When to HOLD a medication...Help!

Woodenpug, BSN · Oct 19, 2008

Not sure I understand the question. The information on when to hold a drug is in the same place as the rest of the information about drugs. You hold medications when they are contraindicated. For example, hold dig if heart rate is below 60 or the patient is showing signs of toxicity. Hold anti-hypertensives when the patient's blood pressure is low.

Pediatric Critical Care Columnist · Oct 19, 2008

Moving to Student Assistance forums.

Melinurse · Oct 19, 2008

.....I can't find this information or maybe I just do not understand.
We are having a BIG test on the cardiovascular Diseases in Med Surge tomorrow and the Prof. said....
"Be sure you know the nursing implication you need to know when to hold a drug ..."
Drugs like Digoxin, catapress ...antidysrhythmias, anti hypertensives....I know implications mean my responsibilities as a nurse but where do I find information on when to hold a drug and why?

Like Woodenpug said; but I would add that some facilities and/or doctors also place/write parameters on the MAR.

For example: Pts vital signs are BP- 101/50 and Pulse = 60

next look at your patient, are they carrying a conversation or lethargic

then look at other previous vital signs - Is this their norm? Do they have a cardiac history? Etc..... etc.....Their are lots of variables here but best to look in your drug book. Good Luck on your test.

annabanana1219 · Oct 19, 2008

.....I can't find this information or maybe I just do not understand.
We are having a BIG test on the cardiovascular Diseases in Med Surge tomorrow and the Prof. said....
"Be sure you know the nursing implication you need to know when to hold a drug ..."
Drugs like Digoxin, catapress ...antidysrhythmias, anti hypertensives....I know implications mean my responsibilities as a nurse but where do I find information on when to hold a drug and why?

:nurse: The nursing implications to hold cardiovascular drugs are the same as the body system that you are referring to in those drugs.....Digoxin slows the heart rate to decrease the workload of the heart so if the heart rate is less than 60 beats/minute, you hold the drug. So therefore the nurse must check a pulse before giving this drug. The same goes for any drug that is given as an anti- hypertensive. You check the blood pressure and hold it if systolic is below the parameters that the prescribing Dr. has ordered; for instance "hold if SBP less than 100". So after checking the pt's BP and the BP is 90/60, you would hold the med. And so on and so forth. When in doubt, always ask the charge nurse or the MD.

TX_TeleRN · Oct 23, 2008

Pharmacology was very overwhelming to me while in nursing school. During clinicals, a RN once told me that it gets easier when you practice, as you will learn (look up those drugs you are not familiar with) as you go. There will be some drugs that are given more often on your unit.

:typing For your exam, I would recommend you pull out your pharmacology text book and your drug book as well. Read up on each class of drugs and understand what and how each class of drugs work. Make a table so that you can compare similarities and differences (highlight them in different colors) to help you learn. No need to get wordy on your table; just focus on key facts.

Your drug book should have a "nursing impliclations" (or similar section). These usually show you what you need to look for before / during / after giving a drug. It helps RNs focus on what needs to be done and what needs to be taught to patients. At my school, they tend to focus on these types of questions. Also note to which population you are giving these drugs to, adults or children. Some drugs have toxicity levels, so consider these numbers when you study. :typing

As mentioned in previous posts, Digoxin, increases contractility of the ventricles and lowers heart rate. It's usually given to patients with heart failure or those with atrial fibrillation (dysrhythmia). You hold this drug if the pulse is less than 60 beats per minute for adults (or 100 bpm for children!). Make sure to check patient's pulse for a full minute if patient is not on telemetry.

All antihypertensive drugs and diuretics should be held if BP is low (i.e.,

Why diuretics? These will make patients pee more, therefore lowers volume to heart. Review your diuretics to understand which are potassium-sparing, etc., as diuretics will affect your electrolytes.

Now focus on the different classes of antihypertensives: ACE inhibitors, Beta blockers, Calcium channel blockers, Nitrates, etc. and understand how each type works.

ACE inihitors should be avoided for those with renal insuficiencies or renal failure. These may cause a dry, annoying cough. [Again... Look at your "nursing implications" of your drug book!]

Beta blockers also lower heart rate, so you would hold if BP is low -OR- if pulse is

Calcium channel blockers... Look at your patient's calcium level. Typically not used in second or third degree heart blocks.

Nitrates are often used for anginas or acute chest pains. These may cause headaches. Avoid use if patients have taken erectile dysfunction meds (i.e., sildenafil (Viagra)). Don't discount female patients, as some may Viagra-type meds for pulmonary hypertension.

Hope this helps! Good luck on your exam. :jester:

dumbell40ish · Oct 28, 2008

Thank YOU to everybody......Man was I blessed to find this site or WHAT!.........got an 80......thanks to all of you I read every message

If you are new to this site and are reading this.......Hey, ask a question,,,you won't believe how fast you get a response! :yeah: ...Dumbell40ish