digoxin (Lanoxin)?
- Recognize that vomiting may cause hypokalemia, which increases risk for digoxin toxicity.
- Report gastrointestinal (GI) symptoms
- Report central nervous system (CNS) effects
- Take apical pulse for a minute before administering digoxin; withhold drug if pulse falls below prescribed parameters (such as 60 beats/min in adults).
- Monitor digoxin levels frequently.
- Monitor serum potassium levels; administer potassium for low or borderline low values.
- Monitor cardiac rhythm and treat dysrhythmias per protocol.
- For severe digoxin toxicity, digoxin immune FAB (Digibind) is administered IV as an antidote to neutralize digoxin.
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What interventions should the health care professional use when caring for a patient who is taking the HMG-CoA reductase inhibitor (Statin) drug simvastatin (Zocor)?
- Monitor for and report myopathy.
- Measure creatine phosphokinase (CPK) if muscle pain occurs.
- Monitor liver function tests and report impaired liver function.
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What interventions should the health care professional use when caring for a patient who is taking the fibrate drug gemfibrozil (Lopid)?
- Report nausea, vomiting, diarrhea.
- Report symptoms of gall bladder disease.
- Report myopathy.
- Measure creatine phosphokinase (CPK) if muscle pain occurs.
- Monitor liver function tests and report impaired liver function.
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What interventions should the health care professional use when caring for a patient who is taking the alpha1 adrenergic blocker doxazosin (Cardura)?
- Monitor orthostatic blood pressure and pulse 2 to 6 hr after first dose or after dose increases.
- Report drop of greater than 20 mm Hg systolic between lying/standing to provider.
- Report tachycardia to provider.
- Report frequent headaches.
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What interventions should the health care professional use when caring for a patient who is taking the alpha/beta blocker carvedilol (Coreg)?
- Monitor blood pressure.
- Report hypotension and dizziness.
- Report heart rate slower than 60 beats/min (or prearranged parameter) to provider.
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What interventions should the health care professional use when caring for a patient who is taking the direct renin inhibitor aliskiren (Tekturna)?
- Monitor for signs of hyperkalemia.
- Monitor periodic potassium levels, BUN, and creatinine in a patient at risk for hyperkalemia.
- Ensure that patient is not taking potassium-sparing diuretics or other drugs that raise potassium levels.
- Report persistent cough.
- Report angioedema immediately.
- Treat moderate to severe angioedema with epinephrine.
- Report diarrhea and abdominal pain.
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What interventions should the health care professional use when caring for a patient who is taking the beta adrenergic blockers atenolol (Tenormin) and metoprolol (Lopressor)?
- Report heart rate slower than 60 beats/min (or prearrange parameter) to provider.
- Monitor for signs of heart failure and report to provider.
- Teach patient not to stop suddenly to prevent rebound excitation causing angina pain or myocardial infarction in a patient who has coronary heart disease.
- On discontinuation, taper dose slowly over 1 to 2 weeks.
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What interventions should the health care professional use when caring for a patient who is taking the class IC/sodium channel blockers flecainide (Tambocor) and propafenone (Rythmol)?
- Report visual effects (blurred vision, difficulty focusing).
- Monitor for crackles in lungs, edema, and weight gain, and report these effects to provider.
- Monitor periodic ECG; use ambulatory Holter monitor if needed to monitor for dysrhythmias.
- Monitor plasma trough levels to detect early toxicity.
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What interventions should the health care professional use when caring for a patient who is taking the potassium-sparing diuretic spironolactone (Aldactone)?
- Monitor serum potassium levels during treatment.
- If hyperkalemia occurs, monitor for cardiac dysrhythmias.
- Spironolactone may be combined with a thiazide or loop diuretic to maintain normal potassium levels.
- Monitor and report menstrual irregularities, abnormal hair growth, deepening of voice, gynecomastia.
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What interventions should the health care professional use when caring for a patient who is taking the thiazide diuretic hydrochlorothiazide (HydroDIURIL)?
- Monitor serum electrolyte levels periodically; notify provider of abnormal levels.
- Monitor carefully for signs of electrolyte imbalance and dehydration.
- If hypokalemia occurs, monitor for dysrhythmias.
