DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

ACTION
Reduces BP mainly Most commonly in Coronary artery disease, Body as a Assessment & Drug Effects
Generic Name by direct effect on stepped-care mitral valvular rheumatic Whole: Hypersensitivity
HYDRALAZINE vascular smooth approach to treat heart disease, MI, (rash, urticaria, pruritus,  Lab tests: Determine
HCL muscles of arterial- moderate to severe tachycardia, SLE. Safe use fever, chills, arthralgia, antinuclear antibody titer
resistance vessels, hypertension. Also during pregnancy eosinophilia, cholangitis, before initiation of therapy
Brand Name resulting in in early malignant (category C) or lactation is hepatitis, obstructive and periodically during
Alazine, Apresoline vasodilation. Has hypertension and established. jaundice). CNS: Headac prolonged therapy.
little effect on resistant he, dizziness,  Make baseline and periodic
Classification venous-capacitance hypertension that Cautious Use tremors. CV: Palpitation,  determinations of BUN,
Cardiovascular vessels. Hypotensive persists after angina, tachycardia, flus creatinine clearance, uric
agent; Nonnitrate effect may be limited sympathectomy. Cerebrovascular accident, hing, paradoxical pressor acid, serum potassium,
vasodilator; by sympathetic advanced renal response. Overdose: blood glucose, and ECG.
Antihypertensive reflexes, which Unlabeled Uses impairment, use with MAO arrhythmia, shock. Speci  Monitor for S&S of SLE,
increase heart rate, INHIBITORS. al Senses: Lacrimation, especially with prolonged
Dosage stroke volume, and Conjunctively with conjunctivitis. GI: Anore therapy.
Hypertension cardiac output. cardiac glycosides xia, nausea, vomiting,  Monitor BP and HR closely.
Adult: PO 10–50 and other diarrhea, constipation, Check every 5 min until it is
mg q.i.d. IM 10–50 vasodilators in short- abdominal pain, stabilized at desired level,
mg q4–6h IV 10– term treatment of paralytic then every 15 min thereafter
20 mg q4–6h acute CHF; ileus. Urogenital: Difficu throughout hypertensive
unexplained lty in urination, crisis.
Geriatric: PO Start pulmonary glomerulonephritis. Hem  Monitor I&O when drug is
with 10 mg 2–3 hypertension. atologic: Decreased given parenterally and in
times/d hematocrit and those with renal
hemoglobin, dysfunction.
Child: PO 3–7.5 anemia, agranulocytosis 
mg/kg/d in 4 (rare). Other: Nasal Patient & Family Education
divided congestion, muscle
doses IV/IM 1.7– cramps, SLE-like  Monitor weight, check for
3.5 mg/kg/d in 4 syndrome, fixed drug edema, and report weight
divided doses eruption, edema. gain to physician.
 Note: Some patients
experience headache and
palpitations within 2–4 h
after first PO dose;
symptoms usually subside
spontaneously.
 Make position changes
slowly and avoid standing
still, hot baths/showers,
strenuous exercise, and
excessive alcohol intake.
 Do not drive or engage in
other potentially hazardous
activities until response to
drug is known.
 Do not breast feed while
taking this drug without
consulting physician.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION
Calcium channel Vasospastic Known hypersensitivity to Body as a Whole: Sore Assessment & Drug Effects
Generic Name blocking agent that "variant" or nifedipine. Safety during throat, weakness, fever,
NIFEDIPINE selectively blocks Prinzmetal's pregnancy (category C) or sweating, chills, febrile  Monitor BP carefully during
calcium ion influx angina and in children is not reaction. CNS: Dizziness titration period. Patient may
Brand Name across cell chronic stable established. , light- become severely hypotensive,
Adalat, Adalat CC, membranes of angina without headedness, nervousness, especially if also taking other
Procardia, cardiac muscle and vasospasm. Cautious Use mood changes, drugs known to lower BP.
Procardia XL vascular smooth Mild to weakness, jitteriness, Withhold drug and notify
muscle without moderate Concomitant use with sleep disturbances, physician if systolic BP <90.
Classification changing serum hypertension hypotensives; CHF; blurred vision, retinal  Monitor blood sugar in diabetic
Cardiovascular calcium alone or in lactation. ischemia, difficulty in patients. Nifedipine has
agent; Nonnitrate concentrations. Class combination balance, headache. CV:  diabetogenic properties.
vasodilator; IV antiarrhythmic. with a diuretic. Hypotension, facial  Monitor for gingival
Antiarrhythmic flushing, heat hyperplasia and report
(Class IV); Unlabeled sensation, palpitations, p promptly. This is a rare but
Calcium channel eripheral serious adverse effect (similar
blocker
Uses edema, MI (rare), to phenytoin-induced
prolonged systemic hyperplasia).
