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How should the angiotensin receptor blocker (ARB) losartan (Cozaar) be given?
- ARBs are available for oral administration only.
- Losartan is also available in combination with the thiazine diuretic hydrochlorothiazide (Hyzaar).
- May be taken with or without food.
- Beginning dose is decreased for patients taking diuretics or with liver failure.
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How should the cardiac glycoside digoxin (Lanoxin) be given?
- Available as oral tablets, capsules and elixir as well as for IV use.
- Give oral form with or without food.
- Tablets may be crushed and mixed with food if necessary.
- IV form may be administered directly over at least 5 min; monitor site carefully for infiltration, which may cause tissue damage.
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How should the class IV/calcium channel blocker verapamil (Calan) be given?
- Oral or IV use.
- Give oral dose with food to prevent gastrointestinal (GI) upset.
- Capsules may be opened and sprinkled on food, but not chewed or dissolved in liquid.
- IV form: Give dose using recommended dilution over 2 to 3 min; monitor cardiac rhythm and vital signs continuously.
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How should the direct-acting vasodilator (hydralazine) drug hydralazine (Apresoline) be given?
- Oral, IM, or IV forms.
- Give oral dose with food to enhance effectiveness.
- Oral dosage usually begins low and is gradually increased.
- Administer IV form undiluted; do not add to other solutions
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How should the direct renin inhibitor aliskiren (Tekturna) be given?
- Available in oral form only.
- High-fat meals decrease absorption.
- Give at a consistent time daily relative to meals.
- Expect a full effect to take 2 weeks.
- Monitor for hypotension at beginning of therapy and after any dose increase.
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How should the calcium channel blocker (dihydropyridine) drug nifedipine (Adalat, Procardia) be given?
- Available for oral use in capsules and sustained-release tablets; sustained-release form is approved to treat hypertension.
- Sustained-release form must be swallowed whole, and not chewed or crushed.
- To prevent reflex tachycardia, nifedipine may be combined with a beta blocker.
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How should the class II/beta adrenergic blocker propranolol (Inderal) be given?
- Available for oral or IV use.
- Use the IV route to treat life-threatening dysrhythmias.
- Take either with or without food at consistent times during the day to minimize adverse effects.
- Take patient's blood pressure (BP) and pulse before administering propranolol; withhold drug and notify provider if BP is below 90 mm/Hg systolic or if pulse is slower than 60 beats/min.
- Give IV dose either directly by IV bolus over 1 min or give an intermittent infusion over 15 to 20 min.
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How should the class III/potassium channel blocker amiodarone (Cordarone) be given?
- Oral and IV use.
- Give oral amiodarone with or without food, but at consistent times during the day.
- Infuse IV dose through central line catheter to prevent thrombophlebitis of peripheral IV sites.
- Begin oral dosing with hospitalized patient.
- Correct low potassium or magnesium levels before beginning therapy.
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How should the class IC/sodium channel blockers flecainide (Tambocor) and propafenone (Rythmol) be given?
- Available for oral use only.
- Begin with low dose and increase gradually no more frequently than every 4 days until maximum or desired dose has been reached.
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How should the loop diuretic furosemide (Lasix) be given?
- Oral, IM, or IV use.
- Give oral form with food to prevent gastrointestinal (GI) symptoms.
- If prescribed more than once daily, give second dose by early afternoon to prevent nocturia and sleep loss.
- Give IV form undiluted; administer slowly to prevent ototoxicity.
- Protect all forms from light; store oral solution in refrigerator and other forms at controlled room temperature.
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How should the beta adrenergic blockers atenolol (Tenormin) and metoprolol (Lopressor) be given?
- Oral or IV use.
- Give IV initially and then orally for acute myocardial infarction.
- Give orally for hypertension.
- Atenolol is available in a tablet, which may be crushed or swallowed.
- Metoprolol is available as an immediate-release tablet (Lopressor) or in a sustained-release dose (Toprol XL) that must not be crushed and must be swallowed whole.
- Absorption of metoprolol may be enhanced with food; take at consistent time each day.
- Atenolol is best taken before meals or at bedtime.
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How should the alpha/beta blocker carvedilol (Coreg) be given?
- Oral use only.
- Give with food to minimize orthostatic hypotension
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How should the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate (Isordil) be given?
- Nitroglycerin is available as sublingual tablets, sustained-release capsules or tablets, a translingual spray or transmucosal tablets, transdermal ointment or patch, and IV form.
- Two types of isosorbide are available.
- Isosorbide dinitrate (Isordil) is available in regular, chewable, sublingual, or sustained-release tablets.
- Place sublingual tablets under tongue to dissolve when chest pain starts; if not relieved in 5 min, call 911, take a second tablet; take a third tablet 5 min later if no relief.
