| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Atenolol (Tenormin)—PO 50–150 mg daily; IV 5 mg initially, wait 10 min, then another 5 mg | Hypertension: angina; arrhythmias | Blocks (cardiac) beta-adrenergic receptors | Fatigue, weakness, bradycardia, heart failure, pulmonary edema |
| NURSING IMPLICATIONS: Give 1 mg/min IV; check vital signs; assess for signs of fluid overload |
| isosorbide dinitrate (Isordil, Isorbid)—sublingual 2.5–10.0 mg q5–10 min for 3 doses; PO 5–10 mg initially, 10–40 mg q6h | Acute angina: long-term prophylaxis for angina; heart failure | Produces vasodilation, decreases preload | Headache, dizziness, hypotension, tachycardia |
| NURSING IMPLICATIONS: Avoid eating, drinking, or smoking until sublingual tablets are dissolved; change positions slowly ; aspirin or acetaminophen for headache. Determine if client is taking drugs for erectile dysfunction—serious drug interaction! |
| Nitroglycerin—sublingual 0.25–0.6 mg prn; transdermal (patch) 2.5–15.0 mg/day; topical 2–3 inches q8h; IV 10–20 mcg/min | Angina pectoris; adjunctive treatment in MI, heart failure, hypertension (IV form) | Directly relaxes smooth muscle, dilating blood vessels; lowers peripheral vascular resistance; increases blood flow | Faintness, throbbing headache; vomiting; flushing, hypotension; visual disturbances |
 NURSING IMPLICATIONS: Instruct client to sit or lie down when taking drug, to reduce hypotensive effect; onset 1–3 min; may take 1–3 doses at 5-min intervals to relieve pain; up to 10/day may be allowed; if headache occurs, tell client to expel tablet as soon as pain relief occurs; keep drug at bedside or on person; watch expiration dates—tablets lose potency with exposure to air and humidity; alcohol ingestion soon after taking may produce shocklike syndrome from drop in BP; smoking causes vasoconstricting effect; causes burning under tongue; may crush between teeth to ↑ absorption |