Esophageal
Dosage hypotension with
disorders;
Angina overdose. GI: Nausea, Patient & Family Education
vascular
Adult: PO 10–20 heartburn, diarrhea, const
headaches;
mg t.i.d. up to 180 ipation, cramps,  Keep a record of nitroglycerin
Raynaud's
mg/d flatulence, gingival use and promptly report any
phenomenon;
hyperplasia, hepatotoxici changes in previous pattern.
asthma;
Hypertension ty. Musculoskeletal: Infla Occasionally, people develop
cardiomyopathy
Adult: PO 10–20 mmation, joint stiffness, increased frequency, duration,
; primary
mg t.i.d. up to 180 muscle and severity of angina when
pulmonary
mg/d or 30–90 mg cramps. Respiratory: Nas they start treatment with this
hypertension.
sustained release al congestion, dyspnea, drug or when dosage is
once/d cough, increased.
wheezing. Skin: Dermatit  Be aware that withdrawal
is, pruritus, symptoms may occur with
urticaria. Urogenital: Sex abrupt discontinuation of the
ual difficulties, possible drug (chest pain, increase in
male infertility. anginal episodes, MI,
dysrhythmias).
 Inspect gums visually every
day. Changes in gingivae may
be gradual, and bleeding may
be exhibited only with probing.
 Seek prompt treatment for
symptoms of gingival
hyperplasia (easy bleeding of
gingivae and gradual enlarging
of gingival mass, especially on
buccal side of lower anterior
teeth). Drug will be
discontinued if gingival
hyperplasia occurs.
 Research shows that smoking
decreases the efficacy of
nifedipine and has direct and
adverse effects on the heart in
the patient on nifedipine
treatment.
 Do not breast feed while taking
this drug without consulting
physician.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION
Potent, rapid-acting Short-term, Compensatory Body as a Assessment & Drug Effects
Generic Name hypotensive agent rapid reduction hypertension, as in Whole: Diaphoresis,
NITROPUSSIDE with effects similar of BP in atriovenous shunt or apprehension,  Monitor constantly to titrate IV
SODIUM to those of nitrates. hypertensive coarctation of aorta, and for restlessness, muscle infusion rate to BP response.
crises and for control of hypotension in twitching, retrosternal  Relieve adverse effects by
Brand Name producing patients with inadequate discomfort. Thiocyanate slowing IV rate or by stopping
Nipride, Nitropress controlled cerebral circulation. Safety toxicity (profound drug; minimize them by
hypotension during pregnancy (category hypotension, tinnitus, keeping patient supine.
Classification during C) or lactation is not blurred vision, fatigue,  Notify physician immediately
Cardiovascular anesthesia to established. metabolic acidosis, pink if BP begins to rise after drug
agent; Nonnitrate reduce bleeding. skin color, absence of infusion rate is decreased or
vasodilator; Cautious Use reflexes, faint heart infusion is discontinued.
Antihypertensive Unlabeled sounds, loss of  Monitor I&O.
consciousness). CV: Prof  Lab tests: Monitor blood
Dosage
Uses Hepatic insufficiency,
ound hypotension,
hypothyroidism, severe thiocyanate level in patients
Hypertensive Crisis renal impairment, palpitation, increase or receiving prolonged treatment
Refractory CHF
Adult/Child: IV 0.5 hyponatremia, older adult transient lowering of or in patients with severe
or acute MI.
–10 mcg/kg/min patients with low vitamin pulse rate, bradycardia, kidney dysfunction (levels
(average 3 B12 plasma levels or with tachycardia, ECG usually are not allowed to
mcg/kg/min) Leber's optic atrophy. changes. GI: Nausea, exceed 10 mg/dL). Determine
retching, abdominal plasma cyanogen level
pain. Metabolic: Increase following 1 or 2 d of therapy in
in serum creatinine, fall patients with impaired liver
or rise in total plasma function.
cobalamins. CNS: Heada
che, dizziness. Special
Senses: Nasal
stuffiness. Other: Irritatio
n at infusion site.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION
Orally: Acts as a Orally to relieve Myocardial damage; heart Body as a Assessment & Drug Effects
Generic Name laxative by osmotic acute block; cardiac arrest except Whole: Flushing,
MAGNESIUM retention of fluid, constipation and for certain arrhythmias; IV sweating, extreme thirst,  Observe constantly when given
SULFATE which distends to evacuate administration during the 2 sedation, confusion, IV. Check BP and pulse q10–
colon, increases bowel in h preceding delivery; PO depressed reflexes or no 15 min or more often if
Brand Name water content of preparation for use in patients with reflexes, muscle indicated.