- Sublingual sprays: Dose equals 1 or 2 sprays; as for sublingual tablets, no more than 3 doses in a 15 min period.
- Patient should not swallow transdermal or transmucosal tablets; may need to moisten mouth to help tablet dissolve.
- Store tablets in a dark, tightly closed container for no more than 24 months after opening.
- Transdermal patches are for prevention only; apply to a hairless area and rotate sites.
- Remove patches for 10 to 12 hr daily to prevent tolerance; apply patch in morning, remove at night.
- Topical ointment: Dosage measured as amount squeezed from tube (e.g. 2 inches = 30 mg); apply to dry skin and cover area with plastic wrap.
- When discontinuing long-acting forms, taper doses to prevent increased chest pain (vasospasm).
- IV form is infused continuously in a glass bottle with special tubing only.
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How should the HMG-CoA reductase inhibitor (statin) drug simvastatin (Zocor) be given?
- Oral use only.
- For greatest effectiveness, take in the evening with or without food.
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How should the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl) be given?
- Available in oral, IM and IV forms.
- Give oral dose 1 hr before or 2 hr after meals for best absorption; give with food if gastrointestinal (GI) symptoms occur.
- Do not crush or chew extended-release tablets.
- If giving IV procainamide, wait 4 hr before administering an oral dose.
- For IV doses, use an IV pump and infuse at recommended rate and dilution.
- Multiple IV solution incompatibilities exist; avoid infusing with other drugs or solutions.
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How should the alpha1 adrenergic blocker doxazosin (Cardura) be given?
- Oral use only
- Give at bedtime - especially first dose; subsequent doses individualized based on orthostatic blood pressure changes.
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How should the fibrate drug gemfibrozil (Lopid) be given?
- Oral use only.
- Usually taken twice daily, 30 min before breakfast and evening meals.
- Monitor periodic LDL, HDL, triglyceride, and total cholesterol levels for improvement.
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How should the potassium-sparing diuretic spironolactone (Aldactone) be given?
- Oral use.
- Take with food to increase absorption.
- Tablets may be crushed and mixed with food or fluid if patient is unable to swallow them whole.
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How should the sympathomimetic drug dobutamine (Dobutrex) be given?
- IV infusion only.
- Dose based on patient's weight and titrated based on continuous monitoring of vital signs, ECG, urine output, and (if available) cardiac output and pulmonary wedge pressures.
- Peak effect obtained about 10 min after infusion begins.
- Multiple infusion incompatibilities exist; use dedicated IV line for infusion.
- Correct any fluid volume deficits before administering dobutamine.
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How should the centrally-acting alpha2 agonist clonidine (Catapres) be given?
- Available orally or as transdermal patch to treat hypertension.
- Give oral dose at bedtime to prevent daytime sedation.
- Begin oral dosage low and gradually increase to prevent severe hypotension.
- Apply transdermal patch to a dry, relatively hairless area of skin on the upper outer arm or anterior chest once every 7 days.
- Rotate transdermal sites and monitor skin for inflammation, irritation.
- Be sure to remove the old patch before applying a new patch.
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How should the class IB/sodium channel blocker lidocaine (Xylocaine) be given?
- Available for IM, IV infusion (IV preferred for dysrhythmias; local administration for anesthesia only).
- Add 1 g lidocaine to 250 or 500 mL dextrose 5% in water (D5W) and infuse at 1 to 4 mg/min (per prescription)using an IV pump.
- Ensure that the correct lidocaine preparation is used for the specific type of therapy (labeled for IV use only).
- Incompatible in solution or tubing with other drugs, such as some antibiotics, phenytoin.
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How should the angiotensin-converting enzyme (ACE) Inhibitor captopril (Capoten) be given?
- Oral use only.
- Take two to three times daily for hypertension; three times daily for heart failure.
- Give 1 hr before meals for adequate absorption.
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How should the aldosterone antagonist spironolactone (Aldactone) be given?
- Oral use only.
- Give alone or combined with other antihypertensive drugs.
- Reduce dose for patients taking CYP3A4 inhibitors.
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How should the phosphodiesterase inhibitor milrinone (Primacor) be given?
- IV infusion only.
- Give a loading dose over 10 min and then administer a dose based on patient's weight by continuous infusion.
- Some solution incompatibilities exist; use dedicated IV line if possible.
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How should the adrenergic neuron blocker reserpine (Serpalan, Sk-Reserpine) be given?
- Oral use only.
- Administer with food or milk to prevent gastrointestinal (GI) symptoms.
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How should the thiazide diuretic hydrochlorothiazide (HydroDIURIL) be given?
- Available orally alone and in fixed-dose combination with multiple other drugs, such as potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers and other antihypertensive drugs.
- Give with food to minimize gastrointestinal (GI) effects.
- Give last dose of day by 3 p.m. to prevent nocturia and sleep loss.
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