Side Effects

Nursing Implications

Why Patient is on It




Class:cardiac glycoside, inotropic, anti-dysrhythmic



0.125mg (1tab) PO OD


-Anticipated effect is control and decrease of rapid atrial rhythms by increasing cardiac output (positive inotropic)

-increasing force of contraction

-decreasing heart rate (negative chronotropic)

-decreasing AV conduction speed by slowing the electrical conduction between the atria and the ventricles of the heart.


Dysrhythmias, AV block, hypotension, headache

-Apical pulse for 1 min before giving, if pulse <60 in adult take again in 1 hr, if <60 in adult call prescriber; note rate rhythm character,
-monitor ECG for changes ECG changes indicating SA or AV block; new onset of irregular rhythm indicating ventricular dysrhythmias; and atrial tachycardia with block, junctional tachycardia and ventricular tachycardia

-Monitor electrolytes K, Na, Cl, Mg, Ca, BUN, creatininie, ALT, AST, Hb, Hct,


Hypomagnesia and Hypokalemia should be avoid while on digoxin as it increases the risk of Digoxin Toxicity

(Mcdonald & Struthers, 2004)

Atrial fibrillation & Heart failure



Class: anti-hypertensive, anti-anginal




12.5mg PO BID




Hold if SBP <100 or Hr < 50

-Anticipated effect is lowered blood pressure and reduced pulse rate

-Blocks sympathetic nervous system (Beta-adrengergic receptors) producing slower HR and lowered BP.

-Lowers BP by beta-blocking effects

-Blocks B2-andrenergic receptors in bronchial, vascular smooth muscle only at high doses

Hypotension, dizziness, bradycardia, pulmonary edema, chest pain, AV block, broncospasm

**Hold if HR < 50

**Do BP also

Apical/radial pulse before administration, notify prescriber of any significant changes or pulse <50bpm.


Edema in feet, legs daily


Skin turgor




For control of hypertension

Acetylsalicylic Acid EC tab

ASA, aspirin


Class: anti-platelet


81mg (1tab) PO OD


-Anticipated effect is decreased platelet aggregation to prevent MI, ischemic stroke and angina.

-Blocks pain impulses in CNS

-Reduces inflammation by inhibition of prostaglandin synthesis;
-Antipyretic action results from vasodilation of peripheral vessels, decreases platelet aggregation

Increased clotting time (takes longer for blood to clot)


Seizures, GI bleeding, laryngeal edema, agranulocytosis, neutropenia, hepatitis

Assess Pain

Assess hepatic studies

Monitor Hepatotoxicity (dark urine, clay stools, yellow skin, abd pain, diarrhea)

Assess for bleeding


Prevent MI, ischemic stroke and angina as patient with atrial fibrillation, CAD and HF are at increased risk.



Class: anti-hypertensive




4mg (1 tab) PO OD


-Anticipated effects include vasodilation and diuresis by decreasing afterload and preload, thus decreasing workload of heart and lowering blood pressure.


-inhibits ACE; prevents conversion of angiotension 1 to 2 causing dilation of arterial venous vessels

Proteinuira, renal failure, angioedema, neutropenia, agranulocytosis

BP, Pulse q4h

Electrolytes: K, Na, Cl

Edema in legs/feet daily

Symptoms of CHF: edema, dyspnea, wet crackles

Monitor dehydration

To control hypertension



Class: Anti-depressant, SSRI (selective serotonin reuptake inhibitor)


30mg (1tab) PO OD)


-Anticipated effect is decreased level of anxiety and depression

-Inhibits CNS neuron uptake of serotonin but not of norepinephrine or dopamine

Nausea, diarrhea, anxiety, tremor, dizziness


**May decrease digoxin levels

*Assess mental status

*Assess BP lying/standing, if drop >20mmHg notify prescriber, hold drug

*ECG flattening T wave

Treatment of depression




Class: thyroid hormone


0.125mg (1tab) PO OD


-Anticipated effect is maintenance of cardiac output, metabolic rate & protein synthesis, as well as, an increase in O2 consumption, growth development at cellular level and temperature.

-Exact mechanism is unknown


Thyroid storm, cardiac arrest, palpitations, tremors, insomnia, anxiety, tachycardia, angina, dysrhythmias

*BP pulse q 4 h

*Check for bleeding bruising

*Assess for increased nervousness, excitability, irritablility

Assess cardiac status

Treatment of hypothyroidism

Calcium Carbonate


Class: Antacid, calcium supplement


1 tab PO OD


-Anticipated effect is relief of heart burn by neutralization of gastric activity

Constipation, diarrhea, rebound hyperacidity, N&V

Monitor for side effects

To decrease gastric acidity and prevention/

treatment of hypocalcaemia



Class: Proton pump inhibitor

Dose: 40mg (1tab) PO OD


-Anticipated effect is reduction of gastric secretions thus preventing gastric ulcers and reflux


