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Temazepam (Benzodiazepine)
Indication:
- Insomnia
Mode of Action:
- Patient's heart arrhythmia may be the cause for sleeping problems

Enoxaparin

Metoprolol (Beta Blocker)
Mode of Action:
- Competitively blocks beta receptors in the heart, peripheral vasculature, bronchi, pancreas, uterus, liver, kidney & brain
- Blocks the beta receptors in the heart (beta-1) & bronchi (beta-2)
- Increases HR, cardiac contractility & BP
- Depresses rate of SA node
- Slow Conduction through AV node
Indication:
- Hypertension
- Angina
- Tachyarrhythmias
- MI
- Chronic systolic heart failure as part of standard treatment (eg with ACE inhibitor, diuretics)
- Prevention of migraine

Nsg Consideration:
Slowly cease to prevent rebound hpt/ exacerbate angina, over at least 2 weeks

Mask important sign of DM such as. Tremor & tachycardia
Monitor for other signs and symptoms of hypoglycaemia, Palpate pulse for rate and regularity, assess blood pressure (lying and standing)

Amlodipine (Calcium channel blocker)
Mode of Action:
- Blocks inward current of calcium into cells in cardiac conduction system
- Cardiac contractility is decreased
Nsg Consideration:
Monitor GI function
Can cause hypotension /
Can cause further depression of cardiac function so monitor cardiac function Amiodarone (Antiarrhythmics)
Mode of action:
- Blocks potassium currents that cause repolarisation of the heart muscle during the third phase of the cardiac action potential. Amiodarone increases the duration of the action potential as well as the effective refractory period for cardiac cells (myocytes).
- Cardiac muscle cell excitability is reduced, preventing and treating abnormal heart rhythms
Nsg consideration:
- Administration need close med & nursing supervision

- Close monitoring of vital sign, ECG & electrolytes & CXR

-IV – close & continuous Cardiac monitoring – severe hypotension & circulatory collapse with rapid infusion

- liver & thyroid function, lung function

amiodarone contains iodine and affects thyroxine metabolism; this complicates the diagnosis of thyroid dysfunction; when requesting thyroid function tests, notify laboratory that the patient is taking amiodarone

KCl
Give IV slowly as a thoroughly mixed, dilute solution to avoid life-threatening arrhythmias. Monitor serum potassium concentration frequently (and fluid balance if giving large volumes); also monitor ECG.

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1. Metoprolol - beta blocker:

Mechanism of action: blocks beta receptors(B1) in the heart and smooth muscle in the bronchi  thus reducing HR, BP and cardiac contractility

Side effects: bradycardia, hypotension, alteration of glucose metabolism, parasympathtic effects

Nursing consideration: Monitor for other signs and symptoms of hypoglycaemia, Palpate pulse for rate and regularity, assess blood pressure (lying and standing)

2. Amlodipine - calcium channel blockers:

Mechanism of action: Block inward current of calcium into cells in cardiac conduction system and myocardium, reducing cardiac contractility, heart rate + conduction OR Block inward current of calcium into cells in vascular smooth muscle, reducing vascular resistance

Side effects: headache, flushing, dizziness, hypotension, vasodilation

Nursing consideration:

3. Enoxaparine

Mechanism of action: antithrombic agent without significant changes to PT, APTT or platelet aggregation.

4. Amiodarone -antiarrhythmic:

Mechanism of action: work to prolong duration of cardiac action potential and decrease SA node activity, slowing AV conduction

Side effects: CNS toxicity, pulmonary toxicity, potential to worsen arrhythmias

Nursing consideration: anticoagulant needs to be given with antiarrhythmics to the pts with atrial fibrillation

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Beta Blockers - Metoprolol
Beta blockers competitively block B 1 & 2 Receptors in the heart, Peripheral Vasculature, Bronchi & other major organs including the lungs. Therefore reducing heart rate, blood pressure & cardiac contractility. They also depress the SA node rate & slow conduction through the AV node.

Beta blockers are indicated / used for
-Hypertension
-Angina
-Tachyarrhythmias
-Myocardial Infarction
-Heart failure
-Prevention of migranes.

Actions:
Competitively block beta receptors in the heart, peripheral vasculature, bronchi, pancreas, uterus, liver, kidney & brain

Block the beta receptors in the b1:heart & b2:bronchi =

decreased HR, cardiac contractility & BP

Depress rate of SA node

Slow Conduction through AV node

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Metoprolol
1. Beta Blocker
Mode of action:
- Beta blockers competitively block beta blockers in the heart, peripheral bronchi and other major organs
- Beta blockers reduces heart rate, blood pressure, cardiac contractility

Amiodarone
Antiarrhythmic
Decrease SA node activity – slows AV conduction – prolongs refractory period of myocardial tissues.