Epsom Salt feces, and causes x-ray of abdominal pain, nausea, weakness, flaccid  Lab tests: Monitor plasma
mechanical intestines. vomiting, fecal impaction, paralysis, magnesium levels in patients
Classification stimulation of bowel Parenterally to or intestinal irritation, hypothermia. CV: Hypot receiving drug parenterally
GI Agent; Saline activity.  control seizures obstruction, or perforation. ension, depressed cardiac (normal: 1.8–3.0 mEq/L).
Cathartic; Parenterally: Acts as in toxemia of function, complete heart Plasma levels in excess of 4
Replacement a CNS depressant pregnancy, Cautious Use block, circulatory mEq/L are reflected in
Agent; and also as a epilepsy, and collapse. Respiratory: Re depressed deep tendon reflexes
Anticonvulsant depressant of acute nephritis Impaired kidney function; spiratory and other symptoms of
smooth, skeletal, and and for digitalized patients; paralysis. Metabolic: Hy magnesium intoxication
Dosage cardiac muscle prophylaxis and concomitant use of other permagnesemia, (see ADVERSE EFFECTS).
Laxative function. treatment of CNS depressants; hypocalcemia, Cardiac arrest occurs at levels
Adult: PO 10–15 g Anticonvulsant hypomagnesemi neuromuscular blocking dehydration, electrolyte in excess of 25 mEq/L.
once/d properties thought to a. Topically to agents, or cardiac imbalance including Monitor calcium and
be produced by CNS reduce edema, glycosides; pregnancy hypocalcemia with phosphorus levels also.
Preeclampsia, depression, inflammation, (category A), lactation, repeated laxative use.  Early indicators of magnesium
Eclampsia principally by and itching. children. toxicity (hypermagnesemia)
Adult: IM/IV 4 g in decreasing the include cathartic effect,
250 mL D5W amount of Unlabeled profound thirst, feeling of
infused slowly, acetylcholine warmth, sedation, confusion,
followed by 4–5 g liberated from motor
Uses depressed deep tendon
IM in alternate nerve terminals, thus reflexes, and muscle weakness.
To inhibit
buttocks q4h producing peripheral  Monitor respiratory rate
premature labor
neuromuscular closely. Report immediately if
(tocolytic
Hypomagnesemia blockade. rate falls below 12.
action) and as
Seizures  Test patellar reflex before each
adjunct in
Adult: IM/IV Mild,  repeated parenteral dose.
1 g q6h for 4 hyperalimentati Depression or absence of
doses; Severe, 250 on. reflexes is a useful index of
mg/kg infused over early magnesium intoxication.
4h  Check urinary output,
Child: IV 20–100 especially in patients with
mg/kg q4–6h prn impaired kidney function.
Therapy is generally not
Total Parenteral continued if urinary output is
Nutrition less than 100 mL during the 4 h
Adult: IV 0.5–3 g/d preceding each dose.
 Observe newborns of mothers
who received parenteral
magnesium sulfate within a
few hours of delivery for signs
of toxicity, including
respiratory and neuromuscular
depression.
 Observe patients receiving
drug for hypomagnesemia for
improvement in these signs of
deficiency: Irritability,
choreiform movements,
tremors, tetany, twitching,
muscle cramps, tachycardia,
hypertension, psychotic
behavior.
 Have calcium gluconate readily
available in case of magnesium
sulfate toxicity.

Patient & Family Education

 Drink sufficient water during
the day when drug is
administered orally to prevent
net loss of body water.
 Recommended daily
allowances of magnesium are
obtained in a normal diet. Rich
sources are whole-grain
cereals, legumes, nuts, meats,
seafood, milk, most green leafy
vegetables, and bananas.