-Suppresses gastric secretions by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production

Headache, diarrhea, abdominal pain, rash, flatulence, insomnia, hyperglycemia

Assess GI system q8h


Assess hepatic studies AST, ALT alk phos during tx

Diabetic patient may cause hypo-glycemia


To prevent gastric acid production




Class: calcium channel blocker, anti-arrhythmic class IV

Dose: 180mg (1tab) PO OD



Hold if SBP<100 or HR<60

-Anticipated effect is decreased blood pressure

& decreased (control of) ventricular rate


-reduces cardiac afterload

-causes vasodilation & systemic vascular resistance

-Inhibits action of calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries

Sick Sinus Syndrome, Hypotension, AV block, Dysrhythmias, CHF, heart block, acute renal failure (decreased amount of urine-oliguria, nocturia, edema in ankles/feet/legs, metallic taste in mouth, changes in mental status)


**increases effect of Beta Blockers and Digoxin


**Sick sinus syndrome

ECG will show inappropriate sinus bradycardia, sinus arrest, sinoatrial block, Afib with slow ventricular response, a prolonged asystolic period after a period of tachycardias

Assess cardiac status: BP, pulse, resp, if systolic BP <90mmHg or HR <60bpm, hold dose, notify prescriber

*assess signs of CHF (SOB, palpitations, weakness, edema ankles/feet)


To control A-fib and hypertension



Class:overative bladder product

(muscarinic receptor anatagonist)


4mg (1tab) PO OD


-Anticipated effect is decreased urinary frequency and urgency


-inhibits bladder contraction

-Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites

Dizziness, vomiting, nausea, anorexia, dysuria

*assess urinary patterns

*assess for allergic reaction

Treatment of urinary frequency and urgency



Class: Anti-lipidemic


10mg (1tab) PO HS


-Anticipated effect is a decrease in blood lipid levels and settle endothelium


Lower blood cholesterol level by decreasing the rate of cholesterol production. In Liver, inhibits HMG-CoA reductase (enzyme needed to make cholesterol)

Myopathy, increased liver enzyme levels, Liver Dysfunction, Rhabdomyolysis, abd cramps, heartburn


*may increase serum levels of digoxin

*assess for signs of liver dysfunction (abd pain, jaundice, loss of appetite)


-To settle endothelium

-To lower blood lipids in order to increase cardioprotection


*Studies show may reduce risk of CV events by promiting plaque stability, reducing imflammation around plaque, reducing coronary artery calcification, and suppressing the production of thrombin. (Lilley, Harrington, Synder, 2007, p.482)



Docusate Sodium

Class: Laxative, emollient; stool


Dose:100mg (1tab) PO BID

[08][ 17]

-Anticipated effect is softening of the stool to allow easier passage in defecation.



- works by increasing the amount of water in the stool, making stools softer and easier to pass


-Increases water, fat penetration in intestine, allows for easier passage of stool

Nausea, cramps, diarrhea, rash, bitter taste, throat irritation

*Monitor effectiveness

*Assess for side effects

*Assess cause of constipation (exercise, dehydration, constipating drugs)

*Assess for cramping , rectal bleeding, N&V

To prevent of dry, hard stools, & treat constipation while avoiding straining



Class: Anti-fungal


Dose:5000U in 5ml swish and swallow qid


Acts by binding to sterols in fungal cell membrane, allowing cell permeability and allowing leakage of intracellular components. Kills susceptible yeast and fungi

Diarrhea, N&V, rash

Assess for infection: WBC, temp periodically, neutrophils

Monitor hydration status

Tx of candida albicans (thrush) in mouth



Class: contrast agent for abdominal CT


Dose: 8mL in 500mL in H20



Water soluble, monomeric, ionic x-ray contrast medium based on tri-iodinated benzoic acid


Assess for allergic reaction

Do not give until CT confirmed by radiology

Must be NPO 4 hours prior to CT

Contrast agent for abdominal CT as patient is allergic to angiodye

Insulin – Humilin R


Class:anti-diabetic, pancreatic hormone


Short acting, Regular Insulin

Onset: 30 min

Peak: 3-4hr

Duration: 6-8hr



SC sliding scale



-Anticipated effect is short acting decrease in blood glucose. Taken 30 minutes before eating to aid the body in the breakdown of glucose from the food you eat


Decreases blood glucose by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increase blood pyruvate and lactate, decreases phosphate and potassium;

Hypoglycaemia, rebound hyperglycemia, lipodystrophy, blurred vision, dry mouth

*GST prior to giving

*monitor for signs of hypoglycaemia during peak time (2.5-5hr)à sweating, weakness, dizziness, chills, confusion, nausea, rapid weak pulse, fatigue, tachycardia, tremors, hunger

-GST 30 min prior to meal

*For hyperglycemia: acetone breath, polyuria, fatigue, polydipsia, flushed, lethargy


To lower blood glucose



Class: digestant


2 caps PO TID with meals


-Anticipated effect is the breakdown of substances released from the pancreas to aid in digestion


Pancreatic enzyme needed for breakdown of substances released from the pancreas

N&V, diarrhea, hyperuricuria

*assess I&O watch for increasing urinary output

*for polyuria, polydipsia, polyphagia


For prophylactic pancreatic enzyme deficiency



Class: Loop diuretic


Dose:40mg (1tab) PO BID

[08][ 14]

-Anticipated effect is a decrease in fluid volume that leads to a decrease return of blood to the heart, or decreased filling pressures.