- If hypokalemia is a risk (e.g. patient also taking digoxin). hydrochlorothiazide may be combined with a potassium supplement or potassium-sparing diuretic.
- Monitor blood glucose periodically.
- Monitor blood glucose more frequently in a patient who has diabetes mellitus; insulin or oral antidiabetic drug dosage may need to be increased.
- Monitor uric acid levels periodically.
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What interventions should the health care professional use when caring for a patient who is taking the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate (Isordil)?
- Caregivers should avoid touching ointment when applying.
- Monitor length and severity of headache.
- Monitor baseline orthostatic blood pressure (BP) and pulse; check again when nitrate form reaches its peak effect (e.g. 1 hr for transdermal forms).
- Monitor heart rate in patients taking nitrates.
- Give beta blocker or calcium channel blocker, if prescribed, to suppress tachycardia.
- Monitor for drug tolerance.
- Give any nitroglycerin form in smallest needed amount; use intermittent scheduling for transdermal and long-acting forms.
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What interventions should the health care professional use when caring for a patient who is taking the class II/beta adrenergic blocker propranolol (Inderal)?
- Monitor heart rate and report rate slower than 60 beats/min (or prearranged parameter) to provider.
- Monitor for signs of heart failure and report to provider.
- Teach patient not to stop beta blocker suddenly.
- On discontinuation, taper dose slowly over 1 to 2 weeks.
- Monitor color, temperature, and pulses in extremities (pulses may be present even if poor circulation exists) because the drug can cause peripheral arterial insufficiency (similar to Raynaud's disease).
- Monitor for confusion, fatigue, drowsiness.
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What interventions should the health care professional use when caring for a patient who is taking the class III/potassium channel blocker amiodarone (Cordarone)?
- Report nausea, vomiting, constipation.
- Consider reducing dose for severe gastrointestinal (GI) symptoms.
- Test baseline chest X-ray and pulmonary function before starting therapy because the drug can cause pulmonary toxicity with pneumonitis (causing fever, cough, shortness of breath).
- Monitor pulmonary function testing results periodically.
- Auscultate breath sounds and report changes or adventitious sounds.
- Monitor for changes in vision, light sensitivity.
- Monitor pulse and blood pressure, and report vital signs below prescribed parameters.
- Monitor cardiac rhythm constantly during infusion.
- Monitor for weight changes and edema for both IV and oral therapy.
- Monitor for blue-grey discoloration of skin.
- Report central nervous system (CNS) effects.
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What interventions should the health care professional use when caring for a patient who is taking the class IV/calcium channel blocker verapamil (Calan)?
- IV form: Monitor cardiac rhythm and vital signs continuously; keep patient supine for 1 hr following dose.
- Monitor blood pressure carefully as starting oral dosage is established.
- Notify provider and withhold dose for BP below 90 mm Hg. systolic or for prearranged parameter.
- Monitor heart rate; withhold dose for pulse rate slower than 60 beats/min or prescribed parameter and notify provider.
- Monitor for and report edema (a diuretic may be prescribed if edema occurs).
- For hospitalized patient, monitor intake and output, and report low output.
- Monitor for crackles in lungs.
- Monitor for and report lightheadedness, dizziness.
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What interventions should the health care professional use when caring for a patient who is taking the loop diuretic furosemide (Lasix)?
- Monitor serum electrolyte levels periodically; notify provider for abnormal levels.
- Monitor carefully for signs of electrolyte imbalance and dehydration.
- If hypokalemia occurs, monitor for cardiac dysrhythmias.
- If hypokalemia is a risk (e.g. patient also taking digoxin), furosemide may be combined with a potassium-sparing diuretic.
- Monitor blood pressure frequently during treatment because the drug can cause hypotension.
- Ensure that the patient does not take other ototoxic drugs (additive effect)
- Monitor for hearing loss, tinnitus, vertigo.
- Monitor blood glucose periodically.
- Monitor blood glucose more frequently in a patient who has diabetes mellitus; insulin or oral antidiabetic drug dosage may need to be increased.
- Monitor uric acid levels periodically.
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What interventions should the health care professional use when caring for a patient who is taking the calcium channel blocker (dihydropyridine) drug nifedipine (Adalat, Procardia)?
- Give nifedipine along with beta blocker to prevent tachycardia.