Also has a Weak beta-blocking effects

Amlodipine: Calcium Channel Blocker
Block the inward current of calcium into cells in myocardium & cardiac conducting system, thereby reducing cardiac contractility, < HR & cardiac conduction & BP

Also  block inward current into cells in vascular smooth muscles - < vascular resistance - < BP

Potassium Chloride: for mild hypokalemia
Severe acute loss may require IV treatment, especially if symptomatic. Give IV slowly as a thoroughly mixed, dilute solution to avoid life-threatening arrhythmias. Monitor serum potassium concentration frequently (and fluid balance if giving large volumes); also monitor ECG.
Temazepam: Benzodiazepine

Enoxaparin - antithrombotic

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Temazepam (Benzodiazepine)
Indication:
- Insomnia

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Metoprolol:
-indication: HT, angina, MI, HF, tacharrhythmias
Action:
reduce HR and cardiac contractility, blocks the andrenoreceptors in smooth muscle of the heart
Adverse:
Bradycardia
Hypotension
Bronchospasm

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Metropolol: Must SLOWLY reduce when treatment is ceased to prevent rebound HPN, MI or arrhythmias, exacerbate angina

-  Mask important signs of hypoglycaemia (tachycardia & tremors)

-  Check & Monitor BP closely if < 60 = careful positional changes

Amlodipine: Differ greatly in duration of action

Amniodarone: Close monitoring of VS, ECG, electrolyte levels & chest x-rays

- Close medical & nursingg supervision

- Pt receiving amiodarone IV should have continuous cardiac monitoring for IV administration in a closely monitored env’t

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AMIODARONE
1. Antiarrhythmic
Mode of action: prolonging the duration of the cardiac action potential to revert tachyarrhythmias back to normal sinus rhythm
2. Risks:
- potential to worsen arrhythmias
- CNS toxicity
- pulmonary toxicity
- potential alteration in electrolyte balances

METOPROLOL
1. Beta blocker
Mode of action:
Competitively blocks beta receptors on cell surfaces in the heart, peripheral vasculature, bronchi and other major organs
2. Risks:
- bradycardia
- hypotension
- bronchospasm
- alteration of glucose metabolism
- hypoglycaemia?
Nursing considerations: Monitor HR & BP before administration

AMLODIPINE
1. Calcium channel blocker
Blocks the inward current of calcium into cells in cardiac conduction system and myocardium (reduces contractility, conduction and HR), vascular smooth (reduces vascular resistance)
2. Risks:
- vasodilatory effects (headache, flushing, dizziness )
- bradycardia
- hypotension
- GI disturbance

POTASSIUM (IV)
1. Electrolyte
Mode of action:
Alters resting membrane potential of excitable cells causing cardiac arrhythmias and muscle dysfunction
2. Risks:
If not managed well may lead to hyper/hypokalemia:
Hyper: arrhythmias, cardiac arrest
Hypo: arrhythmias, ECG changes, anorexia

MAGNESIUM (IV)
1. Electrolyte
Mode of action:
Exerts a sedative effect on neuromuscular junctions decreasing acetylcholines
(neurotransmitters)
2. Risks:
Bradycardia
Hypotension
Respiratory Depression
Muscle weakness (in the heart and all over the body)

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Vital signs, Monitor BP - Pulse prior & following cardiac medications.
Also can do an ECG to get a better reading of the hearts function & rhythm.

Nursing Considerations for B Blockers :
- Beta Blockers must slowly be reduced when treatment is ceased / To prevent complications such as rebound hypotension
-Some B Blockers Mask important signs of hypoglycaemia, including Tachycardia, Tremors & increased severity.

Assess for S&S of toxicity
Assessment of renal function
Assessment of electrolyte levels
Cardiac monitoring for IV administrations

PT PAIN LEVELS!

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Metoprolol: monitor BP and HR - HR should be taken prior to administration. Consider if patient has asthma

Amlodipine: Monitor HR & BP, can cause postural hypotension - be with patient when they get up. Watch for oedema

Amiodorone: Monitor Vitals, ECGs for any changes to QT interval, monitor electrolytes and CNS symptoms

Potassium: Monitor ECGs and blood serum level, food intake - start food chart

Magnesium: Monitor serum levels, BP, renal function, monitor bowel function