Administration of Cardiac Medications

Introduction

Cardiac medications are lifesaving drugs, to maintain daily health and tackle life-threatening conditions. Nurses play a major role in administering, monitoring the effects of cardiac medications, and providing related information for understanding the efficacy of the treatment.

Definition

Cardiac drug administration is giving the therapeutically prescribed agents via oral route or sublingual route, or as intravenous infusion or bolus to maintain the normal cardiac functioning.

Purposes

• To maintain normal cardiac function.
• To reverse circulatory problems.
• To promptly treat any circulatory emergencies.

Indications

• Cardiovascular disease (conductive disorder; circulatory-ACS, shock; heart failure).
• Cardiac surgery or related intervention.

Contraindication

• It may depend on the type of cardiac drug administered.

Classification of Cardiac Drugs

• Sympathomimetic agents.
• Vasodilators.
• ACE inhibitors.
• Angiotensin II receptor blockers.
• Diuretics.
• Calcium channel blockers.
• Phosphodiesterase inhibitors.
• Cardiac glycosides.

Nursing Assessment

• Assess the age, gender, chief complaints, comorbid illness, and current medication history because certain medications may have a possible cardiac or hemodynamic effect.
• Assess the patient’s need for information about the procedure and purpose, and ability to cooperate.
• Assess the ABCD, GCS, and cardiac parameters (PR, BP, ECG).
• Start a separate IV line for administering cardiac drugs and another IV access for routine regimen.
• Assess for signs of hypersensitivity reactions.
• Assess for allergies related to latex, medication, or food.
• Arrange all emergency medication and articles near the patient’s bedside.
• Review the patient’s file and the physician’s order.

Antidysrhythmic Medications

• Assess cardiac and respiratory parameters such as PR, ECG (PR interval, QRS duration, QT interval, atrial and ventricular rates), BP, and RR.
• Intravenous boluses (IV push) have to be given slowly, while monitoring the patient’s parameters, vital signs, and physical responses.
• Administer the loading dose for antidysrhythmic drugs before the desired dose, as it binds to the plasma proteins. Ask the patient whether he or she has light-headedness, dizziness, chest pain, and dyspnea during drug administration and monitor for dysrhythmias or hypotension.
• Monitor periodically for the serum level of the drug, especially in patients with hypoalbuminemia, to detect for the signs of toxicity and serum electrolyte to detect for the potassium level.
• Administer maintenance doses of cardiac drugs at a desirable time interval to maintain therapeutic serum levels, while assessing the patient’s apical pulse before, during, and after administration.
• In case of low BP (systolic <100/diastolic <30 mmHg), inform the physician before administering antidysrhythmic drugs (especially vasodilators).
• Observe for gastrointestinal alterations (nausea, vomiting, diarrhea); if present, assess for electrolyte imbalances or toxicity of a cardiac medication.
• Assess daily weight for fluid volume requirement

Anticoagulant/Antiplatelet/Fibrinolytic Medications

Antiplatelet Drugs

• Review the patient’s record before starting the drug regimen (Hb, hematocrit, platelet count, serum creatinine, PT, and aPTT).
• Post drug administration, assess the patient for signs of bleeding (petechiae, ecchymosis, melena, hematuria, bleeding gums, epistaxis, hematoma, petechiae).
• Monitor the patient for signs of thrombocytopenia purpura (fever, low platelet count, renal dysfunction).

Anticoagulant Drugs

• Assess the route for drug administration [as PO (no absorption) and IM (hematoma) routes are contraindicated].
• Monitor the aPTT level for patients receiving heparin (normal 40 seconds; therapeutic goal 60-80 seconds).
• Monitor PT and INR for patients receiving warfarin (normal INR 0.7-1.2; PT 9-12 seconds).

Fibrinolytic Agents

• Assess for contraindications for administering the fibrinolytic therapy (BP >180/110, recent surgery, bleeding).
• Start the IV line and obtain blood for baseline laboratory investigations.
• Monitor for signs for bleeding (intracranial hemorrhage, internal bleeding).
• Arrange the emergency medications and supplies at the patient’s bedside (e.g., ventricular dysrhythmias: defibrillator and lidocaine/amiodarone; brady-dysrhythmias: atropine).
• Record continuous cardiac monitoring for showing ST changes.

Hemodynamic Medications

Vasodilators

• Assess BP and pulse prior to initiation and during the administration of vasodilators.
• Morphine and hydralazine are administered by slow IV pushes, nitroprusside by intravenous infusion, and nitroglycerine by intravenous infusion/sublingual.

Dopamine and Dobutamine

• Monitor BP, pulse, and peripheral pulses every 15 minutes, cardiac rhythm continuously during the therapy, and urine output and IV site extravasation hourly.
• Ensure that the patient is not hypovolemic prior to drug therapy.
• Notify the physician immediately if oliguria, tachy-dysrhythmias, hypotension, or signs of peripheral ischemia (cold extremities, diminished peripheral pulses, purple extremities) are present.

Special Considerations

• Baseline Vital Signs – Check blood pressure, heart rate, and ECG before administration.
• Electrolyte Monitoring – Assess potassium, sodium, and calcium levels, as imbalances can affect drug efficacy.
• Renal & Hepatic Function – Many cardiac drugs are metabolized by the liver and excreted by the kidneys, requiring dose adjustments.
• Slow IV Infusion – Drugs like amiodarone and digoxin require gradual infusion to prevent toxicity.
• Avoid Abrupt Discontinuation – Beta-blockers and calcium channel blockers should be tapered to prevent rebound hypertension or arrhythmias.
• Drug Interactions – Be cautious with anticoagulants, diuretics, and antihypertensives, as they can potentiate or counteract each other.
• Bradycardia & Hypotension – Common with beta-blockers and calcium channel blockers.
• QT Prolongation – Drugs like sotalol and amiodarone require continuous ECG monitoring.
• Fluid & Electrolyte Imbalances – Diuretics can cause hypokalemia or dehydration, requiring frequent lab checks.
• Elderly Patients – Increased risk of drug accumulation and hypotension.
• Pregnant Patients – Some cardiac drugs are teratogenic and require alternative options.
• Renal Impairment – Adjust dosing for ACE inhibitors and diuretics to prevent toxicity.
• Rapid-Acting Drugs – Epinephrine and atropine require immediate response in cardiac arrest.
• Antidotes for Toxicity – Digoxin toxicity is treated with digoxin-specific antibody fragments.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884

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