-Lowers BP, Reduces pulmonary vascular resistance, reduces systemic vascular resistance, reduces central venous pressure, reduces left ventricular end-diastolic pressure and reduction in pre-load

-Inhibits reabsorption of sodium and chloride in the loop of Henle

Circulatory collapse, loss of hearing, fatigue, weakness, orthostatic hypotension, chest pain, hypokalemia, hypochloremic alkalosis, hypocalcemia, hyponatremia, metabolic alkalosis, hyperglycemia, renal failure,



*Diuretics increase urinary frequency, which Tolterodine is attempting to decrease

Assess for signs of metabolic alkalosis (drowsiness, restlessness)

Assess for signs of hypokalemia (postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness.)

Assess electrolytes K, Na, Cl, BUN, creatinine, blood glucose, blood pH

*teach patient to rise slowly

Used to decrease edema in heart disease and lower blood pressure in hypertension



Class: opioid analgesic


Dose: 1-5mg IV/PO q 1-2h PRN

Anticipated effect is a decrease in the pain level assessed before the morphine was given.


-Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing a generalized depression in the CNS.


Confusion, hypotension, bradycardia, constipation, nausea, vomiting, sedation, respiratory depression


* Elderly Patients who have a long history of hypothyroidism may have increased sensitivity to analgesics because of changes to liver and renal function. Take caution when administering to these patients. (Day, Paul, Williams, Smeltzer & Bare, 2007, p.1220)

*Monitor for respiratory depression, cardiac status

*GI symptoms


For pain relief




Class: Antiemetic, antihistamine, anticholinergic


Dose: 25-50mg IV/PO q4h PRN

-Anticipated effect is a decrease in nausea/vomiting


-Competes with histamine for H1 receptors in GI tract, blood vessels, respiratory tract, which results in decreased vestibular stimulation and blockade of chemoreceptor trigger zone that triggers

Drowsiness, confusion, hypertension, hypotension, nausea, vomiting, constipation, fever


*monitor for Gi symptoms, drowsiness, hypotension

If nauseated or vomiting from effects of medications



Class: anti-psychotic, neuroleptic



Dose: 0.5-1mg IV q1h PRN

-Anticipated effect is a decrease in the level of anxiety assessed before the medication was given.


-Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by dopamine at synapse.

Seizures, neuroleptic malignant syndrome, cardiac arrest, tachycardia

Assess LOC

Assess for EPS

Assess for NMS (hyperthermia, muscle rigidity, altered mental status, increased CPK, seizures, hyper/hypotension, tachycardia, notify Dr stat

Relieve anxiety

Vitamin K


Class: vit K1 fat soluble vitamin


Dose: 5mg IM/SC once weekly (Saturday) while on TPN

-Anticipated effect is a shortened prothrombin time.


Vitamin K needed for adequate blood clotting (factors II, VII, IX, X)

Hemoglobinuria, hyperbilirubinemia, hemoltyic anemia, headache, decreased LFTs

*Monitor for bleeding in emesis, stools, urine,

*PT during treatment (2sec deviation from control time, bleeding time and clotting time)

Monitor for bleeding do BP/Pilse

Supplemental vitamin while on TPN as Vit K needed for clotting

TPN: #2 Central Stress


Nitrogen 9.6 Gm/L

Dextrose 125Gm/L

Lipid 25 Gm/L

Sodium 70mEq/day, Potassium 40 mEq/day, Flow Rate 35ml/hr


Nitrogen 9.6 Gm/L

Dextrose 125Gm/L

Lipid 25 Gm/L

Sodium 70mEq/day, Potassium 40 mEq/day, Flow Rate 35ml/hr

Complications of long term TPN may include fatty liver

*Give Vitamin K 5mg IM/SC once weekly while on TPN

*Monitor liver enzymes

-Chart current rate

To provide nutrition to the patient’s body while NPO.

Nystatin Powder


Class: Anti-fungal

Dose: nystatin powder 100 000 units/g 15g prn to groin

Acts by binding to sterols in fungal cell membrane, allowing cell permeability and allowing leakage of intracellular components. Kills susceptible yeast and fungi


Assess for infection: WBC, temp periodically, neutrophils

Monitor hydration status

Tx of candida albicans to groin

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