 Do not breast feed while taking
this drug without consulting
physician
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION
Calcium is an Negative Ventricular fibrillation, Body as a Assessment & Drug Effects
Generic Name essential element for calcium balance metastatic bone disease, Whole: Tingling
CALCIUM regulating the (as in neonatal injection into myocardium; sensation. With rapid IV,  Assess for cutaneous burning
GLUCONATE excitation threshold tetany, administration by SC or IM sensations of heat waves sensations and peripheral
of nerves and hypoparathyroid routes; renal calculi, (peripheral vasodilation), vasodilation, with moderate
Brand Name muscles, for blood ism, vitamin D hypercalcemia, fainting. GI: PO fall in BP, during direct IV
Kalcinate clotting mechanisms, deficiency, predisposition to preparation: injection.
cardiac function alkalosis). Also hypercalcemia Constipation, increased  Monitor ECG during IV
Classification (rhythm, tonicity, to overcome (hyperparathyroidism, gastric acid administration to detect
Fluid and contractility), cardiac toxicity certain malignancies); secretion. CV: (With evidence of hypercalcemia:
electrolytic and maintenance of renal of pregnancy (category B). rapid infusion) decreased QT interval
water balance function, for body hyperkalemia, hypotension, associated with inverted T
agent; Replacement skeleton and teeth. for Cautious Use bradycardia, cardiac wave.
solution Also plays a role in cardiopulmonar arrhythmias, cardiac  Observe IV site closely.
regulating storage y resuscitation, Digitalized patients, renal or arrest, Skin: Pain and Extravasation may result in
Dosage and release of to prevent cardiac insufficiency, burning at IV site, severe tissue irritation and necrosis.
All doses are in neurotransmitters hypocalcemia sarcoidosis, history of venous thrombosis,  Monitor for hypocalcemia and
terms of elemental and hormones; during lithiasis, immobilized necrosis and sloughing hypercalcemia (see Signs &
calcium: 1 g regulating amino transfusion of patients; lactation. (with extravasation). Symptoms, Appendix F).
calcium gluconate acid uptake and citrated blood.  Lab tests: Determine levels of
= 90 mg (4.5 mEq, absorption of Also as antidote calcium and phosphorus (tend
9.3%) elemental vitamin B12, gastrin for magnesium to vary inversely) and
calcium secretion, and in sulfate, for magnesium frequently, during
Supplement for maintaining acute symptoms sustained therapy. Deficiencies
Osteoporosis structural and of lead colic, to in other ions, particularly
Adult: PO 1–2 g functional integrity decrease magnesium, frequently coexist
b.i.d. to q.i.d. IV 7 of cell membranes capillary with calcium ion depletion.
mEq q1–3d and capillaries. permeability in
Child: PO 45–65 Calcium gluconate sensitivity Patient & Family Education
mg/kg/d in divided acts like digitalis on reactions, and to
doses. IV 1–7 mEq the heart, increasing relieve muscle  Report S&S of hypercalcemia
q1–3d cardiac muscle tone cramps from
Neonate: PO 50– and force of systolic insect bites or (see Appendix F) promptly to
130 mg/kg/d (max: contractions stings. Oral your care provider.
1 g) IV mEq q1–3d (positive inotropic calcium may be  Milk and milk products are the
effect). used to maintain best sources of calcium (and
Hypocalcemic normal calcium phosphorus). Other good
Tetany balance during sources include dark green
Adult: IV 4.5–16 pregnancy, vegetables, soy beans, tofu, and
mEq prn lactation, and canned fish with bones.
Child: IV 0.5–0.7 childhood  Calcium absorption can be
mEq/kg t.i.d. or growth and to inhibited by zinc-rich foods:
q.i.d. prevent primary nuts, seeds, sprouts, legumes,
Neonate: IV 2.4 osteoporosis. soy products (tofu).
mEq/kg/d in Also in  Check with physician before
divided doses osteoporosis, self-medicating with a calcium
osteomalacia, supplement.
CPR chronic  Do not breast feed while taking
Adult: IV 2.3–3.7 hypoparathyroid this drug without consulting
mEq x 1 ism, rickets, and physician.
as adjunct in
Hyperkalemia with treatment of
Cardiac Toxicity myasthenia
Adult: IV 2.25–14 gravis and
mEq q 1–2 min Eaton-Lambert
syndrome.
Exchange
Transfusions with Unlabeled
Citrated Blood
Adult: IV 1.35
Uses
mEq for each 100
To antagonize
mL of blood
aminoglycoside
Neonate: IV 0.45
-induced
mEq for each 100
neuromuscular
mL of blood
blockage, and
as "calcium
challenge" to
diagnose
Zollinger-
Ellison
syndrome and
medullary
thyroid
carcinoma.