1. Discuss action, indication, contraindications, side effects, adverse effects and nursing considerations for patients taking medications in the following classification. Use the prototype drug as an example in each of the classification. a. Direct-acting vasodilators (Nitroprusside) b. Calcium Channel Blockers (Diltiazen) c. Drugs affecting urinary output (Hydrochlorothiazide, Furosemide, Spironolactone,) d. Drugs Affecting coagulation (heparin and Warfarin) e. Cardiac Glycosides ( Lanoxin) f. Drugs to treat Heart Failure (Digoxin
a. Direct-acting vasodilators (Nitroprusside):
Action: Nitroprusside relaxes smooth muscle in blood vessels, leading to vasodilation and reduced blood pressure. It primarily acts on arterioles.
Indications: Used to treat hypertensive emergencies.
Contraindications: Hypersensitivity to nitroprusside, severe heart failure.
Side Effects:Headache, nausea, vomiting, flushing, excessive hypotension.
Adverse Effects: Cyanide toxicity (rare but serious), especially with prolonged use.
Nursing Considerations: Continuous blood pressure monitoring, frequent assessment for cyanide toxicity, protection from light (as the drug is light-sensitive).
b. Calcium Channel Blockers (Diltiazem):
Action: Inhibits calcium influx into cardiac and smooth muscle cells, leading to reduced contractility and vasodilation.
Indications: Used for hypertension, angina, and certain arrhythmias.
Contraindications: Hypersensitivity, severe bradycardia, heart block.
Side Effects: Hypotension, bradycardia, constipation, dizziness.
Adverse Effects: Heart block, worsening heart failure.
Nursing Considerations: Monitor blood pressure and heart rate, educate patients on potential side effects, and assess for signs of heart block.
c. Drugs affecting urinary output (Hydrochlorothiazide, Furosemide, Spironolactone):
Action: These drugs act on different parts of the renal system to increase or decrease urinary output.
Indications: Used to manage hypertension, edema, and conditions like heart failure.
Contraindications: Hypersensitivity, severe renal dysfunction.
Side Effects: Electrolyte imbalances, hypotension, dehydration.
Adverse Effects: Severe electrolyte imbalances, renal dysfunction.
Nursing Considerations: Monitor electrolyte levels, assess fluid balance, and educate patients on dietary restrictions.
d. Drugs Affecting Coagulation (Heparin and Warfarin):
Action:Heparin inhibits clot formation by enhancing antithrombin activity, while warfarin interferes with vitamin K-dependent clotting factors.
Indications: Used for thrombosis prevention and treatment.
Contraindications: Active bleeding, severe thrombocytopenia.
Side Effects: Bleeding, heparin-induced thrombocytopenia (HIT), skin necrosis (warfarin).
Adverse Effects: Hemorrhage (excessive bleeding).
Nursing Considerations: Frequent monitoring of coagulation labs (PT/INR for warfarin, aPTT for heparin), assess for signs of bleeding, and educate patients on dietary and medication interactions.
e. Cardiac Glycosides (Lanoxin):
Action: Lanoxin increases the force of myocardial contractions and slows heart rate.
Indications: Used for heart failure and certain arrhythmias.
Contraindications: Ventricular fibrillation, hypersensitivity.
Side Effects: Nausea, vomiting, visual disturbances, bradycardia.
Adverse Effects: Cardiac dysrhythmias (especially if toxic levels are reached).
Nursing Considerations: Monitor heart rate and rhythm, assess for signs of toxicity (e.g., visual changes), and educate patients about consistent dosing.
f. Drugs to Treat Heart Failure (Digoxin):
Action: Digoxin increases cardiac contractility and decreases heart rate.
Indications: Used in heart failure and certain arrhythmias.
Contraindications: Ventricular fibrillation, hypersensitivity.
Side Effects: Nausea, vomiting, headache, bradycardia.
Adverse Effects: Cardiac dysrhythmias (especially if toxic levels are reached).
Nursing Considerations: Monitor heart rate and rhythm, assess for signs of toxicity (e.g., nausea, visual changes), and educate patients about consistent dosing.
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