- Monitor heart rate.
- Report angina, lightheadedness, dizziness.
- Assist with ambulation as needed.
- Inform patient that facial flushing may occur.
- Report peripheral edema (a diuretic may be prescribed if edema occurs).
- Monitor blood pressure carefully as starting dosage is established.
- Notify provider and withhold dose for blood pressure (BP) below 90 mm Hg systolic or for prearranged parameter.
- Inspect gingival tissue periodically for enlargement (nifedipine may be discontinued).
- Advise regular dental care.
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What interventions should the health care professional use when caring for a patient who is taking the centrally acting alpha2 agonist clonidine (Catapres)?
- Monitor patient for drowsiness, dizziness.
- Tell patient that this effect will decrease over first few weeks of therapy.
- When discontinued, taper dose slowly over several days.
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What interventions should the health care professional use when caring for a patient who is taking the adrenergic neuron blocker reserpine (Serpalan and Sk-Reserpine)?
- Report signs of depression and suicidal ideation to provider.
- Ensure that lowest possible dosage of reserpine is being given.
- Monitor pulse rate and orthostatic vital signs and report bradycardia.
- Assist with ambulation.
- Report severe or prolonged gastrointestinal (GI) effects (diarrhea, cramps).
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What interventions should the health care professional use when caring for a patient who is taking the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl)?
What interventions should the health care professional use when caring for a patient who is taking the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl)?
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What interventions should the health care professional use when caring for a patient who is taking the phosphodiesterase inhibitor drug milrinone (Primacor)?
- Correct fluid deficits and hypokalemia before beginning infusion.
- Monitor potassium levels and correct hypokalemia as needed during infusion.
- Monitor vital signs and ECG rhythm continuously during infusion.
- Decrease dosage for dysrhythmias or blood pressure falling below prescribed parameters.
- Monitor for chest pain during infusion.
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What interventions should the health care professional use when caring for a patient who is taking the class IB/sodium channel blocker lidocaine (Xylocaine)?
- Monitor confusion, drowsiness, restlessness, paresthesias, muscle twitching or tremors, seizures, respiratory arrest; hold dose and notify provider if they occur.
- Monitor vital signs and cardiac rhythm because high doses can cause hypotension, bradycardia, heart block.
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What interventions should the health care professional use when caring for a patient who is taking the sympathomimetic drug dobutamine (Dobutrex)?
- Monitor ECG rhythm and vital signs continuously during infusion.
- Treat cardiac dysrhythmias and chest pain as needed, and prepare to decrease or discontinue dobutamine for tachydysrhythmias.
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What interventions should the health care professional use when caring for a patient who is taking the aldosterone antagonist spironolactone (Aldactone)?
- Monitor for signs of hyperkalemia.
- Monitor periodic potassium levels, BUN, and creatinine in patients at risk for hyperkalemia.
- Ensure that patient is not taking potassium-sparing diuretics or other drugs that raise potassium levels.
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What interventions should the health care professional use when caring for a patient who is taking the angiotensin receptor blocker (ARB) losartan (Cozaar)?
- Treat severe angioedema with IV epinephrine.
- Discontinue use of any angiotensin receptor blocker (ARB) if angioedema occurs.
- Monitor for and report CNS effects (headache, insomnia).
- Monitor blood pressure (BP) before administering losartan dose.
- Manage severe hypotension by expanding volume using IV fluid therapy.
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What interventions should the health care professional use when caring for a patient who is taking the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten)?
- Start angiotensin-converting enzyme (ACE) inhibitors with low dose and gradually increase to prevent hypotension.
- Diuretics may be temporarily stopped before first dose of ACE inhibitor is given.
- Monitor blood pressure (BP) following first dose.
- Manage severe hypotension by expanding blood volume with IV fluid therapy.
- Discontinue use if dry cough occurs.
- Report rash and metallic taste (ACE inhibitor may be discontinued).
- Treat severe angioedema with IV epinephrine.
- Discontinue use if angioedema occurs.
- Monitor potassium levels in a patient who is at risk, because the drug can cause hyperkalemia.
- Monitor white blood cell counts with differential every 2 weeks for first 3 months of therapy and then periodically, because the drug can cause neutropenia and increase the risk for infection.
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