Cardiovascular drugs and the older adult.

This case is typical of cardiovascular drug regimens in the elderly. Indeed, patients are often on several additional drugs for cardiovascular problems as well as other diseases. Familiarity with the pharmacology of all drugs is mandatory. Interactions of drugs can be complex, and a clinical pharmacologist can be a helpful resource. The classic interaction in cardiovascular drug regimens, as in this case, is with the combination of digoxin and potassium-depleting diuretics. The special interactions of cardiovascular and psychotropic drugs will be discussed elsewhere in this symposium. General clinical concerns in the care of patients taking cardiovascular drugs include scrutiny of drug choice, dosage, and combination. The dosage of drugs may need to be altered as the client ages. Drug types and combinations also may need to be changed to meet the needs of the patient's altered physiologic responses. The patient's response to drug therapy must be continuously evaluated. The best rule is to ensure that the patient takes the least number of drugs at the minimum dose required for desired effects. Starting drug dosages low and increasing them gradually often prevent toxicity. The nurse's assessment of subtle behavior or physical changes is important for the early detection of toxicity and adverse reactions. The possibility that a noted change is drug precipitated should always be considered. Health education of the client, family, or appropriate others is a significant nursing contribution to care. Awareness of drug side effects and specific offsetting interventions can prevent many discomforts and complications. Often making the patient aware of his changing body needs helps to elicit cooperation.