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We give the patient a loading dose to ensure they get to the therapeutic range quickly and then the infusion allows for the patient to stay at a steady therapeutic range and stable.

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Something to consider : do we need to think about the patient's underlying condition such as renal function/ liver function when giving a loading dose? Or body weight? If so why??

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Potassium/Magnesium

MOA:

Indications for use:

Nursing considerations:

Drug-drug interactions:

Signs and Symptoms:

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The purpose of a loading dose is to achieve a high plasma concentration of drug in a short amount of time. Without a loading dose, it can take quite a bit of time to reach steady state concentration (about 4-5 half lives). The benefits of this would be a rapid regulation of tachycardia and keeping it at a steady HR rhythm.

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Amlodipine - CALCIUM CHANNEL BLOCKER

MOA: act on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina symptoms. The blockage of calcium channels inhibits the influx of calcium ions in, the cell reducing depolarization of myocardial cells and reduction of myocardial contraction, due to its association with actin and myosin stimulation.

Indications: Hypertension, angina

Nursing considerations:ECG, vitals - BP, HR, due to vasodilation of blood vessels can cause headaches, pain levels of patient

Signs and Symptoms:respiratory depression, vasodilatory effects, hypotension, nausea/vomiting, peripheral oedema

Drug-drug interaction:magnesium - increases the effects of IV magnesium sulphate and the risk of adverse effects
enoxaparin - increases the toxicity of amlodipine

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Therapeutic effect is needed quickly for this patient, and the drug has a long half life, one can use a loading dose to achieve therapeutic levels. Benefits of this are keeping the HR steady

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Metoprolol

MOA:
Competitively block beta receptors especially in the heart, slows down the HR and makes it easier for the heart to pump blood.

Indications for use:
- Hypertension
- Angina
- Tachyarrhythmia
- Myocardial infarction
- heart failure
- Prevention of migraines

Nursing considerations:
-          Monitor vital signs (blood pressure and heart rate)

-          Administer with meals or at bedtime (fewer side effects body absorbs it slower)

-          Decrease use don’t suddenly stop
-        Monitor signs of diabetes

Signs and Symptoms:
-          Bradycardia

-          Hypotension

-   orthostatic hypotension (especially carvedilol, labetalol)
-  Dizziness

Drug-Drug interactions:
Interacts with:
Amiodarone and Metoprolol= Amiodarone may increase metoprolos concentration, increasing the risk of severe bradycardia
- Calcium Channel Blockers (The negative chronotropic of both drugs increases risk of , bradycardia)
- Clonidine
- Certain antidepressants (Increases risk of hypertension, as it increase drug side effects)
- Alcohol (Lowers blood pressure causing dizziness)
- Multi- vitamins (Decreases effect of the medication)
- frusemide (increases dizziness, due to lowering blood pressure and irregular HR)

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Amiodarone

MOA: primarily works to prolong the duration of the cardiac action potential to revert tachyarrhythmia to a normal heart rhythm.

Indications: tachyarhythmia, AF, superventricular tachycardia, ventricular arrhythmia

Nursing considerations: administration requires close medical and nursing supervision, close monitoring of vital signs, ECGs, electrolyte levels a chest x-rays, patients should have cardiac monitoring for IV administration

Drug-drug interactions: warfarin, trazodone, lovastatin
Amiodarone may increase metoprolol’s concentration, increasing the risk of severe bradycardia; consider using a low dose to start metoprolol treatment, and monitor carefully.

Signs and symptoms: non-productive cough, worsened arrhythmia, chest pain, fatigue, weight loss

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Temazepam

MOA: Temazepam works to inhibit the GABA receptors in the brain, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and anti epileptic effects.

Indications for use: Insomnia, trouble falling or staying asleep.

Nursing considerations:
- Can cause the patient to feel really drowsy, e.g. driving risks, falls for elderly patients.
- Monitor patient's consciousness
- Monitor signs of misuse, dependencies, addiction.
- Monitor patients breathing
- Coming of immediately can cause withdrawal symptoms

Drug/Drug interaction:
- Interactions with opioid analgesia can cause respiratory depression
- Metabolism of temazepam can be decreased when combined with Amiodarone

Signs and Symptoms:
- Decreased respiratory rate
- Decreased consciousness
- Decrease in O2 stats.

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Note: Always consider:
Is there anything in the patient's condition/ past history that may increase the risks?

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This will be added once we get to it :)

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Compare and contrast the significant risks for each of the drug classes

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Compare and contrast the significant risks for each of the drug classes

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What were your significant risks? Why are they significant?
Do you understand the MoA of how the patient might develop the risk?
Did you need to go and look them up again?

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What would they be for this medication chart?

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?